The Good Health Magazine : NUTRITION : THE DIET DILEMMA : WEIGHT-REDUCING PLANS DO WORK-- FOR A WHILE. BUT THE TRUE CHALLENGE COMES WHEN THE REGIMEN’S OVER AND THE DIETER RETURNS TO THE EVERYDAY WORLD
First, the good news: They work. The Nutri/Systems, the Jenny Craigs, the Optifasts, the Weight Watchers and all the rest of the parade of mass-market, enrollment-style diets currently on the American scene. Sign up, stick with it and lose weight. If you’re faithful, it’s virtually guaranteed.
More good news: They’re not considered dangerous. Stay within the doctor’s guidelines and the diet’s strictures and you’ll likely stay healthy.
The inevitable catch: The real world. Real meals. Real food. Actual day-to-day eating without diet counselors, group support, weekly meetings, prepackaged foods or strictly limited calorie intake. Going it on your own in the world of restaurants and dinner parties and seemingly limitless food choices.
“These diets all have some really positive points about them,” says Bettye Nowlin, a registered dietitian and a spokesperson for the American Dietetic Assn. “They all use behavior modification and all have an exercise component, and you need both of those to be successful. But they’re not realistic in the long term. People aren’t going to keep up these systems all their lives.”
Still, say medical and diet professionals, the current crop of diet plans, many of which have appeared only in the past decade, are far superior to their gimmicky or ill-advised antecedents that emphasize practices such as food combining, single-food diets, fasting and other questionable weight-loss strategies. The newer diets, which shun such oddities and often recommend or require close medical supervision and sound, basic nutrition, have little relation to fad diets such as the nutrient-deficient Last Chance Diet that was briefly popular in the 1970s and was blamed for several deaths.
But the new diets are playing for high stakes--the enrollment-style diets are estimated to be a multibillion-dollar industry--and each offers a distinctive “hook” to attract the approximately 100 million overweight Americans. The maxim of the diet biz in the late 1980s remains: You gotta have a gimmick.
The enrollment-style diets fall into three basic types:
Liquid, or supplemented fast, diets. These plans typically are medically supervised, either by the dieter’s personal physician or one designated by the diet facility. The regimen involves an initial period of abstaining from solid food and subsisting on the low-calorie, high-nutrient liquid supplement. A normal, balanced diet is then gradually reintroduced during a period of counseling and behavior modification. Optifast and the Cambridge Plan are typical examples.
Prepackaged food diets. Dieters are provided with full menus of prepackaged, low-calorie foods that they prepare themselves. There are periodic group meetings and behavior modification classes with diet counselors. The Nutri/System and Jenny Craig plans belong to this category.
Low-calorie, “real food” diets. Participants attend meetings, behavior modification classes and group support sessions while adhering to a specified, varied low-calorie diet incorporating foods available at a grocery store. Diet Center and Weight Watchers are examples.
All the diets, however, have one thing in common: claims of long-term success. The responses of medical and diet professionals to those claims is equally consistent. They say that, in most cases, they aren’t true.
“(The diets) are, I think, fairly successful in the short run,” says Albert Marston, a professor of psychology at USC who specializes in the study of diet and weight control. “All diets see good weight loss at the beginning. The first problem people face is the loss of motivation after several weeks. They get bored with the food or frustrated with not eating. The really big problem is getting people all the way down to their goal weight.”
Marston says studies he has conducted have shown that dieters reaching their goal weight “have a far better chance of keeping the weight off. If they drop out before that, the tendency is to gain (the weight) back.”
(Claims by the diet plans notwithstanding, independent medical and nutrition experts interviewed say 90% or more of dieters are likely eventually to gain all or a portion of their lost weight back.)
For those who do reach their goal weight, says Marston, other pitfalls lurk. While all the enrollment-style diets emphasize behavior modification and counseling in proper nutrition and the psychology of eating, “they try to get people to come back for maintenance (programs), but once people leave the diet they tend to think of it as history,” Marston says. “Attendance at follow-up meetings is generally very poor, and that’s a time when people need to be very careful. Because when they slip, the attitude tends to be, ‘Oh, I’ve blown it.’ They have a kind of fall-off-the-wagon attitude.”
Dieters are less likely to suffer that slip if good eating habits are emphasized from the very beginning of a diet, says Ann Coulston, a research dietitian at Stanford University Medical Center.
