How Does WW Help Us Lose Weight?

Behavior change is hard. Actively changing another person's behavior is even harder. But there are plenty of companies out there that have been able to crack that code. I'm Kristen Berman, behavioral scientist and co founder of Irrational Labs. Each week I get to chat with visionary product and organizational leaders to uncover their insights about user behavior and how they've managed to change it. I mash this up with some of the latest research in the field to get to the bottom of our core psycholog. So let's dive in and unlock the secrets behind the science of change. The Science of Change podcast is presented by Setsale, the world's number one revenue execution platform. Why is it that we just can't quit diets? Or to put it another way, why is it that we're always quitting diets? Obesity is a global epidemic that is fast replacing tobacco as the single most preventable cause of costly chronic diseases like heart disease, diabetes and cancer. But we still haven't quite figured out the best or easiest way to lose weight. There are all kinds of statistics out there that will tell you that Americans have a complicated relationship with diets. We start them all the time, only to give them up months or weeks or even days later. But the reality is weight loss is hard and there are a million apps out there trying to crack the code to make it easier for us to lose weight. One of the companies that has been at it the longest is ww, the company we used to know as Weight Watchers. My guest today is Julie o'. Brien. She's a behavioral scientist and the former head of Applied Behavioral Science for ww. She has a lot of great insights into how the program works and if it is really effective in getting people to change their habits around food. So does it work? Looks like it probably does. Does it work really, really well? That's a different story. I'm gonna jump right in. What is one thing that you've learned from being at WW about helping people lose weight?

It's really hard. Turns out losing weight is a long term behavior change challenge and it is not a snap of the fingers.

I was hoping for the magic answer. I believe you. It's hard. Most people have tried and failed multiple times. Is there anything that makes it incrementally easier and or people who succeed at weight loss, what do they know that we don't know?

If you think about it from a behavioral perspective, in order to lose weight, you have to basically introduce new habits and then you have to break existing habits. So for introducing new habits, you really don't Want to overthink it. You want to pick foods that you know you can eat on autopilot and have the sense of fluency. So it's like if you're ww, the program is designed to have zero point foods where by definition or by the way the program was created, you're not supposed to pay a lot of attention to these foods. So if you really like bananas, for example, bananas are pretty healthy. You're probably not going to overeat bananas. And so it's a good thing to form a new habit around. And so if you want to form a new habit, you want to have that automatic link between your context key and the action. I think the real challenge with weight loss is more in the breaking existing habits side of the fence. So you hear people anecdotally talking, you know, I was so good all week, but then I blew it on Friday, which is the story of my life. And you know, there's a few ways that we can think about that. One is that it's impossible to be good on every single Friday for the rest of your life. So we have to sort of change our expectations. So now we can think about Fridays as a chance for us to be a little bit less good. Maybe we're not going to blow it, but we're going to plan for a special occasion. And so maybe we're a little bit better on the days leading up to Friday to sort of help us balance over time so that on Friday we can enjoy that takeout, nice restaurant, maybe nice meal that we were kind of waiting for all week.

So before we get too far into the conversation, we should go back to the bigger question I mentioned earlier. Does WW actually work? There are a couple studies that make the answer pretty inconclusive. One study looked at users of some of the most well known programs out there and compared them against a control group. WW did work, but it was one of the least effective. Compared to names like Jenny Craig and Nutrisystem, WW users achieved just 2.6% greater weight loss over the control group after 12 months. The other weight loss systems did a bit better, but it's worth mentioning none of them did much higher than 4% weight loss over the control. I'll say it again, weight loss is hard. The other study was more positive. That one randomly assigned patients to either receive one year of standard care from a primary care team or a 12 month membership to Weight Watchers. The Weight Watchers group lost twice as much weight as those in the standard care group. They were also three times more likely to lose 10% of their body weight. So what does Julie say about WW's overall approach to helping people lose weight?

WW is really focused on helping people think about balance over time and not just what you're doing today and then making sure that you're perfect every other day for the rest of your life, because that would be really boring and it would be pretty impossible to sustain. So one is sort of change your expectations around how to live so that you have, you know, moderation doesn't mean you're always at 70%. It means sometimes you're at 110, and sometimes you're at 50. And on balance, you're at about 70. And then you want to think about what are the behaviors that are really challenging, that are happening automatically, or where you're sort of maybe not planning or not thinking, and you want to start to undo those. And that's where something like food tracking can be really helpful. And so WW and many weight loss programs ask people to track their food. And that's a way of really paying attention and having a lot more what is traditionally described as awareness in the moment around the things that you're eating. And that's great, but the food tracking behavior actually serves a really specific purpose when it comes to habit change. And food tracking can be a way of introducing thinking in the moment when you otherwise would have acted on autopilot. So I think the example that I have is, like, when I'm cooking dinner, I have, like, the kids running around and everybody's hungry and crabby, and so they want snacks. So they pull out like, a bag of chips, and the chips are on the counter, and I'm like, totally not paying attention and really probably trying to ignore everything around me. And so I see the chips on the counter. That's like the context cue that triggers my habit.

