What health systems can learn from Weight Watchers
Most people can stand to lose some weight. And physicians will often point out the health benefits of losing weight to patients. This advice can be helpful, but, when you leave the exam room, you are on your own. The reality is that sustained behavior change is hard. Historically, health systems have invested relatively little in keeping patients well. After all, hospital stays and ER visits were revenue events. With health reform, healthcare organizations are increasingly waking up to the notion that their future success hinges on supporting behavior change so that patients stay well -- and out of the hospital.
Weight Watchers is an example of an enterprise that stepped in the void in order to help people change behavior in order to achieve their health goals. The company has been around since 1963 and operates in 30 countries around the world. Something's working. What lessons can healthcare organizations take from Weight Watchers?
Start with Hopes and Dreams
A team from Kaiser Permanente set out to better understand why 40% of patients are nonadherent in taking prescribed medications. Here is some commentary from one of the researchers:
Let's start with a simple truth: the decision to take a medication rests with the patient. Full stop. No matter what we think as healthcare providers, it is the patient who ultimately decides in the privacy of his or her home. In that vein, and with the help of several colleagues from Kaiser Permanente, we have begun focusing our attention on the less commonly studied factor of patient motivation. Our quest has led us to interview people inside and outside of health care, and one example—Weight Watchers—struck us as particularly salient.
The first thing that Weight Watchers does is interview a participant to understand their unique motivations. Do they want to avoid disease? Lose weight for a family wedding? Weight Watchers encourages its participants to articulate these goals, which become the basis for building intrinsic motivation. The Kaiser team took the following lesson:
Understanding and tapping into this motivation is, I believe, one of the more effective strategies to improve medication adherence. Taking medications for a chronic disease is a lifestyle change driven by the patient’s motivation.
Use Tracking Tools and Feedback Loops
Historically, Weight Watchers has promoted the "scribble before you nibble" concept of food journaling. When the "inputs" from the journal are compared against the "outputs" of the scale, the resulting feedback loop can be a powerful means of sustaining momentum and morale. To support their members, Weight Watchers developed eTools, a suite of digital health tracking tools. These tracking tools help users take control of their health and drive towards goal weight at weekly weigh-ins.
The lesson for health systems should be clear. Provide health tracking tools and tie them to feedback loops in order to drive engagement. Diabetes, congestive heart failure, hypertension, heart disease, and chronic kidney disease are just a few examples of conditions that can be positively impacted by this approach.
Managing diabetes with mHealth
Managing hypertension with mHealth
Managing heart failure with mHealth
Managing kidney disease with mHealth
Managing heart disease with mHealth
Leverage Game Mechanics
Weight Watchers encourages participants to create caloric deficits. To make this easier, they provide a point system. You start off your day with an allotment of points. As you log food in eTools, it calculates how many points you've used. When you win the points game, you lose weight.
Have you ever seen someone glued to a game because they were on the cusp of breaking through to another "level" of the game? Weight Watchers uses status to drive long-term engagement. When you achieve goal weight, you enter a six-week maintenance period. If you maintain goal weight during that time, you become a "lifetime" member. With lifetime status, you are able to use certain services at no charge. You keep this status level as long as you weigh in once a month and maintain weight within goal range.
Status is a well-understood game mechanism. Amy Jo Kim, a game expert with a PhD in Behavioral Neuroscience, illustrates it here:
Source: Amy Jo Kim, PhD
Weight Watchers bridges the offline and online worlds via game mechanics. Health leaders might benefit from the perspective of Jane McGonigal, the author of Reality is Broken: Why Games Make Us Better and How They Can Change the World:
"Games are an incredible language and system. They should be everywhere. Why are we making games only for the bound pages for a computer screen or console? Why aren't we doing that to help people navigate and understand the world around us?"
Is Weight Watchers perfect? No. One study showed that only half of lifetime members maintained a significant portion of their weight loss after many years. But here's the point: a behavior change program doesn't have to be perfect to make a positive impact. For example, reaching a relatively small portion of the millions of patients that are nonadherent with medications would be a huge step forward for the healthcare industry.
The cost curve will not bend without patient engagement.