Enhanced Weight Watchers Program Tops Standard Diabetes Care

Marlene Busko

November 09, 2016

NEW ORLEANS — A regular commercial weight-loss program plus weekly educational emails about diabetes can help patients with uncontrolled type 2 diabetes lose a modest but meaningful amount of weight and attain better glycemic control, a new randomized controlled trial suggests.

Specifically, compared with patients who received standard care, patients in the "enhanced" Weight Watchers program lost more weight (4% vs 1.9%, P < .001) and were more likely to reach a target HbA1c < 7% (24% vs 14%, P = .004) at 1 year.

Thus, "commercial weight-loss programs [that emphasize lifestyle changes], if adapted for patients with type 2 diabetes, may be viable, accessible, and scalable options to be part of the management of type 2 diabetes," said Patrick M O'Neil, PhD, professor in the department of psychiatry and behavioral sciences, at the Medical University of South Carolina in Charleston, presenting this study at Obesity Week 2016. The study was simultaneously published in Obesity.

Importantly, although 95% of the patients were receiving diabetes medications, they all had uncontrolled diabetes at study entry, yet in the intervention group, after a year of following this community-based weight-loss program and receiving weekly educational emails, a quarter of the patients had achieved HbA1c < 7%, Dr O'Neil told Medscape Medical News.

The problem is that effective weight management, a key component of good diabetes care, is "hard to deliver," especially in primary-care offices where patients with type 2 diabetes are typically seen, session comoderator Donna H Ryan, MD, professor emeritus at Pennington Biomedical Research Center, in Baton Rouge, Louisiana, and associate editor in chief of Obesity, told Medscape Medical News.

For practitioners who are trying to help their overweight and obese patients attain better control of their diabetes, blood pressure, and lipids, referring patients to Weight Watchers is "a pathway to improve all of that," she said.

Moreover, echoing Dr O'Neil, she observed that this enhanced Weight Watchers program is "a scalable and accessible model, and we really need a lot more of that."

Lack of Diabetes Education, Accessible Weight-Loss Options

Although guidelines recommend giving patients with type 2 diabetes educational information, "many patients get none and most get very little," said Dr O'Neil. Studies have reported that only 10% of patients with type 2 diabetes seen in an urban, low-income primary-care clinic visited a nutritionist and only 55% of people with diabetes in the United States receive diabetes education.

However, if patients with type 2 diabetes can lose 5% of their weight, they can improve glycemic control, according to studies of obesity medications, bariatric surgery, or intensive lifestyle intervention (such as that delivered by a multidisciplinary team in Look AHEAD).

But those weight-loss options may not be available or covered by insurance or acceptable to patients with diabetes, so "what's needed is something that can be scaled up to reach more people," said Dr O'Neil.

Weight Watchers developed an augmented program in which patients can not only attend weekly meetings and use online tools and a smartphone app, but they also receive two initial phone calls with a certified diabetes educator followed by weekly emails about topics being covered in the next Weight Watchers meeting.

The company sponsored this 12-month trial to compare this "enhanced program" with standard care consisting of an hour of diabetes education given by a registered dietician, a diet with a 500-calorie/day deficit, and written information.

The trial randomized 563 adults aged 18 to 70 who had type 2 diabetes and HbA1c of 7% to 11% and a body mass index (BMI) of 27 to 50 kg/m2 in 16 centers in 13 US states. All patients were receiving diabetes care from a nonstudy physician and continued this care, and all diabetes medications were permitted.

The primary end point was attaining HBA1c < 7%, and secondary end points included weight loss and changes in cardiovascular risk factors.

A total of 279 patients received free access to the enhanced Weight-Watchers program and 284 received standard care, and patients were assessed at baseline and at 3, 6, 9, and 12 months.

Participants in both groups had similar baseline characteristics. They had a mean age of 55; most (70%) were women, and they were ethnically diverse: 37% were African American, 45% were white, and 11% were Hispanic. They had a mean HbA1c of 8.3% and a mean weight of 105 kg.

Almost all (95%) were taking at least one diabetes medication, most often metformin (70%). More than a third were taking insulin (38%) or sulfonylureas (34%), which can cause weight gain.

Fewer Diabetes Meds, Improved Cardiovascular Risk Factors

Participants in the standard-care arm were promised a 1-year free membership in Weight Watchers if they attended the last follow-up visit, and the follow-up rate in both groups was high (86%).

Participants in both groups lost the weight by 6 months and maintained that weight loss for the 12 months.

At 12 months, 34% of participants in the Weight Watchers arm vs 18% of participants in the standard care arm had lost > 5% of their initial weight (P < .001).

Importantly, more participants in the Weight Watchers arm reduced their diabetes medications over the course of the trial (26% vs 12%, P < .001), Dr O'Neil pointed out.

Those in the Weight Watchers arm saw their HbA1c decrease by 0.32% points, whereas those in the standard care arm saw an increase of 0.16%.

Compared with patients in the standard-care arm, those in the Weight Watchers arm also had greater reductions in mean waist circumference (P < .001) and C-reactive protein levels (P = .02).

However, patients in both groups had similar improvements in other cardiovascular risk factors — increases in HDL cholesterol and decreases in LDL cholesterol, total cholesterol, systolic blood pressure, and diastolic blood pressure.

Further research is needed to see whether this program would benefit patients with newly diagnosed diabetes, Dr O'Neil concluded.

This study was funded by a grant from Weight Watchers International (WWI) to the Medical University of South Carolina. Dr O'Neil received grants from Orexigen Therapeutics, WWI, and Novo Nordisk; served on advisory groups for Novo Nordisk, Medscape/WebMD, Pfizer, and Janssen; and received honoraria from Novo Nordisk, Vindico CME, and Medscape/WebMD. Disclosures for the coauthors are listed in the article.

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Obesity. 2016;24:2269-2277. Article

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