So generally speaking, the idea of slowing down and making something less automatic has legs. There are plenty of studies that support this. One study conducted on Google employees measured the distance between the coffee counter and the snack counter. When the distance between the two was bigger and people had to walk farther to grab a bag of chips, they ate fewer snacks. When the distance was shorter, they ate more snacks. Another study found that proximity to fast food restaurants correlates with higher obesity rates. But it can also work for healthy foods, too. When something that's good for you is easier to get, people tend to eat it more. There was a series of studies conducted in college dining halls that when they increase the availability of Plant based meal options. Students bought between 40% and 80% more plant based meals. So these microhabit changes really do matter. What's your feeling on identity creation and how important is this for behavior change?

I think it's really important. I have an anecdote. It's absolutely me search and so take it or leave it. But when I was younger I smoked cigarettes because that's what kids do. And it's really cool. And it was totally part of my identity when I was a rebel. And then at some point during college I realized this is actually really not cool. I don't want to be the kind of person who smokes cigarettes. None of my peers smoke cigarettes. And so I quit. And like that was it. I just quit. And I didn't have cravings. I didn't feel the need to do that because it was so inconsistent with who I was that it just sort of became irrelevant to me. And so identity is just another thing, like a context cue that can be associated or not associated with the action that you're trying to build or break a habit around. And so your identity can trigger the action, which can then make it easier to do it or not doing it, depending on how salient it is.

Can the behavior trigger the identity?

Yeah, of course. Works both ways. I think to your point, there's lots of other things that you also need to do. And tracking your food is like literally one tiny little piece of the equation. And it's not going to fix everything for you because ultimately you want to probably remove your exposure to the context queue in the first place. And we know from a lot of the literature that designing your environment strategically so that you're never faced with a temptation in the first place is also really great. You're not going to have that habitual response if you don't see the chips on the counter or if you sort of like plan ahead about like how you're going to have those chips and then you're not interacting with them in this automatic way. It's like this new type of interaction. And that doesn't rely on food tracking. That's an environment engineering strategy. So if you think about it in terms of a number of behaviors or a number of approaches that you want to take, food tracking is one of the approaches. And we should use it strategically in the way that it can be effective. And that's why we don't say to track a zero point food or a banana or something that you're trying to do on autopilot, because tracking is literally the Opposite of autopilot. And so it's not actually going to help you do those things that you want to build a new habit around.

She's right. Habits are something we either have to interrupt in order to break or practice if we want to continue and create a sustained habit. But there is a hack here. Remember those microhabit changes we talked about earlier? Well, Julie's talking about little one time behaviors that could eliminate certain temptations. Like reorganizing your kitchen so you don't see the cookie jar or even just not buying the chips at the grocery store. Might be easier than creating a new habit. You could order a meal delivery service. This is a one time decision that could lock you in for the next month of healthy portioned pre made meals. The key here is making a one time decision that supports your intention to eat healthier. But as Julie says, it could be trickier than that with food.

With something like food, you have to eat every day for the rest of your life no matter what. And so there's always going to be things that change in your environment that you haven't anticipated or that you might not have control over. And so with something like a one time action, it's great to redesign your kitchen, but then you still have to go to the grocery store the next week. And so it kind of resets in a way on a regular basis. And there's certain natural events like Thanksgiving or Christmas or a holiday party or if we ever go back into offices, you're going to be faced with cupcakes that you have no control over. And so the food environment is just really challenging. And there's so many opportunities for us to be tempted. And like DoorDash is texting me, you know, tempting me to eat something that's easy and it will taste good. And so I can turn off the notifications. That's a one time action. But then I have to do that for DoorDash and Uber Eats and Grubhub and, you know, all of the other things. And I may not always want to have those notifications turned off either. So creating new habits is probably a really interesting part of the equation, but it is really hard.

Okay, back to ww. What triggers people to join? What life event? You know, many times kind of. I bet if you were to poll people in general, all of us want to lose five pounds. And the question is, when are we triggered to take action on that? And the second is when people join, they have a increased momentum and motivation in the very beginning. And that obviously can only get them so far. So how do we keep them engaged over time given that, as you said, we have to eat every day?

