Encore: Diet Wars | Dieting 3.0 | 5

0:06I'm David Brown and this is Business Wars.

0:28The weight loss industry has changed dramatically since the 1960s. The early days of Weight Watchers, Nutrisystem, and Jenny Craig. Digital wellness upstarts like Noom and MyFitnessPal make in-person dieting programs feel rapid-dated. And the newer programs are wrapping themselves in messaging about wellness and body positivity, with, of course, the promise that you'll shed some pounds while getting healthy. Now, diabetes drugs Ozempic and Wegovi have caught on for weight loss, causing a sea change in the industry. Due to their high price tag and promising results, these drugs became the not-so-secret tool of the elite.

1:05Well, now with the shortage settling down, just about everyone wants in on these miracle weight loss drugs, including Weight Watchers. Here to help us understand the implications of this move for the weight loss industry, Emma Court, a health reporter for Bloomberg News. For years, she's been covering digital players like Noom, and she's sharing what diet programs are doing to keep up with the newest wave of weight loss tactics. Later, we'll be joined by Matthew Schneier, a features writer at New York Magazine and The Cut. His article, Life After Food, explored how Zempik went from an open secret among elites to a full-on trend and whether it has the power to reshape our culture.

1:45All that's coming up next.

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3:31Emma Kortz, a health reporter for Bloomberg News. Welcome to Business Wars. Thanks so much for having me. Maybe a lot of listeners have heard about something called Noom, and it is sort of app-based. Could you say something about how Noom changed the trajectory of the weight loss industry? So what's interesting about Noom is it really took advantage of a cultural moment. I think for many years, we can all kind of think of a time period where dieting was like a big bad, right? And everyone was doing it. Everyone was on Weight Watchers or they were doing, you know, Jenny Craig or they were Nutrisystem, right?

4:05My theory is everyone saw their parents kind of cycle through diet after diet after diet and never really get anywhere. We also have these moves towards, you know, more body inclusivity these days, right? And I think they all kind of came together to sort of change the way people have thought about diets. Now people, I think, are more skeptical of it, but they still want to lose weight. So enter Noom. I've heard some of the ads for Noom, and I noticed that they don't really focus on weight loss as much as a kind of a healthier way of thinking about yourself and what you eat. Here's an example from a recent campaign.

4:43I was conditioned to finish my plate since childhood? Noom Weight uses psychology to help you understand your habits, change them, and realize that when it comes to losing weight, it's psychological. Now, am I right to say that that's what they're going for? Is that a fair assessment? No, you're completely on the mark. And that's kind of one of the key draws of Noom, which is this sort of, I call it the not a diet branding, right? We're not a diet. We're a lifestyle change. That's very central to the way that they advertise themselves. They also made about one or two other kind of key changes to the sort of traditional model of dieting, right?

5:21They have, you know, a very app forward approach. There are little articles, there are quizzes, there's coaching, you track your calories and what you eat in the app. So that's one kind of way that they've also appealed to, you know, a new audience. The other kind of key aspect of the Noom approach is psychology. So a big thing that the sort of founders and executives at Noom talk about is the diets tell you what to do, like eat less, right? but they don't show you how. And that's why a lot of diets don't work for people in the long term to keep weight off. You know, when you say that, I think about some of the special diet programs that maybe aren't quite as regimented.

6:02Certainly, I mean, you can find some apps for things like keto programs or Whole30, Paleo. I think of the Atkins plan or all kinds of low-carb variants that also came out of that. Where do they fall in this spectrum of modern weight loss? I think some of the ones you've mentioned have all kind of come about in the last several years, right? I think of sort of keto, paleo, Whole30, even intermittent fasting. And they all take a sort of holistic wellness lifestyle approach, right? They're not like, they don't have the sort of emphasis on different phases that we saw in Atkins or even in the South Beach diet.

6:42They're more like simple, less focused on the scale. For instance, even Whole30 actually says when you're doing this sort of 30-day, very restrictive eating plan that you should not get on the scale. So these kind of changing attitudes have also influenced the kinds of eating regimens people embrace, right? They don't want to, you know, count every single calorie. They want to do Noom, which is sort of more sorting foods into, you know, eat more of the green foods and eat less of the sort of yellow foods, that kind of thing. Yeah, yeah. Well, so what does that do to the older weight loss companies, you know, Weight Watchers out there, the Jenny Craigs?

