health market quality, healthcare, policy, politics

US Healthcare Price Transparency

April 20, 2014 blackfriar

An interesting observation – unintended consequence of non-universal healthcare?: As consumers are being asked to pay more, so they’re trying to become better health-care shoppers.

states have passed transparency laws
medicare has started to dump raw service cost data
private firms are developing their own transparency tools
a report recommends:
- total estimated price
- out-of-pocket costs
- patient safety and clinical outcome data

“Care providers, employers and health plans have negotiated rates, which isn’t necessarily something they want out in the public. They warn making those negotiations publicly could actually discourage negotiations for lower prices — naturally, there are conflicting opinions on this point.”

http://www.washingtonpost.com/blogs/wonkblog/wp/2014/04/16/price-transparency-stinks-in-health-care-heres-how-the-industry-wants-to-change-that/

Price transparency stinks in health care. Here’s how the industry wants to change that.

By Jason Millman Updated: April 16

There’s been much written in the past year about just how hard it is to get a simple price for a basic health-care procedure. The industry has heard the rumblings, and now it’s responding.

About two dozen industry stakeholders, including main lobbying groups for hospitals and health insurers, this morning are issuing new recommendations for how they can provide the cost of health-care services to patients.

The focus on health-care price transparency — discussed in Steven Brill’s 26,000-word opus on medical bills for Time last year — has intensified, not surprisingly, as people are picking up more of the tab for their health care. Employers are shifting more costs onto their workers, and many new health plans under Obamacare feature high out-of-pocket costs.

The health care-industry has some serious catching up to do on the transparency front. States have passed their own health price transparency laws, Medicare has started to dump raw data on the cost of services and what doctors get paid, and private firms have developed their own transparency tools.

“We need to own this as an industry. We need to step up,” said Joseph Fifer, president and CEO of the Healthcare Financial Management Association, who coordinated the group issuing the report this morning. The stakeholder group includes hospitals, consumer advocates, doctors and health systems.

Their recommendations delineate who in the health-care system should be responsible for providing pricing information and what kind of information to provide depending on a person’s insurance status. Just getting the different stakeholders on the same page was difficult enough in the past, said Rich Umbdenstock, president and CEO of the American Hospital Association.

“We couldn’t agree on whose role was what. We were using terms differently,” he said.

The report’s major recommendations include how to provide patients with:

the total estimated price of the service
a clear indication of whether the provider is in-network or where to find an in-network provider
a patient’s out-of-pocket costs
and other relevant information, like patient safety scores and clinical outcomes.

“I think that the focus now, unlike three years ago when it was on access, the focus is about affordability,” said Karen Ignagni, president and CEO of America’s Health Insurance Plans. “What are the prices being charged? It leads consumers to want to know, ‘How do I evaluate all that?'”

To give a sense of just how murky health pricing can be, one of the group’s recommendations is for providers to offer uninsured patients their estimated cost for a standard procedure and to make clear how complications could increase the price. You would think that shouldn’t be too hard — there’s no insurer to deal with, no contracts to consult.

But previous research points out just how difficult it can be to get the price for a basic, uncomplicated procedure. In a study published this past December, researchers found that just three out of 20 hospitals could say how much an uninsured person should expect to pay for a simple test measuring heartbeat rate.

The group’s recommendations also touches on limits to transparency and the “unintended consequences” of too much data being public. Care providers, employers and health plans have negotiated rates, which isn’t necessarily something they want out in the public. They warn making those negotiations publicly could actually discourage negotiations for lower prices — naturally, there are conflicting opinions on this point.

The report nods to other ways at achieving transparency. For example, it talks about “reference pricing” in self-funded employer health plans, in which employers limit what they’ll pay for an employee’s health-care services — thus setting the reference price.

“The employer communicates to employees a list of the providers who have agreed to accept the reference price (or less) for their services. If an employee chooses a provider who has not accepted the reference price, the employee is responsible for the amount the provider charges above the reference price,” the report reads, noting that Safeway grocery stores implemented a successful pilot program that expanded a few years ago.

Perhaps what’s most significant about these recommendations is the stakeholders’ acknowledgement that the health-care market is changing. Consumers are being asked to pay more, so they’re trying to become better health-care shoppers

AHIP’s Ignagni said most insurers already provide cost calculator tools and quality data on their Web sites. Providers, said the AHA’s Umbdenstock, need to be more accommodating to patients’ price-sensitivity.

