Home > Uncategorized > The economics of weight loss

The economics of weight loss

January 7, 2016

Tomorrow’s recording of Slate Money will concern New Year’s resolutions. We’re talking about gym memberships and health classes, Fitbits and other “quantified self” devices, and the economics of Weight Watchers and other weight loss industry companies.

I’m in charge of researching the weight loss industry, which was estimated at $64 billion in 2014. That’s huge, but actually it’s dwindling, as people formally diet less often and instead try to informally “eat healthy.”

In fact, Weight Watchers is an old person’s company; the average age is 48, and Oprah’s recent help notwithstanding, younger people are more likely to be interested in quantified self devices which can track calories burned and so on than they are in getting together in person and talking with people about the struggle.

Also, Obamacare doesn’t cover weight programs outside of a doctor’s office, so that has dried up funds as well.

This is good news, because there’s really no evidence that weight loss programs work long-term, but they are expensive. They keep doing studies but they never come out with any positive results beyond 12 months. That’s because they don’t have any evidence.

For example, if I joined Weight Watchers, I’d pay $44.95 per month, although I get refunded if I lost 10 pounds quickly enough. I’d be able to go to meetings two blocks away from my house every Wednesday. The plan will auto-renew and charge my credit card unless I cancel it, which is tantamount to admitting defeat. I’m wondering what the statistics are on people who are paying monthly but no longer attending meetings.

If you want an extreme example of the current dysfunction around dieting, look no further than the show The Biggest Loser, which the Guardian featured recently with the tag line, “It’s a miracle no one has died yet.”

So, given how much money people put into this stuff even now, why are they doing it? After all, if we were expected to pay a doctor to set the bones of our broken leg, but it only worked for a few months before our leg started breaking again, we’d call the doctor a quack and demand our money back. But somehow with diets it’s different. Why?

I have a complicated theory.

The first level is the “I’m an exception” law of human nature, whereby everyone thinks they somehow will prove to be an exception to statistical rules. It’s the same magical reasoning that makes people buy lottery tickets when they know their chances of winning are slim, and they even know their expected value is negative.

The second level is entertainment. This is also taken directly from the lottery mindset; even if you know you’re not winning the lottery, the momentary fantasy of possibly winning is delicious, and you relish it. The cost of that fantasy is a small price to pay for the freedom to believe in this future for one day.

I think the same kind of thing happens when people join diets. They get to fantasize about how great their lives will be once they’re finally thin. And of course the prevalent fat shaming helps this myth, as does the advertising from the diet industry. It’s all about imagining a “new you,” as if you also get a personality transplant along with losing weight.

But there’s something even more seductive about weight loss regimens that lotteries don’t have, namely public support. When someone announces that they’re on a diet, which happens pretty often, everyone around them has been trained to “be supportive” in their endeavor. At the same time, people rarely announce they’ve gone off their diet. So you’ve got asymmetrical dieting attention.

That attention also has a moral flavor to it. Since people are expected to have control over their weight, they are given moral standing when they announce their diet; it is a sign they are finally “taking control.” Never mind that their chances of long-term success are minimal.

The third and final phase, which is the saddest, is guilt. Because we’ve bought in to the idea that people have direct control over their weight, when people end up giving up, they feel personally guilty and end up paying extra money for basically nothing in return.

Of course, no part of this story is all that different from the story of gym memberships or even Fitbit-like device acquisition. Seen together, it’s just a question of what quasi-moralistic self-help fad happens to be popular at any given moment. And there’s tons of money in all of it.

Categories: Uncategorized
  1. January 7, 2016 at 8:55 am

    “After all, if we were expected to pay a doctor to set the bones of our broken leg, but it only worked for a few months before our leg started breaking again, we’d call the doctor a quack and demand our money back. But somehow with diets it’s different. Why?”

    There are any number of conditions which require on going treatment (diabetes, autoimmune, thyroid, …); some of which will cease being effective for unknown reasons after an indeterminate time. We do not call the people administering those treatments quacks. Good luck demanding your money back.

    So much for diets being unique.

    Note that quacks pose as doctors. The programs you mention (Weight Watchers, etc.) do not pretend to be medical. Like all group help programs ( Alcoholics Anonymous is the Ur-case) reliable statistics are hard to come by but it seems that their effectiveness is marginal: success is pretty close to a control group. Such programs are evaluated not by comparison to mythical fracture setting (your own experience tells you real fracture treatment can be more complicated) but by a cost/benefit against the alternatives.

    There is a comparison which I just thought of: a problem with health implications which was widespread, a problem which had a wide offering of ‘solutions’ (none very effective), a problem which featured near universal relapses. (Another blow to ‘diets are unique’.)

    The problem was cigarette smoking. Nearly everything you said about dieting and weight loss can be said about quitting smoking. Yet the smoking rate has declined dramatically over the last several decades. Lots of people have successfully quit smoking. If you want a compare and contrast, that is a possibility.


    • January 7, 2016 at 9:07 am

      Fair enough, not all doctor visits are one-time events. I get that. But actually cigarette cessation is hugely successful compared to weight loss regimens. So, comparing them head to head, it still seems like the latter is pointless whereas the former is not.