7:22Does this sort of throw them into a hunker down mode or more of a let's go with what everyone seems to be sort of interested in, these more app-based approaches? We've seen, you know, Jenny Craig, the meal delivery service kind of, you know, not in its heyday at all, right? My colleagues recently reported that they're having issues with cash flow. They're looking for buyers. We've seen Weight Watchers in the last couple of years rebrand to kind of similar to what we've been talking about, this sort of focusing on overall health, not just weight loss. That hasn't panned out super well for them.

8:02I think all these companies are, you know, either kind of relying on their name brand and their credibility to kind of keep limping along or they're trying to adapt to survive. Hmm. Well, you know, let's let's just dip into that Weight Watchers pool, if we can. You mentioned the rebranding. I remember when they announced it as WW. And I thought that kind of a clumsy way to say a brand. I mean, WW, right? They want to sort of distance themselves from the old school Weight Watchers. I get that. And they want to focus more broadly on wellness, as you were saying. So how has it gone? I mean, did that seem to bring more people back under the WW tent, if you will?

8:41To your point, it is really difficult to say WW because nobody knows what you're talking about. Trust me as a journalist who writes about this, it's like the company formerly known as Weight Watchers, you know. So the company says basically in the last several years, sort of starting in 2016 and especially in 2018, they started realizing people were thinking differently about weight. Right. Think of this not a diet phenomenon. Right. Right. Gary Foster, who's the company's kind of top scientist, said people used to kind of be ready to leave their lives and go lose weight. Right. The weight loss was just a sort of a confined period where they were losing weight and following a diet.

9:21And then they would kind of go back to their normal lives. And, you know, people thought of it as sort of like going to dieters prison. But now people had started to say, I don't want to leave my life. I want these programs to address the whole me. I want it to be holistic. I want to come out of this not just thinner, but I want to be healthier. And so they sort of thought about how do we fit this program into a broader wellness ecosystem and focus more on other things besides what people are eating, like sleep and stress and all these things. In terms of like how it's paid off, I don't know if they quite nailed the timing.

9:56Something about the way they rebranded doesn't seem to have quite resonated with people. So in 2018, they had about 4 million members. Last year, they had 3.5 million. They have like sort of an in-person workshop and then they also have a digital subscriber component. You know, people can subscribe to the workshops and digital program or just the digital program and they seem to be losing ground in that sort of in-person meeting side of things. So it kind of speaks to where this industry is going, maybe a little bit delayed. I think from my reporting, it feels like there will always be demand for diets, just maybe a new generation of it, because there is always going to be this concern about the sort of medical repercussions of extra weight.

10:41And also there's always going to be some societal focus on it. I think even as we talk about body positivity, we also see a lot of emphasis on thinness and a lot of celebrities that used to be endorsing diets out in the open. Not the same exact people, but those kinds of people are now probably, you know, they might well be taking Ozempic in private. And we know a lot of celebrities have dropped a lot of weight right around the time this got popular. Yeah, there's been quite a bit of buzz around the drugs Wegovi and Ozempic. initially the idea was for patients to use these as diabetes medications but recently there's been a lot of off-label prescribing too specifically for weight loss and then there's this you have Weight Watchers now getting in the medicine game with the acquisition of Sequence that's a company known for prescribing Ozempic and Wagovi.

11:31This is clearly new ground for Weight Watchers and in a way I wonder how that squares with what they've been since, well, since their inception. Why would they buy into a sort of silver bullet medical approach now? It's a great question. So let's start with a little bit of sort of fairly recent history. In the 90s, Weight Watchers was actually a holdout from a trend of weight loss companies like Jenny Craig and Nutrisystem prescribing weight loss medications. If you fast forward to today in an environment where people are obsessed with these drugs, they're fascinated by them. They're really interested in using them to lose weight.

12:19For Weight Watchers to buy into this, in some ways, seems like a no-brainer, right? Weight loss medications that people are, you know, naturally talking about are an obvious kind of detractor for their business, right? People who might join Weight Watchers in a normal, you know, time with these new medications now may be incentivized to try them. One interesting thing is to think about the Weight Watchers brand. People will say what they want about diets, but Weight Watchers is fairly credible in that space. And depending on what happens with these medications, this could be a risk for Weight Watchers' reputation.

