Down for the Count: Comparing Three Different Weight Loss Systems

When the leader of a workshop I attended asked if I was new to the weight control program, I answered, "I'm a lifetime member. I come back every 10 years whether I need it or not."

I began my weight management journey 40 years ago after my first child was born, wanting to reclaim my pre-maternity weight. When I fall off track, I go back. Each decade that I revisit the program, my goal weight is adjusted for my age.

Dissatisfaction with the way I look and how my clothing feels is generally the impetus for returning, but this time around, I have a less superficial motivation — to lighten the load on joints, tendons and bones that have begun to ache for the wear.

I've learned that losing weight has better results when there is support and accountability. Programs may offer different approaches, but the common goals are losing pounds, keeping them off and adopting a healthy approach to eating. For this article, I'll focus on three systems that are well established: medical providers, commercial weight-loss programs and a 12-step program. All three utilize support and accountability for their outcome.

Medical weight loss clinics have evolved along with the way the medical community views obesity. Obesity medicine (formerly bariatric medicine) was established as a board certified practice; then the American Medical Association (AMA) declared obesity a disease; prescription medicine for treatment became refined; and insurance companies followed with expanded coverage. With these advances, medical clinics are a popular and viable form of treatment for individuals battling excess weight.

I spoke with Andre Giannakopoulos, M.D., a program director at the Long Island Weight Loss Institute (LIWLI), who has been board certified in the treatment of obesity since 2007. He describes obesity as "a multi-factorial medical disease that should be treated by health care professionals." Patients are evaluated by a full body composition analysis. BMI (body mass index) of over 25 is overweight, while over 30 is classified as obese.

The clinic focuses on individualized treatment plans that offer full or partial meal replacement (fortified protein shakes and bars) with controlled calorie intake, and the option of FDA-approved weight loss medication. Bariatric surgery is dwindling as a choice now that effective weight loss medications are available.

For a look at a commercial program, I selected WW (formerly Weight Watchers) because I am a second-generation lifetime member. WW is a fee-based program, but services of a registered dietician are available and may be covered by insurance. If a member attains and maintains goal weight, workshop attendance and other program support is free.

When my mother was a member, there were "legal" and "illegal" foods for diet compliance. Today, foods are assigned a point-value based on their desirability for weight loss; the dieter has a set number of points to consume daily. Two hundred foods have a 0-point value because they are basic to a healthy diet with a low risk of overconsumption.

For foods with point-value, portion control is important, requiring weighing, measuring and tracking consumption. Technological advances include a scanner on a phone app to read package bar codes and assign points. We've come a long way from my mother's Weight Watchers.

The "anonymous" organizations center around a 12-step program. The original program, Alcoholics Anonymous, founded in 1935, was restricted to people addressing alcohol addiction, leading to other off-shoots, one of them being Overeaters Anonymous (OA). OA is supported by voluntary contributions.

For eating disorders and compulsions, the concept is that a disharmony of body, mind and spirit is at the root of the addiction. To address the eating behavior, the individual must align those aspects of themselves and put their metaphoric house in order. OA has an eating plan, approved by a nutritionist, that identifies trigger and binge foods. It helps members plan a healthy, reasonable diet.

At LIWLI, patients are counseled individually by health care professionals about their progress. They may initially be seen weekly or bi-weekly, but once they reach a maintenance weight, they can have appointments every three months.

WW encourages attending weekly workshops, offered in person and virtually. Members share successes and tips for weight loss. The leader is a trained professional who focuses on food planning strategies and mindset topics based on positive thinking. My first week back, I took a selfie in front of a sign that reads, "What kind words have you said to yourself today?"

OA meetings are offered live and virtually. At the virtual meeting I attended, a few members expressed gratitude at being able to find a meeting to join online whenever they needed one. Prior to attending, I spoke to an OA contact who explained that their groups are led by members who volunteer. Another important volunteer role is that of a sponsor, a member who has experienced a degree of success and offers to assist someone who needs help coping. Not surprisingly, the contact with whom I spoke asked to remain anonymous.

At LIWLI, patients are given assignments to complete on their own, answering questions about exercise, nutrition and stress. They discuss their answers on their visits with a health care professional. Giannakopoulos says, "Patients who come more regularly see more weight loss and keep weight off more long term."

Accountability is a critical component of the WW program with weekly weigh-ins. For those who scoff at having someone record their weight, the workshop members agree that the looming prospect of the scale instills motivation.

The OA 12-step program focuses on self-accountability by taking an inventory of one's life and becoming spiritually aligned so they can wean themselves from addiction.

Giannakopoulos reports that there is an 11% weight loss for patients who follow the meal replacement regimen with higher results for those who choose the additional medication option.  

WW, on its app, posts a clinical trial that quantifies its effectiveness. Weight loss for individuals using WW was compared to that of individuals applying a do-it-yourself (DIY) approach. After 12 months, a study found those in the commercial weight loss program had significantly greater weight reduction than the other group, losing 5% of body weight.

Testament to the effectiveness of OA for people with eating compulsions and disorders is reflected by the expansion of the program. Since its inception in 1960, the program has expanded to 75 countries with meetings available daily to provide support.

At one WW workshop I attended, the leader shared a Japanese proverb: "Fall down seven times, get up eight." Now in my 70s, I am on my fifth cycle returning to the program after a few stumbles. I anticipate the possibility of cycles six and seven, but I plan to end up on my feet for the count of eight. When I pass away, at least one person who memorializes me will remark, "and she left us at her goal weight."

Linda Goor Nanos is a practicing attorney, author, wife, mother and grandmother. Her writing credits include a memoir "Forty Years of PMS," professional articles and published essays on life lessons. Read More