Sizing up the popular diet plans

June 30, 2003

STORIES BY JIM RITTER Staff Reporter

link to article

Among leading weight-loss programs, Weight Watchers is the best and the Atkins diet is the worst, registered dietitians said in response to a Chicago Sun-Times survey.

Dietitians who specialize in weight management gave Weight Watchers an average total score of 20.4, of a possible 25. Among the seven programs rated, Atkins finished last, with 7.9 points. The lowest possible score was 5.

Weight Watchers is the nation's most popular commercial weight-loss program. Participants attend weekly one-hour meetings and pay $10 to $12 a week.

"Although one method of losing weight does not necessarily work for everyone, Weight Watchers has the highest success rate and provides the most support with the largest national network," one dietitian wrote in answering the survey.

Finishing second in the survey was TOPS (Take Off Pounds Sensibly), followed, in order, by: Overeaters Anonymous, Jenny Craig, Optifast, Slim-Fast and Atkins.

Dietitians from Northwestern Memorial Hospital's Wellness Institute helped design the survey. At the Sun-Times' request, the American Dietetic Association e-mailed the survey to 30 dietitians around the country; 15 responded. The survey is not scientific, and its results should be used for guidance only.

All of the diet plans surveyed can work, experts said--if dieters follow them. The trick is to find one that fits your personality and lifestyle, said Wellness Institute dietitian Dawn Jackson.

The knock on Atkins

Diet books by the late Robert Atkins have sold more than 15 million copies. The Atkins diet restricts carbohydrates, such as bread, potatoes, pasta, rice and cereals, while allowing high-fat and high-protein foods such as pork chops and ham-and-cheese omelets. The idea is to lose weight without feeling hungry.

But dietitians said Atkins doesn't provide a balanced diet and is difficult to maintain.

"I have not seen one long-term success story with Atkins in 25 years of experience," one dietitian wrote. "Many report short-term successes, but, when you look at their weight one year, two years or five years later, most often they have kept off none or regained more than the initial weight."

Other dietitians offered scathing comments on Atkins: "Any diet that restricts fruits, vegetables and whole grains is dangerous because these foods protect against many diseases ... goes against all of our current dietary recommendations ... throws years of solid research out the window ... terrible!"

Colette Heimowitz, of Atkins Health and Medical Information Services, dismissed the criticism, saying dietitians have been indoctrinated by 30 years of conventional wisdom that low-fat diets are the best way to lose weight. Dietitians, she said, will be the last ones to be convinced by emerging research showing you can lose weight on Atkins without increasing cholesterol or other risk factors.

Atkins dieters lost more weight than conventional dieters in two recent studies published in the New England Journal of Medicine. Among people who were more than 100 pounds overweight, Atkins dieters lost 12.8 pounds after six months, compared with 4.2 pounds by conventional dieters. In the second study, Atkins dieters lost 9.7 pounds after 12 months, compared with 5.5 pounds by conventional dieters.

Both studies were flawed, though, by dropout rates of nearly 40 percent. Also, the weight loss in the first study was modest compared with how much dieters needed to lose. And the Atkins advantage in the second study steadily diminished the longer dieters were followed.

Back to basics

At any time, 29 percent of men and 44 percent of women are trying to lose weight. Last year, Americans spent about $40 billion on health clubs, diet soda, diet books and videos, artificial sweeteners, weight-loss centers and liquid diets, according to Marketdata Enterprises, which predicts that will increase to $49 billion by 2006.

But the more we spend trying to lose weight, the fatter we seem to get. The reason is that most people don't do the two things essential to dropping pounds: Eat fewer calories, and be more physically active.

A panel of experts from the National Institutes of Health offers these guidelines for losing weight:

*Your initial goal should be to lose 10 percent of your weight.

*Lose one to two pounds a week. This means burning 500 to 1,000 calories more each day than you consume.

*Cutting fat, by itself, won't work. You have to reduce overall calories.

*Physical activity contributes to modest weight loss and might decrease abdominal fat. Begin with 30 to 45 minutes of moderate activity two to five days a week.


Comparing the plans

Weight Watchers. Weekly one-hour meetings. Foods have points, based on fat calories and fiber. (A salad without dressing, for example, is zero points; a piece of thin-crust pizza, five.) Participants keep track of their points in journals. Physical-activity points can be traded for extra food or saved to enhance weight loss. (A brisk, 30-minute walk is worth two activity points for a 160-pound adult.)