“‘We can’t answer your question’ may have worked in the past, but it doesn’t fly any longer,” said Mark Rukavina, principal with Community Health Advisors and a report contributor. “This [report] basically lays out the principles for creating a new response to the question.”

Jason Millman covers all things health policy, with a focus on Obamacare implementation. He previously covered health policy for Politico. He is an unapologetic fan of the New York Yankees and Giants, though the Nationals and Teddy Roosevelt hold a small place in his heart. He’s on Twitter.

recipe

Guacamole

April 19, 2014 blackfriar

2 ripe avocados, halved, stones removed, peeled
1 small red onion, finely chopped
1 ripe tomato, finely chopped
2 garlic cloves, crushed
1 small fresh red chilli, deseeded, finely chopped
60mls (1/4 cup) fresh lime juice
Salt & ground black pepper, to taste

Step 1
Place the avocado flesh in a medium bowl and use a fork to mash until almost smooth.
Step 2
Add the onion, tomato, garlic, chilli and lime juice and use a spoon to mix well. Taste and season with salt and pepper.

Note: This guacamole will keep for up to 1 day in an airtight container in the fridge. Serving suggestions: spread on sliced Italian bread instead of butter and top with sliced ripe tomatoes, torn rocket leaves, salt and pepper; or serve with homemade pits chips.

From: http://www.taste.com.au/recipes/10934/guacamole

management and leadership

GE’s Talent-Review System

April 19, 2014 blackfriar

http://blogs.hbr.org/2014/04/the-secret-ingredient-in-ges-talent-review-system/

Interesting (extremely high level) observations on the importance of dedicating time to people/performance issues.

The Secret Ingredient in GE’s Talent-Review System

by Raghu Krishnamoorthy | 10:00 AM April 17, 2014

GE is often highlighted as an organization that develops some of the most effective leaders. Most companies have a version of the talent-review system we use at GE. But judging from what I hear from managers of companies that visit us to benchmark our system, the difference between our approach and theirs does not lie in forms, rankings, tools, or technologies. It lies in the intensity of the discussion about performance and values. The debate, the dialogue, and the time taken to have an exhaustive view of an individual − evaluating them based on both what they accomplish and how they lead − are far more important than any of the mechanics. The heart of our system has always been about the enormous time commitment the organization and the leadership devote to the conversation about people.

As the custodian of the talent-review process, I have been lucky to observe this at close quarters. Here is what I’ve learned.

It starts with the attention given to the individual appraisal. Managers are expected to dedicate time to prepare for a detailed discussion of a direct report’s performance and values, strengths, development needs, and development plans. Most employees spend over 1,800 hours a year working for the manager and the company. Is it unreasonable to expect the manager to spend at least a few hours thinking about and discussing the performance appraisal as part of a larger commitment to helping the employee be more successful? (More about that in a moment.) Individual appraisals are considered enormous opportunities for the candid, constructive conversations that employees deserve.

It is not uncommon for a manager’s assessment and feedback to be questioned by his or her own manager, if the commentary does not appear to reflect the individual accurately. I have seen our top leaders return an appraisal because it did not do justice to the feedback on the individual. Such a disconnect is the worst thing that can happen because it is a reflection of the manager, or the HR manager, as much as it is of the employee. This practice of multi-level engagement ensures that the quality of the appraisal is honest and comprehensive.

We continue to use a nine-block grid with quadrants that capture levels of performance and values not as a means of a forced ranking but as a way of facilitating differentiation.Here is how it is done. As our businesses and functions go through the process, the leaders justify the positioning of talent in different quadrants of the grid. The system allows us to link the grid straight to the appraisal. The chairman sets the overall tone and expectations, and leaders across the company make suggestions, comments, and additions to the feedback. While each leader may only have visibility into his or her particular business, the system ensures consistency and provides a consistent view and assessment of talent across the company.

Most of our leaders, including the chairman, spend at least 30% of their time on people-related issues. It’s part of our operating rhythm. These discussions are rich in making calls on leadership, succession, opportunities for development, organization and talent strategy, diversity, and global talent builds. The discussions also afford us the opportunity to assess performance more closely and holistically − including market factors, internal factors, organizational complexity, and risk elements. More importantly, it is the business leaders who take the lead on these discussions, not the HR person. This is consistent with our philosophy that talent development and assessment is a key business agenda, not just an HR activity.

