Twelve years ago, Michael Cameron was on his hands and knees in his doctor’s office. He had once been able to do dozens of push-ups, but because he had put on 105 pounds in the five years since college, his arms now shook with the effort of not collapsing to the floor. “What’s wrong with me?” he moaned. His doctor suggested antidepressants. Cameron walked out of the office and had an epiphany. “I thought to myself, I know how to solve this problem,” he says.
Actually, solving behavior problems was what he did for a living. Cameron was an experimental psychologist specializing in behavior analysis at McLean Hospital, Harvard’s teaching hospital for psychiatric disorders, and was the founding chairman of the behavioral-analysis department at Simmons College, in Boston. Amid all the various weight-loss solutions he’d considered, he’d never thought to try his own field’s techniques. Now he asked himself: What would Skinner do?
Cameron looked for aspects of his environment that were abetting his overeating. He worked nonstop at the office, eating very little there, so he was famished when his commute home took him past a long line of fast-food restaurants. After scarfing a meal from one of those, he would come home to a paperwork session conducive to the mindless munching of calorie-bomb snacks—he was particularly partial to peanut butter. He would vow to exercise the next morning but find himself running out the door to work instead. Little by little, he started making changes. He prioritized eating a decent breakfast and lunch, and found a new route home that bypassed the junky restaurants. He came home and immediately prepared healthy snacks, including a low-calorie peanut-based food, so they’d be in front of him while he worked. To kick-start his workouts, he got his gym bag ready at night and left it in front of the door. He religiously tracked his food intake, exercise, and weight, graphing the results to see how his efforts were paying off. He enlisted his colleagues, friends, and family to support him.
Cameron eventually lost more than 100 pounds, and has kept every one of them off in the years since, losing a few more besides. Though he focuses on children with special needs—he’s now the clinical director of Pacific Child and Family Associates, a national chain of clinics headquartered in Santa Paula, California—he also works independently with a small number of clients who want to lose weight. Five years ago, recognizing that he didn’t have time to personally help as many people as he’d like, he started wondering how he could extend his reach. Could weight-loss programs be administered remotely, or even in a semi-automated fashion?
The tools seemed to exist. Plenty of Web-based programs tracked food intake and exercise, and smartphone apps were starting to offer similar options. Videoconferencing allowed not only for remote one-on-one coaching, but also for group meetings. And Twitter made impromptu check-ins, questions, and encouragement easy. “I realized there wasn’t any part of it that couldn’t be done on a screen,” Cameron says. “And that meant it would be easy to scale up.” He started some pilot projects, enlisting graduate students to help coach and lead groups.
It was Cameron’s name I gave to my brother that night—I had heard about his program from scientists in the behavior-modification field. Starting a few weeks later, the first thing Dan did every morning was step on a scale that wirelessly transmitted his weight to his computer, which automatically Tweeted any loss or gain to the other participants in Cameron’s program. Every time I saw him, he’d pull out his phone to read an encouraging tweet from one of them, or fire off one of his own, or plug in the components of the meal he was eating, or check how many minutes of walking he’d logged that day. Sometimes he’d excuse himself for 10 minutes to take part in a group meeting on his laptop.
Over the course of a few months, I watched him gradually transform from the guy who had always piled his plate high with fried chicken and french fries to the guy who seemed genuinely thrilled to cap off a brisk walk with a piece of grilled fish, some beans, and a salad. As the habits set and his weight stabilized near his goal, the formal prompts and supports of the program were slowly “faded.” But the new routines seem to have stuck. (I just called him to check—he weighed 168 this morning.) Cameron has followed up with many of his past clients, and reports that all of them have kept the weight off.
Cameron was ahead of the game, but the world has been catching up to him quickly. Jeff Hyman, a successful serial Internet entrepreneur, spent one week and about $14,000 for himself and his wife at Canyon Ranch three years ago, and was struck both by the effectiveness of its behavior-modification approach and by the realization that the same techniques could be applied online at a much lower cost. He recruited two highly regarded behavior change–focused obesity researchers to design a one-year, Web-based program called Retrofit, which launched late last year.
Retrofit users track their eating and exercise online and have weekly Skype sessions with a registered dietician, a psychologist, and a “mind-set coach.” (If a client loses 10 percent of his or her weight by the end of the year, Hyman doubles these three employees’ compensation for that particular client.) After the year is up, clients can still arrange occasional consultations, and Retrofit continues to monitor their weight via wireless scale, so that a coach can reach out if the number starts to rise. “We have no interest in helping you lose weight” temporarily, says Hyman. “We want you to keep weight off.”
Though Cameron’s and Hyman’s programs create relatively effective virtual Skinner boxes, they don’t solve the cost problem. Retrofit charges about $3,000, and while Cameron hasn’t charged for his services, he calculates that were he doing this for a living, his fees would have to be in that ballpark as well. That’s a bargain for intensive programs of this sort, but still out of range for much of the public. The reason, of course, is that both programs remain dependent on relatively highly paid professionals to deliver the sort of one-on-one behavioral coaching and problem-solving that has always been key to Skinnerian behavior change.
But technology is radically lowering that cost barrier. Today, for absolutely nothing, would-be weight-losers can download many of the key elements of a Skinnerian behavior-modification program directly to their phones and computers. One of the most popular options is Lose It, an app and Web site that allows users to pick a goal weight and a time line for reaching it, and then formulates a daily calorie count accordingly. Lose It then lets users track their eating and physical activity, which they can do by holding their phones up to a food package’s barcode, or by tapping the screen a few times at the start and end of a walk (the app offers a range of activity categories, including guitar strumming, household walking, and sex). Lose It uses this data to provide clear, graphic feedback on users’ daily progress—you might see at a glance that having dessert will send your numbers into the red, but that if you walk for 20 minutes after dessert, you’ll go back into the green.
My wife, who has been struggling with her weight since the birth of our third child nearly two decades ago, started using Lose It late last year. Within three months, she was down to her college weight. Now several of her friends, family members, and colleagues have downloaded the app and are using it to lose weight steadily and comfortably. Lose It’s Boston-based parent company claims 10 million users so far and an average per-user weight loss of 12 pounds—an amount most doctors consider enough to dramatically improve health. Weight Watchers has since released a roughly similar app of its own.
Like most other Skinnerian weight-loss apps, Lose It lets you share your data with others for that all-important social support. But some tools take this sharing much further. Rajiv Kumar and Brad Weinberg, while on rounds as medical students at Brown University six years ago, were struck by the observation that the patients who lost weight or made other difficult changes in their behavior seemed to be the ones who set clear goals and then got lots of encouragement to meet them from friends, family, and co-workers, and especially from fellow weight-losers. Kumar and Weinberg took two years off from medical school to found Shape Up RI, a nonprofit with a Web site that allowed users to compete against one another on weight-loss and fitness teams. Shape Up RI tracked steps walked, miles run, vegetables eaten, and pounds lost, sharing that information among teammates, competitors, and supporters. Today, a for-profit offshoot, ShapeUp, caters mostly to large companies that run team competitions among employees; reinforcement may take the form of prizes, perks, and even money. Kumar, who is now ShapeUp’s chief medical officer, says that the 14,000 employees at one large client have logged nearly 5 billion steps and lost some 41,000 pounds—a shrewd investment for the employer and insurer paying their health-care costs.