Putting the E in Diet

TIMES HEALTH WRITER

Brandalyn Taylor was trolling the Internet one night last winter when an advertisement caught her eye. She doesn't recall exactly what it said except for the operative words: Lose weight.

Taylor had been struggling to drop the pounds she'd gained during her first pregnancy, and she didn't think twice before lifting her finger and clicking on the ad. Thus began an ongoing and successful cyber relationship between the Aliso Viejo woman and a commercial online dieting company.

A student nurse, wife and mother of a toddler, Taylor, 28, has lost 17 pounds since mid-February. Logging on to her computer each day, she receives software-generated inspirational messages, recipes, meal plans and food shopping lists. Once a week, Taylor weighs herself and reports her weight so that her virtual dietitian can make adjustments to her personal program.

It sure beats her previous attempts to lose weight, including those fat-burning pills her husband brought home one day, she says.

"I was pretty normal until I had my baby," says Taylor, who gained 50 pounds during pregnancy. "It was so hard to get motivated to take the weight off. With [the Web site], they tell you how to do it. It's hard for people to lose weight by themselves."

Online dieting companies are eager to help.

The publicly held eDiets.com, which Taylor uses, saw its number of paying customers soar from 33,000 in 1999 to 250,000 last year. Its main competitors, DietWatch.com and CyberDiet.com (which are part of one company) and DietSmart.com, are privately held and will not release sales figures but claim "tens of thousands" of paying members.

Even the venerable Weight Watchers International is branching out with an interactive Web service.

"I think the Internet is potentially an important source of weight management, says Dr. Thomas Wadden, director of the weight-loss and eating-disorders program at the University of Pennsylvania School of Medicine. "Possible, you're going to find that Patty, the electronic dietitian, can be just as good as Patty, the flesh-and-blood dietitian."

But though e-dieting appears to be attracting members in droves, there is no evidence that it works any better than traditional, in-person diet counseling, especially over the long term.

"It doesn't really have a track record," says Morgan Downey, executive director of the American Obesity Assn.

And, notes Wadden, dieting is a notoriously fad-driven business, and e-dieting is the low-calorie flavor of the month. "Every new diet goes through a cycle and catches fire, and then it either gets rained on or it continues to smolder," he says.

Cyber dieting has captured the public's interest for now, however. Scores of weight-loss Web sites are little more than online stores selling products and pills. Other sites offer free information on dieting and, perhaps, chat rooms for sharing experiences. Online, interactive dieting services go a step further by providing personalized services, much in the way that a local Jenny Craig or Weight Watchers franchise would do.

By sticking to fairly sound medical advice and keeping their fees low, the online dieting services have managed to muscle into the weight-loss industry without ruffling too many feathers, says Downey.

"If these sites can provide a supportive, anonymous, nonjudgmental way for individuals to lose weight, that's fine," he says. "There is a lot that would appeal to consumers: the anonymity, the 24-7-365 access, the tips and helpful suggestions. The Internet is a very powerful communications tool."

You don't need to tell that to Dave Humble, chief executive of eDiets.

"Look at the basic economics of an online company versus thousands of Jenny Craigs. They have 600 centers [to manage] and I have one center," says Humble, whose company turned profitable late last year.

EDiets, which recently expanded to Ireland and the United Kingdom, had its origins as a supermarket kiosk that shoppers could access for nutritional advice.

"It can cost $150 to go to a nutritionist for this advice," says Donna DeCunzo, who created the kiosk idea and is now eDiets' director of nutrition services. "It's a shame that people can't get good advice because they can't afford it."

But busy shoppers ignored the kiosks, and Humble suggested putting the program on the Net.

EDiets' growth exploded last year when it began advertising on heavily traveled sites such as iVillage. Humble says that paying members stay with the program an average of six months--double the time dieters typically devote to traditional walk-in programs.

"Even when they reach their goal weight, they want to stay because they have made friends online," says DeCunzo.

Dieters Feel Safe in Anonymity

DeCunzo credits eDiets' success to the anonymity the Internet offers.

"What I found was how open people were to it because they were able to be anonymous," she says. "When they came to the office, it took them about six weeks before they trusted me enough to get down to the real issues. Online, they are more apt to tell me that they have relationship issues and that's when they turn to the refrigerator."

If nothing more, the Internet has been a beacon to people in search of support and solace but who are reticent about seeking it face to face.

Jessy Ellison, 52, was feeling miserable after abandoning her self-imposed diet over the Christmas holidays. She signed up for eDiets in January and has lost 20 pounds.

"I was feeling very out of control," says the resident of Leisure World. "I would eat because I was upset or bored or happy. I had no discipline."

Ellison, who had previously attended Overeaters Anonymous meetings, liked the convenience and privacy of dieting online.

"At first, I just followed the meal plans, and I started losing weight," she says. "Then I got into the chat rooms and bulletin boards, and I started writing about my feelings. I got into some real emotional work with some of the women online about dealing with anger. The online [support group] meetings are fantastic."

Feedback appears key to managing weight loss, and the Internet is a virtual chatterbox. In one of the first studies to examine Internet dieting programs, researchers from Brown Medical School in Providence, R.I., randomly assigned dieters to one of two Internet dieting programs--one that offered information only and another that also provided feedback in the form of e-mail from a therapist, weekly online submissions of food diaries and bulletin boards.

The dieters in the interactive program lost three times as much weight during the six-month study. The research was published in March in the Journal of the American Medical Assn.

"There is a phenomenon of group support that is very important in weight control," says Dr. Steven Heymsfield, deputy director of the Obesity Research Center at St. Luke's-Roosevelt Hospital in New York. "People have known this for years."