Some skills are more important than others to be a great leader. As I have observed these discussions, some of the patterns are becoming increasingly obvious to me. For instance, the difference between a great leader and a good one is not just about intellectual capacity; it is often about judgment and decision-making. Likewise, a hunger to win, tenacity, customer advocacy, and resourcefulness can trump some of the skills we often look for − analytical skills, for instance. Such traits are best unearthed through discussions and become important considerations for future talent mapping.

Effective talent review is an intensely human process that calls for extensive demands on a leadership’s time. There are no formulas or equations. The power lies in giving people the attention, candid feedback and mentoring they deserve through a company-wide commitment to human-capital development.

RAGHU KRISHNAMOORTHY

Raghu Krishnamoorthy is GE’s vice president of executive development and chief learning officer.

healthcare, healthy habits, musings, nutrition, policy, politics, rapid learning health systems

Katz on managing severe obesity

April 18, 2014 blackfriar

good, balanced diatribe..

http://www.linkedin.com/today/post/article/20140408142414-23027997-severe-obesity-let-em-eat-kale

Severe Obesity? Let ‘Em Eat Kale!

The tale of aristocratic indifference on the part of Marie Antoinette, Queen of France at the time of the French Revolution, wife of Louis XVI, is, we now know, likely apocryphal. Still, like many historical distortions, this one reverberates through modern culture just the same, and harbors meaning as archetype, if not as reliably archived fact. You no doubt know the tale:

The peasants were starving and had no bread. Marie allegedly suggested: “let them eat cake!”

We find a modern day analogue in the advice dispensed by foodie elite who suggest that the masses should just eat “real” food. The definition of “real” is generally left open to interpretation- but of course, Marie never said what kind of cake, either.

The connotations of “real” are clear enough: pure, unpackaged foods; those icons of nutritional virtue about which the wholesome truth is so self-evident that ingredient lists and nutrition fact panels are superfluous. Wild salmon comes to mind. And broccoli, presumably organic. And fresh berries.

In other words, since the people have no whole-grain bread: let ‘em eat kale!

Now, frankly, I’m quite partial to kale. And, for that matter, the potentially even more nutritious fiddlehead ferns. But I have a real antipathy for fiddling around, or issuing jejune exhortations, while Rome is burning. And burning, it is.

For those inclined to celebrate the recent and radically distorted ping about childhood obesity rates ‘plummeting,’ came this week’s predictably countervailing pong: they have not plummeted after all. More importantly, the most recent paper on childhood obesity trends shows that severe obesity is rising disproportionately.

That’s worth reiterating: whatever is happening to overall obesity rates, rates of severe obesity are rising briskly in children. Prior research had already indicated that was true in both children and adults, so speaking of cake, this is really just icing on what was already well baked. But we seemed in need of a timely reminder.

Fundamentally, this means that it may no longer help us much to ask and answer: how many Americans are overweight or obese? That number, or percentage, may now be level and rather uninteresting, if only because it is pressed up against the ceiling. To gauge the severity of hyperendemic obesity in our culture, we may now need to ask: how overweight and obese are the many?

The answer, ever more often, is: severely.

That severe obesity rates are rising steadily and perhaps steeply has two flagrant implications. The first is that we are not doing nearly enough at the level of our culture to make eating well, being active, and thereby controlling weight the prevailing norm. These two behaviors and one outcome remain exception rather than rule, costing us dearly- in every currency that matters, human potential above all.

The second implication is that we need good treatments for severe obesity, since it is already well established among us.

I have first hand experience with severe obesity, in adults and kids alike. Unlike garden-variety weight gain, severe obesity generally occurs in the context of diverse hardships. Sometimes, there is the duress of a dysfunctional family dynamic. Sometimes there is an underlying mental health problem. Sometimes the propagating factors are preferentially, if not exclusively, socioeconomic: a rough neighborhood, with lack of access to “real” food and recreational opportunities, and the inevitable clustering of fast food franchises. That latter peril makes me think of wolves surrounding the most vulnerable member of a herd. Almost inevitably, there is ridicule, disparagement, and disadvantage; the literal, daily addition of insult to injury.