TOPS (Take Off Pounds Sensibly). Not-for-profit weekly support group, with motivational rallies, workshops and retreats. TOPS recommends low-fat exchange diet (for example, a cup of plain nonfat yogurt can be exchanged for a cup of skim milk). Members get weight goals and food and exercise plans from their doctors.

Overeaters Anonymous. Not-for-profit, 12-step support group for compulsive overeaters, modeled after Alcoholics Anonymous. The goal is to abstain from overeating, one day at a time. Following the 12 steps is said to promote inner change. "As old attitudes are discarded, we often find there is no longer a need for excess food," OA says.

Jenny Craig. Includes private, weekly weight-loss consultations, manuals, walking audio tapes and journals to track progress. Encourages up to 30 minutes of physical activity most days. Jenny Craig sells low-fat, high-fiber foods that follow "food pyramid" guidelines.

Optifast. Low-calorie liquid diet plus nutrition bars for people at least 50 pounds overweight. Requires medical exam and doctor's care. Program claims hunger typically fades after the first week or so. After weight loss, dieter gradually transitions to a low-fat diet rich in fruits, vegetables and grains.

Slim-Fast. Replaces two daily meals with Slim-Fast shake or meal bar. Three low-calorie snacks a day (such as fruit, fat-free pretzels or Slim-Fast snack bar) are allowed. Advocates 30 to 60 minutes of daily physical activity. No meetings; Web site for support.

Atkins. Low-carbohydrate diet. Phase one restricts carbs to 20 grams a day (the equivalent of about half a bagel.) Phase two increases carbs to 25 grams a day the first week, 30 grams the second week, etc. until weight loss stops. Then, subtract 5 grams per day. Phase 3 increases daily carbs in 10-gram increments each week as long as gradual weight loss is maintained. Phase 4 controls carb intake to maintain weight.

KEEPING IT OFF

For every five people who lose weight, at least four gain it all back.

"We focus on losing weight and don't focus on keeping it off," said James Hill of the University of Colorado. "We're focusing on the wrong part."

Hill has studied 4,000 people on the National Weight Control Registry who beat the odds by losing at least 30 pounds and keeping it off for at least one year. Average weight loss: 67 pounds.

Most registry members do four things to keep the weight off:

*Eat breakfast. Seventy-eight percent do that every day, which helps ease hunger later in the day.

*Keep to a low-fat, high-carbohydrate diet. Registry members report they get just 24 percent of their calories from fat. The actual percentage might be higher; people tend to underestimate fat consumption. But the figure almost certainly is lower than the 30 percent maximum in government dietary guidelines. Americans average 33 percent.

*Self-monitor. Most members weigh themselves at least once a week and also do things like keep food journals.

*Exercise. Ninety-one percent do regular physical activity, typically an hour a day. They burn about 2,800 calories a week, through walking briskly, biking, swimming or other exercise. Many said they hated it at first but got used to it. The key, Hill said: Start slowly, increase gradually.

Barbara French, who has kept off more than 100 pounds for nearly 10 years, shows how it's done. She usually eats breakfast, typically Kellogg's Wheat Bran.

"It helps get me through the day," French said. "I'm not hungry, so I'm not focusing on the next meal."

She avoids high-fat foods. Though her husband and two teenage sons are supportive, the boys grumble there's never cake or cookies to eat.

French spends at least 30 minutes a day, five days a week walking, peddling a stationary bike and doing floor exercises such as situps. She weighs herself two or three times a week. If she gains two or three pounds, she becomes extra-vigilant, recording all she eats in a food diary.

French, a first-grade teacher, weighed 311 pounds when she attended her first meeting of Take Off Pounds Sensibly on June 12, 1992. "They're my extended family," she said. "When you gain weight and are feeling discouraged, they support you and say, 'Next week, you'll do better.' "

If she didn't know how many calories a food had, she'd avoid it. She gave up pizza and fried food, and satisfied cravings for junk food with tiny portions--a bite-size Nestle Crunch rather than a whole candy bar. And she wouldn't go to bed until she exercised.

It took 1-1/2 years to lose 100 pounds. She now weighs about 200, hopes to drop to 175 and still goes to weekly TOPS meetings in Hickory Hills. "I'm leader of the chapter," she said. "I don't want to let them down."

If you've lost weight, qualify for the registry and would like to join, call (800) 606-6927.

WHEN NOTHING ELSE WORKS

Mike Figliulo tried everything to lose weight--Atkins diet, Weight Watchers, Herbalife--and failed with all of them.