Yeah. So the second question is really hard. I'll describe some possible ways to think about this. But on the first question, it's not very surprising that weight loss is a very seasonal industry. People are always really motivated on January 1st to do everything in their life in a new and different way. And weight loss is another example of that. I think, like, weight loss is especially relevant to people on January 1st because they just partied for two weeks straight and now they probably weigh more because of that. And so there is this more immediate need that people are feeling. And you do see other temporal effects too. Like, I mean, I don't know if we have exact data on this at ww, but it is the case that there is a fresh start effect on a Monday. Like Monday is the beginning of the week. We have this sort of optimism. We feel like we're going to have a whole new me starting today and I can forget about the weekend that was old me. And so I'm ready to go on Monday. You're also just like, more rested. And so it's easier to think about doing the things that do require more effort. And then of course, by the weekend, life is harder and you're tired and so those sort of natural temporal effects go away. I think the question of, like, are there other things that motivate people? There's certainly a lot of anecdotal things like, you know, I had a major life event and we don't actually know if that really plays a role or not. I think there's something that is happening in the essence of someone's motivation that is triggering this willingness to put in the work and effort because it, it is a lot of work and effort.

Basically what Julie is saying is normally there is no good day to start a diet. Today is no good. I'll start tomorrow. And when tomorrow comes, oh, next week will do. The new year can give people this reason to do something, anything today. But it may be short lived. According to Foursquare, in the early part of 2018, visits to fast food restaurants fell by 4.6% while gym attendance grew by 6%. But this doesn't last long. Foursquare estimates that things start to even out and go back to normal around the second week of February. But maybe that's okay. Six weeks of being healthier is likely better than nothing. But life events, as Julie suggests, could be more sustaining. What is a life event? Well, it could be an illness, but it could be a big moment that matters to you. There's a study that found successful dieters reported a higher number of life events than unsuccessful dieters. Examples of these life events were things like my clothes didn't fit me, my doctor recommended I lose weight, or I weighed myself and I'm heavier than I've ever been. Reacting to these types of things could be more sticky than assigning a random day on the calendar to start a diet.

I don't actually know what causes that, but it does seem to be that if you can start with momentum, you're going to be a lot more successful. So dabbling in weight loss means you're probably not going to lose very much weight up front and then you're not really going to feel like it's worth even the little sacrifice that was required for dabbling. And so you're probably not going to stick with it. But if you do give it a go in the beginning and you're really committed and you sort of go all in, you might actually see results more quickly, which is kind of self reinforcing and gives you that spark to feel like there's a more immediate payoff for some something that is going to take a long time, but at least it feels like the journey is a little bit faster.

Are there small things maybe kind of like that that can fundamentally increase the likelihood that people stick with it?

What we do know is that getting the timing right is really important. So if you think about weight loss as a long term journey, there's always going to be moments when you're doing really well and moments when you're not doing as well. We know that the what the hell effect happens. Or in the diet world this is called the abstinence violation effect, where I blew it. I ate more than I thought I going to and now I feel really bad about it and I end up making this internal attribution about myself. I say I'm the kind of person who can't actually do this, I can't actually succeed, I might as well give up right now. I'll just have more cookies, cake, whatever. The thing is that I was sort of giving into and if we can accelerate that comeback, if you can get somebody in that moment to break that cycle of blaming themselves and spiraling into this, I'm the kind of person who can't do it and bring them back quicker, then you basically lose less time that way. You sort of don't create a weight gain that might happen otherwise. And so I tend to think about it as something where you're not on a linear path that's just going to be successful in this very predictable way. There's going to be a lot of fluctuation along the way. And it's just a matter of bringing people back up as quickly as possible so that they don't kind of undo their past progress when they have those lows. But it's going to fluctuate. Like there's no way people are just not perfect and there's too many temptations in the world. And so really it's more of a timing question or even a personalization question of how do you give them the right solution that they need in that moment so that they can come back a little bit quicker.

Here's another way. What she's talking about mirrors what happens in the finance world. On payday, we're motivated to check and see how much money we have, but when our bank balance is low, we don't want to see. It's the same kind of information aversion Julie's talking about. And it really works against us. If we see how much money we have in our account, especially if it's low, we might be able to make some quick changes. At ww, the same could be true for people who keep logging in even after they've gone over their points. But in most cases, the science suggests people would eat the whole bag of chips, get discouraged and stop tracking.

