The escalating global prevalence of obesity has spurred significant interest in effective weight management strategies. With a substantial portion of the adult population grappling with weight-related challenges, many individuals turn to commercial weight loss programs for assistance. This article synthesizes research findings on the efficacy, personalization, and various components of these programs, offering a comprehensive overview for individuals and practitioners seeking evidence-based solutions.
The Landscape of Commercial Weight Loss Programs
The commercial weight loss industry is a multi-billion dollar market, offering a diverse range of programs with varying dietary approaches. These programs often incorporate elements such as structured meal plans, personalized coaching, online support, and exercise guidance. While numerous reviews have highlighted the potential of these programs to facilitate weight loss, it's crucial to critically evaluate their effectiveness and long-term sustainability.
Web-Based Delivery of Weight Loss Programs
To enhance accessibility, numerous web-based programs have emerged, offering features like self-directed modules, advanced tools, and online support communities. While early meta-analyses suggested that web-based interventions could achieve similar weight loss to traditional methods, more recent reviews indicate that programs with enhanced features may yield greater success. However, the heterogeneity in study designs makes it challenging to pinpoint the key elements driving weight loss in these online programs.
Commercial programs are increasingly shifting their focus to digital delivery, accounting for a significant portion of the diet industry's market share. While early reviews suggested that self-directed online programs were suboptimal, advancements in technology have improved the offerings, with associated RCTs suggesting moderate effects for weight loss. The success of these programs in real-world contexts, where attrition rates can be significant, remains an area of ongoing research.
Personalization in Digital Weight Loss Programs
Digital behavioral weight loss programs are effective and offer an opportunity for personalization to address the needs of individuals in a scalable manner. Personalization can include tailoring intervention characteristics, such as content, timing, or goals, and may be based on anthropomorphic data, health behaviors (eg, diet), goals, and psychosocial variables. The conceptual basis of personalized behavioral interventions is that they reduce cognitive load by increasing the relevance of intervention content to each user and eliminating superfluous content, which can then improve intervention acceptability, credibility, and ultimately adherence. Mobile technology has allowed user data to be leveraged to personalize behavioral interventions using algorithms that produce in-the-moment support. Personalizing interventions has generally been shown to improve outcomes in behavior change interventions. Two systematic reviews-one involving 6 interventions and the other involving 31 interventions-have examined the efficacy of personalized technology-based interventions targeting lifestyle behaviors. One found that personalized interventions were more effective for weight loss than nonpersonalized or waitlist controls and that participants felt that personalized intervention content was more relevant, helpful, and easier to understand than generic content. Similarly, the other systematic review found that personalized lifestyle interventions have moderate positive effects on lifestyle behaviors, and the authors recommend that future personalized interventions should investigate the integration of multiple types of data from different sources and include personalized features in addition to intervention content. However, more research is needed to test the acceptability and efficacy of personalized digital behavioral weight loss interventions.
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The WeightWatchers (WW) Program and PersonalPoints
The WeightWatchers (WW) program is a well-validated commercial weight management program that now leverages a personalized eHealth approach. WW’s dietary approach assigns each food and drink a points value (ie, PersonalPoints) based on calories, saturated fat, unsaturated fat, added sugar, fiber, and protein. Calories, saturated fat, and added sugar increase the PersonalPoints value of a food, whereas unsaturated fat, fiber, and protein decrease the PersonalPoints value. In addition, foods that represent the cornerstone of a healthy pattern (eg, fruits, vegetables, seafood, lean proteins, and low-fat dairy) are assigned a points value of 0 (ZeroPoint foods [ZPFs]). These ZPFs do not need to be weighed, measured, or tracked. WW’s personalized version of the program, called the PersonalPoints program, creates a fully personalized dietary plan with >28,000 options. Personalization inputs are both surface level, including age, height, weight, and sex, and deep level, including food preferences, diabetes status, breastfeeding status, physical activity habits, and water consumption. The app uses user-entered data regarding the factors that influence energy needs, including age, height, weight, and sex, to personalize the PersonalPoints budget. This is further personalized based on breastfeeding status and physical activity level, which also directly affect energy needs. Users receive a personalized list of ZPFs that includes foods that form the basis of an overall healthy dietary pattern and can reduce hunger and cravings, given their macronutrient composition (eg, high fiber and high protein). This minimizes hunger because, as ZPFs do not need to be tracked, even if no PersonalPoints remain in a user’s budget for the day, they may eat foods on their ZPF list. The program reinforces physical activity by allowing users to receive additional PersonalPoints for being active. The personalization is also dynamic such that participants can change their food preferences, physical activity habits, nonstarchy vegetable consumption, and water intake at any time, which then changes their PersonalPoints daily and weekly goals as well as their ZPF list (which includes >300 options). The purpose of the PersonalPoints program is to provide dynamic, personalized targets to help members lose weight while improving overall dietary patterns, reducing hunger and cravings, encouraging physical activity, and simplifying diet tracking by not requiring all foods consumed to be tracked.