At 347 pounds, Figliulo had diabetes and sleep apnea. Walking even a block left him breathless and sweaty.

Desperate, Figliulo had gastric-bypass surgery. Surgeons blocked off most of his stomach, leaving a thumb-size pouch and rerouting his digestive tract. Food now goes from Figliulo's stomach directly to the lower segment of his small intestine, bypassing portions of his digestive tract that absorb calories and nutrients.

As a result, Figliulo, 51, can eat only small amounts. A typical breakfast? Eight ounces of yogurt. Lunch? Five ounces of tuna salad, with no bread. He'll have a piece of fruit or a sugar-free Popsicle for a snack, and half a chicken breast for dinner.

In 18 months, Figliulo has lost more than 100 pounds. Now, he walks two miles and barely breaks a sweat, and his diabetes and sleep apnea are getting better.

Stomach surgeries are an increasingly common last resort for those who are morbidly obese. An estimated 80,000 to 100,000 people will undergo the surgery this year, up from 40,000 in 2000. There are several techniques, but gastric bypass is by far the most popular. Some surgeons are booked for up to a year.

"The demand is overwhelming," said Dr. James Madura, a gastric-bypass surgeon at Rush-Presbyterian-St. Luke's Medical Center.

That popularity is in part because of coverage of operations done on singer Carnie Wilson and TV weatherman Al Roker. Also, laparoscopic techniques have made the surgery less invasive and safer. And insurance companies are more willing to pay bills totaling $20,000 to $30,000.

Under government guidelines, the surgery can be considered for people with a body mass index higher than 40 (about 80 pounds overweight for women, 100 pounds for men). Having a body mass index between 35 and 40 and an obesity complication such as heart disease or diabetes also qualifies you for the surgery.

Most gastric-bypass patients lose between 50 percent and 80 percent of their excess weight within two years. Then they stabilize, or perhaps gain back 10 or 20 pounds. Few reach their ideal weight.

Major surgery on extremely obese people can be risky. Excess fat makes the operation more difficult. Obesity-related conditions such as diabetes increase surgical risks. Complications, which can require additional surgery, include infections, life-threatening blood clots, ulcers and leakages in the gastrointestinal tract. About 1 percent of patients die.

Another hurdle: Rapid weight loss can cause gallstones. And the shortened digestive tract might not absorb enough calcium, vitamins and other nutrients, so patients must take supplements for the rest of their lives. They also are susceptible to "dumping syndrome": If food moves too fast through the small intestine, they can suffer nausea, weakness, faintness and diarrhea.

After losing so much weight, many patients need plastic surgery to remove sagging skin. And some have trouble adjusting psychologically when they're no longer able to eat food for comfort: Studies have even found that divorce and suicide rates increase after bypass surgery.

No magic pill

The long search for a simple pill that melts away fat has largely failed so far.

Researchers are learning just how difficult it is to change the body's metabolism or disrupt the brain's appetite circuits without producing serious side effects.

Prescription and over-the-counter drugs generally have produced modest weight loss, with some pills posing severe health risks.

Once-popular amphetamines have been banned because they're addictive and cause psychotic behavior and brain damage. The "fen-phen" diet-pill combination was taken off the market after being linked to heart valve damage.

Ephedra is the latest casualty. The herb, once a popular supplement, has been linked to strokes, anxiety and other side effects. Illinois recently banned the supplement, and stores around the country have pulled it off their shelves. Drug and health food stores sell ephedra alternatives, such as green tea, bitter orange, guarana and banaba, but there's little research to prove that these products are safe and effective.

That leaves three prescription drugs:

*Phentermine (the "phen" in "fen-phen") suppresses appetite, but it works only for a few weeks because the body builds up resistance.

*Meridia also affects appetite and can be used for months. But it can increase blood pressure and heart rate and isn't intended for heart patients. Side effects include headache, dry mouth, constipation and insomnia.

*Xenical blocks the absorption of dietary fat. But it can cause bowel changes, especially after eating high-fat meals. These changes include gas with oily discharge, more bowel movements and an inability to control bowel movements.

Weight loss from Meridia and Xenical is usually modest--10 or 15 pounds--and people typically put the weight back on after they stop taking the pills.

Eleven new obesity drugs are in clinical trials, according to the Pharmaceutical Research and Manufacturers of America. It's too early to tell how well and how safely any of those will work.

There might never be a drug that restores an obese person to an ideal weight. But losing even a few pounds has health benefits, said Dr. Samuel Klein of the North American Association for the Study of Obesity.