Winning strategies for shedding pounds include eating less fat, exercising more, using prescription weight-loss drugs, and joining a weight-loss program, researchers found.

In a review of data from the National Health and Nutrition Examination Survey (NHANES), these methods were significantly associated with losing 10% of body weight or more, at least in the short term, Jacinda Nicklas, MD, MPH, of Beth Israel Deaconess Medical Center in Boston, and colleagues reported in the American Journal of Preventive Medicine.

Liquid diets, fad diets, and using herbs and over-the-counter dietary products, on the other hand, weren’t linked with weight loss.

Several trials have looked at the efficacy of various weight-loss strategies, but these often lack generalizability, Nicklas and colleagues wrote.

So to assess what works in the real world, they looked at NHANES data (2001-2006) on 4,021 obese adults, 63% of whom reported trying to lose weight in the previous year. Of these, 40% lost at least 5% of their body weight, and 20% lost at least 10%.

“Despite the popular perception that obese people are unable to lose weight, a substantial proportion of obese participants in this survey did report successful weight loss, suggesting that some obese U.S. adults can and do lose weight,” they wrote.

The most popular strategies were eating less, exercising more, eating less fat, and switching to lower-calorie foods. Only a small percentage used commercial weight-loss programs, liquid diets, and prescription weight-loss medications.

The four factors significantly associated with losing the most weight - at least 10% of body weight - were:

Eating less fat (OR 1.37, 95% CI 1.04 to 1.79)
Exercising more (OR 1.36, 95% CI 1.12 to 1.65)
Using prescription weight-loss medications (OR 2.05, 95% CI 1.09 to 3.86)
Joining a commercial weight-loss program (OR 1.72, 95% CI 1.00 to 2.96)

All of these were also associated with losing at least 5% of body weight, except for weight-loss programs, which were of borderline significance:

Eating less fat (OR 1.41, 95% CI 1.14 to 1.75)
Exercising more (OR 1.29, 95% CI 1.05 to 1.60)
Using prescription weight-loss drugs (OR 1.77, 95% CI 1.00 to 3.13)

Liquid diets, over-the-counter diet pills, and fad diets weren’t at all linked with weight loss, and eating special diet products made patients less likely to lose 10% of their body weight, the researchers found (OR 0.48, 95% CI 0.31 to 0.72).

It’s possible that patients may overeat these special products because they perceive them to be healthy or low in calories, they said. And even though being in a weight-loss program may require eating specially prepared foods, the findings suggest that the structure of being in a program may play a bigger role in weight-loss success, they added.

Still, these programs, along with prescription weight-loss drugs, were only used by a small proportion of Americans, even though they were associated with good results. Nicklas and colleagues said this finding, along with wider use of over-the-counter diet pills and herbal products that had no effect on weight loss, may signal a need for greater public health efforts to get patients to adopt more proven dieting methods.

They also said providers should encourage greater use of the strategies that actually lead to successful weight loss.

The study was limited because of its cross-sectional nature and by a lack of information on whether weight loss was maintained.

Primary source: American Journal of Preventive Medicine
Source reference: Nicklas JM, et al “Successful weight loss among obese U.S. adults” Am J Prev Med 2012; DOI: 10.1016/j.amepre.2012.01.005.