      • JSE
        January 7, 2016 at 10:48 am

        Smoking cessation is actually incredibly hard — something like 7% of quit attempts succeed. Are weight loss regimens really as bad as that?


        • January 7, 2016 at 10:50 am

          It’s way worse! like, 2% success, or less! Of course that’s longterm. After 1 year it’s more like 5%.


        • cat
          January 7, 2016 at 11:33 am

          Is it fair to compare people trying to quit smoking to people trying to diet? Cathy’s point about ‘taking control of your weight’ sounds a lot like dissatisfaction turned inwards. I’m not sure people try to stop smoking for the same reason.


        • January 7, 2016 at 6:45 pm

          In Australia in 2013, 58% of adults had never smoked and 26% of adults were ex smokers, so more than half of adults who had smoked at one time no longer did (admittedly including some who had only been ex-smokers for a short time). So eventually people are able to give up smoking, often with some repeat attempts. Hence it looks like smoking cessation is achievable for the majority of people who want to do it.


        • January 8, 2016 at 12:09 pm

          *Any* time spent not smoking provides health benefits while yo-yo dieting can actually be *worse* for your health than maintaining a consistent weight (Virginia Chang now at NYW has done a lot of research on this, e.g. here). In contrast, any time spent not smoking helps reduce the risks associated with smoking (though it will raise BMI because nicotine is an appetite suppressant — no good deed goes unpunished).


      • January 7, 2016 at 4:16 pm

        When your comparing treatments with sub-ten percent success rates you have to get in the weeds (What constitutes success? How are the groups defined?) to be sure artifacts are not blurring the differences. Perhaps most important consideration is the success rate among the control group. According to the American Cancer Society (http://www.cancer.org/healthy/stayawayfromtobacco/guidetoquittingsmoking/guide-to-quitting-smoking-success-rates) about 4% to 7% of people are able to quit smoking on any given attempt without medicines or other help.

        This makes the 7% success rate reported below for smoking cession programs less than impressive.

        You have to find the equivalent figures for weight loss to even start a comparison.


  2. Sami
    January 7, 2016 at 10:44 am

    There was a really good podcast from Inquiring Minds about the science of weight loss that would be really relevant for this!


  3. cat
    January 7, 2016 at 11:49 am

    Successful dieting, not to mention maintenance, takes years with constant adjustments to your current short term goals as the body is pretty complicated. Weight management consumes a lot of time and mental focus.

    In today’s world where just basic living takes is a huge cognitive load I think its most people don’t have the resources to deal with the effort it takes to manage a long term plan that is weight management.

    Add in Nutritional Industrial Complex intentionally engineering bad food choices, much like cigarette companies engineered cigarettes, its a wonder normal people manage it at all.


  4. Jim Bender
    January 8, 2016 at 7:05 am

    The gold standard of weight loss is eating low-carb, where you eat a lot of salad, low-sugar fruit, and watery vegetables. I lost 55 pounds in the last half of 1999, while following that sort of meal plan. Since I now have to eat a banana a day, that no longer works for me. I started Weight Watchers in February 2006. I got down 58 pounds by June of 2007. After going through the stress of caring for my mother from late 2007 to June 2010, I gained some of that weight back. (I am a “life time member”). If I were not attending a meeting every week, as part of a hard-core group of long-time members, I would have ended up gaining it all back and getting bigger than ever. Instead, I am stayed down 20 pounds and am working to get back down further. WW has been promoting exercise, but what you eat is really what matters. Reduce starch and sugar. The new system for calculating points uses calories, total fat, saturated fat, grams of fiber, grams of carbohydrates, grams of sugar, and protein. They keep improving the points calculation over the older, simpler system. Keeping within a points budget has not changed (the modern system). I thought well of WW because my father had been an early adopter in the late 1960’s and had been successful. WW is not so much a diet, but a life style to follow to stay healthy. You find a meal plan that works for you, within the system, and keep control of your weight.


  5. January 8, 2016 at 12:11 pm

    Cathy, the NY Post did a couple of stories last January on the Biggest Loser as well that might be interesting (the Guardian article appears to go into a little more depth on what the Post initially reported): http://nypost.com/2015/01/18/contestant-reveals-the-brutal-secrets-of-the-biggest-loser/ and http://nypost.com/2015/01/25/were-all-fat-again-more-biggest-loser-contestants-reveal-secrets/


  6. portia
    January 9, 2016 at 10:05 am

    It is impossible to eat processed food and maintain optimum working stasis in your body. When I exercise moderately, eat meals from scratch from single ingredients according to how they are digested so that the food moves through digested thoroughly (as in not eating meat/cheese/eggs/dairy with potatoes or bread, eating fruit alone, etc), My body reaches its ideal weight on its own. I am constantly subject to ridicule because I refuse to make my body do things it is not designed to to, but I am 61, on no medications, have the best cholesterol levels my doctor has ever seen, she says, and am managing my arthritis and allergies without drugs. I think “dieting” is hopeless until we respect the way our body processes food, i.e. with alkaline (starches) or acid (animal protein) environments, and not mix foods that require different environments for digestion. And this idea of rewarding ourselves with food has got to go too.


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