Taking off Pounds Sensibly (TOPS), a nonprofit support organization with many local chapters, is one of the least expensive programs, costing $26 a year.
Most of the commercial programs, such as Weight Watchers, Jenny Craig, and NutriSystem, offer individual or group support, lifestyle changes, and packaged meals. These programs tend to be expensive. There are few well-conducted studies on these programs.
Many regard the inability to follow a diet and lose weight as reflecting a lack of willpower. Unfortunately, these feelings simply reinforce a sense of failure. Some suggest attempting to shift the approach to one of managing where one focuses their attention. Evidence exists that exercise and adequate sleep will enhance the ability to manage and self-regulate behavior.
Short-term specific goals regarding exercise and eating should be approached as something to be learned rather than performed. Also, planning ahead when invited to eat out or going to another home for food is recommended.
Cognitive Behavioral Approaches. Most support programs use some form of cognitive-behavioral methods to change the daily patterns associated with eating. They are very useful for preventing relapse after initial weight loss. The following is a typical approach:
- The patient first records in a diary all activity related to eating patterns, including the times of day, length of meal, emotional states, companions, and, of course, the kind and amounts of food eaten. Most people -- even professional dieticians, according to one study -- tend to underreport their daily calorie intake. However, writing it down is still a good method for increasing a person's awareness of eating patterns. (One patient said that recording circumstances surrounding relapses was a particularly valuable guide for understanding the stresses leading to her own eating behaviors.)
- The patient reviews the diary with a therapist or group to set realistic goals and identify patterns that the patient can change. For instance, if food is normally eaten while watching television, then the patient may be advised to eat in another room instead.
- Good eating habits are reinforced by rewards. These rewards are other pleasures that substitute the high calorie consumption and sedentary activities.
Behavioral modification has been shown to be helpful particularly for people who have an overly strong response to the taste, smell, and appearance of food. It also may be useful for binge eaters.
Review Date: 04/14/2010
Reviewed By: A.D.A.M. Editorial Team: David Zieve, MD, MHA, and David R. Eltz. Previously reviewed by Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital (4/14/2010).