Nutrisystem, headquartered in Fort Washington, Pennsylvania, is a commercial provider of weight loss products and services. Initially, the company offered weight loss counseling and products in brick and mortar centers. In 1999, the company moved to a direct-to-consumer business model, selling its products and programs over the Internet and through a company 800 number. Nutrisystem’s programs have been sold on the QVC television home shopping network since 2001 and in Costco stores since 2009.
The company states that its mission is to provide a weight loss program based on quality foods and a nutritionally balanced meal plan. The foundation of all Nutrisystem programs is the home delivery of portion-controlled entrees and snacks. Customers supplement these packaged foods with grocery foods, including vegetables, fruits, and dairy items. When followed, the diet is low in glycemic index and provides nutrition consistent with the Dietary Guidelines for Americans – 2010. Resources are also available for increasing physical activity and obtaining behavioral support.
Separate plans are offered for women and men, at calorie levels that support a weight loss of 1-2 lb/week (approximately 1200 calories per day for women and 1500 per day for men). Approximately 57%, 23%, and 20% of calories come from carbohydrate, protein, and fat, respectively. All plans contain at least 30 g of fiber per day, and have no more than 85 g of sugar, 170 mg of cholesterol, and 2300 mg of sodium per day. Four categories of plans are available: Basic, D, Silver, and Vegetarian. Basic is the core weight management program, which is designed to meet nutrition recommendations for the general population. The D program is designed for people with diabetes and has a nutrition profile that aligns with the recommendations of the American Diabetes Association. The Silver program is marketed to men and women aged 65 years and over. The Vegetarian program supports a lacto-ovo vegetarian diet. The nutrition content of each of these programs – including macronutrient distribution as well as fiber, sugar, cholesterol, and sodium content – is summarized on Nutrisystem’s website for healthcare professionals.
Currently the Nutrisystem program provides over 150 menu choices in four categories: breakfast, lunch, dinner, and snacks/desserts. Most options are shelf-stable products which include bars, muffins, pretzel snacks and pancake mix, as well as microwavable soups and dinner entrees. All shelf-stable microwaveable entrees are developed through retort preparation, which uses heat and pressure to cook food in a strong, sealed package (like a can or pouch). This preparation method allows for safe holding at room temperature and minimizes the need for added preservatives or sodium. Overall approximately 75% of Nutrisystem products have no added preservatives. Nutrisystem also has a line of frozen food choices available called “Nutrisystem Select.”
The Nutrisystem products provide approximately 60% of daily calorie needs. The remaining 40% of daily calorie intake comes from grocery foods, which the customer purchases separately. These grocery food additions include fresh fruits and vegetables and low-fat dairy and protein sources. The program provides specific guidance on how to choose and when to use these grocery additions.
Nutrisystem encourages, but does not require, customers to increase their physical activity (dietary intervention is the main focus of the program). Customers who choose to set exercise goals are given targets for aerobic and strength training activities at the beginner, intermediate, and advanced levels. Online resources in support of customers’ activity goals include sample workouts, articles, discussion boards, tips, and exercise trackers. Nutrisystem recommends that customers consult with a health professional before beginning a new fitness program.
Behavioral Support and Additional Resources
Because Nutrisystem is not offered in brick-and-mortar centers or clinics, behavioral support is not available in face-to-face interactions. The program, however, includes several resources intended to promote motivation, behavior change, and success.
Customers have free access to trained counselors via telephone, online chat, and email. Contact with counselors is initiated by the customer and is not regularly scheduled as a required part of the program.
Research on weight loss programs has consistently found that self-monitoring (i.e., keeping track of weight-related behaviors) is related to losing more weight. Nutrisystem provides paper, online, and mobile device application to encourage customers to record their food intake and physical activity. Customers can also keep track of their progress (weight loss and changes in measurements) on the company’s website.
Behavior modification guide
“Mindset Makeover” is Nutrisystem’s behavior modification guide. The guide includes 13 topics – related to making mental and behavioral changes in support of weight control – that are intended to be completed over 13 weeks. Customers can access the guide in its interactive form online, download a copy of the guide in .pdf format, or purchase a printed copy.
The Nutrisystem website supports an online community, which allows members to participate in discussion boards and chats with their peers or to keep a blog if they wish to do so. Participation in the online community is not a required aspect of the program.
Other resources available on the member website are largely educational or intended to help customers adhere to program recommendations. They include: nutrition, health and wellness articles; daily tips; online recipe center; printable list of recommended grocery foods; comprehensive dining out guides
The standard package includes 28 days’ worth of breakfast, lunch, dinner, and snack entrees. At the time of writing (July 18, 2011) the cost of the Women’s Select package (which includes frozen meal and snack entrees for 10 days), with automated monthly delivery, was $339.99. The Basic package (in which all provided foods are shelf-stable) was sold at $279.99. Men’s packages include an additional snack entrée each day and cost approximately $30 more. Note that Nutrisystem customers must purchase additional grocery foods (e.g., fruit, vegetables, dairy) to complete the meal plans. In January 2011, Nutrisystem was named the “Least Expensive Home Delivery Program” by CBS Money Watch.
