Lose weight your way

9,000 readers rate 13 diet plans and tools

Consumer Reports magazine: February 2013

Need to drop a few pounds—or more than a few? If so, there's a lot of good news in our new survey of thousands of dieters and their experiences with a wide array of commercial and do-it-yourself weight-loss programs. We rated diets based on people's overall satisfaction with the programs. (They included various versions of the same diet.) We also looked at the typical amount of weight our dieters said they lost. Here are some of the survey highlights:

An app rules! MyFitnessPal, a free smart-phone app and website, did better than any of the commercial diet plans, including Weight Watchers. It received a reader satisfaction score of 83 out of a possible 100.

Go Stone Age. The Paleo Diet is based on a book that instructs dieters to eat like a caveman, consuming lean meats, fish, seafood, fruit and non-starchy vegetables, and avoiding cereal grains, legumes, dairy products, and processed foods. Readers gave it a high satisfaction score of 80, a statistical tie with MyFitnessPal.

Weight Watchers is the people's choice. A whopping 43 percent of respondents said they signed up for Weight Watchers. The second most popular plan, a generic low-carb (non-Atkins) diet, was chosen by 13 percent of respondents. Of the four commercial diets we rated, Weight Watchers got one of the top reader scores, 74, but it was in the middle of the pack of the 13 diets overall.

9,376 dieters were polled. 3,598 reported losing at least 20 pounds.

Medifast losers lost big. People using the low-calorie Medifast program lost more weight than those on other diets: 20 to 43 pounds for men and 14 to 40 pounds for women. They also had big weight-loss goals, hoping to lose an average of 47 pounds.

Men shed more pounds than women. Both men and women reported that they lost a similar percentage of their starting body weight. But men, who started off heavier, lost more pounds than women. So if you're competing with a spouse at dieting, look at percent of starting body weight lost, not pounds lost.

Satisfaction depends on more than pounds lost. Surprisingly, there was only a weak relationship between actual weight loss and subscribers' satisfaction with the various diets. Instead, they gave higher marks to the diets that helped them maintain their weight loss and prescribed lifestyle changes that were easy to make. It seems our dieters made a calculation about how much they were willing to sacrifice to lose weight. So low-cost, do-it-yourself diets typically received higher satisfaction scores than commercial diets.

Significant weight loss is possible on all plans. Almost 80 percent of the respondents who reported their starting and after-diet weight lost a significant number of pounds. The median loss was about 18 pounds for men and 15 pounds for women, which was enough to move many from obese to overweight or from overweight to a healthy weight. And they did it on all 13 diets. The diets were as varied as online and app programs and Jenny Craig, which offers a selection of commercial options that rely on branded meal replacements. People lost weight on diets such as Weight Watchers and MyFitnessPal that restrict the amounts but not the types of food you eat. They also lost weight on diets such as Paleo and Atkins that do the opposite, restricting what you eat but not how much. But dieting is never easy. Dieters listed their inability to get motivated for exercise as a top weight-loss barrier. (For inspiration, see our Ratings and reviews of ellipiticals and treadmills.)

The lesson from these findings is that "there's not one single solution to losing weight," says Chris N. Sciamanna, M.D., M.P.H., professor of medicine at Penn State College of Medicine and a consultant on this project. "People get bored. These results give you an idea of how many opportunities there are to mix it up."

The best strategy for would-be dieters may be to select a diet based on your personal preference. "What works for one person is not necessarily going to work for someone else," says Alice H. Lichtenstein, D.Sc., director of the Cardiovascular Nutrition Laboratory at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University. "If the first try doesn't work, don't give up. Just try something else."

The survey asked Consumer Reports subscribers about diets they had been on in the past three years. Readers had freely chosen these diets themselves, and they reported substantial weight loss. It's possible that respondents who didn't do well at weight loss declined to answer that section of the survey. Also, subscribers are older and wealthier than the average American, so their results may not be typical of the U.S. population. And our respondents had a lot of weight to lose. When they started their diets, 65 percent of men and 61 percent of women were obese.

How can you tell which of the diets has the best chance of working for you? Read on for some clues that we gleaned from our survey.

