Whats Wrong With Weight Watchers?
There are many things wrong with Weight Watchers. I want to touch on a few of these things.
First, why am I talking about Weight Watchers? Primarily because weight loss is a multi-million dollar industry in North America. Second, and that is the reason for the first, obesity is a large and growing problem that has been associated with many preventable diseases. Third, Weight Watchers is the only program I know of that has been evaluated in a randomized, controlled study (see Heshka, et al., (2003)) and found to be effective.
What are the problems with Weight Watchers? First, there is no emphasis on exercise. This is perhaps the most damning critique of their program. They give lip service to exercise in their printed materials, but the vast majority of the program is focused on eating. Yet, exercise is a critical component in weight gain and weight loss as well as maintenance. The so called mood leveling effects of moderate exercise might even be contributory to dietary compliance.
Second, in their "Flex-Point" system they give the impression that you can eat "whatever you want" so long as you do not exceed their points. Points are the weight watchers simplified calorie counting system that weights calories with factors like fat and fiber content (Thus, a food that is calorie equal to another one that has different levels of fat calories and different amounts of fiber would have slightly more or slightly less "points". However, it would be close). This is not correct. Even if you strictly comply with caloric recommendations but live on a diet of, say, pizza and soda pop you are headed for an early grave. Lip service is given to nutritional balance, but this is stressed as a desirable, not absolutely necessary, component of the program (much like exercise).
Third, they offer life-long group therapy with no termination point. This is also my complaint about traditional psychotherapy where the patient is allowed to determine when they feel termination would be desirable. In Weight Watchers termination is never reflected on. They have a "lifetime member" category and like the Jets gang in West Side Story you are a member for life. This is, however, ridiculous . Not that good eating and exercise habits aren't a lifelong practice. But it is the case that a group therapy based intervention need not continue forever. This is "excessive medicine". Weight Watchers charges by the meeting and by the month. They have a strong financial incentive to keep you coming until you die.
From a behavior-analytic standpoint Weight Watchers misses many opportunities to be more effective. First, they encourage a self-monitoring system ("trackers") wherein the members write down everything they eat, including water, vegetables and oil, as well as track exercise. However, there is no mechanism to encourage compliance with self-monitoring.
Second, they have weekly motivational meetings. However, there is no attempt to discover who is most likely to be motivated by these meetings or why. They have the format of religious revivalist meetings - "How I fell, and then found Redemption!" and encourage participants to discuss their successes. These meetings could be video-taped and/or made available for download on the internet. Since meeting content is thematic rather than point-by-point meetings will vary in the utility of their content. Some content is generated by members themselves in the form of good advice or a what-worked-for-me type suggestion. This is not recorded anywhere. The consolidation of the best speakers and best members suggestions and talks would likely be highly useful.
Third, they are expensive. Weight Watchers is a program that costs as much as a gym membership - which may also be useless - but provides basically good advice and motivational talks. But motivation comes from many places, and many of them are self generated or non-weight watchers generated and free.
Fourth, it is dominated by women. This is not really a problem per se as an observation. Founded by a woman and presumably dominated by women in the leadership the program is somewhat aimed at women. Women definitely need a program just as much as men and this is a criticism because it means that men are not embraced by their program. A better program would be aimed at men or allow for more of a "coed" feeling to the program, program literature, assumptions about members, and so on. There is nothing that has lead me to believe that women are disproportionately obese. Men need support as well, and Weight Watchers seems less likely to find them coming.
Fifth, there is no attempt to fade the prosthetic environment. This is perhaps a variation on the "life long" group therapy criticism, but it points more constructively to what they should be doing instead of what they are doing. Using the model of Weight Watchers as a prosthetic environment, like a crutch or cast for a physical injury, there is no "fading" of the support Weight Watchers provides. They could make meetings less frequent and attempt to have the members generalize the program into their lives with less prompting and self recording. They could set strict time limits and develop a time chart as to when the members will be over the most intensive weight loss phase. This could be done by simple line graphs, for example. I cannot find any explicit discussion of this as a part of their program. Members are basically given the program until they fail - which seems likely - and then they are resold on the same program to redeem them from their overeating ways.
One possible motivation for this lack of a fading element is the economic structure of the program which is dependent upon meetings and attendance for payment. Since Weight Watchers makes more money for more meetings planning on having members not come back is, as they say, bad for business.
A minor note is that the JAMA study was conducted many years ago. Weight Watchers changes its program from time to time and presumably is using a method that is more or less the same one in the study. Weight Watchers, interestingly, does not finance studies of the effectiveness of its program. Although, even if it did such studies might be suspect as a result. It could make data on member behavior available to researchers for independent evaluation. As far as I know it does not.
In summary, Weight Watchers is an experimentally validated method of weight loss. It does suffer from some design and program implementation effects including an implicit validation of poor eating, not exercising and a lack of program termination and fading procedures.
Reference:
Heshka, et al. (2003) Weight Loss with Self-Help Compared With A Structured Commercial Program. Journal of the American Medical Association, 289, 14, 1792-1798.
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