In the past, support for dieters was typically found at weekly meetings of people sitting in a circle of metal folding chairs in some church basement. Support in cyberspace may be just as good, says Wadden.

He and colleague Leslie Womble have launched a yearlong study comparing a group of dieters using a weight-loss manual with people using eDiets.

"I think what people would really like is drive-through weight loss. And eDiets is as close to that as you come," says Wadden. "We live in a society where time is so precious that even spending 60 minutes at a Weight Watchers meeting is a barrier to people."

Add low fees to the mix, and you get the recent explosion of online dieters.

Personalized Menus Plus Interaction

The major commercial online dieting services all operate in a similar manner. Consumers join at fees that average about $10 to $15 per month, typically with a three-month minimum commitment. Individuals then fill out a detailed questionnaire about their medical history, exercise habits, food tastes and whether they prefer cooking or buying convenience foods.

"If you're allergic to milk or won't eat certain foods, they will take that into account. That is very helpful," says Felicia Busch, a spokeswoman for the American Dietetic Assn. who has studied online dieting.

A computer program generates the diet plan, which is updated weekly. Most sites also augment their paid plans with free newsletters (eDiets has a circulation of 5 million for its twice-weekly newsletter), chat rooms, message boards and food calculators that compute calories and do other nutritional number-crunching.

Some sites are trying to carve out distinct features. For instance, members of DietWatch and CyberDiet, part of the privately held DietWatch Inc., can link to one of 350 registered dietitians throughout the country for private online counseling at fees set by the dietitian.

DietSmart offers five general diets to choose from--such as a plan higher in protein or one that features more snacks--that are then further personalized.

Even the granddaddy of weight-loss programs, Weight Watchers, has acknowledged the lure of online dieting--although the company says it is sticking to its belief that face-to-face diet counseling is best.

"The question is: What can we do for people during the six days and 23 hours when they are not at a Weight Watchers meeting?" says Alex Inman, the company's director of communications. "Obviously, people are spending more time on the Internet."

Weight Watchers' cyber program, called eTools, was launched in February and costs $29.95 for a three-month subscription. Available to members only, Inman says, the program helps people keep better track of their "points." Under the Weight Watchers system, each food is assigned a point value and individuals aim to stay within a certain point range each day.

"ETools is designed to complement the meetings," Inman says. "It helps members get more out of their experience."

Though eTools is offered only to Weight Watchers clients who also attend traditional meetings, a program for nonmembers is in the incubation stage.

"The biggest part of dieters are the self-helpers who don't look to anyone to attempt weight loss," Inman says. "That's what we are looking at for the future."

The leading interactive dieting companies have generally made an effort to abide by mainstream medical advice, Wadden and other experts say. Most programs are designed for a one to two pound per week weight loss, based on a balanced diet consisting of no more than 20% of calories from fat.

"We've seen a minor revolution in the marketing of weight-loss programs," Wadden says. "Most programs are taking the high road now."

EDiets, for example, is adhering to expert consensus about successful weight loss by adding an interactive exercise program, available for an extra $10 for the first three months and $5 per month thereafter. About 25% of eDiets' members have subscribed to the exercise plan. They receive a weekly personal exercise plan, instructions, feedback and inspirational messages, says Humble.

However, several questions about the future success of cyber dieting remain, experts say. For example, the appeal seems limited to women. Ninety percent of eDiets' members are women, Humble says. The company is testing a variation of its program aimed at attracting more men.

And there is no long-term data on whether users will maintain their weight loss, with or without the help of the service.

"Call me in five years and show me the data that it not only helps people lose weight, they keep it off," says Heymsfield of the Obesity Research Center. "That is where I'm cynical. It's critical that we find out if members keep the weight off."

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Weigh Pros, Cons of Net Services

Thinking of using an online dieting service? Consumers should examine a site carefully before signing up. Weight-loss experts offer these tips:

* Read the site's privacy policy. Most commercial dieting sites ask users to complete a detailed health questionnaire. Find out how protected this information is and if others will be privy to it.

* Find out just how much counseling you'll receive. Many sites offer computer-generated feedback. You may have to pay extra for one-on-one consultations with human beings.

* Who is dispensing the advice? Find out if questions are answered by registered dietitians, diet technicians (who are trained to answer basic nutrition questions but do not have the educational degree of a registered dietitian) or mere telephone receptionists.

* Check out the specifics of a site's chat rooms and bulletin boards. Some sites offer specific chats for diabetics, new mothers, etc.

* Compare fees. Most sites cost about $10 per month with a three-month minimum for basic services. If you're paying more, find out why.

* Most sites allow you to fill out a "free" profile to give you a sample of how your personal diet plan might look. If you participate in this, be aware that you might trigger countless, continued e-mail pitches from the site urging you to join.

* Find out if the site offers a personalized exercise plan.

* Investigate whether the site offers a maintenance program--and at what cost--after you reach your weight-loss goal.

* Be wary of sites that promise quick and effortless weight loss.

* Avoid sites whose diet plans rely on their own dieting products.

* Check to see if the site subscribes to the principles of the Health on the Net Foundation. (The foundation advocates for high-quality health information on the Internet.) Such sites will display an "HON" icon.

Sources: American Obesity Assn.; American Dietetic Assn.

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Top Health Sites in April

* WebMD

* eDiets.com

* drugstore.com

* dietsmart.com

* medscape.com

* drkoop.com

* healthandage.com

* po.com

* merckmedco.com

* mayoclinic.com

Source: Jupiter Media Metrix

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