Bariatric surgery is effective treatment for severe obesity, and I have long advocated strenuously that it should be available, and reimbursable, for all who truly need it. But meaning no disrespect to the surgeons who provide or patients who receive it, it’s a rather poor option and should be a last resort, not a first, especially for children. The surgery is potentially major, and thus encumbered by all of the customary risks. The long-term effects are far from perfect, and substantially unknown for children. The monetary costs are apt to be unmanageable if this becomes the “go to” solution for an increasingly prevalent problem.

And most importantly: nobody learns anything under general anesthesia. The root causes of severe obesity are not addressed with scalpels. There is no way to share the benefits of a redirected gastrointestinal tract. In contrast, “skillpower” can be shared. A systematic effort to empower those most in need with the skills and resources needed to eat well, be active, lose weight, and find health- physical and mental- would allow for paying it forward, to family and friends, and the next generation. The good of surgery is contained within a body. The good of propagating skills and resources for healthy living reverberates throughout the body politic.

My friend David Freedman, the highly accomplished health journalist, and I have had a spirited and fairly public exchange on the topic of “getting there” from here. When Mr. Freedman suggested that better junk food could be part of the answer, I protested: anything that is genuinely part of the solution is, by definition, no longer junk. When I emphasized the importance of knowing what dietary pattern is best for health, Mr. Freedman parried back that I might be diverting attention from the critical need to pave a way of getting there from here, accessible in particular for those currently most forestalled.

But in the end, our private exchanges indicated that our public argument was mostly smoke and just about no fire. We both agree that we can’t have good diets supporting good health if we don’t acknowledge we know what a good diet is. And we both agree that knowing that “real” food is good does just about nothing to help modify and improve the diets and health of real people.

For that, we need an expansive cultural commitment; a movement; perhaps even a revolution. We need approaches to severe obesity that don’t just fix it after it happens. Big Surgery and Big Pharma may be beneficiaries of this, but the rest of us will be in one helluva fix. The better way is introducing innovative solutions that confront it at its origins and spread of their own accord.

We need to reorient our cultural attitude about obesity so it is not an excuse to argue the respective merits of personal responsibility and public policy. Rather, if we are to fix it at its origins, we need to acknowledge that people who are empowered are most capable, and most inclined, to exercise responsibility. So let’s build it, and see what comes.

We can, and should, empower people to trade up the food choices they are already making.Better chips may not satisfy the purists, but the evidence is in hand that improving food choices- even among the homely fare that comes in bags, boxes, bottles, jars, and cans- adds up to make a truly important difference for populations, and individuals alike. This can be done without spending more money, urban legend to the contrary notwithstanding. Still, we could likely accomplish far more by combining nutrition guidance systems with financial incentives that encourage their use.

Among such approaches, too, are community and New-Age approaches to gardening that might even allow many more of us to grow our own kale- and perhaps fiddlehead ferns.

But “let ‘em eat kale” simply won’t do. It’s fatuous, unrealistic, elitist nonsense. It’s fiddling around. And all the while, Rome burns.

-fin

Dr. David L

healthy habits, musings, nutrition, policy, politics

Is Big Food the new Tobacco?

April 18, 2014 blackfriar

Finally commented on the Food Politics blog. Excitement.

APR172014

Is Big Food the new Tobacco?

Thanks to Maggie Hennessy at FoodNavigator-USA for her report on a meeting I wish I’d been able to attend—the Perrin Conference on “Challenges Facing the Food and Beverage Industries in Complex Consumer Litigations.”

Hennessey quotes from a speech by Steven Parrish, of the Steve Parrish Consulting Group describing parallels between tobacco and food litigation.

From the first lawsuit filed against [tobacco] industry member in 1953 to mid-1990s, the industry never lost or settled a smoking and health product liability suit. In the mid ‘90s the eggs hit the fan because the industry for all those decades had smugly thought it had a legal problem. But over time, it came to realize it had a society problem. Litigation was a symptom of the disease, not the disease itself.

