While exploring the diet app Noom recently, I wasn’t sure if I was supposed to be losing weight or healing my inner child. The program encourages you to banish “thought distortions” such as labeling foods “good” or “bad.” It assures you that slipups don’t mean failure, and nudges you to practice “joyful movement.” For the first week, all Noom asks you to do is “simply believe.”
And if this psychological approach fails, there’s always Ozempic.
Noom and the dieting stalwart WeightWatchers have both recently added services that will allow their customers to obtain Ozempic and other blockbuster new GLP-1 obesity drugs, such as Wegovy and Mounjaro. This spring, Noom launched Noom Med, which pairs its behavior-change program with prescriptions for various weight-loss drugs, the GLP-1s among them. Noom Med will connect its users with doctors who prescribe the drugs–though it won’t cover their often-gargantuan monthly cost. And WeightWatchers recently acquired Sequence, an online provider of the obesity drugs. People who sign up get a free WeightWatchers membership thrown in.
The move marks the latest reinvention of the diet industry–an acknowledgment that, for some people, joyful movement will never be enough, counting calories is insufficient, and drugs like Ozempic can be a crucial tool in achieving good health.
It also reflects the diet world’s awkward, enduring reality: Many obese people do want to lose weight, but the desire to be slimmer has become a little gauche. We are supposed to love our body, even as we fight like hell to reshape it. To Adrienne Bitar, a Cornell historian of the diet industry, this turn shows that although the weight-loss world has periodically dabbled in fuzzy concepts like “wellness,” “at the end of the day, most people just really want to lose weight.” Why not let them?
Americans go on yo-yo diets, but we also have a yo-yo relationship to dieting. For the past century or so, the weight-loss industry has bounced between moralizing, shaming, and tepid body positivity, depending on the sentiment of the times. Early eating reformers, such as the cracker namesake Sylvester Graham, thought that eating better could literally make a person better, more virtuous. Gluttony, Graham and others believed, led to sins like violence and masturbation, as Susan Yager describes in her book The Hundred Year Diet. “Treat your stomach like a well-governed child,” Graham advised.
During World War I, eating less was considered patriotic, a way of freeing up precious caloric resources for American troops fighting abroad. Later, doctors and psychologists came to the (wrong) conclusion that overweight people were lazy, and society adjudicated heaviness a “disgrace,” in the words of Lulu Hunt Peters, an early diet-book author. Dieting organizations ruthlessly shamed people into losing weight. In the early ’50s, one such “support” group held public weigh-ins and forced members who’d gained weight to stand in a “pig line,” where they would sing a song that included the lyric “We are plump little pigs who ate too much, fat, fat, fat.”
WeightWatchers began in the 1960s, when a housewife named Jean Nidetch invited six friends to her house to talk about their weight struggles. Nidetch eventually lost 72 pounds, and she established group support as a pillar of her new program. Still, she remained preoccupied with the “weight” part of WeightWatchers, urging members to carry photos of their former, heavier selves. Yager quotes her as saying, “I pray that I’ll never forget where I came from.”
But in recent years, dieting has gone the way of the Livestrong bracelet. Magazines stopped using phrases such as bikini body on their covers. Lean Cuisine offered a browser extension that blocked the word diet from web pages. A Dove commercial reminded everyone that size-10 women use soap. It used to be moral to diet; now it was moral to not diet. “Americans are just simply not dieting anymore,” a Nestle USA executive told one news outlet in 2016.
In 2018, WeightWatchers dropped “weight,” literally, and rebranded itself as WW, with a new focus on “wellness.” The company stopped requiring members to have a weight-loss goal, and cut “before and after” photos from its ads. Its expanded set of goals for subscribers included “developing a positive mindset.” At the time, then-CEO Mindy Grossman said, “The world doesn’t need another diet,” and “Healthy is the new skinny.”
Even so, WeightWatchers and other diet programs worked by modifying behavior, with the goal, spoken or otherwise, of losing weight. (The company now goes by both names.) Noom has a strong focus on psychology; the app includes many articles about stress triggers, mindless eating, and “behavior chains.” “You are not your thoughts, but the observer of your thoughts,” the app told me at one point. It also, however, encourages users to weigh in every day, log their food, and stick to a daily calorie goal. And even as it de-emphasized “weight,” WeightWatchers still offered workout plans and its “points” system of tracking food’s nutritional value. Meetings were renamed “workshops,” but they still happened.