“The two diets I would consider the best,” she says, “are Nutri/System and Weight Watchers, because they provide participants with real foodstuffs rather than liquid drinks. They’re learning how to eat less, which is what they’re going to have to do for the rest of their lives. When you start out like that from the beginning, you have more time to help them learn to change their behaviors.
“All the liquid nutrition diets go to weight maintenance at the end of the treatment, which includes real food. But by that time, a lot of the participants have dropped out. In 8 to 12 weeks, they’ve been on liquid only and they haven’t learned to eat in a different manner. It’s a difficult thing to achieve, and you don’t achieve it with one or two weeks of instruction and practice.”
Liquid diet programs such as Optifast “try to teach people about proper eating when they’re not eating,” says Marston, “and that makes it more difficult to retrain them.”
Most diet professionals interviewed say the Weight Watchers program was the least regimented and therefore probably the most effective of the diet plans. It is also the oldest, having been in business since 1963. Apart from the plan’s longevity and history of success, Coulston says, Weight Watchers “provides an option of several levels of caloric intake. They don’t force people into very low-calorie diets. They rely on a good balance of regular foods.”
Weight loss under the Weight Watchers plan is far more gradual than the quick loss that accompanies liquid diets, which helps to establish better eating habits, says Coulston. However, she adds, there are traps.
“When you use real foods (as part of a diet) and portion them out for yourself, you can more readily go overboard and maybe take a double portion.”
This also can be a drawback of the prepackaged food diets, says Nowlin, for it is possible that once dieters stop eating the prepackaged food “and start eating their own food, this is where the breakdown can occur.”
Also, say diet experts, a plan that does not include exercise is doomed. All the enrollment-style diets provide exercise recommendations but, Marston says, actual exercise classes at the diet centers usually are not included “for liability reasons.”
It is exercise, says Grant Gwinup, a professor of endocrinology at UC Irvine, that is one of the ultimate determiners of permanent weight loss.
“More important than all the diets,” he says, “is the outflow of energy that can only be accomplished by an aerobic exercise program. People are unlikely to be successful unless they change their life style and become very physically active. That’s a fact of life.”
Another fact of life in the diet business is show biz, for there is nothing like a good testimonial to put the spurs to a few thousand more overweight potential clients. Phones at Optifast centers around the country rang for days after talk show host Oprah Winfrey revealed a new size-10 figure, courtesy, she said, of Optifast. And celebrities such as Elliot Gould and Susan Saint James tout other plans in television and print ads.
“A lot of the advertising is misleading,” says David Heber, the director of the Clinical Obesity Center at UCLA Medical Center. “They use people in the ads who have lost 100 pounds or more. Then they’ll say that weight loss will vary with the individual, but I don’t think that lets them off the hook.”
There is also what Heber calls “a disturbing trend in some of the ‘shopping center’ programs such as Jenny Craig and Nutri/System, the lay-directed programs” to market ancillary items such as food scales, measuring cups and books. Weight Watchers, he says, also markets a line of frozen foods and other food products available in grocery stores.
Still, Marston says, “there has, in general, been a great improvement in the dieting industry. It’s gotten more and more sophisticated and has been providing better service. Like every business, there’s always that effort to strike a balance between concern for the dieter and a need to make a profit, but even physicians could be accused of that.”
Is there an ideal diet? That question can start diet experts arguing like economists. To Heber, a clinical program closely supervised by a physician, tailored to each individual’s specific diet needs, is the answer.
“The weight-loss population is so heterogeneous,” he says, “and people have such individual problems, that if they find the wrong program they’ll keep looking for another until they succeed. Anyone who has the ability to do so should participate in a medically supervised program, one that offers a number of pathways for people to take depending on how much they want to lose and the time they want to spend, with maybe a program with strictly whole food or strictly meal replacement or any combination of the two where you can adjust the calorie intake weekly. But not everyone can afford such an ideal program.”
To Gwinup, the ultimate diet is no diet at all. Like other experts, he acknowledges that many dieters--numerous but usually undocumented in surveys--simply decide to eat less, eat right and exercise more. And often they succeed once and for all.
Unlike other dietitians and eating authorities, however, Gwinup says any regimen that deviates from the less-food-more-exercise model is nothing more than window dressing.
“There’s no such thing as a magic diet,” he says. “Any diet that’s deficient in calories will make you lose weight. But generally speaking, the closer the diet is to real foods that you buy in the grocery store, the more likely you are to be successful in the long run.
