A Way Forward for WW

By S. Bryn Austin posted 23 Sep, 2019 09:41

  

In August, WW, formerly known as Weight Watchers, a company founded in 1963 to promote weight loss among Americans, released Kurbo, an app for children ages 8 to 17 years old to track their weight, diet, and activity. Immediately upon release, WW was deluged with protests and recriminations on social media from eating disorders specialists and community advocates. Mainstream media too published harsh critiques of the app, including a trio of negative pieces in the New York Times, by writers Harrison, Sole-Smith, and Klass, and accusations that the company was targeting children to create the next generation of lifelong dieters and thus WW customers.

Even leading clinical scientists in the field of pediatric weight management greeted the app with some trepidation. Pediatric weight management clinical specialists Michelle Cardel of University of Florida College of Medicine and Elsie Taveras of Harvard Medical School did not come out against the app, but the “friendly fire” critiques they offer are damning enough to give pause to any pediatrician or parent considering the app for a child. Their criticisms include:

  • The Kurbo app is based on the Traffic Light Diet, which has been tested primarily with white, higher income families, which means that generalizability to and possible effects with families of color and lower-income families are not known.
  • The Traffic Light Diet was designed to be used as one element of a more comprehensive clinician-led intervention program, where parents are trained in how to manage diet and physical activity and health professionals provide clinical supervision to the participating children. The Kurbo app, in contrast, veers quite far from the evidence base for the original intended implementation design of the Traffic Light Diet by offering the app as a standalone intervention with no clinical supervision and no way to ensure parental involvement.
  • The app is free. While that seems a plus at first glance, it creates a two-tier intervention, one for the haves and the other for the have nots. For a monthly fee, participants and families can hire a WW virtual coach. As Cardel and Taveras note, because of the fee, it is likely to leave children from lower-income families without any professional supervision at all.
  • The version of the traffic light system used by Kurbo again veers quite far from that of the original Traffic Light Diet. The Kurbo approach, Cardel and Taveras write, “excessively focuses on calories rather than the quality of those calories,” and thus may confuse children who mistakenly infer that red light means low-quality food rather than healthful foods, such as hummus, nuts, and milk, to consume in moderation.
  • While WW reports that Kurbo is not meant to promote dieting and is “not prescribing weight loss to kids,” as WW’s Chief Science Officer Gary Foster told the New York Times, the app includes before-and-after images of children, placing the emphasis for praise on the change in their physical appearance and weight loss rather than reinforcing healthful nutrition goals. Tellingly, Taveras summed up many people’s disappointment with WW’s new app, particularly with its reliance on appearance comparison to motivate children, when she commented to the New York Times, “They should have known better.”

In case you missed it the first time, let me say again these critiques were from “friends” of the WW mission -- internationally recognized experts in the field of pediatric weight management. From those opposing the app altogether, the criticism is continuing to mount, just as WW and others argue that to do nothing to address nutrition and physical activity in children living in larger bodies would be unethical.

At this point in the debate, the lines between the opposing sides are starkly drawn, but the path forward is not.

Perhaps to find a way forward, we need to step away from the debate about whether an app like Kurbo could or could not ever be healthful. Instead let’s ask why the app’s release provoked such immediate and impassioned protest and concerns for the mental health and well-being of children. There is nothing inherently harmful about helping children become more knowledgeable about nutrition. However, in our current era where people with higher-weight bodies are routinely stigmatized and denigrated – with HBO TV host Bill Maher’s recent call for more fat shaming being a prime example of this – any app for children about nutrition and weight loss will be refracted through a harsh stigmatizing lens. So what can WW -- or any corporation seeking to use the marketplace to promote healthful nutrition and physical activity – hope to accomplish without being tainted by or, worse, intensifying an already toxic environment, given how fraught this space is with stigma and pain?

Before attempting to answer that, I have another question: What do the members of WW’s customer base share in common? By and large, the company’s base is made up of people living in larger bodies – or perhaps more to the point, as people who see themselves as overweight -- in a deeply weight-stigmatizing world. In fact, since its inception in the early 1960s as “Weight Watchers,” the company has singularly depended on them. That means in the life experience of many of WW’s customers, they have been bullied and treated disrespectfully, have painfully endured constant denigration in social media, and some, perhaps many, have experienced weight-based discrimination. Weight discrimination is nearly universally legal around the world, with the exceptions of just a few cities and states in Australia, Iceland, and the U.S., and is well-documented in educational settings, employment, and healthcare settings. These noxious forces have been clearly shown to negatively affect mental health, increasing the risk of depression, anxiety, and eating disorders, impaired physical health through physiological stress pathways and allostatic load, and unhealthy nutritional and physical activity behaviors. In other words, weight-based stigma and discrimination negatively affect the health, well-being, and life opportunities of WW’s customer base in profound and pervasive ways globally.

WW launched its rebranding in 2018 when it changed its name from Weight Watchers to WW with the tagline “Wellness that works.” Executives at the company were very aware that a singular focus on weight loss was losing support in the community, especially among millennials, and well-being was moving up the list of priorities for people. In interviews, they touted their decision to rebrand as a business strategy to embrace the cultural shift rather than stick with its original weight-loss brand and likely suffer the consequences in the marketplace. When the company’s profits dropped precipitously after the rebranding launch, business writers were quick to assert that the losses were evidence that WW had “pivoted too much” from its original weight-loss brand identity. But what if the real reason is that WW didn’t pivot enough?

