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Biomedicine

The Weight of Innovation

Want people to use an innovation? First make it worth the effort.

If you’re an adult U.S. citizen, chances are you’re overweight. Indeed, there is almost a one-in-five chance that your body-mass index is greater than 30, which technically qualifies you as obese. Yet somehow, surveys say that at any given moment, almost 40 percent of the country’s population is attempting a diet. Bon apptit!

The lipid-losing marketplace is growing even faster than the population’s waistline. Weight loss is conservatively a $30 billion a year industry in the United States. Consequently, few industries are more competitive, more profitable, or more innovative. Can’t summon the willpower to sustain a diet? Pop an appetite suppressant. Lack the patience to shed those unsightly pounds slowly? Consider liposuction. Still morbidly obese after failing diet after diet? A stomach reduction or stapling may be the surgical solution for you. The caloric continuum stretches from Diet Coke to nascent genomic techniques for reengineering the digestive tract.

What makes the weight loss enterprise so intriguing is just how cleverly it gets people to reframe the fundamental questions asked by anyone giving serious consideration to adopting an innovation. The most important question always asked, of course, is “Does it work?” But the question that will ultimately make or break the adoption is “Is it worth it?”

As any dieter or candidate for elective surgery knows, that question concerns issues of self-image and safety as much as personal finance. The ability to perform liposuction under local rather than general anesthesia has contributed enormously to the procedure’s popularity. Medical reports that link many diet pills to irreversible organ damage, on the other hand, have reduced the appeal of such remedies.

Weight Watchers International offers a superb case study that demonstrates the way a seemingly trivial innovation utterly transformed how the company’s clients asked themselves “Is it worth it?” The company radically simplified the dieter’s food selection process by assigning each food item a point value and eliminating the need to tally calories.

Most vegetables have no points per serving; most pieces of fruit are worth one point; a Big Mac rates a whopping 14 points. A typical dieter might be instructed to consume from 22 to 27 points’ worth of food each day and might be allowed to “bank” the unused points from one day to the next depending upon weekly intake.

This simple reframing sent the company’s compliance and satisfaction rates soaring. Survey after customer survey confirmed that dieters found counting points to be far easier and less judgmental than counting calories and selecting the “right” foods. (Indeed, some users objected that the point system might be too flexible.)

The point-counting weight-loss system, which began in the United Kingdom in the mid-1990s, was so successful that it was swiftly exported to the United States. The innovation had legs. The executive responsible became Weight Watchers’ CEO. The company, which went public in the teeth of the IPO recession in 2001, has seen both its market share and its stock price rise. And the point system, which the company has patented of course, is credited with transforming the Weight Watchers’ lifestyle vocabulary.

Weight Watchers still relies heavily on support group meetings, where attendees affirm and reinforce their lifestyle changes. But changing the value vocabulary from “calories” and “food groups” to “points” has changed the conversations. Group members now have a common language that lets them talk more comfortably about their own eating habits as well as others’, says a Weight Watchers spokeswoman.

But the firm also has little hesitation using other tactics to make it easier for clients to answer “Is it worth it?” Weight Watchers played a critical role in the recent decision of the U.S. Internal Revenue Service to make doctor-prescribed weight-loss programs tax-deductible. The tax code now subsidizes the Weight Watchers innovation. By contrast, fat-free foods and cosmetic surgeries are not tax-deductible.

Continuous competition in this marketplace imposes “Is it worth it?” tests for the unhappily overweight. Suppose a new generation of genomics or fat-blocking chemicals inspires a new kind of patch or pill. What if liposuction becomes even less expensive and invasive than it is now? What happens if the IRS provides such treatments with the same kind of tax breaks it now gives weight reduction programs? Altering the trade-off between the discipline of tallying points and the ease of popping pills, such public policy shifts could force dieters to revisit their core innovation-adoption question.

“You have to understand,” says the Weight Watchers spokeswoman, “that pills and surgery only deal with the symptoms, not the problem itself.” That focus might turn out to be its ultimate weakness. Often the most profitable innovations are the result of treating symptoms and not the causes: consider the success of the antidepressant Zoloft.

The challenge of such approaches is what makes tomorrow’s market for weight reduction innovation so interesting. Will the diet innovators make more from treating the symptoms of superfluous avoirdupois or from attacking its cause? Let’s weight and see.

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