Did you ever experience something that affects you so much that you remember if forever? I remember Nancy (not her real name), a sweet middle aged mother who had come to me for help with binge eating (and she wanted to lose weight). If you saw her, you would never know she had any eating or weight concerns. She certainly did not look like she needed to lose weight. She had always been a yo-yo dieter, gaining and losing some weight over the years, but bigger troubles emerged after starting Weight Watchers. She would basically restrict herself before her “weigh ins” when she went to her meetings, which meant eating even less than the diet called for. All she thought about was the reaction she got after stepping on that scale. She just had to get through that minute. If the number did not go down, she felt like a failure (the fact that they let her into a weight loss program with her weight scared me, but maybe it is different now?). Anyway, Nancy would leave her meeting with relief, proceed to the grocery store or fast food place and binge eat. All day. Because she did not have to be weighed for another week. And then she would purge, feel terrible, depressed and like a failure. But she would be back on track again a day or two later, just to repeat the process. She was stuck in the Weight Watcher’s trap, hold, spell, whatever you want to call it. Unfortunately, Nancy was not the only WW casualty I encountered in my private practice. There were many more. Not all of them developed the eating disorder bulimia, but they all never learned how to eat healthily and happily. Some would lose weight, but then have no idea how to transition to a “real life” without “points”. It was the counting of the points that drove my patients to a place that was not good. After losing weight (by eating less, points, calories, counting carbs, it is all the same) there was no where to turn. What next? The patients I saw did not know and so either gained weight or transitioned into an eating disorder. Not all people who diet or follow Weight Watchers or count points develop eating disorders. I have known many friends and acquaintances who absolutely love the program. “It works!” they say. Every year, even after they have regained the weight again. Some people even maintain their weight loss for longer. But inevitably (in my experience, with the people I know), the weight is regained, there is a period of living “Outside of diet jail”-how I refer to it. Diet Jail is when someone is following a diet. When they can’t do it anymore, they break out, eat what they want, forget about it for awhile. They eventually remember the “success” (????) with Weight Watchers. They DID lose weight and they felt great. So they start again. I think people believe each time they restart the diet that it will be different. What I have seen (and I can only speak for myself, my experience with patients and others in my life) is that if fails them. They do not learn about themselves in any meaningful way.
Which brings me to something that I really wanted to share with you before you might read it in the news.
You are going to be hearing about a new study on Weight Watchers which was published on line in the American Journal of Public Health on February 18th. As with most studies, when they are publicized in the news (usually one dramatic blurb that catches your attention, such as “wine is good for you! chocolate is good for you! Caffeine is good for you!”) we believe it. Because we want to. Most people don’t have any inclination to doubt “research”, it sounds so scientific, it has to be right. So with Weight Watchers, I wanted to fill you in a bit (yes, as you probably noticed, that program leaves a real bad taste in my mouth). The Nancys of the world are the reason I am not a fan. But for now, let’s talk briefly about the study.
The study was conducted by researchers at Indiana University School of Medicine. The objective was to compare WW with another program to find out if it was as effective in promoting weight loss and improvements in metabolic outcomes such as Hemoglobin A1c. It was comprised of 225 subjects (with prediabetes) and was a randomized controlled study (that part is good). The results were good for WW in that their groups had better weight loss and metabolic improvements that were maintained for 6 and 12 months compared to the other program. The negative part (and what people don’t always know) is that the study was funded by Weight Watchers, according to this LA Times Article . The abstract of the research article is available at the link to the Study , and although the entire article is not available unless you are a member or you pay for it, you can clearly see (if you check out the Study link) that two of the researchers are from Weight Watchers. Most would consider this a conflict of interest, and this happens sometimes, but it is ok as long as it is spelled out (and it is). You can make up your own mind, but to me, if a company who is selling a product is involved in the research evaluation the product, as well as the way the article is written, it just bothers me. In this case, the researchers from the university are clearly respected and that helps, but to me, it would have been better if WW were not involved in any way.