Keeping track helps

"Everyone should try using self-monitoring, by tracking calories eaten and physical activity," Sciamanna says. "It really works. It's a pillar of behavioral science. The more you monitor, the smarter you get about your food and exercise habits."

Keeping a food diary used to involve toting around a calorie guide and a notepad. Today you can do it all online or on your smart phone with trackers that draw on huge databases of foods and meals.

Apps like MyFitnessPal make it easy to keep a food diary, a proven weight-loss strategy.

MyFitnessPal is a smart-phone app and website that sync automatically. It enables you to keep a diary of your weight, what you ate, and how much you exercised, complete with useful features such as a bar-code scanner and the ability to save and retrieve meals and dishes that you eat frequently.

Eighty-seven percent of those who relied on MyFitnessPal said they used it to record what they ate, as did 81 percent of readers who used SparkPeople, another website-and-app product. And so did 68 percent of those on Weight Watchers, which offers paid-up members weight, food, and exercise trackers on its website and through an app. Unsurprisingly, respondents gave those three diets the top marks on calorie awareness.

A survey respondent who lost more than 40 pounds using MyFitnessPal said the nutritionist he consulted "gave me a bunch of paperwork to log my daily intake. Using an app on the phone seemed like a smarter/easier way to do it. It worked for me. No tricks or silver bullets—just discipline."

Adjust your expectations

Although readers who finished their diets lost weight, they had hoped to lose even more. Weight Watchers dieters were fairly typical in this regard: Respondents wanted to lose an average of 40 pounds, but only 13 percent succeeded in getting within 5 pounds of their goal weight. Falling short of expectations clearly disappointed our readers. Those who reached their goal weight were much more satisfied with their diets than those who didn't.

Our medical consultants say that dieters often overestimate how much weight they can realistically lose, perhaps not realizing that dropping as little as 5 to 10 percent of starting weight can pay real health dividends.

And in that our readers were successful. Almost 45 percent of respondents lost 10 percent or more of their starting body weight. In other words: Lighten up about lightening up.

Define your eating style

Some diets on our list are built around eliminating or severely restricting major categories of food. Those include the Atkins Diet, the Paleo Diet, the initial stages of the South Beach Diet, and the catchall category of generic "low-carb diet." Of those, the Paleo Diet was the best-liked, with reader satisfaction scores significantly higher than for the others. But readers gave all of them relatively low scores when it came to dietary variety and the inclusion of favorite foods.

The Paleo Diet was well liked by our readers, with a satisfaction score of 80.

But to some, the restrictiveness is what makes those diets appealing. "The low-carb diets are often restricted in quality, but not quantity," Sciamanna says. "If you remove white flour and sugar, the core of what people overeat, it's really a shortcut on how to eat well."

By contrast, Weight Watchers, MyFitnessPal, and SparkPeople got high reader scores for dietary variety. That's not surprising because you can use those diets and tools without having to buy branded food products.

"We don't believe it's practical for people to follow rigid diet recommendations long-term," says Mike Lee, co-founder of MyFitnessPal. "If you want to have a glass of wine at dinner, you can eat a lighter lunch or go for a run. It's up to you to spend that calorie budget."

There is medical consensus that weight loss can be done safely if calorie intake is reduced enough to achieve an average 1-to-3-pound weight loss per week. "Although weight loss is safe for most healthy individuals, everyone reacts differently, and if you have special problems like diabetes or heart disease, it's a good idea to consult with your doctor," says Sachiko St. Jeor, R.D., Ph.D., professor emeritus of internal medicine at the University of Nevada School of Medicine, a consultant on this project. "If you lose weight too fast, you may have unexpected medical complications. And for diets below 1,000 calories a day, you need to take precautions to avoid nutrient inadequacies."

To cook or not to cook?

Three of the commercial diets in our Ratings­—Jenny Craig, Medifast, and Nutrisystem—are built around membership and the use of branded, packaged, portion-controlled meals and foods such as bars and shakes. Those foods are supplemented by your own groceries, including fresh fruits and vegetables.

