Subject: New York Times Online Placement
From: "Merilee Kern" <[email-masked]>
To: "David Roddenberry" <[email-masked]>, <[email-masked]>, "Merilee Kern" <[email-masked]>
Date: Tue, 15 Nov 2011 18:27:48 -0800

http://opinionator.blogs.nytimes.com/2011/11/15/for-weight-loss-a-recipe-of-teamwork-and-trust/

November 15, 2011, 9:00 pm 

For Weight Loss, a Recipe of Teamwork and Trust
By TINA ROSENBERG

On Friday I wrote about Saddleback Church, which is using its small groups as an infrastructure to help its members lose weight and live healthier lives. The megachurch has megaplans for this idea - the church's pastor, the Rev. Rick Warren, hopes to expand it through the worldwide network of thousands of churches that are affiliated with Saddleback and the 150,000 pastors who subscribe to his newsletter.
  Group support and incentives, even cash, can help people stick to their new, healthier lifestyles.

Research has always shown that if you want to adopt and maintain new habits, it helps to not do it alone.  Organized religion has always known this - hence Jesus's fellowship with his disciples and the Jewish law that at least 10 men are needed for public worship.  When churches grew, they divided members into small groups that meet regularly to create support and accountability for spiritual growth. Churches' small groups help people adopt more spiritual habits, but they are also an ideal structure for other kinds of change.

Few other organizations, however, have that kind of built-in infrastructure.  But that doesn't mean it can't be created.   As several readers mentioned, one model is the 12-step self-help group Overeaters Anonymous, an Alcoholics Anonymous for compulsive eaters.   O.A. has some 54,000 members in 75 countries.  A 12-step group, with its surrender to a higher power, is also not for everyone.  It's also possible, of course, to do what Jean Nidetch did on the way to founding Weight Watchers: assemble a group of friends and meet weekly.

While small groups are better than individual efforts, some kinds of structures are more effective than others.  A reader calling herself GoodMaine Woman (9) reveals a common misconception: "It seems to me the problem is you need a small group of people you trust, and not everyone has that, or wants to," she wrote.   What you really need is a group you sort of trust: a group that has a common goal, but is not made up of close friends.   People who are too close to each other tend to fall into permission-giving.  If a member of the group comes back from a vacation five pounds heavier, group members are sympathetic - It was vacation! Of course you gained weight - the social norm of the group shifts.  It becomes a force for weight gain, much worse than no group at all:  even my weight loss group says it's O.K.  Sympathetic understanding needs to be balanced by tough love.

So how do you create a social norm of tough love?

Weight Watchers does it through the weekly weigh-in - it's confidential, kept between you and the meeting receptionist who weighs you, but that receptionist will not be sympathetic when you have too many pancakes.   More important is the role of the meeting leader.  Weight Watchers has 15,000 of them; virtually all have done the program.  Leaders make sure the group acts as a superego instead of an id.  David Kirchhoff, chief executive of Weight Watchers International, found this in his own weight loss.  He started to use Weight Watchers online.  "But I was only able to lose weight by going to a meeting," he said.  "The leader is not afraid to push and nudge people to take personal responsibility and stay focused and challenged in a positive way.  You feel like you want this person's approval and the approval of the people in your group.  I wanted my gold star every week."

Mary Hurst/News ChiefA weigh-in at a Weight Watchers meeting in Florida.
The leader can change the group dynamic - not an easy thing to do - because that's the job.  The leader has social permission to violate the normal rules of a group.  A leaderless small group can manage to give its members permission to administer tough love, but it takes something strong enough to counteract a group of friends' natural tendency to commiserate and soothe.

There is something strong enough: the competitive instinct, boosted by money. "The Biggest Loser" TV show, which appalls doctors with its emphasis on crash diets, nevertheless turns out to be on to something.  In many workplaces, people are starting their own Biggest Loser contests, assembling people into teams that compete against one another.   Often these contests are sponsored by companies alarmed at the rising costs of their increasingly obese work force.

Individuals and corporations aren't always able to give these contests the structure they need for people to take them seriously.  Enter HealthyWage.  The company, which is less than three years old, started by paying people $100 if they moved from obesity to a healthy weight.  (It makes money through partnerships with companies and advertising to dieters.) Paying individuals didn't work very well - but team competitions did.  So now in HealthyWage's most effective program, people form groups of five.  Each person pays $60 to enter the team in a three-month weight loss contest..  Any loss greater than 1.5 percent of body weight per week isn't counted, to discourage rapid weight loss that is so often not sustained.  Teams compete against others in their city or region for substantial prizes: $10,000 for the team that loses the highest percentage of body weight.  What's important is that the team wins as a group, so every member has a stake in other members' success.

Competition - especially when thousands of dollars are at stake - gives team members social permission to do things they would never have imagined doing before.  Neil Ylanan and Andy Davis, who work at LSG Sky Chefs in Irving, Tex., were on a team that won a $10,000 prize in a competition for teams largely from Dallas and Los Angeles.  Mr. Ylanan, Mr. Davis and their three teammates all lost the maximum weight: for most of them, around 50 pounds.

They did it with the expected strategies: they went to the gym together or played racquetball at lunch hour.  But they also used unorthodox methods.  They set up a BlackBerry Messenger group and sent one another photos of their meals.  There were lots of pictures of grilled chicken salads, but the photo exchange was also a way for members to police one another. "If you were walking by the lunchroom and saw a teammate sneaking a cookie, it made a nice opportunity to take a picture," said Mr. Ylanan.  He took the candy bowls off everyone's desk - whether they were in the competition or not.  He once picked up the box from a frozen meal Mr. Davis was eating to check the ingredients.

"We set up a Google Docs spreadsheet online," said Mr. Davis.  "Anywhere anyone was traveling in the world they could look on the Web page and see everyone's weight goals for the week.  It was interesting to see the numbers and get in tune with what happens every day."

Men often feel a little weird about doing something like checking the ingredients in a colleague's lunch.  That's not normally socially acceptable, especially for a man.  But the competition gave the team members guy permission.  "We were keeping stats online - we knew who was in the lead, who had the most points," said Mr. Ylanan.  "We ran it like fantasy football."

Would they have had that permission if there had been no money involved?   Mr. Ylanan thinks they would have, but maybe not as much.  Money obviously helps, especially with men, who might not otherwise think such intrusiveness acceptable.  But people compete all the time when there's no money in it.  Recognition and bragging rights also matter.

Related
More From Fixes
Read previous contributions to this series.

If Saddleback's Daniel Plan doesn't do well, my guess is that the reason will be that the person each small group designates as health champion wasn't able to create an ethic of tough love.  The solution is specific training in this skill, and perhaps an explicit agreement among members requiring the health champion to emphasize personal accountability.   As for those without a Daniel Plan, so far the evidence says the best scheme is to form teams and compete for a prize big enough that people will set aside the normal rules of polite behavior.  Small groups are the key to behavior change - but they need something to step up the peer pressure and make it work in the right direction. We can't serve God and Mammon, the Bible tells us, but both can help us lose weight and live healthier lives.