On the Weight Watch
Thomas Goetz watches over the intersection of health, consumerism, data, design and technology. It’s a road he hopes more employers travel.
Thomas Goetz went from executive editor of Wired magazine to wellness watcher. Photo by Christopher Michel.
In their quest to find what motivates employees to eat right, exercise, quit smoking or take a greater interest in their health benefits, employers are experimenting with wellness apps, personal tracking gadgets, workforce health challenges and other ways to encourage behavior change. But one organization figured it out decades ago in what could be the nation’s first successful social wellness program — Weight Watchers.
Employers, take note. Thomas Goetz, the former executive editor of Wired magazine, examined why the popular weight-loss organization has been so successful in helping people lose and maintain their weight in his 2010 book “The Decision Tree: Taking Control of Your Health in the New Era of Personalized Medicine,” a look at how consumers can find meaning in the deluge of health care data and take greater control over their health. It’s the powerful combination of “the rational and the emotional,” something many wellness programs strive for today, he said.
The rational, or clinical component, is what the founder of Weight Watchers — a housewife from Queens, New York — gleaned from a weight-loss program developed by the New York City Health Department in the late 1950s, said Goetz, who is an expert on health care data and design. It was a straightforward, low-fat, reduced-calorie program that was effective but slow to show results and hard to stick with. So she invited a few friends to join her and meet at her house to encourage each other; from that, an industry was born.
‘Behavior change is the biggest opportunity that we have, but also the biggest challenge.’
— Thomas Goetz, former executive editor of Wired
The social aspect is the key to its success, Goetz said. Group meetings to share stories and offer support have been a mainstay of the program since its inception in the 1960s.
“That’s what Weight Watchers added to the equation,” said Goetz, who left Wired in 2012 to launch a digital health company called Iodine Inc. Besides heading up a high-profile tech publication, Goetz has also become the first entrepreneur-in-residence at the Robert Wood Johnson Foundation, a philanthropic organization focused on public health. He is also a popular speaker on the intersection of health, consumerism, data, design and technology with a much-viewed TED talk, short for Technology, Entertainment and Design, on redesigning medical information. He also has a new book coming out in April on the history of tuberculosis called “The Remedy: Robert Koch, Arthur Conan Doyle, and the Quest to Cure Tuberculosis.”
“What was neat about Weight Watchers is that they hit upon this formula and that was their proprietary model: ‘We have a method and we have our groups and you can join if you pay us money.’ ”
As employers know too well, without behavior change, wellness programs are likely to fail, so the focus on individual choices and decisions is well-placed. Goetz points out that more than 70 percent of health care costs are rooted in human behaviors. Or to put it more dramatically, “America’s Top Killer: Us,” which was a 2009 Newsweek headline cited in his book.
“Behavior change is the biggest opportunity that we have, but also the biggest challenge,” Goetz said. “It’s such a juicy target, but people aren’t so easy to cajole. But I believe that, just because it’s hard, it doesn’t mean that we shouldn’t keep trying.”
And if the multibillion dollar wellness industry is any indication, employers are certainly trying hard. The good news is that technology is helping their efforts tremendously, making wellness programs accessible to greater numbers of people through online tools, social media applications and fitness gadgets that track activity, like FitBit and Nike Plus wristbands. Weight Watchers’ own research shows that members who use its website follow the points system and attend meetings have 50 percent greater weight loss than those who only use the program offline, according to “The Decision Tree.”
But getting employees to engage with these tools poses another challenge — making the message compelling and the tools easy to use. In this era of consumer-driven health care where employers are urging workers to take greater control of their health in an effort to manage costs, companies can’t afford to lose sight of their audience. According to Goetz, employers can take some lessons from those who are experts at driving customer behavior: retailers.
“Amazon works really hard at making sure that every square inch, every centimeter, every pixel of their website is driving people to make better decisions,” he said. “They have honed their website so carefully because they know that for every fraction of a second that there’s a lag, somebody’s going to click away.”
It’s a mistake to think that employees interact with their health and wellness tools any differently, he said.
“The problem is, when we get to health and wellness, oftentimes we think we’re going to get the customer’s full attention and they’re going to stay on this website for half an hour and be very meticulous about going through every resource that we have. We assume that because we are calling them employees that they will behave differently than when they are in their normal consumer role. That’s not true at all.”
Employers ignore these best practices at their peril, he said. As he told an audience at a recent conference sponsored by industry trade group America’s Health Insurance Plans, “Only with that level of awareness and ambition are we going to move the needle on health care.”
Although Goetz has been writing about health and technology for more than a decade — as editor at Wired and now as a blogger for The Atlantic magazine — he has more than a journalist’s interest in these topics.
