Health

The Noom App Makes Big Claims About Helping You Lose Weight. Does It Work?

Noom claims remote behavioral psych coaching is a winning weight loss strategy, but the good-habits approach is ultimately uneven.
October 26, 2020, 4:10pm
feet on a scale

Janet Gollhardt has done Noom lessons first thing every morning since June. Every day, she opens the app and sees a list of eight to ten to-do’s. Three of them are always the same: log everything you eat and drink, achieve your activity goal, and weigh yourself. The app also shows her the best foods to eat (it rates them on a scale from green to yellow to red), prompts her to read about healthy habits, rate her motivation, and quizzes her after. 

"It's been really, really good for me," she said. Thanks to a “great personal coach,” group support, and “smart and fun reads,” Noom teaches her how to be mindful about why she snacks when she's feeling sad, she said, and what she can do instead.

Gollhardt described herself as having been overweight all her life. When she saw advertisements for Noom on TV about a year ago, promising prospective users that they'll "lose the weight for good," its "proven-psychology based approach” appealed to her immediately. But Gollhardt found Noom expensive—$59 monthly or $199 annually—and despite her interest, she didn't want to spend that kind of money.

Several months later, the combined effects of turning the age her mother was when she died, a frightening chest pain episode, and losing her job made her want to use some of her severance pay to give Noom a try. "I just decided I would rather live and not die at 49 like my mom did," she said. Today, Gollhardt has lost 25—almost 26—pounds, and, for the first time in 30 years, she started jogging.

Gollhardt is one of more than 45 million Noom users worldwide, according to the company, and part of the one and a half million people that Noom claims to have successfully helped lose weight. In practice, the program is not all that dissimilar from a standard diet: It instructs users to eat low-calorie, nutrient-dense foods and count calories. However, it also claims to approach weight loss through a psychology lens, bringing awareness to users' emotions, habits and thoughts related to food, with the aim of gradually adjusting unhealthy behaviors. 

But ultimately, not everyone has been as satisfied and successful with the program as Gollhardt. Noom advertises widely and aggressively, claiming its users will lose more weight than with other programs. It compares itself to Weight Watchers, which it blasts for prescribing a crash diet (this led to a legal complaint). Meanwhile, Noom markets itself as “not your typical diet program with strict rules, restrictions or pre-set goals.” But according to users and experts VICE spoke to, Noom’s diet does not differ much from what’s already out there. It recommends restricting calories—sometimes, to a worrying degree. And while the behavioral psychology techniques the program relies on are innovative and proven to be effective for weight loss, the app seems to be struggling to keep up with demand. Assigning a single coach to several hundreds of users has resulted in many of them feeling like the coaching service is ineffective. 

Lycia Tomlinson from North Carolina reports that after seeing one of Noom’s ads on YouTube, she subscribed to their two-week trial offer for $1. Not satisfied by what they offered, Tomlinson requested that same day that her personal information, including her card information, be removed. One week later, as she opened her bank statement, she was stunned to see that Noom had charged her card $149. When she reached out to them asking for her money back, she never received any reply—not until she went on Twitter and publicly grumbled.

Tomlinson's case isn't unique. Since July 2017, the Better Business Bureau has received 2,295 complaints alleging that the company offers misleading free trials and that subscriptions are difficult to cancel after free trials are complete. Like Tomlinson, consumers often claimed difficulty trying to contact Noom’s customer service to request a refund of charges. The company’s BBB Business Profile displays a D rating due to the high volume of complaints filed against the business, and last August the BBB issued a warning for consumers. "I quickly realized that it was a money-making scam," Tomlinson told VICE, adding: "when a person decides they want to lose weight, the decision is often accompanied by feelings of failure and despair. Capitalizing on those feelings to make money and no real help for these individuals is unconscionable." 

Noom claims to provide its users access to "highly-trained specialists" who use cognitive behavioral therapy (CBT) techniques. It defines CBT as a “goal-oriented psychotherapy treatment that helps people understand the things that trigger negative thoughts, compulsive actions, and unwelcome consequences.” Noom aims to uncover users’ "ultimate goal" beyond just losing weight. The app instructs users to ask, "Why?" repeatedly. When I signed up for Noom, I wrote that I wanted to be healthier (But why?) to fit in old dresses of mine (But why?) … to feel beautiful, I guess? 

Once onboard the two-week trial, I was able to access the lessons Gollhardt talked about. They’re short, colorful, and filled with hashtags like #NoomNerds or #healthFORALL. One is about motivation, with the main take-away inscribed on a pictured post-it note: “Good things take time.” Another is about winning. There’s a cartoon of a jolly looking man where it says: “You ROCK!” I was greeted with a message from the in-app “concierge,” an automated service that gets users up and running and pairs them with a coach. A day after being an official user, I was welcomed by my goal coach, via what looked like a text. She’s not a bot, it read, but “a real person,” and I should view these messages more like emails, rather than a live chat. Her message ended by asking me to come up with one small step that I could start this week that I believed would help me move closer to my goal. Unsure, I reply: maybe, drink less wine in the evening?

