Shahar Madjar, MD

Charlene leans forward, hands on hips, a wide smile on her face. I saw her picture on the website of Jenny Craig — a commercial weight loss program — where I learned that she had lost 60 pounds. She is a picture of health, fitness, and happiness. Jamie, on Nutrisystem’s website has lost 127 pounds which is quite evident from the Before- and After- pictures. In the Before- picture she is rounded and wearing a skirt. In the After picture, she is slim, and wearing jeans. And on the Weight Watchers’ website, I found the Then- and Now- pictures of Jacqueline who had lost 55 pounds. She looks wonderfully athletic, her face radiates with confidence and happiness.

Do commercial weight loss programs work? And if so, which program is the best?

Commercial weight loss programs in the USA are 2.5 billion dollar industry. There are more than 140 such programs, but the three leading weight loss programs, in terms of market share, are Weight Watchers (currently branded as WW), Nutrisystem, and Jenny Craig. Together they compromise 72% of the commercial weight loss market with WW controlling 45% of that entire market. It is therefore that I will focus my discussion here on these three programs.

First, let me tell you how these programs work.

WW works by assigning each participant a budget of “points.” The budget is based on the participant’s weight, eating and exercise habits. Each food item has a point value which is based not only on its caloric value, but also on its nutritional value–the content of saturated and unsaturated fats, lean protein, and fiber. Some items–such as fruits and vegetables–are considered “ZeroPoint” for their health benefits. Eating carrots, broccoli, and spinach will earn you additional points and so will exercise. The participants are then encouraged, through personal guidance and at times group meetings, to adhere to their point budget.

In the WW diet program, you don’t count calories, but you have to count points. In Jenny Craig and Nutrisystem no calorie-counting, nor point-counting is necessary. Instead, these companies will send prepared meals to your home. And as one advertisement declares: “You eat the food, you lose the weight.”

Do these programs work? In an article published in 2015, a group of researchers from Johns Hopkins University reviewed and analyzed 39 randomized controlled studies. In all of these studies participants were randomized into two groups. One group participated in a commercial weight-loss program, while the other group, serving as a control group, had no intervention at all, or was given only educational support or counseling.

Three months after embarking on their diet, Nutrisystem’s participants lost 3.8% more weight than their control group. Longer term results were available for Jenny Craig and WW: at 12 months, Jenny Craig’s participants lost 4.9% more weight than their control group, and WW’s participants lost 2.6% more weight than their control group.

So Jenny Craig is the best, right? Not so fast! Each study was conducted as a separate endeavor with different groups of participants who had different characteristics, and each diet was compared with no diet at all, or merely some kind of educational support, or counseling. To really compare apples to apples, the researchers would have to directly compare one commercial diet with its competitor!

And, magically, or just naturally, that is exactly what they did! In a research study that followed, the same group of researchers directly compared commercial diets against each other. They compared WW, Nutrisystem, and Jenny Craig. And the results are–do you hear the drumroll?–in this head-to-head comparison, none of these three diets came ahead. There was no statistical difference among the groups.

In a review on commercial weight-loss programs published in 2017 in the Journal of Health Psychology, Samantha McEvedy wrote that in a recent meta-analysis (a study that summarizes other studies), “57 percent of individuals who commenced a commercial weight program lost less than 5 percent of their initial body weight. One in two (49%) studies reported attrition ≥30 percent.”

Then there is the question of cost. The standard monthly fee at WW is $22.95, a Simple Meal Plan (the most basic plan which includes 7 breakfast and 7 lunches a week) at Jenny Craig is $13.99 a day, and Nutrisystem’s plans run from $9.99 to $13.21 a day.

Looking at the half-full glass, though, I remind myself that the results of the studies represents statistical averages, and while there are many participants whose results may not be clinically significant, or personally satisfactory, some participants are doing much better than others. These are individuals who stick with the program and use the resources that these programs offer including counseling toward habit-changing behaviors. These individuals may have lost significant amount of weight even without a commercial weight-loss program, but for those who need a jump-start, or a structured environment, for their diet to work, a commercial program might not be a bad idea.

Editor’s note: Dr. Shahar Madjar is a urologist at Aspirus and the author of “Is Life Too Long? Essays about Life, Death and Other Trivial Matters.” Contact him at smadjar@yahoo.com.