Evaluation of the WW PersonalPoints Program
A 6-month single-arm trial examined the effect of this personalized program on percentage weight loss from baseline to 3 and 6 months. It also described participation and acceptability as indicators of program satisfaction, and examined the impact of this program on fruit and vegetable intake, physical activity, sedentary behavior, hunger, and food cravings. The trial also examined the impact on sleep, quality of life, self-compassion, overall well-being, and behavioral automaticity at 6 months. This is the first trial to evaluate the WW PersonalPoints program.
The inclusion criteria for the study were aged 18 to 75 years, BMI between 25 and 45 kg/m2, Wi-Fi connectivity at home, having an iPhone (because the app was only available on iOS at the time), English proficiency, self-reported desire to lose weight, and US residence. The exclusion criteria were being pregnant, lactating, or planning to become pregnant during the study period; severe mental illness (eg, bipolar disorder, severe depression, or psychosis); eating disorders; hospitalization for psychiatric disorders during the past 12 months; type 1 or type 2 diabetes; taking medications that affect weight; currently in a structured weight loss program; had bariatric surgery or plans to have any surgery during the study; unable to walk one-fourth of a mile unaided without stopping; smoker or uses nicotine vape daily; medical condition that precludes ability to make dietary changes or increase physical activity; weight loss of ≥5 kg in the last 6 months; WW membership in the last 12 months; major surgery within the previous 6 months; implanted cardiac defibrillator or pacemaker; history of cancer within past 5 years or current treatment for cancer; and unable to attend any virtual workshop meeting times.
The 6-month intervention included WW’s mobile app (beta version of the PersonalPoints program), weekly group virtual workshops, weekly one-on-one virtual check-ins, and an invitation to a private members-only digital community. The PersonalPoints program guides members toward their weight and wellness goals through a weekly curriculum that is complemented by specific behavioral goals each week across 4 main pillars (food, activity, sleep, and mindset) to drive healthy habits. The WW program is based on recommendations by national and international guidelines to form the foundation for a healthy pattern of eating . Furthermore, the WW app provides members with a self-guided personalized weight management plan that includes a weekly check-in and progress report, which has options to track one’s weight, ask how the week went, and provide an opportunity for reflection, as well as allows for goal setting for the next week. The app also includes food, activity, water, sleep, and weight trackers; meal planning tools; recipes and a food barcode scanner; a personalized ZPFs list; and guided meditations and workouts.
