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Choosing a Weight-Loss Program

Finding the One that Works Best for You

"What’s the best diet for losing weight?”

  • Any diet that you can stick with for a long time.
  • It should be as good for your overall health—your heart, bones, colon, and psyche—as it is for your waistline.
  • It should offer plenty of good-tasting and healthy choices, banish few foods, and not require an extensive and expensive list of groceries or supplements.

Weight-loss program choices

Each year, millions of people enroll in weight-loss programs. These include well-known commercial programs such Weight Watchers and Jenny Craig (both of which have online versions) 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. In addition, many free online diet and exercise programs are now available.

The commercial programs charge a fee for meetings. They offer advice on diet and exercise regimens as well as online tools for tracking your weight and food consumption. In some cases, they 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.

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. Following are descriptions of the different programs and what you can expect from them.

Commercial programs

Like self-help programs, the commercial programs hold regular meetings to provide encouragement and support. But a significant difference between the two types of programs 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. Costs for these programs vary, depending on how long you commit to the program, whether you attend meetings in person or online, and whether you purchase the foods or diet aids. Check with the specific organization for more information.

Weight Watchers

The most popular of the commercial programs, Weight Watchers, has more than 25 million participants worldwide. As a member, you receive a daily allotment of points (based on your weight, age, gender, and other factors) to spend on food, along with point values for a wide range of foods.

In late 2010, Weight Watchers introduced PointsPlus, a revamped system that puts more emphasis on the nutritional value of each food to assign point values. On the old plan, a 100-calorie bag of cookies was two points, the same as a 100-calorie apple. Under the new plan, fruits and non-starchy vegetables are now zero points. And foods high in protein and fiber have lower point values than foods high in fat and refined carbohydrates. The idea is to encourage people to eat more healthful, nutrient-dense foods and fewer "empty" calories from treats.

There's no need to buy Weight Watchers–brand foods. The program also encourages members to get regular exercise. Two published trials showed that people who went to Weight Watchers meetings regularly lost about 5% of their weight over three to six months. Meetings are led by people who have successfully lost weight and kept it off through the Weight Watchers program.

Jenny Craig

The other leading commercial weight-loss program, Jenny Craig, has more than 725 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 and three snacks each day, 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 such as pedometers. Members have the option of preparing their own meals, but the prepared foods have been shown to help them stick with the diet.

Online options for dieters

In addition to the Weight Watchers and Jenny Craig online programs, there are numerous other Web-based diet and exercise programs, some of which are free. Similar programs are also available for use on a smartphone (see "Smartphone applications to spur weight loss"). Most offer tools that allow you to easily track your eating and exercise habits, count calories, and chart your weight loss. Some have programs specifically targeted to men or women, and many offer plans that follow specific types of diets, such as low-carb, Mediterranean, or vegetarian. Most also feature online chats or discussion groups, and some provide e-mail advice from experts, including psychologists and dietitians.

These are some of the better-known options:

But how well do they work? A study published in Obesity involving more than 2,800 members of the Kaiser Permanente health plan revealed that people who followed a tailored expert system lost more weight than those assigned to an information-only plan. Both options were offered online only, but while the information-only group received just factual information about weight management and diet strategies, the tailored system focused on a healthy diet and provided tips targeted to the participant's particular issues. For example, those who believed overweight people lacked willpower were given messages attempting to change that perception, and those unable to exercise weren't given exercise advice.

According to a review of Web-based interventions for weight loss published in 2010 in Obesity Reviews, the frequency of a user's log-ins, self-monitoring occasions, chat room attendances, and bulletin board posts was correlated with losing weight or keeping it off in many studies. But there's a dearth of information on the long-term impact of Web-based interventions, the authors noted.

It's certainly worth checking out a few of the online programs. Even without proof of clear benefits from a specific one, the very act of paying more attention to your eating and exercise habits seems to help.

Smartphone applications to spur weight loss

Smartphones such as the iPhone, Android, Blackberry, and Palm WebOS can make it even easier to track your eating and exercise, thanks to an ever-growing number of applications (apps) designed for dieters that run on these multipurpose computers.

Food diaries and supportive communities are proven factors in successful weight control programs. Lose It! (for iPhone, free) offers both. You enter your height, weight, age, gender, and target weight, and the app calculates your daily caloric allotment. As you go through the day, you log in every morsel you put into your mouth and each minute of physical activity. The app draws from a very comprehensive database of foods and physical activities to keep a running tab of the calories you've consumed and expended and the number remaining in the day's allotment. It also computes your nutritional intake in terms of calories, carbs, protein, saturated and unsaturated fats, and sodium.

To stay on track, you can set up e-mail notes to yourself reminding you to fill out the log. You can also register on the Lose It! Web site to get support from a community of people who've had success in losing weight.

Calorie Counter by FatSecret (for iPhone, Android, and BlackBerry, free) is similar but less intuitive to use and does less of the math for you.

iTreadmill (for iPhone, 99 cents), CardioTrainer (for Android, free), and Endomondo Sports Tracker (for Android and BlackBerry, free) use the phone's GPS to turn your phone into a pedometer and navigator.

Absolute Fitness (for most smartphones, $4.99) allows you to log and manage your food intake, exercise, and weight. It displays the nutritional composition of food and the calorie expenditures of different activities. You set your personal diet, exercise, and weight-loss goals, and the app tracks your progress.

Note: Many more smartphone apps are now available for the iPhone and Android platforms.

Self-help programs

These nonprofit programs have local chapters around the world. 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 members to check with their doctors first. Weekly private weigh-ins are followed by meetings, during which members discuss 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 holds retreats and rallies to give members extra incentives to stay with their weight-loss plans. It also features online support. Members receive a monthly magazine that contains low-calorie recipes as well as inspirational stories by members who have met their weight-loss goals.

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 for health reasons. Other clinical programs offered in the United States include Health Management Resources and Optifast.

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. In the U.S., very low-calorie diet programs usually cost $1,000 to $2,000 for three months.

Today, however, clinical programs are 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 behavior-based treatment with weight-loss medications or surgery.

Adapted with permission from Healthy Solutions to Lose Weight and Keep it Off , a special health report published by Harvard Health Publications.