“Although every diet is advertised to make you lose weight, if you’re not prepared to put up with hunger, forget it. People have to be taught to stay hungry. If you can say that you’re hungry, you can say that you’re burning body fat. If people did that, they would not have to do anything else in the short run. It’s uncomfortable, and my patients hate me for it, but you have to be realistic with them.”
Mass-market diet plans, Gwinup says, “are selling their patients dreams. It doesn’t make sense, putting the patient on something very artificial. Forget all that lead-in business with gimmicks and let’s get to the real stuff. Real food.”
Such a self-administered diet should be most people’s first choice, Marston says.
“I would do it in steps. First, I would try to do it on my own, because I think the more independent we are with these problems, the more effective it is. If that didn’t work, I’d go to the diet programs.
“If the problem is more severe and the person has had no success with those common programs, they should go to the physician-monitored programs with more intensive care. The care and cost levels escalate depending on the trouble you’re having. Most people will have to shop around.”
After the diet drinks, however, and after the flavor enhancers and the sugarless candy and the prepackaged food and the low-cal frozen entrees and the nutritional supplements, one great dieting truth emerges: In the end, they’re all the same.
“What people do ultimately,” Heber says, “is eat the same diet to maintain their weight in the long term--a low-fat, high-fiber diet. Ultimately, everybody’s on the same diet.”
ENROLLMENT DIET PROGRAMS AT A GLANCE
HOW IT WORKS
NUTRI/SYSTEM
After an initial round of interviews, goal-setting and counseling, participants are put on an 800- to 1,200-calorie-a-day diet consisting of prepackaged foods that can be prepared at home. During weight loss, participants meet weekly with counselors. Periodic meetings are offered after goal is reached.
EFFECTIVENESS
Average weight loss of 2 to 2 1/2 pounds a week.
COST
No definite figures available. Cost will rise with the amount of weight participant needs to lose. Prices also vary from center to center because each operation is an individually owned franchise with fees set by the owner. Acknowledged to be generally higher in price than the similar Jenny Craig plan (see below).
MEDICALLY SUPERVISED
No.
ADVANTAGES
Food is easy to obtain and prepare. The program also offers a guarantee that if participants do not reach their goal weight on schedule, Nutri/System facilities and services may be used free until the goal is reached.
DISADVANTAGES
Lack of exposure to actual grocery store food during weight-loss phase. Cost of prepackaged food.
HOW IT WORKS
JENNY CRAIG
Similar to Nutri/System, with a program using prepackaged foods and daily calorie totals of around 1,000. When dieters lose half the weight they intend, they may gradually introduce their own food choices into the diet regimen. Weekly counseling and behavior modification classes are held during the weight-loss phase, and periodic follow-up visits to centers are encouraged after the weight is lost. Strenuous exercise is discouraged during weight loss. Specially constructed programs for adolescents also are offered.
EFFECTIVENESS
Average weight loss of approximately 1 1/2 to 2 pounds a week.
COST
Varies by region of the country, between $185 and $235 for use of facilities and services. Prepackaged food is extra, costing between $65 and $70 a week. Once goal weight is reached, participants pay a $99 fee to cover maintenance program for one year.
MEDICALLY SUPERVISED
No.
ADVANTAGES
Prepackaged food eliminates temptation in grocery stores. Weight loss is guaranteed by a set date or further use of the program and materials is free.
DISADVANTAGES
Cost of prepackaged food. Lack of exposure to grocery store food.
HOW IT WORKS
CAMBRIDGE PLAN
A liquid-diet regimen incorporating 800 or 420 calories a day in the form of drinks, soups or dessert bars. The 800-calorie plan--the regular program--is based on three daily servings of the liquid formula, plus 400 calories of prepared frozen foods and other lean recipes. The 420-calorie, or fast start, program, incorporates only the liquid or bar diet and is designed for those with relatively little weight to lose or who want to lose weight quickly as a preparation for entering the regular program. The physician-monitored program (monitoring is done by participants’ personal physicians) uses only the liquid portion of the regular program and a small amount of lean or snack foods. It is recommended for those with 30 pounds or more to lose. Behavior modification program is self-administered with workbook and audio cassettes. Meetings are optional.
EFFECTIVENESS
Average weight loss of 2 to 5 pounds a week on the regular program, up to 15 pounds in two weeks on the fast start program and 16 to 20 pounds in four weeks on the physician-monitored program.
COST
About $120 a month with an initial investment of about $62.