It's extremely painful to track that you went over your budget for the day. That's a really hard thing to do. And doing that can be really productive because it means that you're not having that negative emotional reaction. Probably. Of course, we don't know the emotional reaction that someone is having in real life, but we can intuit what that might be. And if somebody is tracking their food when they've gone over, that's some signal that they've kind of gotten over that pain that would be associated. But to your point, it's really hard to get over that pain. And so for the most part, you don't see people tracking days that their points values are higher than what you would expect. But that's also a challenge with the data that any company like that would have where you don't know if they didn't track a day where they went over or they just didn't eat over their points budget. We don't actually know what they're eating in real life. We only know what they're telling us. So we can assume that, yeah, like some days are going to Be more than others.

One thing about WW is it takes the kind of calorie in calorie out that in general requires people to understand how many calories or points are in each food, which is some sort of math. But then there's this whole other world of dieting which is about kind of rules of thumb which is just don't eat carbs or don't eat before 11am this to me seems fairly intuitive where people are saying yes or no and there's no slippery slope of was that an extra point? Or you just know if you've eaten bread or not. What do you think about the trade offs between kind of a point system versus the rule of thumb system? And if you were to give advice to listeners about which one to try, how should they think about that decision?

Either way, a rule of thumb is really important for the reasons that you described. You don't have to think, there's no decision making required. You don't have to be super perfect either way. So a rule of thumb is going to be good enough. I think what the point system does that's interesting is it does actually create a rule of thumb. And it's a more complex rule of thumb because you have to understand what's a low point versus a high point. But it's pretty intuitive and you start to learn that really quickly. So I think maybe it's a cop out answer to say it's personal preference. But there is something about allowing yourself to have indulgences that I think is really helpful when you're restricting yourself for a longer period of time. And so if you're doing like Paleo, for example, which I have done, and I've also done whole 30 and I've also done intermittent fasting just to, you know, try all the rules of thumb. And I've tried ww. I think the thing that the point system allows for is intentional indulgence in a way that you don't feel bad about. And you can still have rules of thumb around it where you say when I indulge, I'm going to eat a meal that has X number of points. And so you're creating heuristics around this is an appropriate amount for breakfast, this is an appropriate amount for dinner, this is an appropriate amount for when I'm eating out or going to, you know, kind of a special occasion. And so the thing that that allows for is responding to moments that you can't predict.

So how do you help people pick goals or do you. And then when they are Picking the wrong goals. What's the approach?

It's also tricky because if somebody has a larger goal, by definition it's going to take them longer to achieve that goal. And there's differences in how rapidly you lose weight based on how high your weight is in the beginning. So it's not super straightforward to be able to calculate what ideal or what is optimal. In general. People that have more aggressive goals tend to do better, but it could also be that that's because they're losing weight more rapidly because they're kind of starting out at a higher weight. It's also the case that maybe there's this extra boost that happens in the beginning because you're like, I've got this long way to go and so now I'm going to be more motivated. And then, you know, maybe at some point later you drop off and we don't have good data on that piece of it. But from a behavioral perspective, we don't want somebody to set a really large goal and then that's it, we walk away. And so what we did at WW was to then also help people create much more short term goals based on just one week. So, you know, you can have your weight loss goal and that's great and that's important. But what matters a lot more is what you're going to do tomorrow and the next day and the next day. And so that's actually more effective from a behavioral perspective because we want people to focus on the actions that they're going to take and then make a plan for those actions.

How do you get people to do the action? So I'm imagining somebody fundamentally would have to learn to cook or learn to not go out to eat every Friday or Saturday night. Are there ways to nudge this behavior that's outside of the actual points?

Yeah, definitely. I mean, I think this is where it's really helpful to have people identify the barriers that exist for them and then make a plan for removing those barriers or an alternative strategy that they're going to have. And that process of what's your goal? What are the barriers that are going to get in the way? And then what's your plan? And if then plan for doing something when you're faced with that barrier that's universal, like you can apply that to any kind of behavioral challenge that you have inside of weight loss or outside of weight loss. Those basic foundational steps are actually really important and can achieve all kinds of different particular nuances that an individual will have. And so what we were working on with the app was how do you just build out a user flow that prompts the planning piece of it and prompts that barrier piece of it. So if you can build out a flow that helps people identify, maybe my barrier is I go out with friends and then I get tempted by the appetizers. Great, now I know my barriers and then I can make a plan to overcome that. So the actual solution is just figure out your barriers, make a plan for overcoming them, and then of course, like, committing to it is also really helpful. And that's kind of an easy thing to do. And there's lots of ways that you can do that in an app or in an in person experience, but that just is another way to reinforce it and make it feel a little bit more powerful.

So the point tier system, how does it actually work?

