| By Carol Milano
If you’re trying to lose weight, the options include doing
it on your own, joining a commercial program, or working with
a specialized counselor. Which approach is likely to be most effective?
At the end of a recent two-year multi-site clinical trial led
by the New York Obesity Research Center (St. Luke’s/ Roosevelt
Hospital and Columbia University), the average weight loss in
a group of people instructed to enroll in Weight Watchers was
six pounds.
Those who actually did enroll, and who attended most of the weekly
meetings, maintained a loss of about 10 pounds. A group instructed
to lose weight by dieting on their own lost an average of one
pound. Researchers note that obese participants in diet and exercise
programs rarely achieve a normal weight and, eventually, often
regain pounds they’d lost.
Study participants – 65 men and 358 women -- were randomly
assigned to either a self-directed program which included two
twenty-minute counseling sessions with a nutritionist who provided
self-help resources, or to Weight Watchers, which provides a food
plan, an activity plan, and a behavior modification plan at weekly
meetings.
All services were provided at no charge. "We didn’t
want cost to be a factor in measuring how successful a program
was. If people had to pay for their own Weight Watchers sessions,
that might be a deterrent," observes lead author Stanley
Heshka, PhD, Research Associate at New York Obesity Research Center.
On the other hand, he notes, some people believe, "if you’re
not paying for it, it’s not worth much."
Most dieters regain some weight during the second year, perhaps
because they may begin to follow recommendations, like calorie-counting,
a little less carefully. "People may simply tire of hearing
the same thing over and over. After a while, unless it’s
really become part of your daily routine, you revert to your former
state," Heshka finds. "It’s hard to do it alone.
A structured program, where you’re getting weighed, getting
group support, etc., helps provide focus."
The researchers found a wide range of success and failure in their
study. "In general, those who attended more Weight Watchers
meetings took off more weight," says Heshka.
In real life, he believes, people who self-select Weight Watchers
may feel that it is the best approach for their particular needs.
"Possibly for them, that kind of program will work better
than for those randomly assigned to it." (This study was
the first to use randomization in order to achieve a clinically
rigorous comparison of Weight Watchers and a self-help approach.
It was funded by the well-known commercial program.)
Weight loss was definitely found to improve quality-of-life factors.
Before and after the trial, Heshka’s team assessed such
self-reported factors as how energetic each participant felt,
whether weight hindered performance of any daily activities, vitality,
weight-related embarrassment, etc. "We found a strong correlation
in improvements to the degree of weight loss," Heshka reports.
"Our results show that Weight Watchers provides modest weight
loss but is more effective than brief counseling and self-help
for overweight and obese adults."
Professional Counseling
"The biggest mistake dieters make is not seeking out the
objectivity of someone experienced in this field. It takes a while
to lose, say, 30 pounds. If you have to continue a diet for a
long time, you really need guidance," declares Kathy Isoldi,
RD, MS, Coordinator of Nutrition Services for Comprehensive Weight
Control at New York Presbyterian/Weill Cornell Medical Center.
Her program provides medical and nutritional guidance to people
who typically need to lose 50 pounds and have weight-related health
problems. Each patient meets with a registered dietitian, reviewing
medical and weight history. "We do a comprehensive nutritional
assessment, and put together a plan with food or liquid protein
drinks. Some need to fine-tune their exercise and diet,"
says Isoldi, who’ll see a patient for six months to two
years. Frequent at first, sessions taper off to meeting every
three to six weeks.
"We try to replicate previous success, and avoid what’s
failed. My role is educator and coach. You need someone to evaluate
your progress so you don’t get discouraged. If a patient
sees only a one-pound loss, she may ask, ‘why am I doing
this?’ I remind them of the benefits, such as the added
energy that comes from exercise. Dieting is also about changing
the way you think; the program makes a difference in keeping you
focussed and motivated," Isoldi feels.
She’ll tell a patient needing to lose 50 pounds that it
will take one to two years. In reality, a patient losing ‘only’
30 pounds a year is disappointed. "You still need to be monitored
somewhere and get guidance. You must have someone coaching you
for two years," Isoldi maintains. She reports that her patients
lose an average of 30-70 pounds a year (which is remarkably high
for any type of weight loss program). "After six months,
as metabolism slows down, so does weight loss. "When the
diet starts getting old, you start giving in. A counselor who
can bring you back to reality helps you feel control and get back
on track."
Patients keep food diaries for Isoldi to review, and can call
or e-mail her anytime. "Our patients say we are a great source
of their success. I’ve never had anyone say, ‘I would
have done better on my own,’" Isoldi reports.
RESOURCE FOR READERS:
"The Woman’s Day Weight Loss Plan: Eat Right, Lose
Weight, Be Fit & Feel Great At Every Stage of Life" by
Kathy Isoldi (Filipacchi, 2003).
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