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stickK.com was free. Users who put money at stake entered their credit card information during the Commitment Creation process, and the card was charged only if the user was unsuccessful. But stickK offered its program to corporations as a private, customized web platform. Instead of using loss aversion (negative incentives) as stickK’s public site did, corporations could offer rewards (positive incentives) to employees who reach goals set by the organization. Rewards were customized to the corporation’s culture and ranged from gift certificates and merchandise to a golf outing with the CEO or a prime company parking spot. For each corporate program, stickK charged fees for setup, service fee, and rewards processing.
Scientific evaluation of efficacy of support-based programs An Annals of Internal Medicine article analyzed studies of Weight Watchers, eDiets.com, Health Management Resources, and Take Off Pounds Sensibly. “Of three randomized, controlled trials of Weight Watchers, the largest reported a loss of 3.2% of initial weight at two years. Patients who completed treatment lost approximately 15%–25% of initial weight. These programs were associated with high costs, high attrition rates, and a high probability of regaining 50% or more of lost weight in 1 to 2 years. Commercial interventions available over the Internet and organized self-help programs produced minimal weight loss. Because many studies did not control for high attrition rates, the reported results are probably a best-case scenario. With the exception of one trial of Weight Watchers, the evidence to support the use of the major commercial and self-help weight loss programs is suboptimal. Controlled trials are needed to assess the efficacy and cost effectiveness of these interventions.” [61]
A few trials in which volunteers with obesity were blindly assigned to either a standard low-fat diet or a low-carb, high-protein diet concluded that a low-carb, high-protein diet led to quicker weight loss than a low-fat diet. In the studies that lasted for a year or longer, though, weight loss was about the same regardless of diet type. The overall results masked individual differences. In one trial, on both low-carb and low-fat diets, some people lost weight while others gained. In the low-fat group, the range was from 53 pounds lost to 31 pounds gained; in the low-carb group, it was from 65 pounds lost to 18 gained. [62]
Clinical practice guidelines developed by expert physicians incorporated lifestyle modification into “best practices” treatment protocols. They diverged from the views of those private practice physicians, payers, and patients who thought that lifestyle modification was ineffective, not validated by rigorous clinical studies, or merely another form of complementary and alternative medicine.
Weight loss clinic Some hospitals maintain weight loss clinics that focus on personal counseling and/or surgical treatment of obesity. A director of a Boston weight loss center noted that it was not a profitable business when overhead was factored in. [63]
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