Readers on Medifast, Jenny Craig, or Nutrisystem were significantly more likely to report that they relied exclusively on products and advice from their plan while dieting. Slim-Fast also uses meal replacements but isn't in this category. That's because as a group our Slim-Fast dieters took a more do-it-yourself approach, integrating advice or products from other diet plans.

The commercial meal-replacement diets got middle-of-the-road marks or lower for food variety. But a significant minority of dieters—17 percent on Jenny Craig, 23 percent on Medifast, and 38 percent on Nutrisystem—didn't like the taste of the prefab foods. And about one in five of the dieters on those plans said that the cost was higher than they had been led to believe. In the first three months on the plans, Jenny Craig clients spent a median of $809, Medifast dieters $677, and Nutrisystem customers $582.

Nearly 40 percent of people on Nutrisystem didn't like the taste of the prefab foods.

Still, our consultants say, those diets may be a good choice for the growing number of Americans who rarely cook, whether out of lack of interest and knowledge or because they're too busy. "Cooking feels incredibly labor-intensive for a lot of people," Sciamanna says.

A survey respondent on the South Beach Diet told us that although she liked not having to "buy specific foods sold by South Beach Diet," in the end she felt that she "spent most of my time shopping, prepping veggies, cooking, making lunches."

By contrast, a satisfied Jenny Craig customer liked how "delicious pre-packaged foods made mealtime mindless," even though the cost was "more expensive than it should be."

Prioritize lifestyle changes

"If somebody's going to make a permanent change in their body weight, they most likely will need to make fundamental changes in their dietary and lifestyle patterns," says Lichtenstein at Tufts.

Our respondents apparently agree. Those who said their diet had lifestyle changes that were easy to incorporate into their daily lives were more likely to be satisfied than those who didn't. On that factor, MyFitnessPal particularly excelled. Respondents were also more satisfied with diets that taught them general self-control strategies.

We also asked about whether the diets encouraged specific positive lifestyle changes. For encouraging them to eat more fruits and vegetables, respondents gave top marks to Weight Watchers, the Paleo Diet, the Mediterranean Diet, and the Glycemic Index Diet. Weight Watchers and SparkPeople got the highest scores for encouraging exercise.

Get the most out of Weight Watchers

We did a deeper dive into the survey results for Weight Watchers because so many of our respondents used it. About two-thirds said they attended the in-person group meetings, which can be supplemented with Weight Watchers online tools. The others followed the diet online only.

People on Weight Watchers who attended meetings did better than those who did not.

Judging from what they told us, if you want to get the most out of your Weight Watchers membership, you'd be well advised to get yourself to the meetings. Readers who did had slightly higher overall satisfaction scores. And a much higher percentage who went to the meetings reported that Weight Watchers had taught them self-control strategies. Plus, the meeting-goers also lost more weight than readers who followed the diet online.

Sciamanna says those results make sense: "When you go to a group, you get accountability to another human being and the belief that change is possible, because when you look around, you see that somebody is doing well. I think face-to-face programs are never going to go away because they're probably always going to do better. I'd be shocked if it were otherwise. We're social beings."

How much weight did readers lose?

We found that even respondents on the same diet had very different weight-loss experiences.
Starting weight seems to affect the amount of pounds dieters can expect to lose. For example, the men in our survey, who on average started out with higher body mass, lost more pounds than the women did. Another possible reason for variation is that some dieters stayed on their plan longer than others. Faulty recall and reluctance to report on weight loss may also factor into those results.

Because dieters had such varying experiences, we present the typical range of weight lost for men and women for each diet. The small percentage who gained weight were excluded. The diets are listed in alphabetical order, within plan types. We also show the median number of months that readers reported being on each diet.