…When it came time to resolve the litigation, we couldn’t just sit in a room and say, ‘how much money do you want?…A lot had nothing to do with money. It had to do with reining the industry in…We spent so much time early on talking to ourselves about greedy trial lawyers, out-of-touch regulators, media-addicted elected officials and public health people who didn’t know how to run a business. At the end of the day, it didn’t matter. We would have been much better off recognizing these people had legitimate agendas.”

… Maybe there are some parallels, but I urge people not to succumb to the temptation to say, ‘cigarettes kill you, cigarettes are addictive. But mac and cheese, coffee, and Oscar Meyers wieners don’t. That may be true, but there are still risks for the industry.

The article also quotes Michael Reese, plaintiff’s attorney for Reese Richman LLP, talking about the increasingly accusatory tone of media coverage of Big Food:

There’s this idea, which has picked up steam in the media, that large food companies are manipulating ingredients to hook people on food. It hasn’t been manifest in litigation yet, but we’re seeing it with legislative initiatives, like Mayor Bloomberg in New York City saying sugar hooks people and causes diabetes. We’ve seen some with GMOs, though most of that legislation is about consumers’ right to know. But there’s this overarching concept that Big Food is somehow manipulating our food supply and as a result, giving us non-food.

Sounds like the message is getting across loud and clear.

Thoughts?

Paul • a minute ago

If I smoke a cigarette right this minute, I am no more likely to die than if I drink a bucket of soda. But if I repeat these activities sufficiently frequently and over a long enough period of time, I will most certainly be harmed, and in time, killed.

To deny these realities because there are no clear differences in types of food, or to claim that we need to eat, while smoking is optional, plays directly into the hands of the spivs fighting for the status quo.

Drop the academic pretensions and start fighting the good fight, just like Prof Nestle and Mayor Bloomberg.

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Jennie • 17 hours ago

Tobacco and food are too dissimilar to succeed with the same strategy. It was realistic to insist all tobacco products should be avoided and to legislate against smokers. People have a choice between not smoking or smoking while standing outdoors only. And of course there was second hand smoke to up the ante. With food there is no secondhand smoke and we all must eat something. Can we successfully vilify all food and all eaters. Maybe we can make everyone eat outside if they insist upon eating at all. It is so impractical I wonder why anyone would try to pattern food legislation after tobacco legislation. I certainly wonder what the agenda really is because to outlaw some food and some eaters implies there will be specially anointed experts to distinguish the “bad” foods from the “acceptable” foods. Who will be wearing the badges to get this accomplished? It just sounds too creepy somehow. Or maybe just lazy and ignorant.

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kalihikai • 9 hours ago

There are profound similarities between how the Tobacco industry hid toxicity findings to human health and that of big aquaculture, particularly salmon and shrimp farming. As you may know, by traveling to Norway–where there are no longer any wild salmon due to pollution and disease from farmed salmon in the migratory Fjords, farmed salmon preferentially accumulate dioxin-like PCBs to such an extent that a recommended 200 gram serving exceeds the WHO’s tolerable daily intake for dioxins. Just like tobacco, salmon aquaculture across Norway, Scotland, Canada and Chile promote their product as “healthy” when it is anything but. We have known the contamination since 2004 with Dr. Hites landmark publication in the journal Science. Today, we have pediatricians, pathologists and academic diabetes researchers in Norway calling for revising the national guidelines to reduce farmed salmon consumption, especially for pregnant women and children. The similarities are clear, if you really look.

healthy habits, nutrition, quantified self, rapid learning health systems, research methodology

Quantified Diet Findings

April 18, 2014 blackfriar

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People have more goals than they have willpower for. That’s just the way our ambition works. They give up, get distracted, or prioritize some other goal.

https://medium.com/inside-lift/be4809e34563

TLDR; This is the story of how we used the Lift Goal Coaching app to build an ongoing 15,000+ person experiment to compare popular diets. The good news is that dieting works, especially if it means giving up sugar and fast food. See our charts below or take our weight loss calculator. Or better, join one of our diets and contribute to science.

About a year ago, we ran a one-off research project into the Slow-Carb Diet™ that turned up surprisingly strong results. Over a four week period, people who stuck to the diet showed an 84% success rate and an average weight loss 0f 8.6lbs.

But are those results legit? If I picked a person at random out of a crowd, could they expect to see the same results? Almost immediately after publishing the results we started getting feedback about experimental bias.