Stefan G. Hofmann, a clinical psychologist at the Department of Psychological and Brain Sciences at Boston University, told me that "the interventions of CBT for eating disorders have been worked out quite well. And we know that these are highly effective interventions for different types of eating problems," Hofmann said, "more effective than the most effective drugs that we have available." What matters is regular feedback and support to provide motivation, help people adjust their behavior, keep their expectations realistic, and boost the belief that they can do it. 

Hofmann said it shouldn’t matter too much that most of Noom’s coaches are not “highly trained,” or that, according to sources VICE spoke to, many are fresh out of college. "As long as the human who is involved in this program is not contradicting the CBT protocol described in the app,” he said, “I wouldn't think it's a highly critical issue.” For an app like Noom to work, he said, what’s most important is that the user feels regularly guided by a real human, with preferably a few face-to-face or video conversations here and there. 

Yet just last month, Sandra Bouckley reported the following on the review site Trustpilot: "Today is my 6th day and I've yet to have a conversation with a coach or a concierge. All I get are high fives and messages that I can half-read." Bouckley told VICE  that despite finding the readings and quizzes informative and useful, she was not yet given a goal specialist: "My Coach (John) is apparently out, and Ivy is filling in. So far, apparently, because I'm so new, this isn't useful or helpful. I don't have a Goal Specialist yet either."

Several users have complained that their coach's responses seemed "impersonal and canned" or "very autobot" especially during but also after their two-week trial. A Reddit thread dedicated to the topic of whether the coaches are all real people as promised commented on the lack of helpful responses. "There are two coaches, your personal and group coach," wrote another reviewer this month, "I didn't find either particularly useful. The personal coach would send me a generic weekly message about how my week had been, and no matter what I replied, even if it was a question, it got turned into a question back at me. It was like talking to a mirror and not particularly helpful." 

Similar comments can be found on a Noom weight-loss Facebook support group of more than 50,000 members, with one recent member posting last month: “I am on my free trial and my coach pipes a tiny blurb once a week. Do they do more once your a member? So far I am not finding it very useful." While the answers varied, from “there is a goal specialist? I’ve never heard from anyone,” to “my goal specialist is awesome,” most of the comments in this Facebook post said they found their group and goal coach lacking. 

This was the case for Patricia Keefe Saizan, who replied on the same thread: “The goal coach is a joke imo.” Saizan told VICE that the coaching service is not personalized, and that the group coaching setup is difficult to navigate. She is one of many members to rely instead on the Facebook group for motivational support, especially to post “NSV,” or non-scale victories, such as “walking away from a piece of cake,” or  “being able to walk for 30 minutes without feeling out of breath.” 

Saizan also read something on Facebook that she said could explain a lot: “From what I understand, these coaches have about 300 people so you can’t expect much,” she said, adding, “I don’t think the coach can care if she has 300 people. It would be impossible.”

Saeju Jeong, the Co-founder and CEO of Noom, told VICE:  “All Noom coaches are real, human coaches are at the heart of the Noom program.” He said there are about 2,300 full-time coaches to support its millions of users, and as demand continues to grow, the company plans to hire several hundred additional coaches by the end of the year. He added: “today each coach is able to effectively support up to 250 active users.”

VICE spoke to a former Noom employee who was present during Noom's early days. (The employee asked to withhold their name to protect their privacy at work.) The app went from having fewer than a handful of coaches to more than a thousand in no time, according to the employee. “I think you can grow too big too fast. It was taxing. It was draining.” According to the employee, what started as about one coach for every 70 users grew to become a "crazy number"—"almost unsustainable to a certain degree." And although they wouldn't reveal what exactly that “crazy number” was, in a Reddit chat from six months ago, one employee wrote that it was around one coach for 280 to 550 users. On Glassdoor, another wrote: “We had 250-300 users each to coach each week and it was doable. Now we all have 415+ users with the same pay.” The former employee later confirmed coaches support more than 400 active users.

Like many diet services, Noom has published its own research in support of its success claims, including one study asserting “64% of Noom users lost 5% or more of body weight.” But looking closer, those 64% of Noom users amount to only 43 people (out of the 121 participants studied), which according to several experts VICE spoke to, is a small number to make such significant health improvement claims. Earlier this year, Noom funded another study claiming that Noom's service is superior to "standard care." Yet according to an article by a scientist from Yale, Noom’s authors compared the app to nothing at all, or no treatment, which was called out as "inappropriate and potentially misleading." 