Participants were asked to complete their profile and log their food intake and exercise daily, weigh in at least once a week but no more than daily, and attend the weekly virtual workshops and individual check-ins. When participants hit a weight loss milestone, they were sent small keychains to commemorate the milestone they achieved (eg, 5 lb, 10 lb, 15 lb, 20 lb, and 25 lb).Virtual workshops were conducted via videoconferencing software and occurred weekly for 6 months. WW offered meeting times on several different days and times. Study staff assigned each participant a workshop based on their preferred days and times. The workshops, which ranged in size from 16 to 19 participants and lasted between 30 and 60 minutes, were led by a trained WW coach. During the workshops, the coach led a conversation on a topic related to effective weight management and behavior change. The participants also had the opportunity to receive group support by discussing their successes and setbacks as well as help to troubleshoot challenges. Virtual check-ins with a WW coach were conducted over Zoom (Zoom Video Communications, Inc) and occurred weekly for 6 months. Check-ins lasted approximately 5 minutes and were conducted one-on-one. During check-ins, coaches queried participants about their progress and setbacks, answered questions, and set goals for the week. Check-ins allowed participants to receive individual support to complement the group support from weekly workshops. All participants were invited to an optional private members-only digital community group where they could interact with, and support, each other. Participants could share their journey via posts, photographs, videos, and comments. The group also was a place for participants to ask questions as well as to give motivational support to other participants and receive motivational support from them. The group moderator was a WW coach who posted in the group 3 to 4 times per week to share recipes and ask questions to foster conversations among participants regarding healthy lifestyle changes.
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Results of the WW PersonalPoints Program
Of the 153 participants, 107 (69.9%) were female, and 65 (42.5%) identified as being from a minoritized racial or ethnic group. Participants’ mean age was 41.09 (SD 13.78) years, and their mean BMI was 31.8 (SD 5.0) kg/m2. Participants had an average weight change of −4.25% (SD 3.93%) from baseline to 3 months and −5.05% (SD 5.59%) from baseline to 6 months. At 6 months, the percentages of participants who experienced ≥3%, ≥5%, and ≥10% weight loss were 63.4% (97/153), 51% (78/153), and 14.4% (22/153), respectively. The mean percentage of weeks in which participants engaged in ≥1 aspects of the program was 87.53% (SD 23.40%) at 3 months and 77.67% (SD 28.69%) at 6 months. Retention was high (132/153, 86.3%), and more than two-thirds (94/140, 67.1%) of the participants reported that the program helped them lose weight. Significant improvements were observed in fruit and vegetable intake, physical activity, sleep quality, hunger, food cravings, quality of life, and well-being (all P values <.01). This personalized, digital, and scalable behavioral weight management program resulted in clinically significant weight loss in half (78/153, 51%) of the participants as well as improvements in behavioral and psychosocial outcomes.
The CSIRO Total Wellbeing Diet Online Program
The CSIRO Total Wellbeing Diet Online is a 12-week higher-protein, lower-glycemic index, commercial weight loss program managed by Digital Wellness and available to individuals at a cost of A $199 for the first 12 weeks. The user registration process collects information on year of birth, sex, physical activity levels, and weight loss goals to tailor eating and exercise plans. Individuals are assigned to 1 of 3 kilojoule bands depending on their starting weight (6000, 7000, or 8000 kJ/day). The diet is structured around 3 meals (breakfast, lunch, and dinner) and 2 snacks each day through use of a food group system where portions of food are presented as standard units for each food group. There are 7 food groups: fruit, vegetables, meat and alternatives, breads and cereals, dairy, healthy fats and oils, and indulgences. Meals are designed around a template of standard units, which ensures daily allowances of food groups are met and provides optimal nutrition and energy to promote weight loss. Daily and weekly meal plans can be customized by swapping meals using the recipe database. The online platform is a fully responsive web app with an interface that is optimized for viewing on a desktop and on mobile devices. The platform features are designed to support individuals throughout the program. The meal plans provide individuals with meals and snacks planned for the day or week ahead. The food diary can be used to log meals and snacks consumed, either by entering prepopulated recipes from the meal plan or recipe database, or by entering individual foods from a comprehensive food database. The food search function allows members to search through the food database for individual foods or recipes and view information about their composition and food units. The food tracker tallies the food units and total energy consumed over the day. The exercise diary is where completed exercises can be logged or where activities chosen from a database of different exercise types and intensities can be recorded. Progress data are presented in a graph and table form. The platform also has a forum for members to share their stories or discuss relevant issues with other members.
