GLP-1 Comes For Weight Watchers
As U.S. adult obesity rates doubled between 1990 and 2022 (43.8% in 2022 for women and 41.6% in 2022 for men) Weight Watchers flourished as a focused diet program and service. At its peak in 2018 Weight Watchers had a $6 billion market cap and its’ stock was trading at $100 per share. In 2020, it boasted 4.4 million members.
But to those watching obesity directly or as kindred comparison to substance use disorder treatment approaches, it was no surprise when Weight Watchers’ parent company, WW International (WW), declared bankruptcy on May 6, 2025. As digital times changed including free weight-tracking apps and websites, and with the introduction of GLP-1 drugs, Weight Watchers’ membership programs, emphasizing calorie counts and personal support groups, came under great challenge. The May 2024 departure of celebrity spokesperson Oprah Winfrey, who had been candid with her weight loss and the use of pharmaceuticals, did further damage.
A report in “The Street” reviewed what brought Weight Watchers to this reorganization (“Can Weight Watchers be saved? A look at the company as it files for bankruptcy” Story by Laura Rodini). The idea behind Weight Watchers began in the early 1960s with Jean Nidetch, a Queens, New York homemaker. A compulsive eater, she tried everything, from pills to “fad diets” and hypnosis without success. By age 38, she weighed 214 pounds and was miserable. She invited a group of overweight friends to join her on a diet including that they would help talk each other through their “anxiety, doubt, and gnawing hunger” (in AA and et al “share their experience, strength and hope”). Weight Watchers was formally launched in 1963.
Since its beginnings Weight Watchers has focused on losing weight through diet plans and communal encouragement. Weekly meetings consist of “weigh-ins” and support groups where neighbors and strangers provide praise when the scale registers lower and encouragement when it does not. The Weight Watchers system, which assigns “points” to foods, has been updated to reflect each era’s guidelines for “healthy” eating.
A report by the Associated Press in March of 2023 reviewed Weight Watchers’ response to GLP-1 drugs. (“Weight Watchers going into prescription weight loss business with telehealth provider acquisition”, The Associated Press, March 2023). Weight Watchers decided to participate in the use of pharmaceuticals by purchasing telehealth provider Sequence. As Weight Watchers had produced a food line previously, entering this kind of service to members was not so great a departure. At that time Sequence was a telehealth provider that offered users access to GLP-1 drugs. Even then, however, Weight Watchers noted that weight loss through these drugs worked best with life style changes such as exercise.
Although data from inside the company are not readily available, several reports suggest that this effort did not evolve as well as Weight Watchers had envisioned. Community mutual support, workout meetings, and evidenced based studies about weight and weight loss had been a key element of Weight Watcher’s members’ success and it is not clear that Weight Watchers had figured out how to incorporate these new drugs into its philosophy and system.
To be clear, pharmaceuticals were not the only issues for Weight Watchers. The rise of fitness apps that can be done at home and alone, and the evolution of guided weight loss apps online all ate into Weight Watchers market.
Those of us focused on recovery from substance use disorder cannot help but notice the similarities between approaches like Weight Watchers and twelve step programs like Alcoholics Anonymous that have been the mainstay of recovery for 90 years. Certainly, the twelve steps suggested as a program of recovery, mutual, self-help through meetings that have been augmented but not replaced with online options, and one-on-one personal sharing of strength and hope have similarities to the Weight Watchers programs.
We have previously reported that there are pharmaceuticals deployed for use with substance use disorder and have been since the 1960s. There are two, general categories of pharmacologic treatment – agonists and antagonists. Agonists activate neurotransmitter receptors in the brain mimicking the effect of a specific drug and are often used to ease withdrawal. Agonists typically produce only mild neurological stimulatory effects and are therefore much less habit-forming than drugs of misuse. Antagonists block neurotransmitter receptors in the brain, and like agonists are designed to target receptors activated by particular drugs. Antagonists intend to reduce the likelihood of use of a targeted drug by limiting the “high” and reducing the reward from use. They are also deployed to remedy overdose by reducing the effects of illegal drugs after use. Methadone, naloxone, naltrexone and buprenorphine are all prescribed for use today as short term relief from withdrawal, long term alternatives to opioids, and in some cases a permanent option for the most difficult cases. There are approaches that promote continued alcohol use through the use of naltrexone. Disulfiram, in the product name Antabuse, has become much less popular though still deployed in some cases.
In Substance Abuse and Addiction (“Can Medicine Help With Alcohol Use Disorder?”, Medically Reviewed by Carol DerSarkissian MD, Written by Sonya Collins, May 2023) Sonya Collins discusses these uses of pharmaceuticals for alcohol use disorder. “Most research shows the effects of taking medications for 6-12 months. The benefit of longer-term use is less clear. But the more important question may be: Is medication alone enough to stop a person from drinking? You can take medication, but if you don't change your behaviors, nothing else really changes. Medication is only as good as an individual's motivation for recovery. How you achieve that behavior change can vary from one person to another.”
An article from Stanford University (“Alcoholics Anonymous most effective path to alcohol abstinence”, Mandy Erickson, March 2020) summarizes research conducted at the School of Medicine. “After evaluating 35 studies - involving the work of 145 scientists and the outcomes of 10,080 participants Keith Humphreys, PhD, professor of psychiatry and behavioral sciences, and his fellow investigators determined that AA was nearly always found to be more effective than psychotherapy in achieving abstinence. In addition, most studies showed that AA participation lowered health care costs. “AA works because it's based on social interaction”, Humphreys said, noting that members give one another emotional support as well as practical tips to refrain from drinking.