John Torous, a Harvard professor leading the American Psychiatric Association's workgroup to evaluate smartphone apps, told VICE that the main focus of startups like Noom is growth—against a backdrop in which neither investors nor consumers are interested in rigorous scientific validations. “If you compare the app to absolutely nothing compared to something that's a fair comparison, like talking to a friend, the apps are not always as effective. And certainly, I think a company may realize that's the truth and, that's not as exciting.” Torous explained how it's usually easier to help people on "the right side of change," or what he calls "early adopters," whom any app would have helped no matter what. 

He and colleagues made a term called the “digital placebo effect.” He said that some people tend to show improvement with apps at a higher rate, and more quickly, than would be expected. “There are also some people who seem to show improvement even when they don't engage with the technology; this may be related to the role of expectations or other factors associated with the app,” said Torous. He and colleagues commented how it can be a major accomplishment to simply log in into an app and connect with a support person, never mind exploring interactive features, such as quizzes, read content, and track progress. For some, this single action itself might be highly influential, especially if the app is recovery-focused.

This coincides with information Noom’s former employee told VICE when it came to testing the use of AI instead of human coaches during the first 48 hours. They explained that Noom uses AI heavily during this time to “weed through who’s really serious,” and then will switch to human support. "We didn't actually notice that much of a difference between dropout rates, which means that those people that really wanted to be there would be there no matter what. They're motivated, and they're ready to make changes." 

Elizabeth Eikey, a professor at the University of California San Diego, explained to VICE that she observed in a 2017 study how the use of weight loss apps could exacerbate eating disorders. Apps encourage this through practices like obsessive logging, the need to be exact about calories, an acute awareness of numbers (associated with food and exercise), restricting calories, and manipulating the app to make it seem as if the person is losing weight, for example, by misreporting the actual calorie intake to avoid negative emotions. 

While Eikey praised Noom’s injection of positive affirmations even when users go over their calorie-budget, she noted that the app doesn’t seem to ask users for personalized information such as their history of eating disorders. "It let me set a rather unreasonable weight loss goal… to 85 pounds," Eikey told VICE. "Also when I input an unreasonable number of calories burned, as if I was on the treadmill for hours and hours and hours, it was like, great job! You burned every single calorie that you had in your budget, plus some." Eikey explained how these messages could unintentionally reinforce the perception that burning more calories than you consume in a day is healthy. Many diet and fitness apps tend to do that, she said, which isn't great, and can be triggering for people with a history of eating disorders or who have a history of obsessive behavior. "I had people in my studies talk about wanting to get down to zero or negative calories," she said.

One reviewer said Noom recommended a 1,100-calorie diet—which many dietitians would find too restrictive and limiting. This was echoed by dietitian Abby Langer who wrote about how when she was assigned a low calorie level, “1200 calories is starvation for me (and for most people),” after expressing concerns to her goal coach, she was told that when exercising, she can get those calories back in her allowance, allowing her “some wiggle room.” Another reviewer wrote on the Appstore about starting with a 2000 calorie budget, and then watching the app drop her calorie limit lower and lower: "I feel as if Noom wants me to starve myself. I work outside, I am constantly sweating and walking around. I'm going to eat, and I shouldn't have to feel bad about going over 1300 calories while eating healthy foods." The user decided to drop out of their trial because they felt the app was too restrictive. 

Noom pitches itself as something different. Thanks to its use of CBT-based coaching and “anti-diet approach,” it wants to inspire significant change and lasting outcomes. While its program works for many, it appears to largely rest on the all-too-common calorie-restriction-based diet, whereby not all users can meaningfully adopt healthy habits. Meanwhile, the idea to pair human coaches with an app is a good one, according to several experts, including Hofmann, Eikey—and Torous, who said it’s the digital health field’s future. But according to him, there’s still a lot that needs to be worked out in terms of how effective that hybrid model can be. Torous pointed VICE to Lantern, an app that used CBT trained coaches to empower users daily to learn how to manage their anxiety, stress, and body images. Lantern went bankrupt two years ago.

“Coaching clearly costs money, it's a human being," said Torous over the phone. “Coaches are to some extent scalable, but they max out. They can only talk to and interact with so many people per day. And you can make them more efficient, but it is a question of can these services, when they start small, can they actually scale? I think we just don't know."

The issues with the app don’t stop Saizan from being satisfied with Noom. “The coach thing isn’t a make or break point for me,” she said. She likes Noom’s calorie tracker, incentive to weigh daily, and lessons: “Before I would give up if the needle on the scale wasn’t consistently going down. Now I know that is a part of the deal.” And then she added: Noom is a “great program.”