Evaluation of the CSIRO Total Wellbeing Diet Online Program
A study analyzed the data from the CSIRO Total Wellbeing Diet Online program in the first 5 years after it launched to determine the program’s reach and weight loss results over this period and to investigate the key determinants of weight loss success. Specifically, it aimed to determine average weight loss and its relationship to the duration of membership, features of the platform that members used most, and the member and usage characteristics that were associated with greater weight loss.
The study included individuals aged ≥18 years who joined the CSIRO Total Wellbeing Diet Online of their own volition between October 2014 and September 2019 (N=61,164; referred to as “members”). In the registration and setup processes, individuals younger than 18 years or who had a BMI that placed them in the underweight category (BMI <18.5 kg/m2) were automatically excluded. The participants who were removed from this analysis were as follows: pseudomembers (ie, platform testers or affiliated staff), those whose membership was paid for by their employer because their motivations might have been different to those who signed up and paid for their membership voluntarily, members living outside of Australia because the context in which they were following the program was different and the menu plans were not optimized for seasonal or local produce, and members without a paid subscription.
Results of the CSIRO Total Wellbeing Diet Online Program
Data were available from 59,686 members for analysis. Members were predominately female (48,979/59,686, 82.06%) with an average age of 50 years (SD 12.6). The average starting weight was 90.2 kg (SD 19.7), and over half of all members (34,195/59,688, 57.29%) were classified as obese. At week 12, 94.56% (56,438/59,686) of the members had a paid program membership, which decreased to 41.48% (24,756/59,686) at 24 weeks. At week 12, 52.03% (29,115/55,958) of the remaining members were actively using the platform, and by week 24, 26.59% (14,880/55,958) were using the platform. The average weight loss for all members was 2.8 kg or 3.1% of their starting body weight. Stayers lost 4.9 kg (5.3% of starting body weight) compared to starters, who lost 1.6 kg (1.7% of starting body weight). Almost half (11,082/22,658, 48.91%) the members who stayed on the program lost 5% or more of their starting body weight, and 15.48% (3507/22,658) achieved a weight loss of 10% or more. Of the members who were classified as class 1 obese when they joined the program, 41.39% (3065/7405) who stayed on the program were no longer classified as obese at the end, and across all categories of obesity, 24% (3180/13,319) were no longer classified as obese at the end of the program. Based on multiple linear regression, platform usage was the strongest predictor of weight loss (β=.263; P<.001), with higher usage associated with greater weight loss.
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This comprehensive evaluation of a commercial, online weight loss program showed that it was effective for weight loss, particularly for members who finished the program and were active in using the platform and tools provided.
Short-Term Interventions for Weight Loss
Short-term lifestyle change programs can produce weight loss that may be associated with reduced risk of chronic diseases. A systematic review examined interventions of 6 months or less for weight change. The study’s population was specific to adults with overweight or obesity who were also diagnosed with a mental illness. The search included peer-reviewed studies on lifestyle change interventions of 6 months or less that were published from January 2012 through January 2023. The search strategy used a combination of key terms including 1) a health condition or lifestyle and behavior term (eg, physical activity, overweight), 2) a program or intervention term (eg, lifestyle change, intervention), and 3) an outcome term (eg, weight loss). We included peer-reviewed primary research studies published in English that reported on lifestyle change interventions of 6 months or less (operationalized as 26 weeks) for adults aged 18 years or older with overweight or obesity. Studies had to report weight loss outcomes to be eligible for inclusion. We excluded studies in which participants were already diagnosed with a chronic condition, such as hypertension or diabetes, but included studies that were intended for populations with heightened risks for developing chronic conditions. We included randomized controlled trials (RCTs) only and excluded other study designs, such as observational studies, given that other designs are more susceptible to bias or confounding, and studies that did not conduct an intention-to-treat analysis, because complete case analysis may lead to bias in the intervention effect estimates.
