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The Lean Plate Club: Sally Squires

This Just In: Most Diets Don't Work

By Sally Squires
Tuesday, January 4, 2005; Page HE01

Before you make a New Year's resolution to join an organized diet program, consider this: A University of Pennsylvania study finds a high cost per pound lost and very limited evidence for long-term success of any of nine popular diet programs studied.

Oh, yes, and large proportions of people -- sometimes more than half -- drop out within months of beginning the programs.

_____Sally Squires_____
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If you want to achieve a healthier weight, "the first step is to try to do this on your own," said Thomas A. Wadden, director of the Weight and Eating Disorders Program at Penn and co-author of the study, which appears in this week's Annals of Internal Medicine. "If that doesn't work, then get assistance."

Backed in part by a grant from the National Institutes of Health, Wadden and Penn physician Adam Gilden Tsai reviewed 1,500 weight loss studies of adults and zeroed in on 10 commercial or self-help programs.

Using those studies, plus additional data supplied by the programs themselves, the team examined nine plans: Weight Watchers, Jenny Craig, L.A. Weight Loss and eDiets.com; the self-help groups Take Off Pounds Sensibly (TOPS) and Overeaters Anonymous (OA); and three medically supervised commercial programs, Optifast, Health Management Resources and Medifast/Take Shape for Life.

"With the exception of one trial of Weight Watchers, the evidence to support the use of the major commercial and self-help weight loss programs is modest or nonexistent," the team concludes. "Controlled trials are needed to assess the efficacy and cost-effectiveness of these interventions."

Price is likely to put many of the programs beyond reach of those trying to achieve a healthy weight, the study found. The medically supervised programs, which also provided food, cost the most, ranging from $840 to $2,100 for three months, or "about $50 per pound lost," Wadden said.

Jenny Craig cost $1,249 for three months, including all daily food. Both Weight Watchers and L.A. Weight Loss cost about $170 for three months, while Ediets.com was $65, TOPS $26 and OA had no charge.

While the study found little evidence to prove that most commercial or self-help weight loss programs work, here's what experts say can help you to achieve a healthier weight by doing it yourself in 2005:

Pace yourself. Sure, it's tempting to start changing all your habits at once, but Wadden and his colleagues have found that doing too much too soon can be a program for failure. In fact, behavioral studies suggest that new habits begun at the same time are also more likely to be abandoned at the same time. So it's best to spend the first two weeks getting some of your eating habits in order. "Then introduce exercise in the third or fourth week," Wadden said.

Keep records. Yes, you may feel like an accountant, but studies show that recording daily eating and exercise increases your chances of success. Susan Burke, vice president of nutrition services at eDiets.com, notes that participants who record the food they eat on their site fare much better with weight loss than those who sign up but fail to log on regularly. "Unless you use it, you're not going to lose it," she says.

Make big changes in small steps. To foster a sense of mastery over your new habits, begin with something you know you can do. Maybe you want to decrease calorie intake: Start with a level that isn't too onerous -- say, 1,800 calories per day this week, then drop to 1,600 daily next week and so on, until you reach the appropriate level for the weight loss you want to achieve.

Revel in your progress instead of obsessing about your long-term goal. "Focus on what you achieve," Wadden said. "So celebrate the 10 pounds lost, even if you need to lose 70 pounds. You can only feel miserable about the latter and, hopefully, somewhat proud of the former."

Be the turtle, not the hare. Plenty of weight loss programs and best-selling books promise quick success. But losing pounds too fast can raise the risk of gallstones, constipation, cold intolerance and hair loss. Plus, quick weight loss doesn't give you the chance to make the fundamental lifestyle changes necessary for long-term success. About half a pound to two pounds per week is considered a safe rate of weight loss. It takes a deficit of about 3,500 calories to lose a pound. But things don't always go according to plan: Hormonal fluctuations and water retention can sometimes slow the scale's decline even when you do everything right. One of the last contestants to be booted off "The Biggest Loser" reality television series lost two pounds in a week -- and she was working full time at losing weight.

Reward yourself. Most people forget to give themselves a good pat on the back for reaching an interim goal. Just make sure that reward isn't food. Think about renting a movie you've always wanted to see; go to a concert; buy a new CD; get a massage or new workout shoes or clothes.

Enlist support for your efforts. "Recognize that you need a supportive atmosphere to be successful with weight loss," said Karen Miller-Kovach, chief scientist for Weight Watchers. "So turn to co-workers, family or friends for help."

Share Your Tips or ask questions about healthy nutrition and activity when Sally Squires hosts the Lean Plate Club online chat, from 1 p.m. to 2 p.m. today, on www.washingtonpost.com. Can't join live? E-mail leanplateclub@washpost.comanytime. To learn more, and subscribe to our free e-newsletter, visit www.washingtonpost.com/leanplateclub.

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