This first study was biased, which means it doesn’t carry any scientific confidence. That’s a fixable problem, so we set off to redo the study in a bigger and more rigorous way.

That led to the Quantified Diet, our quest to verify and compare every popular diet. We now have initial results for ten diets. This is the story of our experiment and how we’re interpreting the diet data we’ve collected.

Understanding Bias

To understand bias, here’s quick alternative explanation for our initial Slow-Carb data: a group of highly motivated, very overweight people joined the diet and lost what, for them, is a very small amount of weight. In this alternative explanation, the results really are not very interesting and they definitely aren’t generalizable.

However, we had some advice from academics at Berkeley aimed specifically at overcoming the biases of the people who were self-selecting into our study. The keys: a control group following non-diet advice and randomized assignment into a comparative group of diets.

Our Experimental Design

The gist of our experimental design hinged on the following elements:

We were going to start by comparing ten approaches to diet: Slow-Carb, Paleo, Whole Foods, Vegetarian, Gluten-free, No sweets, DASH, Calorie Counting, Sleep More, Mindful Eating.
Lift wrote instructions for each diet, with the help of diet experts, and provided 28-day goals (with community support) for each diet inside our app.
We included two control groups, one with the task of reading more and the other with the task of flossing more.
Participants were going to choose which of the approaches they were willing to try and then we would randomly assign from within that group. Leaving some room for choice allowed people to maintain control over their health, while still giving us room to apply a statistically relevant analysis.
Participants who said they were willing to try a control group and at least two others were in the experiment. This is who we were studying.
A lot of people didn’t meet this criteria, or opted out at some point along the way. We have observational data on this group, but they can’t be considered scientifically valid results for the reasons around bias covered above.
Full writeup of the methodology coming.

Top Level Results

At the beginning of the study, everyone thought we were going to choose a winning diet. Which of the ten diets was the best?

Nine of the diets performed well as measured by weight loss. Here’s the ranking, with weight loss measured as a percentage of body weight. Slow-Carb, Paleo and DASH look like they led the pack (but keep reading because this chart absolutely does not tell the whole story).

If you don’t like doing math, the above chart translates to between 3-5lbs per month for most people. If you really don’t like doing math, we built acalculator for you that will estimate a weight loss specific to you.

Sleep, which never really had a strong weight loss hypotheses, lost. We ended up calling this a placebo control in order to bolster our statistical relevance.

Before moving on, lets just call out that people in the diets were losing 4-ish pounds over a one month period on average. That’s great given that our data set contains people who didn’t even follow their diet completely.

The Value of the Control

The control groups help us understand whether the experimental advice (to diet) is better than doing nothing. Maybe everyone loses weight no matter what they do?

This sounds unlikely, but we were all surprised to see that the control groups lost 1.1% of their body weight (just by sleeping, reading and flossing!)

Is that because they were monitoring their weight? Is it because the bulk of the study occurred in January, right after people finished holiday gorging? We don’t actually know why the control groups lost weight, but we do know that dieting was better than being in the control.

Here’s the weight-loss chart revised to show the difference between each diet and the control (this chart shows the experimental effect).

The Value of Randomized Assignment

Randomized assignment helps us feel confident that the weight loss is not specific to the fans of a particular diet.

Because of the randomization, we can ask the following question. For each diet, what happens if we assigned the person to a different diet?

This is an indicator of whether a diet is actually better or if the people who are attracted to a diet have some other characteristic that is effecting our observational results.

The obvious example of bias would be a skew toward male or female. Bigger people have more weight to lose (male), plus we observed that males tended to lose a higher percentage of their body weight (2.8% vs. 1.8%).

Comparing the diets this way adds another promising diet approach: no sweets. But let’s, be real, the differences between these diets are very small, less than half a pound over four weeks, as compared to doing any diet at all, five pounds over four weeks. Our advice is pick the diet that’s most appealing (rather than trying to optimize).

Soda is bad! And other Correlations.

What else leads to weight loss?

It helps if your existing diet is terrible (your new diet is even better in comparison). People who reported heavy pre-diet soda consumption lost an extra 0.6% body weight.
Giving up fast food was also good for an extra 0.6% (but probably not worth adding fast food just to give it up).
Men lost more weight (2.6% vs 1.8%).
Adherence mattered (duh). Here’s a chart with weight loss by adherence.