This report is corroborated by scores of similar studies. However, this is a report about people who remain in AA. The criticism of AA is often that insistence on strict abstinence from the start is too great a hurdle for many alcoholics who either do not remain in AA or do not try AA in the first instance. To some this is the basis for “harm reduction”, an approach that suggests that there are many people who will, given enough experience, come to understand that abstinence is the only approach for them but that remaining alive until then enables that awakening. Others hold that abstinence is not possible in any event for some and that alternatives must be found. This is one basis for so-called methadone maintenance.
We have reported separately and in questioning terms about pharmaceutical use to continue drinking given the evidence available to date. We did report that use of these pharmaceutical approaches and self-guided approaches seemed most successful when combined with clinical counseling and twelve step programs such as AA.
While not biomedical scientists ourselves, it seems reasonable to assume that research and clinical application of agonists and antagonists are the beginning of research and there will be advances in that field. If so, then further clinical applications are likely to come. Perhaps there will be advances in these pathways that eliminate the negative effects entirely, or new pathways we have not anticipated, or even gene therapies. The question for twelve step programs like AA will be how their program changes if at all. Perhaps that day is already here.
Today there are many in twelve step programs who insist on strict adherence to the twelve steps. Yet, no less than Bill Wilson (one of AA’s founders) was not one of them. In an article on the Recovery Research Institute website William White and Ernest Kurtz discuss Wilson’s views (“The Portrayal of Multiple Pathways of Recovery in the Writings of Alcoholics Anonymous Co-Founder Bill Wilson”, Aside, January 2020, Website Author - Steve K, By William White, M.A. and Ernest Kurtz, Ph.D.). Their quotes from Wilson include, “The process [trial and error] still goes on and we hope it never stops. Should we ever harden too much, the letter might crush the spirit. We could victimize ourselves by petty rules and prohibitions; we could imagine that we had said the last word. We might even be asking alcoholics to accept our rigid ideas or stay away. May we never stifle progress like that!”. “We have to grow or else deteriorate. For us, the “status quo” can only be for today, never for tomorrow. Change we must; we cannot stand still.” According to this article Bill Wilson himself used pharmaceuticals at least for one behavioral health comorbidity and was aware of other approaches from psychiatry and psychology that he often praised.
This flexibility would seem to conflict with the Third Tradition of Alcoholics Anonymous -- “The only requirement for A.A. membership is a desire to stop drinking”. To be certain, few AA members stopped entirely, immediately themselves and relapse is common among many members. This is warmly and understandably recognized and tolerated. Yet, the expectation of most AA members is that other members will at minimum follow the Third Tradition if not eventually embrace abstinence. How will this align with programs that intend to allow continuing use of alcohol?
Bill Wilson himself recognized that there may be those who can correct their drinking. His view was that AA was not for them but for those who were incurable, had “hit bottom”, and proven to themselves that they could not do this alone. There were yet others who could get a handle on abstinence on their own or in another pathway such as “the pledge”. While these individuals, in compliance with the Third Tradition, were welcome Wilson recognized that most would not become members.
AA and NA have experience with a similar controversy, that having to do with their Third Step, “Turned our will and our lives over to the care of God as we understand Him”. This controversy originated from the Chirstian roots of The Oxford Group, predecessor of AA, and the Christian roots of the founders. To this day, many AA meetings end with recitation of the Lord’s Prayer. Jews and Muslims found these roots uncomfortable but consistent with their faith traditions in the end. Later feminists (both women and men) reacted to describing a deity with the masculine pronoun. Today with 25% of Americans reporting they are non-believers this controversy is readily present.
In practice most groups recognize that not everyone is a professed Christian, that there is room to de-gender God, and some even describe God as “Good Orderly Direction”. This did not, however, discourage the evolution of secular offshoots such as AA Agnostica and Reformers Unanimous.
It would seem that the time for AA to consider its path forward given the welcome changes in approach to substance abuse and addiction has already arrived. Yet, the Twelve Steps and Twelve Traditions remain unchanged for many decades. What to do?
The issue of a successful path to continued drinking via pharmaceutical intervention seems straightforward. If one can and wishes to continue to drink, then AA is likely not for them as Bill Wilson points out. Similarly, to the extent that harm reduction still promotes abstinence, then the day for those adherents to join AA may (hopefully) come. Further, as Bill Wilson himself noted, there can be many paths and as long as abstinence is the goal then there is a place in AA from those who arrive from other pathways and utilize other resources. This is happening now through Self-guided, Clinical Pathways without Pharmaceuticals and those with pharmaceuticals. The Third Tradition can stand.
Further, the evidence from countless studies is that the benefit of AA, NA et al from the group approach is a substantial part of early recovery and the life style choices that almost always are required. Knowing that one is not alone in abuse and addiction, seeing the success of others, confiding in one, trusted person (sponsorship), and helping others are all important parts of why these twelve step programs work well.
We are not here to discuss the future of Weight Watchers. They have the issue of return on investment to consider which we recognize without criticism. As AA does not have that concern and does not offer services for profit (other than literature) it does not have the need to enter the medical or counseling field itself. The key is the Third Tradition. As we have noted elsewhere, abstinence is not a penance for bad behavior but the norm in a society where 30% of American adults do not drink, 84% do not use cannabis recreationally, and 93% do not use other schedule 1 narcotics or abuse schedule 2 narcotics.
The research is clear that recovery from alcohol and other drug abuse and addiction is more than “putting the plug in the jug” but achieving a lifestyle change. As long as that remains the case then Twelve Step programs (and Weight Watchers) will have their place.
Gene Gilchrist
June 2025