As the research increasingly shows, an ever-present foe of health and well-being for people living in larger bodies is weight stigma and discrimination, and in children we know these noxious forces increase the risk of eating disorders. Rather than throw an app at the problem, WW could follow the lead of other major corporations that have made a commitment to promote health and well-being of their customers and society beyond just through the products they put on the market.

Before you dismiss this as Pollyanna wishful thinking about a kinder, gentler form of capitalism, consider the evidence emerging from inside the corporate world. Business and public health researchers are documenting positive movement by many companies making the advancement of community health and well-being core to their business model. In some cases, these initiatives take the form of corporate policies that can have the potential for wide-reaching positive impact on the public’s health while raising the bar for competitors to follow their lead. For example, in 2014, CVS became the first major pharmacy chain in the U.S. to stop selling tobacco. What was noteworthy about this move by CVS is that the company’s rationale was that it was a business strategy decision, one that executives argued would be good for business at the same time it was good for public health.

Walmart, after a tragic mass shooting in August in a store in El Paso, Texas, announced it would stop selling handguns and some types of ammunition. The company had already cut back on other gun sales. Clearly these moves by Walmart are nowhere near enough, as mass shootings in the U.S. have escalated, but given the fact that the company holds 20% of the market share on ammunition sales in the country, which is expected to drop to 9% once the new policy takes effect, the potential impact is likely to be meaningful. 

But it’s not just corporate policies that are changing, as some companies are engaging in major prosocial and pro-public health legislative initiatives. CVS, for instance, in 2016 launched Be the First, a five-year, USD $50 million campaign against tobacco that included funding of youth civic advocacy projects to strengthen laws prohibiting youth access to tobacco. From a business perspective, executives describe this investment as not just philanthropy, but rather as a central part of the company’s business model to reposition itself as a “health” company.

Unilever’s Dove introduced this kind of rebranding shift toward prosocial investments close to two decades ago and in fact is considered in the business world as the industry pioneer in the strategy. Not long after Unilever launched the rebranding strategy in 2000, Dove executives commissioned a global survey, led by psychologist Nancy Etcoff of Harvard Medical School, Susie Orbach of the London School of Economics, and colleagues, of women’s feelings about themselves and not surprisingly found appearance-related negative self-assessment to be prevalent. These findings, executives said, informed the creation of a whole new rebranding strategy with a sizable investment in high-visibility marketing to challenge the beauty myth writ large rather than just promoting specific products. The brand’s multiple “Real Beauty” campaigns, Evolution video, and the genesis and rationale for the initiative as a business strategy are all documented in a Harvard Business Review case. As might be expected, at the launch, the initiative was initially greeted with skepticism in the business world, with industry experts predicting it would drag down brand recognition, revenue, and ultimately fail. As it turns out now nearly 20 years later, the critics were wrong.

The Dove strategy began with what were primarily communications campaigns designed to expose the underside of the beauty myth and promote themes of body acceptance, but more recently Dove actively engages in and funds legislative advocacy similar to the kind of advocacy CVS is doing around tobacco. For instance, Dove is a lead partner in a global coalition to address structural barriers to men’s participation in childrearing by advocating for company policy and legislative changes that allow more time for parental leave from work for new fathers. The program won a Shorty Social Good Award in 2018. In the U.S., Dove is a central partner in the Crown Act Coalition, a national advocacy campaign to get laws on the books state by state to add to anti-discrimination protections for natural hairstyles, such as twists, dreadlocks, and braids. This form of race- and appearance-based discrimination is pervasive in employment, education, and other settings in the U.S. and targets African-Americans, especially women. The Crown Act was signed into law in July of this year in both California and New York, and the Dove-supported coalition is actively working in a number of other states to continue the momentum to improve legal protections nationwide.

CVS and Dove offer WW market-tested models of what a rebranding pivot can look like when promotion of meaningful change in laws and policies that undermine well-being are part of the business plan. For instance, WW could position itself as an industry leader on company policies explicitly banning weight and appearance discrimination in hiring, promotions, and salary; instituting trainings for all employees, including management, in how to identify and intervene on weight and appearance bias in the workplace; and eliminating health insurance coverage rewards for employees who lose weight or penalties for those who do not. Like Dove’s role in the Crown Act Coalition, WW could make a meaningful impact by helping to get anti-weight discrimination legislation passed in states and provinces across the country and globally. The company could start by joining the coalition advocating for a bill currently in the Massachusetts legislature sponsored by lawmakers Sen. Rebecca Rausch and Rep. Tram Nguyen to make the state the second in the U.S. to ban weight discrimination by statute.

If WW were to seize these opportunities to bring more vigor to its rebranded business model, will the industry pundits chastise the company again for going too far? Probably. But all signs point to a way forward that will require the company to put advancing the well-being of people living in larger bodies front and center in its business model. Pivot, WW, keep on pivoting.

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