How much of the time did people follow the diet advice?

Choosing a Diet

Ok. Now I think I’ve explained enough that you could choose one of these diets. All of them are available via the Lift app available on the web, iPhoneand Android.

Given that all the diets work, the real question you should be asking yourself is which one do you most want to follow.

I can’t stress that enough. It’s not just about which had the most weight loss. Choose a diet you can stick to.

Let’s Talk Success Rate

Adherence matters. Even half-way adherence to a diet led to more than 1% weight loss (better than the control groups).

This brings up an interesting point. So far, our data is based on the people who made it all the way to the end of our study. This is the survivor bias. We don’t know what happened to the other people (hopefully the diets weren’t fatal).

In order to judge the success rate of dieting you’ll have to use some judgement. But we can give you the most optimistic and most pessimistic estimates. The truth is somewhere in between.

Of people who gave us all of their data over four weeks, 75% lost weight. Let’s call this the success rate ceiling. It includes many reasons for not losing weight, including low adherence. But at least they paid attention to the goal for the entire time. The weight loss averages are based on this group.

Of people who joined the study, only 16% completed the entire study (and 75% of those lost weight). So, merely joining a diet, with no other data about your commitment, has a success rate of 12%. Let’s call this thesuccess rate floor.

Read that floor as 12% of people who merely said that they were interested in doing a diet had definitely lost weight four weeks later. There’s no measure of commitment in that result. If we filter by even a simple commitment measure, such as the person fills out the first survey on day one, then the success rate jumps from 12% to 28%.

If you are making public policy, then maybe that 12% number looks important. People have more goals than they have willpower for. That’s just the way our ambition works. They give up, get distracted, or prioritize some other goal.

If you are an individual, I’d put more weight in the ceiling. You want to know that whatever path you choose has a chance of succeeding. 75% is a number that should give you confidence.

Losing Weight?

We’ve focused on losing weight for two reasons. One, it’s a very common goal. But, two, it’s also the strongest signal we got out of our data.

We also measured happiness and energy but the signal was weak. We didn’t measure any other markers of health. That’s important to note.

We are behavior designers, so we’re looking at the effectiveness of behavior change advice. You should still consult a nutritionist when it comes to the full scope of health impacts from a diet change. For example, you could work with our partner WellnessFX for a blood workup (and talk to their doctors).

Open Sourcing the Research

We’ve open sourced the research. You can grab the raw data and some example code to evaluate it from our GitHub repository.

All of the participants were expecting to have their data anonymized for the purposes of research. Take a look and please share your work back (it’s required by the CC and MIT licenses).

There was some lossiness in the anonymization process. We’ve stripped out personal information (of course), but also made sure that rows in the data set can’t be tied back to individual Lift accounts. For that reason some of the data is summarized. For example, weight is expressed as percentage weight loss and adherence is expressed on a 1-5 scale.

If you want to go digging around in the data, I would suggest starting by looking at our surveys where we got extra data about the participants: day 1,week 1, week 2, week 3, week 4.

Citizen Science or No Science

I’m expecting that our research will spark some debate about the validity of scientific research from non-traditional sources. I expect this because I’ve already been on the receiving end of this debate.

Here’s how we’re seeing it right now. I acknowledge that we already have a robust scientific process living in academia. And I acknowledge that the way we ran this research broke the norms of that process.

The closest parallel I can think of is the rise of citizen journalism (mostly through blogs) as a complement to traditional journalism. At the beginning there was a lot of criticism of the approach as dangerous and irresponsible. Now we know that the approach brought a lot of benefits, namely: breadth, analysis and speed.

That’s the same with citizen science. We studied these diets because we didn’t see anyone else doing it. And we’re continuing to do other research (for example: meditation) because we’re imagining a world where everything in the self-improvement space, from fitness to diet to self-help, is verifiably trustworthy.

Continuing Research

One of our core tenants with this research is that we can revise it. We didn’t have to write a grant proposal and it didn’t cost us anything to run the study. In fact, we’re already revising it.

To start with, we’re adding in one more diet: “Don’t Drink Sugar.”

We wrote this diet based on the study results and a belief in minimal effective interventions. So, if you’re at all interested in losing weight while contributing to science, please sign up for the Quantified Diet.