Discounts and promotions are frequently offered as an incentive to join the program. A common promotion is the inclusion of multiple weeks of “free” food typically divided among a corresponding number of months. Customers who enroll in the “auto delivery” option (i.e., subsequent shipments of food are delivered without further action by the customer) receive free shipping and a discount of approximately 10% off the month-to-month price. A long-term contract is not required, but purchasing fewer than two orders on “auto delivery” will result in a retroactive charge for shipping on the first order.
Individual Testimonials and Celebrity Endorsements
Until 2009, Nutrisystem’s results were communicated solely in the form of before-and-after photos and testimonials from individual customers. Celebrities that the company counts among its “Success Stories” include Marie Osmond, Dan Marino, Billy Jean King, Angie Everhart, Chris Berman, and Charlie Manuel.
Research on Nutrisystem Programs
In 2009, the first clinical trial related to Nutrisystem was published. The research was funded by Nutrisystem and conducted by Gary D. Foster, Ph.D., and colleagues at Temple University. Participants in the study had type 2 diabetes (not on insulin) and were randomly assigned to receive the Nutrisystem D program plus weekly counseling sessions or a control intervention of diabetes support and education. Weight loss, diabetes control, and other metabolic outcomes were compared after 3 months of intervention. Those in the Nutrisystem group lost significantly more weight than those in the control group (18.1 vs. 1.3 lb). They also achieved significantly more favorable changes in HbA1c (-0.88% vs. +0.03%), fasting blood glucose (-35 vs. -7.4 mg/dl) systolic blood pressure (-5.9 vs. +3.6 mmHg), triglycerides (-44 vs. +6 mg/dl), and total cholesterol (-22.3 vs. -1.8 mg/dl). A greater percentage of participants in the Nutrisystem group (79%) than those in the control group (47%) achieved HbA1c < 7% (a goal for people with diabetes) at 3 months.
The 3-month randomized phase of the study was followed by a 3-month extension period in which all participants received the Nutrisystem D intervention. Those who began on Nutrisystem D for the first 3 months and continued for the next 3 months increased their weight loss to 9.7% of initial weight and maintained a reduction of 0.9% in HbA1c. Those who began in the control group and crossed over to the Nutrisystem D intervention for months 3-6 achieved a weight loss of 5.3% of initial weight and a reduction of 0.87% in HbA1c at that time. There was no follow-up period to examine changes after the intervention was discontinued.
In attempt to determine the real-world applicability of the Foster et al. study results, researchers compared weight loss achieved by study subjects with the results of actual Nutrisystem D customers. Those who recorded their weight online at the time of purchase and again 3 months later achieved an average weight loss of 18.1 lb (equivalent to a 7.6% reduction in initial body weight). More than three-quarters of customers lost at least 5% of their body weight and nearly one-quarter lost at least 10% of their starting weight at 3 months. By comparison, the 5% and 10% thresholds were met by two-thirds and one-quarter of Foster et al. study subjects, respectively.
Nutrisystem researchers presented a study titled “Holiday Weight Change in a Commercial Weight Loss Program” at the 2011 Advances and Controversies in Clinical Nutrition conference, organized by the American Society for Nutrition Medical Nutrition Council. The study examined the average weight change among Nutrisystem customers during the time between Thanksgiving and New Year’s Day and compared it with average changes achieved during similar lengths of time at different points during the year. On average, customers lost 5.5 lb (0.9 lb per week) during the holiday season, and 8.4 – 9.5 lb (1.4 – 1.6 lb per week) during the comparison periods.
Maintenance of Weight Loss
Reviews of the Nutrisystem program criticize the company’s approach as not conducive to long-term weight control. For example, the review on webmd.com states, “Think of the NutriSystem diet as a temporary plan that can help get you started on the road to healthier eating, but keep in mind that you will ultimately have to do it on your own. The challenge is to continue losing weight on a calorie-controlled diet without the advantage of the prepackaged foods.” In response to concerns such as these, Nutrisystem began offering “transition” plans in 2011. The idea behind these plans is to help customers continue following the principles of the Nutrisystem program (portion-controlled, low-GI eating) after they no longer purchase pre-packaged foods from the company. This is achieved by allowing customers to select partial programs (e.g., exclude pre-packaged dinners from their orders) and offering portion-control tools and recipes that are consistent with the nutrition profile of the main weight loss program.
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