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As weight loss becomes more about health than vanity, insurers might increasingly be footing the bill for non-surgical reducing methods, researchers say. And they’ll want to know which ones are the best investment. And such might be the case in California workers’ compensation where a weight loss program may be ordered as part of treatment for a physical injury or a pre-surgical recommendation that is delaying the case.

In a new analysis reported by Reuters Health, the popular Weight Watchers program and the drug Qsymia were the most cost-effective strategies to lose weight. If a third-party payer didn’t cover the high cost of Jenny Craig’s food, that would be the most effective plan, the study found. “To me the main message is that there are only a few viable options for weight loss,” Eric Finkelstein told Reuters Health in an email. “(Weight Watchers) and Qsymia currently provide the best bang for the buck but Jenny Craig is most effective.” Finkelstein is the study’s lead author from the Duke-National University of Singapore Graduate Medical School and the Duke Global Health Institute. He’s also worked with Jenny Craig, Weight Watchers and a number of companies that manufacture weight loss drugs.

Insurers and employers are under increasing pressure to cover weight loss strategies for their customers and employees, Finkelstein said. “As such, they care both about the costs and potential benefits,” he said. “To date, no study has been conducted that compares all programs against each other.”

For the new analysis, Finkelstein and his co-author reviewed randomized controlled trials – the “gold standard” of medical research – that evaluated non-surgical weight loss strategies over at least one year. They then paired those results with data on prices to estimate the cost per kilogram of weight loss and cost per “quality adjusted life year,” which is the cost for each year of life gained by using the program or drug. After excluding studies that lasted less than a year or had other problems, their analysis included Weight Watchers and Vtrim, both diet and lifestyle programs, the Jenny Craig meal-replacement program and the drugs Qsymia, Lorcaserin and Orlistat.

The researchers found that the average cost per kilogram (2.2 pounds) lost ranged from about $155 for Weight Watchers to about $546 with the Roche drug Orlistat, which is available by prescription as Xenical or over-the-counter as Alli. The second most cost-effective strategy at about $204 per kilo was Qsymia, a drug from VIVUS, Inc., which provided some support for the study. The Vtrim program was the third most cost-effective strategy per kilo of weight lost, followed by Jenny Craig, the drug lorcaserin – marketed as Belviq by Arena Pharmaceuticals GmbH. Orlistat was the most expensive per kilo.

Insurers and policymakers often prefer to consider treatments based on their cost per quality adjusted life year gained, and typically interventions are considered effective if that cost is less than $50,000. The researchers found that Weight Watchers, at $34,630, was the cheapest program per quality adjusted life year gained. It was followed by Qsymia, which is more effective at fostering weight loss, but more expensive at $54,130 per quality adjusted life year gained.

“As an individual the choice of which to choose should be based on perceived costs and benefits and all may be viable options given (their) benefits that extend beyond (cost-effectiveness) analysis,” Finkelstein said. Those benefits include the taste of food and convenience, for example.

As someone paying for the program, however, he said he would limit his investment to programs proven to work and those that have the participant take on some cost responsibility, such as weight loss success. Finkelstein also cautioned that these results are based on clinical trial results. Participants often receive the programs, food or drugs for free. “Real world results could be better or worse,” he said.