So essentially, the point system is intended to be a simpler way of interpreting a nutrition label. So if you look at the back of a food item, there's calories, there's a fat, there's sugar, there's carbs, there's vitamins, there's all of this stuff that is almost. It's impossible to look at that and know what it means. And so the point system is a way to quickly distill what matters for making something nutrient rich and dense and something that's going to keep you satiated and also be like high quality calories. And that's what contributes to the points. So foods that have higher points are generally less nutrient rich, less dense, probably higher sugar, probably higher fat. Although not all fat is the same when it comes to health, so they do factor in what type of fat it is. So it's like basically a scientific algorithm that scans the nutrition content of the food and then creates a really simple way to understand what you would want to eat more of and what you would want to eat less of.

It seems like points are basically a substitute for calories. They're a rule of thumb so we don't have to count them. But calorie counting itself doesn't work. Although there is research showing that people believe calorie counting influences what and how much they eat, most studies have found that it doesn't. One meta analysis from 2014 found that while calorie counting doesn't necessarily decrease consumption, labeling calories, like using a red, yellow, green traffic light system, was somewhat effective. One caveat would be that most of the included studies on labeling seem to be lab studies. So it's unclear how well that would work in real world settings and over time. Bottom line, Academic work doesn't have good data that labels work, but there also isn't conclusive data that they don't. Weight Watchers is doing a full form of labeling. They're giving people some heuristics for making decisions on food that is easier to digest than counting calories. So one of the very first times that people were filming something, like on an actual video camera, they filmed it, but at the end, it's only really seen from one angle. So they basically placed a camera down and then there was a scene in front of it. And in hindsight, you're like, well, that's interesting. Why didn't you just move the camera? So the question for you is, when we think about behavior change and let's focus on weight loss, when we look back at this moment, what's the future of weight loss that we're not seeing right now?

I don't know because I have not seen it. But I would say that the approach that the industry has taken is to rely on the clinical trial research, which is the best that we have to go on. But it's kind of like the camera analogy where it's done in a really controlled setting where the parameters are known and controllable. And then you go into the real world and it's way more chaotic and there's a ton of noise. And so I. I mean, in general, in life and behavioral science, I like to say let's assume that our assumptions are just completely backwards and wrong. And now let's start over and let's introduce like the opposite set of assumptions. And so it could be an interesting conversation or an interesting brainstorming session to look at the clinical trial research, look at every single weight loss program that ex today, and then pick it apart and say, let's assume that this is wrong. Let's assume that this is wrong. Let's assume that this is wrong. And then what would we do instead? And I think if we took an approach like that, we'd probably come up with something really different that might not look anything like what we have built.

That was Julie o' Brien, for reference. Julie is the real deal. She has been a behavioral scientist at opower Duke University, WW and she just moved to US Bank. We said it throughout the episode. It's undeniable that losing weight is hard with or without the help of a doctor. Two thirds of American adults with obesity try to lose weight each year using every diet imaginable. Yet the US adult obesity rate remains at 43%. Even intensive diet and lifestyle interventions have historically struggled to exceed a sustained 5% loss of body weight, and most weight loss drugs are no more effective. So we're talking about an incredibly difficult thing that most adults try to do at some point in their life. You could argue that all diets work to some degree. The problem is that none of them work very well. If you're overweight and you stick to just about any diet for a few months, you will probably lose about 10 pounds, which is fine, but probably isn't much comfort for someone who is 40 pounds overweight. And it isn't comparable to the size of the obesity epidemic. The real win would be giving consumers better food choices and having them not tempted to make the wrong choice so often. But we can't always control this. In most cases, the defaults are bad for us. We order food at Applebee's and it comes with fries. We have to ask for a side salad. At sporting events, you don't see carrots and hummus, you see nachos and ginormous pretzels. This is an uphill battle for people to change our diets, points or no points. As for ww, my sense is that it doesn't work for everyone all the time, but it probably works for some people some of the time. And overall, the food industry is still winning. We're asking people to fight a very tough battle, and we're not giving them sharp knives to do it. So even if WWE is still trying to crack that nutrition, they're not alone. No company has. Otherwise we'd all be a lot thinner. Don't forget to like and subscribe to the Science of Change on Apple Podcasts or anywhere you listen to podcasts. And while you're at it, why not give us a review? Writing a review takes only seconds and is wildly helpful for the show, and we'd love to hear what you think. The Science of Change podcast is presented by act on the Moments to Lead to a Sale. Visit them at Setsale co or on LinkedIn to learn more about the world's number one revenue execution platform. This podcast is produced by me, Kristin Berman and StudioPod Media. Our executive producer is Rachel Roberts, and all episodes are written by Jack Ewer.