The second thing that bothers me is the sample size and length of follow up. Yes, the results were “significant” statistically, but in the real world, 225 people from Indiana is just a start. The study needs to be replicated over and over to really mean anything. And the 12 month follow up is really NOT a long time in the world of weight management. True story: when I was doing some research for a PhD back in the day my adviser would not approve my project unless I did a 2 year follow up. As it turned out, the program that I was a part of was discontinued and I was going to have to start over (ugh). I ended up going back to my normal job and never finishing due to the fact that I just did not have another 2 years. But is always stayed with me, the length of time truly needed for weight management results to mean much (to me anyway, and to many others). It is good news that diet and lifestyle changes can help prevent diabetes and reverse prediabetes. You just don’t need to spend time and money on a program to do it.
Another thing that bothers me about the study is the motivation. According to the LA Times article (link above) Weight Watchers “was trying to get its system of counseling and motivational goals certified as a diabetes prevention regime by the government, which meant it had to develop data”. I am a little conflicted about this because on a positive note it would be more likely for insurance to cover the program if it is approved, but on the other hand, I hate the thought of even more people counting points.
Which brings me to the real reasons I am not a fan of the program. Years ago, the Weight Watchers program was different,and the issues were different. It was focused on the number on the scale, and labeling food as “legal” or “Illegal”or something to that affect. It instilled guilt with foods, and feelings of failure (especially at weekly weigh ins). But at least back then it was a simple and balanced “diet”, not too overwhelming, and perhaps some people learned they needed to eat three meals a day with all of the food groups included. But now, this point system is just plain overwhelming. I am good at math, but when it comes to food and eating, who can sustain figuring out some mathematical system of adding up points for very long? Yikes. Another REALLY bad consequence is the way the point system contributes to binge eating. I believe people who count points know they are supposed to spread out their points over meals and snacks. Do you really think a typical dieter or person who tends to overeat or even binge is not going to be tempted to “save up” points when they are going to a party so they can eat more? What does this teach? It is the same bad habit many dieters have: restricting during the day and then overeating later. Does this teach a healthy lifestyle? Do you really think this is going to help someone to get more in tune with their hunger and fullness so they actually learn to prevent overeating and binge eating by just eating “normally”? No. Counting points is just like counting calories (just a bit trickier, a new gimmick, and dieters love gimmicks). It is a form of “cognitive restraint” which I have talked about before. When you use your “head” to figure out how much to eat, you get disconnected from your true body signals. Those signals that help you be the weight you are supposed to be (yes, there are those who are prone to binge eating especially on foods high in fat and sugar, but I am referring to the typical dieter who only became obsessed with food after dieting).
So when the weight is lost, then what? A normal “healthy thinking” person is NOT going to be able to keep counting points. They are not left with much else to transition to. Any person I have ever known who has been successful with weight management has taken the time to really reflect on what has changed in their lives to make them gain weight beyond what is normal for them. It is different for everyone. For some, they gave up a sport when they started working. For others, they started making money and going out to eat and drink more often. Or maybe they took on a new job and stopped going to the gym. Maybe they went through a divorce and became depressed. Or they moved out of their parents home and started to stop for fast food because they don’t know how to cook. It could be mindless eating they have gotten into the habit of (eating in front of the TV or at the computer). It could be a million things that affect our bodies and our health. Counting points, or calories, or even following the Hot Dog Diet will result in weight loss. But that does not mean it “works”or fixes anything permanently. What “works” is taking the time to reflect on your lifestyle, then making the tough decisions as to what changes you want to make depending on what unhealthy habits or lifestyle patterns you have fallen into. You might want to seek out professional help from a Registered Dietitian or even a therapist if your eating issues are rooted in a psychological or emotional issue. You may not see the fast results a diet or diet program can offer. But a year from now, or two years from now, you will be happier and healthier.
In case you did not notice, Weight Watchers recently came out with a television ad with Oprah as the new face of WW. This helped boost the stock at first but just like dieting according the the LA Times article, it did not last long. Check out Dare Not To Diet for some great insight by the experts on Oprah and Weight Watchers.
Anyway, I covered the “bad” and the “ugly, so what about the “good”? I actually think Weight Watchers has some pretty good recipes (I have friends who have brought over yummy healthy dishes, and they were happy to brag “weight watchers recipe!”). I wish anyone who decides to go on the program and count points figures out how to take the good things (like healthy cooking) from the program and leave the rest. Everyone is different, and if someone loves Weight Watchers, I just wish them luck. We all need to learn from our own experiences.
But please think about it. If you did it before, and regained the weight you lost, did it really “work”?