Results of Short-Term Intervention Studies
The pooled mean difference for weight change was less than −2.59 kg (95% CI, −3.47 to −1.72; 14 RCTs; 2,407 participants; I2 = 69%). The negative difference in mean weight change indicates that people in the intervention groups lost more weight than those in the comparison groups. For the studies with interventions lasting less than 13 weeks, the pooled mean difference for weight change was −2.70 kg (95% CI, −3.69 to −1.71; 7 RCTs, 1,051 participants, I2 = 73%). For the studies with interventions lasting 13 to 26 weeks, the pooled mean difference for weight change was −2.40 kg (95% CI, −4.44 to −0.37; 7 RCTs, 1,356 participants, I2 = 69%) (Figure 3).
This meta-analysis of 14 RCTs found that interventions lasting 6 months or less were effective at achieving weight loss. Each study showed weight loss relative to control groups.
Commercial Weight Management Programs vs. DIY Approaches
A 1-year, randomized clinical trial compared the differences in weight change between individuals randomly assigned to a commercial weight management program with reduced requirements for dietary self-monitoring and individuals randomly assigned to follow a DIY approach. Major inclusion criteria were being 18 to 75 years of age, body mass index (BMI) of 25 to 45 (calculated as weight in kilograms divided by height in meters squared), access to a smartphone, and residence within 48.3 km of a location of this commercial weight management program. Major exclusion criteria were recent, current, or planned pregnancy; recent weight loss of 5 kg or more; health conditions or medications known to affect weight or make weight loss or unsupervised exercise unsafe; and prior or planned bariatric surgery. Participants underwent a 15- to 30-minute meeting reviewing common DIY strategies for weight loss that are available in the public domain. Participants engaged in a short discussion of prior weight loss attempts and successes and were provided with a brief resource guide with information about a variety of strategies (diet tracking or self-monitoring apps, meal plans, meal replacements, and physical activity) and dietary approaches to reduce energy intake healthfully (low fat, low carbohydrate, vegan, and Mediterranean diet). Emphasis was placed on strategies that used dietary self-monitoring to achieve a weight loss energy deficit, and referral to free digital dietary self-monitoring resources was given. Participants were informed that 50% of people in the National Weight Control Registry, a research-based registry of individuals who had lost weight and kept it off successfully, followed a DIY approach. Participants were encouraged to select a DIY strategy that best fit with their preferences, adopt that strategy for at least 8 weeks, then reevaluate, and, if needed, try another strategy.
Results of Commercial Program vs. DIY Study
At 3 months, participants in the commercial program had a mean (SD) weight loss of −3.8 (4.1) kg vs −1.8 (3.7) kg among those in the DIY group. At 12 months, participants in the commercial program had a mean (SD) weight loss of −4.4 (7.3) kg vs −1.7 (7.3) kg among those in the DIY group. The mean difference between groups was −2.0 kg (97.5% CI, −2.9 to −1.1 kg) at 3 months (P < .001) and −2.6 kg (97.5% CI, −4.3 to −0.8 kg) at 12 months (P < .001). Adults randomly assigned to a commercial weight management program with reduced requirements for dietary self-monitoring lost more weight and were more likely to achieve weight loss of 5% at 3 and 12 months than adults following a DIY approach.
Head-to-Head Comparisons of Commercial Weight Loss Programs
A systematic review directly compared weight loss, waist circumference, and systolic and diastolic blood pressure (SBP, DBP) outcomes between commercially available weight-loss programs. The review included randomized, controlled trials (RCTs) of at least 12 weeks duration that reported comparisons with other commercial weight-loss programs.
Results of Head-to-Head Comparison Review
The review included seven articles representing three RCTs. Curves participants lost 1.8 kg (95%CI: 0.1, 3.5 kg) more than Weight Watchers in one comparison. There was no statistically significant difference in waist circumference change among the included programs. The mean reduction in SBP for SlimFast participants was 4.5 mmHg (95%CI: 0.4, 8.6 mmHg) more than that of Atkins participants in one comparison.
In the present study, most commercial programs perform similarly with respect to short-term changes in weight, waist circumference, and blood pressure among eligible head-to-head RCTs included in this review.
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