MEDICALLY SUPERVISED
No. Personal physician monitors liquid-only program.
ADVANTAGES
Quick weight loss. Lack of strict regimentation.
DISADVANTAGES
Primarily due to low calorie count: Occasional initial temporary side effects such as headache, diarrhea, frequent urination, fatigue, cold intolerance, hair loss, constipation, dry skin, nausea, decreased libido and dizziness. Problems in adapting to solid food after liquid-only phase.
HOW IT WORKS
OPTIFAST
Participants drink only a nutritional supplement, which provides 420 calories a day, for the first 12 weeks of the diet. In the following weeks, lean foods are gradually reintroduced into the diet and participants attend nutrition and behavior-modification classes (this phase lasts until goal weight is reached). Continuing classes and group meetings are available, as well as counseling on nutrition and exercise.
EFFECTIVENESS
An average weight loss of about 85 pounds by the end of the program (participants must be at least 30% above ideal body weight to qualify for acceptance into the program).
COST
Roughly between $3,000 and $5,000 for one year.
MEDICALLY SUPERVISED
Yes.
ADVANTAGES
Close medical supervision, fast weight loss, counseling.
DISADVANTAGES
Primarily due to low calorie count: Possible temporary hair loss, dry skin and intolerance to cold during the liquid-only phase. Problems in adapting to real food after liquid-only phase. High cost. Time commitment required.
HOW IT WORKS
DIET CENTER
A five-phase program, beginning with a two-day transition from present diet to leaner foods and some dietary supplements in tablet form. The second phase, which lasts until goal weight is reached, incorporates lean foods and supplements totaling around 1,000 calories and requires daily supervision and weigh-ins. The third, or stabilization, phase allows slightly higher calorie totals and a wider variety of foods, without supplements, and lasts a maximum of three weeks. The maintenance phase incorporates weekly consultations for one year. Weekly classes in nutrition, behavior modification, exercise and stress management are offered throughout the program.
EFFECTIVENESS
Average weight loss of between 17 and 25 pounds in six weeks. If 50 pounds or more need to be lost, counselors consult with participants’ personal physicians at each 40-pound loss interval.
COST
For a loss of approximately 30 pounds (average time: 9 weeks), $700. This includes the cost of the stabilization program after the weight loss and one year of maintenance. Franchises are individually owned and prices will vary accordingly.
MEDICALLY SUPERVISED
No.
ADVANTAGES
No prepackaged foods, fasting or liquid-only regimens. Foods used in program are obtained by participants at the grocery store.
DISADVANTAGES
Daily commitment to weigh-ins.
HOW IT WORKS
PRITIKIN PROGRAM
Not a diet plan per se, but a regimented program designed to reduce risks of cardiovascular and other disease through diet and exercise. Residential programs at the Pritikin Longevity Center in Santa Monica (other centers are located in Florida and Pennsylvania) emphasize low-fat, high-carbohydrate eating, medical evaluation, counseling and exercise. Participants live and eat at the facility for 13 or 26 days. A six-week, non-residential program called Pritikin P.M. also is offered (three evening classes a week for six weeks).
EFFECTIVENESS
Average weight loss during the 26-day program is 13 pounds. On Pritikin P.M., 8 to 12 pounds.
COST
The 26-day residential program costs $7,541; the 13-day program costs $4,456. Pritikin P.M. is $1,075.
MEDICALLY SUPERVISED
Yes.
ADVANTAGES
Close medical supervision. Intensive education. Supportive atmosphere. May be covered by medical insurance. May be tax deductible.
DISADVANTAGES
Highly regimented eating plan; limited foods. High cost.
HOW IT WORKS
WEIGHT WATCHERS
Flexible program in which participants adhere to a prescribed, varied diet based on the four food groups. Varied menus--none below 1,000 calories a day--allow participants to use grocery store food or Weight Watchers frozen meals (also available at grocery stores). Quantity and variety of food increased with progress of diet. Weekly optional group meetings and individual counseling.
EFFECTIVENESS
Varies, but dieters who are faithful to the program can lose about 2 pounds a week or more.
COST
Varies with individually owned franchises, averages about $7 to $8 a week. One-time registration fee of $12 to $25, depending on franchise.
MEDICALLY SUPERVISED
No.
ADVANTAGES
Long record of success. Lack of rigidity. Extensive food choices. Group support.
DISADVANTAGES
Slower rate of weight loss.