During his tenure at Wired, Goetz earned a master’s degree in public health from the University of California at Berkeley, and after stepping down in 2012 he and a former Google Inc. software engineer co-founded Iodine, which is based in San Francisco, to develop tools that help consumers make sense of health data.
“Technology traditionally has been a cost-driver in health care, so I was interested in whether information technology could actually change that and finally start doing in health care what has happened in so many other industries, and that is drive costs down and drive consumer experiences up,” he said. “For many years I had been exploring that as a journalist. The stuff that I was thinking about and nibbling on through a health care technology lens was more interesting to me than what I was thinking about in terms of journalism. That led me to take the step in January of leaving Wired and trying to see what could happen with these ideas.”
Goetz has written extensively on the need to redesign medical data, like medical charts and lab result reports, to make them more understandable to patients.
Goetz is also a big believer in the power of personalized medicine to transform the health care system. This is a relatively new field of health care that takes an individual’s clinical, genetic and environmental information into account when developing a course of treatment for a particular condition. Data are the driving force behind this movement, which is already underway with personal tracking tools that record our steps, movements, calories and even sleep patterns. And a growing number of people are embracing the trend with online communities like Quantified Self, which helps people make sense of their health data, and PatientsLikeMe, where patients can share and compare their data with others.
But in a workplace setting, the sharing of personal health data raises privacy concerns. Goetz said that privacy and trust are critical issues for employers, but that benefits to employee health outweigh the risks.
“I do think that there needs to be a thorough and robust amount of disclosure and a way for employees to opt out,” he said. “And employees need to go into their jobs wide-eyed regarding company policies. I feel like employers have an obligation to keep employees as healthy as they can and, on a whole, that’s a benefit to the employee.”
It was Goetz’s innovative thinking that caught the eye of the Robert Wood Johnson Foundation, according to Brian Quinn, assistant vice president for research and evaluation. The part-time position for an entrepreneur was created at a time when the foundation was looking for ways to tap creative ideas and fund more cutting-edge projects. Quinn had worked with Goetz in 2012 when Wired and the foundation teamed up to host a health care data and technology conference. “When we heard he was leaving Wired, we thought it would be fun to bring him in.”
“By virtue of the fact that he was at Wired and in the Bay Area, he was exposed to an array of new ideas and technologies, which is different from how organizations in philanthropy operate,” Quinn said. “We certainly think a lot about data here but through more traditional channels — from a researcher’s perspective or a physician’s. He approached it with a Silicon Valley perspective.”
‘We certainly think a lot about data here but through more traditional channels — from a researcher’s perspective or a physician’s. [Goetz] approached it with a Silicon Valley perspective.’
— Brian Quinn, Robert Wood Johnson Foundation
Goetz seems to draw experience from many worlds: journalism, technology, health care, data, visual design and others. It’s a powerful synthesis in this time of health care transformation.
One project he’s working on with the foundation is called Visualizing Health, which he describes as an experiment in data visualizations to help patients understand their health risks.
“One of the fundamental challenges in engaging people in health care is communicating information in a way that they can understand it,” he said. “Things like cholesterol and blood pressure, what do their numbers say? What is their risk for certain diseases? All that stuff could be greatly aided by effective visualization, but its been very poorly validated in what actually works.” Iodine is working with the University of Michigan to create a library of proven data visualization that will be available to the public.
Another project is Flip the Clinic, which aims to transform the patient-doctor visit. It’s based on a concept borrowed from the education world known as the “flipped classroom,” where students watch videotaped lessons at home and do their homework in class where teachers can provide more individualized attention. In a medical setting, the goal would be to create more meaningful interaction between patient and provider.
“There is a great bottleneck in the way we deliver health care, which is called the doctor’s office,” Goetz said. “We put so much emphasis on the doctor-patient encounter, but the problem is that the physician is overstressed. They are seeing hundreds more patients a year than they can effectively manage, so we’re not maximizing this opportunity with the doctor-patient encounter. So with Flip the Clinic we’re trying to identify new tools that might empower the patient and provider alike in more effective delivery of care.”
Goetz said the patient should be at the heart of the health care system — a simple but profound shift from the doctor-centric model of health care. His focus is on giving everyone the tools to get there.
“Today, we have the opportunity to engage with our health more prudently, more strategically and more effectively,” he writes in “The Decision Tree.” “We can engage through new science and technologies, tapping the best practices of genetics, behavioral science, information technologies and even each other. We can make sense of the Babel of data to craft a personal strategy for making the best choices that lead to the best outcomes. We can take a central role in our health and be the better for it.”