Wednesday, December 6, 2023
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Associate Professor, Department of Family Medicine, Case Western Reserve University School of Medicine, University Hospitals, Case Medical Center, Cleveland, Ohio
This activity is intended for pharmacists, nurses, physicians, nurse practitioners, and physician assistants.
The goal of this activity is to review available dietary supplements that are marketed for weight loss, describing studies that have examined their efficacy and safety, so that clinicians will be able to counsel patients on this topic.
Upon completion of this activity, participants will be able to:
As an organization accredited by the ACCME, Medscape, LLC requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.
Medscape, LLC encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.
Associate Professor, Department of Family Medicine, Case Western Reserve University School of Medicine, University Hospitals, Case Medical Center, Cleveland, Ohio
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Commonly known as CLA, this supplement is a naturally occurring polyunsaturated fatty acid and is essential for the delivery of dietary fat and glucose into cells. In a year-long study, 122 patients with a BMI > 28 underwent an 8-week period of dietary restriction.[22] Patients who lost > 8% of their initial body weight (N = 101) underwent a randomized, double-blind trial of CLA supplementation 3.4 g per day or placebo. After 1 year, there was no significant difference in weight loss or adverse events between the 2 groups.
In a 16-week double-blind, randomized, placebo-controlled trial, 54 patients consumed a very-low-calorie diet for 3 weeks and then started a 13-week intervention period in which they were randomized to low dose CLA (1.8 g per day), high-dose CLA (3.6 g per day), or placebo.[23] There was no significant difference in adverse events or weight regain, but feelings of fullness were significantly increased in the treatment groups. There was no significant difference in energy intake at breakfast.
Take-home message. Evidence is lacking to support recommending CLA for weight loss. However, it may help attenuate weight gain in patients with dietary deficiency of CLA.
Dietary fiber has long been thought to increase satiety, but there is little evidence to support this claim. Eleven healthy men and women with a usual fiber intake ≤ 15 g per day were studied in a single-blinded study of two 3-week treatment phases with a 4-week washout period between phases.[24] In the first phase, subjects consumed methylcellulose, a non-fermentable fiber, and in the second phase, they consumed fermentable fiber (pectin, beta-glucan). There was no significant difference in energy intake, weight, or body fat when comparing phases or baseline values.
In a randomized, double-blind, placebo-controlled, parallel study, 52 patients were randomized to treatment for 6 months with an energy-restricted diet and 7 g fiber per day or placebo.[25] Weight loss was significantly greater in the treatment group while hunger feelings were significantly reduced. There was no significant difference in blood pressure or adverse events.
In two other studies, fiber or placebo tablets were given along with dietary restrictions to moderately obese women for 2 and 3 months.[26] Mean weight loss in both treatment groups was significantly greater than placebo. No significant difference in hunger feelings was reported in any group.
Take-home message. In generally, the average Western diet is relatively low in fiber. While there may be good reasons to increase the amount of dietary fiber, weight loss alone is probably not one. Excessive fiber intake may result in loose stools, intestinal cramps, and bloating.
Green tea extract is made up of polyphenols (flavanols or catechins) that are thought to be responsible for its claimed benefit in weight loss. In a randomized, parallel, placebo-controlled study, the effects of green tea were studied in 104 overweight and moderately obese subjects.[27] Patients consumed a very-low-energy diet for 4 weeks, followed by green tea 104 mg per day or placebo for 13 weeks. During the 4-week very-low-energy diet phase alone, subjects lost on average 7.4% of their initial body weight. However, body-weight regain was not significantly different between the green tea and placebo group in the subsequent 13-week phase. Habitual high caffeine consumption in the treatment group was associated with a higher weight regain than habitual low caffeine consumption in the treatment group.
In a randomized, placebo-controlled trial of 34 obese Chinese women with polycystic ovarian syndrome, patients were treated with green tea or placebo for 3 months.[28] At the end of the study, researchers concluded that green tea supplementation did not significantly reduce body weight or alter glucose or lipid metabolism.
In a case report, a previously healthy 44-year-old white female was admitted after consuming 720 mg of green tea per day for 6 months; she had also increased her physical activity and had lost 20 pounds.[29] Her bilirubin, liver enzymes, and International Normalized Ratio (INR) were increased, and her symptoms worsened until she consequently required liver transplantation.
Take-home message. Commercially available green tea products contain varying amounts of caffeine. Caffeine exhibits a mild diuretic effect, which some patients may perceive as weight loss, but which is only a transient loss of sodium and water.
Guar gum is a soluble dietary fiber derived from the Indian cluster bean.[30] In a 5-week prospective, randomized, double-blind study, researchers measured body weight, hunger/satiety ratings, glucose, insulin, cholecystokinin, and leptons in 25 obese but otherwise healthy females taking 20 g guar gum daily or placebo.[31] Guar gum fiber produced heightened postprandial cholecystokinin response but did not alter other satiety hormones or increase satiety ratings in fasting or postprandial state. Predominant adverse events that have been reported are gastrointestinal-related and include flatulence, diarrhea, and nausea.[30]
Take-home message. While guar gum may be a suitable source of soluble dietary fiber, there is insufficient evidence to recommend guar gum as a weight loss aid.