  Median months on diet
Typical weights loss, in pounds

Commercial diets

 

All

 

Men

 

Women

 

Jenny Craig

 

9

 

15 to 34

 

10 to 30

 

Medifast

 

6

 

20 to 43

 

14 to 40

 

Nutrisystem

 

5

 

10 to 30

 

7 to 24

 

Weight Watchers

9

 

12 to 35

 

10 to 28

 

Do-it-yourself plans

     

Atkins Diet

 

7

 

15 to 30

 

8 to 25

 

Glycemic Index Diet

 

9

 

11 to 29

 

10 to 27

 

Low-carb diet (other than Atkins)

 

8

 

13 to 35

 

10 to 29

 

Mediterranean Diet

 

-

 

10 to 25

 

7 to 25

 

MyFitnessPal

 

5

 

10 to 30

 

4 to 18

 

Paleo Diet

 

7

 

10 to 32

 

6 to 20

 

Slim-Fast

 

6

 

10 to 25

 

5 to 22

 

South Beach Diet

 

5

 

11 to 27

 

8 to 23

 

SparkPeople

 

-

 

10 to 25

 

5 to 21

 

A dash (-) indicates insufficient data.

To keep weight off, practice first

Here's a novel idea: Before even trying to lose weight, practice the strategies that can help you keep the pounds off.


Michaela Kiernan, Ph.D., a senior research scientist at the Stanford University School of Medicine, actually tested that idea in a clinical trial and found that it worked. Half of the overweight women in the study got the usual treatment—they followed a weight-loss program for 20 weeks, then for eight weeks received standard advice on how to maintain their weight loss. The other half did it in reverse: They got eight weeks of advanced training in weight maintenance strategies, then tried to lose weight.


The results were stunning. Both groups lost the same amount of weight after 28 weeks. But a year later, those in the "maintenance first" group had regained an average of only about 20 percent of the weight they had lost; those in the usual-treatment group had regained an average of 43 percent.


Here are some of the pre-maintenance strategies Kiernan suggests:


• Weigh yourself every day for several weeks to see how your weight fluctuates. Once you know your pattern, you won't panic if your weight goes up by a pound or two or even three from one day to the next (which, it turns out, is pretty common).


• Pick a target 5-pound weight range that accounts for those fluctuations, and try to stay within it for several more weeks. If your weight drops to the bottom of your range, you can eat a bit extra to bring it back up.


• It's not always smart to settle for low-calorie versions of high-calorie foods that make you yearn for the real thing. Try something that tastes completely different but is still satisfying, such as salsa on your baked potato instead of sour cream. You'll need to experiment a bit.


• Learn to eat your favorite high-calorie treats mindfully, in moderation, without thinking of it as a slip-up.


• Practice disruptions ahead of time. Pretend to go on a vacation—eat five high-calorie meals in a week—and compensate with tweaks to your exercise and your other meals during that time.




Overeating: Psychologists weigh in


The idea that negative emotions can trigger overeating is so embedded in our culture that it has spawned its own visual cliché: the heroine of the chick flick who has endured a romantic disappointment sitting in bed and spooning ice cream straight from the carton.

The cliché reflects a real problem. Respondents to our diet survey said they had less success keeping weight off if their diet plan didn't address the emotional triggers to overeating.

It turns out that psychologists couldn't agree more. As a companion to our survey of dieters, we worked with the American Psychological Association to survey 1,328 licensed psychologists on how they dealt with patients' weight and weight-loss challenges. They repeatedly identified emotional factors as not only an important factor in clients' weight problems but also the major barrier to overcoming them.

Asked what they found helpful, seven of 10 psychologists identified these three strategies as "excellent" or "good":

• Cognitive therapy, which helps people identify and correct thoughts that lead to unhelpful emotions and behaviors. For example, someone who eats a cookie at a party might blame it on a lack of willpower, conclude she'll never get the weight off, then proceed to eat more cookies. Cognitive therapy would teach the person to think of the cookie as a one-time-only slip-up, because everybody makes mistakes.

• Problem-solving aimed at overcoming barriers to weight loss. A patient who says he's too tired after work to go to the gym might consider alternatives, such as a walk at lunchtime or working out in the morning.

• Mindfulness training, an approach that trains people to allow negative thoughts and emotions to come and go without dwelling on them, and instead concentrate on enjoying the moment.

Many psychologists said they collaborated with other professionals to help clients with weight problems. Though primary-care physicians were the most common partner cited, the psychologists found that nutritionists and registered dietitians were the most helpful.




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