Urology Pearls: Which Weight Loss Program Is Best? | News, Sports, Jobs


Shahar Madjar, MD

Charlene leans forward, hands on her hips, a broad smile on her lips. I saw her picture on the Jenny Craig website – a commercial weight loss program – where I learned that she had lost 60 pounds. She is an image of health, fitness and happiness. Jamie, on the Nutrisystem website, lost 127 pounds, which is evident in the before and after photos. In the Before photo, she is curvy and wears a skirt. In the After photo, she is slim and wears jeans. And on the Weight Watchers website, I found yesterday and today’s photos of Jacqueline who had lost 55 pounds. She looks wonderfully athletic, her face radiates confidence and happiness.

Do commercial weight loss programs work? And if so, which program is the best?

Commercial weight loss programs in the United States are a $2.5 billion industry. There are over 140 such programs, but the top three weight loss programs, in terms of market share, are Weight Watchers (currently under the WW brand), Nutrisystem and Jenny Craig. Together they represent 72% of the commercial weight loss market, with WW controlling 45% of the entire market. It is therefore on these three programs that I will focus my discussion here.

First, let me tell you how these programs work.

WW works by assigning each participant a budget of “points.” The budget is based on the participant’s weight, diet and exercise habits. Each food has a point value based not only on its caloric value, but also on its nutritional value – the content of saturated and unsaturated fat, lean protein and fiber. Certain items, such as fruits and vegetables, are considered “Zero point” for their health benefits. Eating carrots, broccoli and spinach will earn you extra points and therefore give you exercise. Participants are then encouraged, through personal guidance and sometimes group meetings, to stick to their point budget.

In the WW diet program, you don’t count calories, but you must count points. In Jenny Craig and Nutrisystem, no calorie counting or point counting is required. Instead, these companies will ship prepared meals to your doorstep. And as one ad states: “You eat the food, you lose weight.”

Do these programs work? In an article published in 2015, a group of researchers from Johns Hopkins University reviewed and analyzed 39 randomized controlled studies. In all of these studies, participants were randomized into two groups. One group participated in a commercial weight loss program, while the other group, serving as a control group, had no intervention or only received educational support or counseling.

Three months after starting their diet, Nutrisystem participants lost 3.8% more weight than their control group. Longer-term results were available for Jenny Craig and WW: At 12 months, Jenny Craig participants lost 4.9% more weight than their control group, and WW participants lost 2.6% more weight. weight more than their control group.

So Jenny Craig is the best, right? Not so fast! Each study was conducted as a separate undertaking with different groups of participants who had different characteristics, and each diet was compared to no diet at all, or just some kind of educational support or counseling. To really compare apples to apples, researchers should directly compare a commercial diet with its competitor!

And, magically, or just naturally, that’s exactly what they did! In a subsequent research study, the same group of researchers directly compared the commercial diets to each other. They compared WW, Nutrisystem and Jenny Craig. And the results are – do you hear the drumbeat? – in this head-to-head comparison, none of these three diets came out on top. There was no statistical difference between the groups.

In a 2017 review of commercial weight loss programs published in the Journal of Health Psychology, Samantha McEvedy wrote that in a recent meta-analysis (a study that summarizes other studies), “57% of people who started a commercial weight training program lost less than 5% of their initial body weight. One in two studies (49%) reported attrition ≥ 30%”.

Then there is the question of cost. The standard monthly fee at WW is $22.95, a simple meal plan (the most basic plan that includes 7 breakfasts and 7 lunches per week) at Jenny Craig is $13.99 per day, and the plans from Nutrisystem range from $9.99 to $13.21 per day.

Looking at the glass half full, however, I am reminded that study results represent statistical averages, and while there are many participants whose results may not be clinically significant or personally satisfying, some participants come out much better than others. These are people who stick with the program and use the resources these programs offer, including counseling on behaviors that change their habits. These people may have lost a significant amount of weight even without a commercial weight loss program, but for those who need a boost or a structured environment for their diet to work, a commercial program may not be possible. – not be a bad idea.

Editor’s note: Dr. Shahar Madjar is a urologist at Aspirus and author of “Is life too long? Essays on life, death and other trivial subjects. Contact him at [email protected]



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