12:58These drugs are still pretty new. There's a lot of excitement in the medical space about them, but people will need to probably take them for years. And they haven't been studied for many years. Is Weight Watchers actually incorporating the prescription of weight loss medications into their regimen? It kind of remains to be seen. There may be some Weight Watchers members who do get on medication, but stay members and participate in that lifestyle program. I can also imagine this could be a source of growth for them. But it does come again with some big questions about, like you said, how is this exactly going to work, right?

13:32And are your kind of like old school members, the people who came to you because you're Weight Watchers and you can be trusted? Are they going to be turned off by this? Right. I mean, why pay Weight Watchers when you could pay a doctor for the prescription and avoid whatever added on with Weight Watchers? I'm just not clear on all of that. One point I would make is, even though I think a lot of people think of these drugs as being silver bullets, they're really not. First of all, they don't work for everyone, although some people have had really good results on them. You are also still supposed to be eating healthier and exercising and doing all those things we know we're supposed to do when you take these medications.

14:15And this is what Weight Watchers is saying to sort of justify this combination, right? We have that lifestyle program that you still need on these drugs, and we can support people as they're taking them. Another kind of reason that Weight Watchers might be an attractive platform for this is they're offering it with telemedicine, virtual consults with doctors. This has become a very popular way of accessing these weight loss medications. I also would point out that Weight Watchers CEO has said, you know, startups move fast and break things. Like there's a lot of, quite frankly, shady things going on in terms of the telemedicine companies that are working in the space.

15:00We are different. We don't do that. We're Weight Watchers. People can trust us. There's a lot of misinformation. We're a reputable source. And so I think they're trying to also leverage that brand to become a trusted name in this space that has really taken off and exploded. Well, I think that that underscores what I was about to ask. And that is Weight Watchers may be one thing, right? But what about the whole idea of these, you know, membership weight loss programs writ large? Are membership weight loss programs, are they dead? I mean, that's a billion-dollar question, David. You know, I don't think it's a coincidence that we're seeing these programs hop on the bandwagon of weight loss drugs.

15:48You know, one analyst compares, you know, what Weight Watchers is doing to sort of like blockbuster Netflix kind of thing. like, you know, these weight loss drugs, depending on what happens, could really transform an industry that's been devoid of innovation for decades. But it's not totally clear where things will go. Unfortunately, I think some of the same issues that plague diets and weight loss membership programs also plague these new weight loss drugs, right? I think for many people, it's hard to believe that you can participate in one of these programs and it'll be a lifelong kind of commitment for you because so many people feel like it just isn't sustainable in the same way like these drugs are also going to have to prove themselves so you know the future is very unknowable here but i do think weight loss programs are jumping aboard the bandwagon because they are afraid of being left in the dust emma court is a reporter for bloomberg news covering the health and wellness industry you can check out all of her stories at Bloomberg.com.

16:51Emma, thanks so much for joining us. Thank you. Hey, after the break, we're taking a deeper dive into weight loss drugs like Ozempic and Wegovi and why we seem to be hearing about them everywhere these days. Stay with us.

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19:17Weight loss programs like Weight Watchers and Noom aren't the only ones buying into the Ozempic craze. The weight loss drug is also sweeping through Hollywood. Jimmy Kimmel even called it out in his monologue at this year's Oscars. Everybody looks so great. When I look around this room, I can't help but wonder, is Ozempic right for me? And TikTok is abuzz with creators trying to figure out which celebrities are using the drug. New York Magazine features writer Matthew Schneier covered the Ozempic craze in his viral article, Life After Food, published in The Cut. He joins us now to talk about the side effects you can't see, the ones impacting our culture.

19:57Matthew Schneier, welcome to Business Wars. Thanks so much for having me. So, Matthew, did you catch Jimmy Kimmel's Ozempic comment at the Oscars? You must have. That leaped right out at me. And I can't exactly say I was glad to hear it, but it did at least confirm that we're really on to something here. Well, you know, I know you've written about the elite's obsession with this drug. You think that touched a nerve, perhaps? You know, I mean, I think they would probably be sensitive to being called out individually and by name. But, you know, as I was reporting my piece, and certainly since the piece has been released and has been read pretty widely, I've heard a lot from people in the entertainment industry, in Los Angeles and Hollywood in particular, saying, yes, you know, this really is very prevalent.

20:40And to some extent, you know, we've been kind of waiting for someone to say so in a comprehensive way. Well, obviously, your article, Life After Food for the Cut, has been getting a lot of attention. And for those who haven't seen it, you take a deep dive into drugs like Ozempic and Wagovi or semaglutide, I guess, as they're known generically. When did you start to notice these catching on? You know, this has been one of these things that you notice in little dribs and drabs, then all of a sudden, once you kind of poke at it, it turns out to be much more ubiquitous than I had ever at least expected.

