Behavior Change Part 2: Case Studies
Noom is an app that delivers a weight loss program to consumers, who pay roughly $50/month for the service. They’re mobile-first, well-designed, and more expensive and hands-on than your typical weight loss app or diet. Their offering includes:
Education that helps people understand the why and how of behavior change and how to lead a healthy lifestyle
Education about nutrition
Logging food and tracking progress towards nutritional goals
Coaching (with a human), applying cognitive behavioral therapy (CBT)
Communities (you connect with a cohort through the app)
They’ve been fairly successful, with $237M in revenue a year ago and are often held up as a positive example in conversations about health and behavior change. Reviews are generally positive, though some report the coaching isn’t particularly high quality.
Omada sells programs to employers to better manage diabetes, hypertension, and other issues that have a strong need for behavioral intervention. They’ve done studies to establish that their programs improve health outcomes, they have a clear value proposition to bring to employers in reducing cost.
They have a nicely designed app that delivers education, provides data integration for blood pressure cuffs and blood glucose monitors, and enables interacting with a coach. They provide personalized plans across diet, exercise, and medication adherence to ensure you’re working on the most important component at all times. Their plans often last over a year.
Generally, they show that with coaches, community, education, and data feedback loops, they can materially improve outcomes. It’s uncertain how much consumers will value and pay for longer-term outcomes, but they’ve found a good fit by selling to employers. They’re private, but various sources estimate their annual revenue to be roughly $100M (link).
Peloton is a premium spin bike with a subscription to live classes, displayed on a giant screen on the bike. As a cyclist I find riding indoors very unpleasant, which makes their success even more impressive. Their magic comes from lowering the barrier to exercise (it’s in your house after all), and maximizing motivation through great instructors, gamification and competition from others on the platform, and generally providing a great experience while riding. Plus, they deliver an outcome that time-crunched athletes value: it’s one of the most time-efficient ways of getting in a good cardio workout. They’re currently sitting at a $31B market cap, with $1B in revenue and a slim 6% margin (ref).
AA is one of the original cohort-based communities for personal transformation. A desire to stop drinking is all that’s needed to join. Most of the time, a meeting leader chooses a discussion topic, and participants share their experiences. Their famous 12-step program takes members through a admitting the reality of the situation, then believing that change is possible, then acting on this decision, before eventually giving back to the community. The language is quasi-religious, but “AA’s beneficial effects seem to be carried predominantly by social, cognitive, and affective mechanisms” (ref). Studies show it’s the most effective path to alcohol abstinence, which is very impressive because groups of “laypeople” outperform trained professionals delivering validated techniques like cognitive behavioral therapy and motivational enhancement therapy. The organization has over 2 million members across 180 countries.
Universities create massive behavior change. They’re expensive, require an immense amount of work, and ideally provide massive upside in terms of life experiences, network, and job prospects. Universities provide many services (more here), but let’s just focus on the learning component. How do they get people to work so hard? It has a massive carrot: by getting a good job when you graduate, you’ll be able to make money, find fulfillment, and life the life of your dreams. And it has a few big sticks: If you fail, you’ll lose status, you’ll lose friends, your parents will be upset, and you will have an extremely difficult life ahead. Not all of these are true, but speak to the kind of massive outcomes that drive massive personal change.
Tiktok is at the other end of the spectrum. There’s no penalty if you don’t use it, it’s often misaligned with longer-term success (it’s hard to be productive when you’re addicted to scrolling through videos). However, Tiktok, and essentially all other social media, are absolute masters of behavior change. They have clear cues (usually boredom), a very simple action (refresh your feed), and strong variable rewards (did you discover a delightful new piece of content or are you getting likes). The Tiktok format supercharges this this with very highly engaging content and high frequency of the reward (with short content and an easy mechanism to skip).
Tiktok also efficiently provides “status as a service”, as described in the popular essay by Eugene Wei. Views, likes and followers require some work to achieve, so they’re worth some social currency, while Tiktok provides a relatively easy path to virality, so that’s where people prefer to create content. Providing the “most efficient path to maximizing social capital” provides significant motivation for behavior change.
David Goggins, who wrote the book Can’t Hurt Me, is the ultimate example of internally driven personal transformation. You likely know someone who woke up one day and decided to go from couch potato to marathon runner, but they’re rare. In David’s case, he was abused as a child, was overweight, and generally feeling hopeless about life, before turning things around, completing Navy Seals and Army Ranger training, breaking the world pull up record, and running ultramarathons. How did it happen? He woke up one day, was sick of his life, gave himself a massive dose of tough love, and changed his identity to someone who loved hardship, mental toughness, training and personal growth above all else. He’s full of inspirational quotes like, “Pain unlocks a secret doorway in the mind, one that leads to both peak performance, and beautiful silence.” More here.
It’s easy to dismiss this approach as overly masculine and aggressive, but his book has achieved wide appeal, with reviews from grandmothers in their 60s saying they love the book and find it extremely motivating. It demonstrates the power of tough love, and believing in and overcoming yourself, and of the value of big, ambitious goals. You can look yourself in the mirror, and decide you’re going to change who you are, in terms of both your identity and your actions, and things can snowball until you achieve more than you thought possible. This isn’t an easily replicated approach, but it demonstrates the upper bound of what is possible.
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