Weight-loss programs

 | September 1, 2006

Weight-loss programs

Each year, millions of Americans enroll in weight-loss programs. These include well-known commercial programs such Weight Watchers and Jenny Craig and organized self-help programs such as Overeaters Anonymous. Fewer people may be familiar with medically supervised programs, which include hospital-based programs or individual care from a physician. Internet-based commercial weight-loss programs have grown in popularity.

The commercial programs charge a fee for meetings. They offer nuts-and-bolts diet and exercise regimens and, in some cases, sell prepared foods and diet aids. The self-help programs tend to focus mainly on providing emotional support and encouragement in sticking with a weight-loss plan. Clinical programs, which are provided through a doctor's office or hospital clinic, offer comprehensive diet, exercise, and behavior-modification programs, supplemented as needed with prescription treatments, such as very low-calorie diets, weight-loss medications, and, increasingly, surgery.

It's important to note that none of the programs can guarantee that you will lose a particular amount of weight. With the exception of the clinical programs, these approaches are adjuncts to, not substitutes for, professional guidance for those who need it. Indeed, the self-help and commercial plans encourage participants to consult with health care professionals about weight-loss strategies. Here is a description of the various categories of weight-loss programs, what you can expect from them, and their relative costs.

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Commercial programs

Like self-help programs, the commercial programs hold regular meetings to provide encouragement and support. But a significant difference between the two categories of program is money. The commercial programs charge fees to participate in meetings and also sell diet plans, as well as prepared foods and diet aids to go along with those plans.

Weight Watchers. The most popular of the commercial programs, Weight Watchers, has more than 25 million participants worldwide. The heart of the Weight Watchers program is its points system, which attempts to take the guesswork out of calorie counting. Weight Watchers scientists assigned a point value to various foods based on their calories, fat, and nutrients. When you start, the Weight Watchers staff will tell you, based on your weight, how many points you can eat each day to lose weight. You will also receive literature listing the point values of a wide range of foods. You can eat whatever you like, as long as you don't exceed your daily point total. There's no need to buy Weight Watchers–brand foods. The program encourages members not only to follow the points system, but also to get regular exercise.

Weight Watchers doesn't promise that you will lose a certain amount of weight on its points system. Two published trials showed that people who went to Weight Watchers meetings regularly lost about 5% of their weight over three to six months. Weight Watchers charges about $12 per meeting, although the fee varies slightly by region. Including membership fee, the approximate cost for three months is $167. Meetings are led by people who have successfully lost weight and kept it off through the Weight Watchers program. There is also an online version of the program, which costs about $65 for three months.

Jenny Craig. This is the other leading commercial weight-loss program, and it is only for women. Jenny Craig consists of about 640 weight-loss centers around the world. To get started, you visit a local Jenny Craig center and have your weight analyzed by a staff member. These staff members are not dietitians or other health professionals, but they're trained in the Jenny Craig program, which, according to the company, was developed by dietitians. Based on your weight, the staff member recommends a dieting, exercise, and behavior-modification program to help you lose about 1 pound a week.

In general, members are advised to eat three meals a day and three snacks, as well as to drink eight 8-ounce glasses of water each day and to increase their physical activity as much as they can. Jenny Craig also sells a wide array of packaged foods, diet aids, vitamin and mineral supplements, and even devices. One such device, used by many programs, is a pedometer, a small, pager-sized box you wear that counts the number of steps you take, helping you estimate your activity level. People have the option of preparing their own meals, but the prepared foods have been shown to help them stick with the diet. Adding together the membership fee and meal plan costs, the approximate cost for three months is $1,249.

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Self-help programs

These nonprofit programs have local chapters around the country. They make no promises that they will help you lose any weight. However, they aim to improve your odds of doing so by holding regular (usually weekly) meetings where members share success stories and frustrations and offer one another encouragement and personal tips. Meetings are run by volunteer group leaders. Each self-help program has a different focus.

Overeaters Anonymous. This is a 12-step program modeled after Alcoholics Anonymous for people who suffer from compulsive overeating. The main purpose of the meetings is to help people stop overeating by exploring their underlying emotional issues. Overeaters Anonymous has chapters around the world. It is free, although members are asked to contribute what they can. A special feature of the program is a buddy system in which you have another member to call if you feel the urge to overeat. Whether this approach is appropriate or effective for overeaters remains controversial.

Take Off Pounds Sensibly (TOPS). This program takes a practical approach, giving members incentives to follow whatever diet plan has been recommended by their health care practitioners. One program that TOPS recommends is the "exchange" diet established by the American Dietetic Association and the American Diabetes Association, but TOPS asks that members check with their doctors first.

Upon joining, members record their weight and then compete to see who can lose the most. Winners get rewards. Weekly meetings begin with members weighing themselves (although not necessarily revealing their weight to the group) and then discussing their successes and difficulties in reaching their weight-loss goals. Some chapters arrange for doctors, nutritionists, and other weight-loss experts to speak at meetings. TOPS also holds retreats and rallies to give members extra incentives to stay with their weight-loss plans.

TOPS charges an annual membership of $24, as well as dues. The dues vary from chapter to chapter, but are usually less than $5 per month. Members receive a monthly magazine that contains low-calorie recipes as well as inspirational stories by members who have met their weight-loss goals.

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Clinical programs

These programs are run by health care professionals, either in private practice or at hospital-based centers. Many of these programs are staffed by multidisciplinary teams that may include doctors, dietitians, exercise therapists, and psychologists or social workers, who provide a wide range of services, such as nutrition education, medical care, behavioral therapy, and guidance on exercise.

The mainstay of clinical programs used to be a very low-calorie diet of 800 or fewer calories a day, which is at least 400 calories per day less than conventional diets. Very low-calorie diets feature commercially prepared liquid formulas, such as Optifast, that replace all of the food in a patient's diet and induce a rapid loss of about 20% of his or her initial weight over 12 to 16 weeks — as much as 5 pounds a week. This type of diet is considered appropriate only for patients with a BMI greater than 30 who need to lose weight quickly and for health reasons. Other clinical programs offered in the United States include Health Management Resources and Medifast/Take Shape for Life.

As part of the program, people on very low-calorie diets should have regular medical checkups to identify any adverse health effects. Patients should also have counseling to help them adjust to the diet, as well as guidance on how to reintroduce regular food once the diet is over. Many programs also offer support groups to help people maintain their weight loss by adhering to a low-calorie diet and getting regular physical exercise. Very low-calorie diet programs usually cost between $1,000 and $2,000 for three months.

Today, however, clinical programs are now inclined to recommend a more moderate low-calorie diet in conjunction with a program of exercise and behavior modification. For one thing, very low-calorie diets have been associated with complications in some people, including chemical abnormalities and irregular heartbeats. And in the long run, such diets are no more effective than conventional low-calorie diets in which people consume about 1,200 calories daily. For patients with obesity — and for those who are overweight but at high risk for obesity-related complications — clinical programs now often combine behavioral-based treatment with weight-loss medications or surgery.

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Review Date: 2006-09-01

Harvard Medical School does not endorse products or services.