21:15I mean, the past several months, I've been, you know, hearing a little something here, a little something there. There was a big media moment around the Met Gala, you know, the quote unquote Oscars of fashion with Kim Kardashian allegedly taking Ozempic or one of these drugs to fit into her Marilyn Monroe dress that she borrowed. For the record, Kim has denied it, but that really kind of brought it all back to the fore. And I guess maybe a couple months after that, that, you know, we saw enough of it and it seemed to be catching on in such a way that we started digging deeper and speaking to patients, speaking to doctors, speaking to providers about what is this really a revolution?

21:51And I think in multiple ways, both medical and cultural, there's good evidence that it may be. Well, let's talk a little bit about the cultural side of it. Just how popular does Ozempic seem to be? Is there any way of actually tracking this sort of thing? You know, certainly in terms of prescribing numbers, you do expect that for recent drugs that they will have a boom at the outset. But what's interesting about Ozempic is that Ozempic, that particular drug, has been around since 2017. It's not brand, brand new. And prescriptions for Ozempic, again, that one specific drug, are up enormously since a year previous.

22:28It's just an enormous jump. And you see also that these particular drugs, what are called GLP-1 agonists, are responsible for a huge percentage of the profit growth at the companies that produce them. There are millions and millions of people suffering from diabetes or prediabetes in this country. So it's obviously a big opportunity and it may be a big medical necessity, but it's also a big win for the companies that are making these drugs. And they're well aware that the people who are taking them, who are being prescribed them, you know, are both on and off label consumers or both people who have, you know, the diabetic condition for which these medications are indicated.

23:07and also those people who are not diabetic or pre-diabetic, but who on either the legitimate market or the gray or black market are taking these drugs for the weight loss side effects. Well, Matthew, walk us through what you know about how these drugs work exactly. Could you explain that? Yes. You know, with the caveat that I am not a doctor, I certainly put myself through the paces in reporting this particular story. So Zempic was greenlit for diabetes 2 in 2017. Wagovi, which is actually the same ingredient as Ozempic, same active ingredient, semaglutide, is a reformulation. It's a slightly higher dose.

23:43And that was approved for chronic weight management in 2021. And then Monjaro is a different drug, a different active ingredient. It's called trisepatide. That was approved in 2022, also for diabetes too, like Ozempic. These drugs mimic a hormone that's naturally occurring in the body that's known as GLP-1, glucagon-like peptide one. And what these drugs essentially do is stimulate the production of glucagon, which acts sort of as a counter to insulin. That's why these drugs are generally, at least with Zempic and Manjaro, are indicated for diabetes. It helps to regulate blood sugar. But in so doing, one, they slow down the emptying of the stomach so you feel fuller faster.

24:29And And there's also evidence that they work on the hunger sensors in the brain. So you actually don't kind of chemically feel hungry. Your interest in food is reduced, as it were, from the inside. And in speaking to a lot of patients, that's what really comes across strongly. People who were overeating or even just eating regularly suddenly were finding that even their favorite foods had lost all of their appeal. They simply weren't hungry and they weren't interested in food. And when they were eating for nutrition and for strength, they often found themselves sort of forcing food down without any of the pleasure they used to derive from it.

25:09Wow. I have to say it's a little scary what you're describing where you have people who really love a particular food and they no longer want it. They have to cram the food down, that sort of thing. Could you say a little bit more about the reported physical side effects that people experience while on this type of drug, these semaglutides? Yes. I mean, you know, there are known side effects for these drugs. I should say that they are generally well tolerated. Doctors will tell you, certainly the companies will tell you that relative to their benefits, the side effects are minimal. You know, if you talk to patients, they may have a different take on the scenario.

25:46You know, the most common ones are basically stomach upset. You know, you can have diarrhea, you can have constipation, you can have nausea in some case vomiting. I've heard of fatigue, sometimes headaches. You know, it's not a walk in the park. But for people who have struggled for years and years and maybe longer with their weight and diabetes, these can be hugely beneficial drugs. And I don't want to lose that either. I spoke to people in the diabetes medicine community who said, you only a couple times in a generation get a drug with results like these that have positive knock-on benefits for cardiovascular health, things like this.