GLP-1s work much better than any of these strategies; they take whatever behavioral modification you’re doing and supercharge it. Being aware of the concept of mindless eating is one thing, but with a GLP-1 you won’t be as tempted to mindlessly eat. The GLP-1 drug Mounjaro can help people lose 22.5 percent of their body weight–approaching the amount someone would lose with bariatric surgery. (And people overwhelmingly prefer the medications to surgery.) With Wegovy, it’s 15 percent–still a life-changing number for the 42 percent of Americans who are obese. Compare that with diet and exercise, which generally lead to less than 5 percent weight loss, according to Scott Kahan, the director of the National Center for Weight and Wellness, or 7 percent if you add in a guided program like Noom. Some people’s bodies cling to extra fat; research has shown that when obese people begin an intense exercise program, their resting metabolic rate declines–making it even harder to lose weight. Obese people have often tried everything, and “then these drugs come along … like, go for it, man,” Lara Dugas, an associate professor at Loyola University Chicago and an author of that study, told me. “You take that help.”
The advent of these drugs raises the question of whether there’s any point for obese people to frantically diet and exercise with no end in sight. “The behavioral approach to weight loss has been under pressure for a few years now,” says Alex Fuhrman, an analyst at Craig-Hallum Capital Group who covers WeightWatchers. These companies, seeing the upsurge of Ozempic, want “a horse in the race themselves.”
Both WeightWatchers and Noom seem to be acknowledging that diet and exercise alone–the mainstays of their programs in the recent past–just don’t work for some people. Executives from the organizations told me they see obesity as a chronic medical condition that sometimes requires ongoing pharmaceutical treatment. “Way back in the ’60s and ’70s, our thinking was people were bad; they ate too much. They don’t exercise, they develop obesity, and then everything else goes haywire,” Noom’s chief medical officer, Linda Anegawa, told me. “We now have learned that, actually, there are certain individuals who, for example, are genetically predisposed to have insulin resistance.” This can lead to abnormal fat storage and a dysregulated appetite–which can be helped with GLP-1s.
To WeightWatchers CEO Sima Sistani, the drugs might be a solution for obese people who couldn’t lose weight on the program, or who kept regaining it. “There are people who joined this program and lapsed from our program because it didn’t work for them,” Sistani told me. “And we have to be honest about that. And we now know better. So we should do better.”
To qualify for GLP-1s through either Noom Med or Sequence, a person has to be obese, with a BMI higher than 30, or overweight with a qualifying health condition, such as diabetes. Customers are screened by doctors to ensure that they meet the criteria. Sequence costs $99 a month, and Noom Med costs about $120, but neither rate includes the cost of the drugs, which can top $1,000 a month without insurance.
To my surprise, weight-loss doctors told me that this merging of diet apps and injectable pharmaceuticals could be a good thing. Kahan cautions that the drugs don’t work well for many people. But services like Noom Med may help obese people who live in remote areas or can’t reach a specialist. “We’ve increased the ranks of obesity-medicine doctors, but still, the majority of Americans don’t have access to one,” he said. “Done well, these virtual-care programs could potentially be extremely valuable.”
Though medications like Ozempic and Wegovy help people feel fuller and think about food less, the person taking them does have to consume fewer calories in order to lose weight. And that’s where a program such as Noom or WeightWatchers can be helpful. Something like the Noom app, which includes quizzes about which foods are healthiest (grapes or raisins? It’s grapes), may allow people on GLP-1s to maintain a lower weight in perpetuity. What leads to the most dramatic weight loss is a combination of obesity drugs and healthier habits. And dramatic weight loss is, after all, a goal for many people.
At one point, Sistani used the phrase weight health, and I asked her whether “Healthy is the new skinny” was still the company’s ethos. “I think the word diet and diet culture and where it went wrong was a preoccupation with thinness,” Sistani said. She appreciates the concept of body positivity, she told me. But she also seemed clear-eyed about obesity’s downsides: that it shortens a person’s life span, for example, and increases the risk of cancer and other maladies. “Within that framework is still the opportunity to talk about well-being, and How do I live? How do I achieve longevity? How do I have a strong, healthy life? Your weight is going to be a part of that.”
The yo-yo has snapped back, and we’ve conceded that dieting people don’t want to be moral, patriotic, or shamed. They just want to lose weight. That desire has always been value-neutral. But now it’s more attainable.
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