Article Summary Systematic Review: An Evaluation of Major Commercial Weight Loss Programs in the United States. Tsai AG, Wadden TA. Ann Intern Med. 2005;142:56-66. Objective: To evaluate cost and efficacy of major commercial and self-help weight loss programs currently available to consumers, and to provide data to assist physicians in the treatment and management of patients diagnosed with obesity and/or type 2 diabetes. Methods: Web sites of nonmedical commercial and medically supervised weight loss programs were examined, along with telephone conversations with company representatives when appropriate. MEDLINE searches and reviews of bibliographies were also conducted for articles published between January 1966 and October 2003 using Medical Subject Headings obesity and weight loss combined with terms such as behavior therapy, cognitive therapy, diet, exercise, Internet, nutrition, reducing, and self-help groups. More than 1500 abstracts were reviewed; however, only 10 studies met all criteria for disclosure of program components, staff qualifications, costs, and risks of treatment as defined by a joint task force of the National Heart, Lung, and Blood Institute of the National Institutes of Health. Observations: Programs evaluated included Weight Watchers, Jenny Craig, L.A. Weight Loss, Health Management Resources, OPTIFAST, Medifast/Take Shape for Life, eDiets.com, Take Off Pounds Sensibly (TOPS), and Overeaters Anonymous. Of the commercial programs (specifically Weight Watchers, Jenny Craig, and L.A. Weight Loss), only Weight Watchers has sponsored 3 randomized, controlled trials. Two of these trials resulted in weight loss of approximately 5% over 3 to 6 months. The cost of a Weight Watchers program was also considerably less than that of Jenny Craig and L.A. Weight Loss in the commercial program category. Staff qualifications for these 3 programs include company-trained counselors. Medically supervised programs are overseen by licensed physicians or other health care providers and include OPTIFAST, Health Management Resources, and Medifast, which makes them appropriate for patients with obesity-related complications. OPTIFAST and Health Management Resources programs include meal replacement and lifestyle modification components, and both require mandatory medical monitoring during the first 2 of their 3 phases, although the programs differ in types of diets recommended. These programs report that people completing either a low-calorie (≥800 kcal/d) or very low-calorie (420 kcal/d) diet can expect to lose 15% to 25% of initial weight during 3 to 6 months of treatment. After 1 year of treatment, these patients may maintain a loss of 8% to 9%. Estimated costs for 3-month participation in these programs was $1800 to $2000, $1700 to $2100, and $840 for OPTIFAST, Health Management Resources, and Medifast, respectively). Several Internet-based commercial weight loss programs were reviewed, but only eDiet.com was included, because it had published 1 study. The program provides lists of low-calorie recipes and offers 13 diets from which to choose, designed to induce weight loss of 1 to 2 pounds a week. Not-for-profit self-help weight loss programs included in this review include TOPS and Overeaters Anonymous. It was not possible to evaluate the loss of initial weight in these programs. Conclusion:The guide developed by the National Heart, Lung, and Blood Institute and the North American Association for the Study of Obesity, as well as other recent publications, can offer physicians and patients assistance. Health care providers should consider offering appropriate patients support in their weight loss efforts.