While a company like Weight Watchers requires customers to pay for its services, a program at Temple University takes a different tack, paying teenagers as they succeed in losing weight.
The weight-loss program at Temple's School of Medicine is focused on teenagers like 11th grader Isaiah Sutton, who stood 5-foot-7 and weighed 190 pounds. Since he joined the program in January 2009, Sutton, 17, has lost more than 20 pounds.
On average, participants in the group have lost 10 pounds over two years - not the gargantuan drops logged on reality TV, but sustainable and life-changing, participants hope. Besides the weight loss, they've gotten to build relationships with Temple medical students.
Obesity among teenagers and adolescents is rampant in the United States. About 17 percent of children and adolescents are obese, according to 2007-08 federal surveys. Unhealthy weight gain from poor diet and lack of exercise is responsible for more than 300,000 deaths of children each year, according to a 2008 report by the American Academy of Child and Adolescent Psychiatry.
The Temple effort was begun in January 2009 by Temple pediatrician Eric Schaff, who still refers all the patients to the program.
"We see a great number of teens who are overweight, and who need a combination of social support, education, and concrete exercise to target their weight problems," he said.
So he created a program run by about 20 medical students that's part discussion, part activity. It was recently recognized as an official group on campus and receives school support. Before that, Schaff paid for everything, including supplies, snacks, and incentives.
"He cares more than most about these teens," said second-year medical student Ida Teberian, the program's president. "Without him, this whole program would not have been possible."
Volunteer medical students meet with the teenagers once a week for a couple of hours, and collectively see about 100 patients a year.
The teens are also offered financial incentives for losing weight. They get a $5 gift card for the first five pounds lost, two gift cards for the next five pounds, and so on.
"We hoped that the incentives combined with everything else would create a program that would help teens feel better about themselves," Schaff said.
There's some evidence to support that approach. Financial incentives "appear to be highly effective in inducing initial weight loss," a 2008 study in the Journal of the American Medical Association found.
The researchers, led by Kevin Volpp of the University of Pennsylvania, found that participants in the incentive-based weight-loss group lost significantly more weight than those in the control group; 52.6 percent of those in the first group met the 16-pound target weight loss, compared with only 10.5 percent of those in the second group.
"There is research out there that has shown that adults respond well to incentive-based weight-loss programs, but no one has really studied the effect in teenagers," Schaff said. "We've found that the teens are actually pretty responsive to it because it's the only source of income for many of them."
The sessions alternate between discussion and physical activity. The discussions cover everything from healthy diets to disease, violence, and sexual education.
"We usually ask them what they want to talk about," Teberian said. "We cater to the people we're talking to, so when we talk about healthy eating, we discuss things like how to avoid obstacles in the school cafeteria."
When the classes focus on physical activity, they may involve basketball or football, or even a hip-hop dance class.
Outside the program, the teens are assigned two medical students as mentors whom they can phone or text any time. Each teen gets two students in case one has no time to talk that week.
"We decided early on that we didn't just want the program to be based on weight loss, because as a teen, everything in your life affects that," Teberian said. "Every teen is going through a lot at this stage in their life, and it's even worse in North Philadelphia."
Teberian described the mentors' interactions with the teens as a "careful balance between being a friend and using your authority."
"Most of us didn't grow up in North Philly, and it took a lot of time to get a flow and see what was going to work," she said. "You have to be on their level and act like you're their age a bit, but be an adviser at the same time too."
Teberian said she and others volunteered because "the first two years of medical school can feel unrewarding because you're just studying." The group brings Teberian "the most true form of joy," she said.
"I went through a lot in life that made me look for true happiness," she said. "Being in medical school and helping other people has done that for me. I can't get that feeling from anything else than when I realize I've gotten through to one of these teenagers and they tell me they miss me."
Isaiah Sutton texted Teberian throughout the summer, about everything from academic-related stress to just saying hi.
He texted her in October while in a diabetes walk, saying how happy he was that he had been able to keep walking and not have to stop.
Isaiah also used Teberian as a job reference.
Before joining the program, Isaiah was becoming increasingly depressed about his weight. He now belongs to the school track team, and wants to get a business degree after graduating from the World Communications Charter School, his high school.
"We always have so much fun," he said of the program. "We're like a little family."
Both of Isaiah's parents are diabetic, so he makes sure to bring home information on the disease, and he has helped his mother, Tina, lose 68 pounds.
"The program hasn't just helped my son - it's helped the whole family," Tina Sutton said.
Teberian stresses that the program is not just about weight loss, but about becoming healthier overall. And having these teenagers respond to their mentoring is a good sign this is working.
"It's a testament to the fact that becoming truly healthy is not about shedding weight right away, but teaching them things that will impact them for the rest of their lives," Teberian said.