program in Hopkins, Minnesota, who’s one of eight dietitians
working with the program there. The program is designed only
for adults with a BMI greater than 30 (eg, someone who’s 5’5”
and weighs 180 lbs or someone who’s 6’0” and weighs 221 lbs).
The Optifast program generally spans over a two-year
period and can be broken into three phases: the Active Phase,
or the active weight-loss phase, which is a low-calorie diet that
typically lasts one to four months and provides approximately
800 kcal per day in meal replacement drinks or bars; the Tran-
sition Phase, in which meals and snacks are gradually added
back to increase calorie intake (the length of time patients are
in this phase varies considerably, but on average it lasts about
six weeks); and the Maintenance Phase, which is the remain-
der of the program, which Pleimling says is the most impor-
tant time to consult with the dietitian to help with lifelong
tools for weight maintenance. The program is only for adults
between the ages of 18 and 75.
CO S T: Meal replacements typically cost $3 to $4 each. During
the initial Active Phase, five meal replacements per day are
recommended. The cost of the program itself varies among
locations.
S U PP O R T: Although programs can vary from clinic to clinic,
counseling with an RD as well as a doctor, physician assis-
tant, and/or a nurse practitioner typically is available for cli-
ents along with weekly group sessions. Some Optifast clinics,
including Allina, blend their medical and Optifast practices.
Regular classes are offered as part of the program. Optifast
also offers the MY OPTIFAST JOURNEY app, which, for an addi-
tional charge, provides a toolbox of exercise videos, meal plans,
recipes, and tracking features.
MAINTENANCE: This is the third and last phase of the pro-
gram, and meeting with a dietitian is a critical part, as clients
eat only one Optifast meal per day and eat self-chosen healthful
meals for the remainder.
RESEARCH: More than 80 studies have focused on the
Optifast program. The most recent was a large randomized
controlled trial, published this year in the journal Obesity.
The results showed Optifast to be significantly more
effective than a food-based intervention for weight loss and
maintenance after one year.
BOTTOM LINE: Optifast is only for patients who are clinically
obese, not for those who wish to lose only a small amount of
weight. It’s the only program that’s medically supervised but
may be more expensive than more self-guided programs.
NOOM
Established in 2008 in New York City, Noom is the newest pro-
gram of those listed here and the only one that’s solely an
online platform. According to the company, Noom has millions
of users who sign up each year, and about 1,000 sign up each
day for a two-week trial. Noom’s curriculum was developed
and is tweaked by a team that includes a psychologist, dietitian,
and nutrition researcher. It began as an exercise tracker but
now focuses on behavior changes rather than exercise, nutri-
tion, or diet alone. Jennifer Major Hartman, MS, RD, director
of business development with Noom Enterprise Partnerships,
says it’s now more psychology than nutrition and describes it
as “an anti-quick-fix program.” No meal plans, dietary restric-
tions, or exercise routines are prescribed.
When individuals go to Noom’s website, they’ll answer
several questions about their overall goals, eating, and
exercise habits to identify behaviors that can help them
achieve their weight-loss goals over a specified amount of
time. Based on that information, a customized calorie goal is
provided. Daily lessons and challenges are sent to the client’s
phone on everything from nutrition and physical activity to
psychology and behavior changes. Some users stay with Noom
for a few months; others stay for one or more years.
CO S T: Pricing depends on the length of the plan a user
chooses. Paying by the month costs $59; a two-month sub-
scription costs $99, and a 12-month subscription costs $199.
However, a two-week trial is available for $1.
S U PP O R T: Each enrollee is matched with a dedicated “goal
specialist” and a group coach to work with during their time
with Noom. Users have 24/7 access to a virtual support group
of peers who are at similar stages in their behavior change
journey. Coaches are available Monday through Friday, during
business hours.
MAINTENANCE: Maintenance is considered at the beginning
of the user’s program and is incorporated at every stage by
helping the individual identify and develop behaviors and skills
needed for lifelong healthful lifestyle habits.
RESEARCH: Several studies have been published in The
BMJ, Nature Scientific Reports, and the Journal of Human
Hypertension that have demonstrated the long-term efficacy
of the Noom program.
BOTTOM LINE: Noom is best suited for clients who are
comfortable using apps and likely works best for those who
are highly motivated and want help without ordering foods
or attending meetings. There are no prepackaged foods or
prescribed diet plans.What to Consider When Recommending
a Weight Loss Program
Each program comes with its unique benefits and draw-
backs. Whether a program is appropriate will depend on your
client’s goals, motivation, and budget. The affordability of any
one program depends on how much a person normally spends
on food and beverages and whether they’re single, respon-
sible for food preparation for a large family, or accustomed to
dining out regularly. If clients are responsible for shopping for
a family, the cost of the diet products and meal replacements
should be added to the family’s food budget.
Before recommending a program, ask clients about their
lifestyle, budget, motivation, and organizational skills, and
whether they prefer a more flexible approach or a prescribed
plan. For those programs that offer little or no counseling,
your support as a dietitian can help them stay on track, regard-
less of the type of program they choose.— Densie Webb, PhD, RD, is a freelance writer, editor, and
industry consultant based in Austin, Texas.august 2019 http://www.todaysdietitian.com 31