Health as a service: Tackling obesity with technology
It turns out that one of the most interesting and devastating exports from the US during the past few of decades has been the fast food industry. I still remember when the first Taco Bell opened in Bangalore and the hoopla around the event was closer to a five star hotel opening or a red carpet premier of a Bollywood blockbuster than that of a chain restaurant. The fact that McDonalds and KFC are considered cool spots for casual gatherings, especially for young people from middle class families, is leading to a potential explosion of Delhi Belly (a must see movie).
Indians are also genetically pre-disposed to diabetes, hypertension, high cholesterol and other metabolic ailments, which is a recipe for a health disaster in the near future. In the last five years, I have known nearly a dozen people in their 30s and early 40s who have died of massive cardiac arrest. This is a catastrophic epidemic that ought to ring serious alarm bells, especially in India.
Lack of exercise and high caloric intake shows that the US is charting a course for its own demise. With an aging and horizontally-expanding population, the impact of this crisis will be far-reaching than the healthcare crisis the country finds itself in today. The statistics are alarming. Roughly one-third of the US population is overweight and more than an additional quarter of the population is considered obese, and that number is climbing. Unlike emerging economies like India, in the US and other developed countries, the poor are the most obese, thanks to the cheap and voluminous fast food coupled with little exercise. Fortunately, initiatives like the Soda Ban in New York City are a step in the right direction, but soda is still the drink of choice for Indian youth, especially kids. Pepsi and Coke are hitting record numbers through their core soda businesses in virtually every emerging economy. Additionally, when one thinks of Indian food, especially north Indian snack foods, virtually everything is fried across the spectrum from shallow to very deep oil, most of which has been used or reused since 1947.
There are early signs of positive change in the making. In India, I have seen a proliferation of gyms, health and fitness chains as well as med-spa and botox infusion outfits to make the ultra-wealthy look like wrinkle-free Bollywood stars. Personal training and meaningful exercise is still on the fringes of society, done primarily by the wealthy and early adopter crowd. In the US there is a clear dichotomy. A geographical heat map of health and wellness will show more activity in the West where the organic food movement has taken hold from Seattle to San Diego and people seem to be more aware of treating their bodies well. This admittedly is a gross generalisation. One can still witness significant obesity issues throughout the country, so the prior statement is more a relative measure than an absolute one. The issue has reached chronic stage, however, in the Southeast, parts of the Midwest and East Coast of the US, where burgers, fries, steak and potatoes are still the norm.
But with this challenge comes a great opportunity. And entrepreneurs are envisioning a trillion-dollar market with the expansion of waistlines. The combination of aging population, deteriorating lifestyle and the desire to live longer is leading to a rise in health and wellness startups. Following in the footsteps of "pick a letter" as a Service (SaaS, PaaS, IaaS etc.), there is emerging a "health as a service" (HaaS) market, coined by yours truly.
There is a confluence of trends that are fuelling this wave of innovation in the space, divided into three key categories: networked devices, applications/gaming and services. On the device front, companies like Fitbit, Nike, Withings and dozens others are creating digital pedometers, wifi-connected scales, heart monitors and the like that help continuously measure key output and data like activity level, weight, body mass index, heart rate, and more. There is also a wave of startups looking to capture other vitals through portable blood test modules connected to smart phone to extend measurements to lipid profiles (cholesterol, triglycerides etc.). Some are even working on in-vivo chips, inserted under the skin, which continuously monitor vital functions. All of the data is wirelessly transmitted to a connected laptop or smartphone to create an individualised health and wellness snapshot. The device manufacturers have led the wave of further data logging, primarily through online capture of physical activity as well as food consumption.
Leveraging the iOS and Android revolution with more inexpensive devices, application and gaming companies are using the logged data to create content to engage consumers in increasingly meaningful ways, such as games (either solo or in teams) to catalyze behavioural change through healthy eating habits and physical activity. Others have taken an e-commerce approach by partnering with grocery and fitness chains to offer discounts or personalised offerings to individuals based on their preferences (what they like to eat, for example, but with healthier options), and links to content and health and wellness experts. The services angle is one I think will have incredible growth in the coming years.
This fall, I led DFJ's first investment since returning to the U.S. in Retrofit, which is a company trying to impact lives by combining personalised service from experts with data and predictive analytics. The target segment for Retrofit is the busy professional who does not have an exercise routine, is often on the road and potentially lacks the knowledge and/or the discipline to address his/her own healthy (or likely unhealthy) lifestyle. Over any twelve-month period, roughly 50 per cent of the US population is on a diet programme of some sort.
In a fast-paced world, people are programmed to look for a quick fix, which is generally not conducive to long-term, sustained weight loss. Retrofit is a one-year commitment, with the goal of losing 10-15 per cent of one's body weight usually in the first six months, and then maintaining it for the following six months. Before making this investment, I joined as a client (Yes, like the old TV commercial says, I am not only an investor, I am also a customer). I was not obese but aimed to lose about 20 pounds. I have lost 15 lbs in 13 weeks and am well on my way towards my 10 per cent weight loss goal. I am not a marathon runner or a frequent gym enthusiast. I have made some relatively simple but life-changing modifications. My goal is to walk 12,000 to 15,000 steps per day; an average American walks about 5,000 steps as a point of reference. Now, one can see me taking calls at work while walking in the parking lot behind my office. Sometimes, even meetings with entrepreneurs turn into walks on Sand Hill Road, rather than a sedentary meeting with virtually no movement for two hours. Combine more movement/activity with portion control, frequency of healthy food consumption, and I end up looking good and feeling great.
By recruiting a couple of colleagues in the office to join the programme, Retrofit has turned getting healthy into a game with competition. We watch out for each other and make sure that the lunch plate is split into appropriate portions of produce, protein and carbs, while measuring our collective step count online and making sure that we outdo one another on daily, weekly and monthly basis. I can say that the Retrofit programme is not rocket science, but having accountability and motivation through interaction with one's peers as well as a team dedicated to helping me achieve incremental but sustainable changes, has had a clear impact. There is no better testament than my own kids commenting on the physical improvement. It's still early and the key question is whether I can keep it going, but the key indicators are positive.
Behavioural change usually requires a social component (as a matter of fact, there is actually a startup with ex-MIT founders that manufactures robots purely as an exercise/training companion). Relying purely on devices is an approach that may work for some but not for most. So, while the US VC investment thesis is often based on technology , the DFJ partnership (thankfully) understood the merit in combining technology and analytics with expert (human) advice. Retrofit provides a combination of expert dieticians, physiologists and behavior coaches to, slowly and steadily, change the way people think about themselves, their diet and their bodies. I feel an accountability to my team with whom I Skype periodically, and communicate constantly through an online Yammer-like interface. The interesting thing about Retrofit is that the company matches up clients with the types of experts one might be looking for (a drill sergeant approach (a la the stick), or one that is more encouraging and softer rewarding one (the carrot), which is more my style).
While Retrofit is only an example, this HaaS market is one that is extremely large and global. The issues of health and wellness are across cultures, geographies and body types. And the trend across the globe, both in the emerged and emerging economies is heading in the wrong direction, the former because fast food is cool, and the latter because fast food is cheap. Kudos to the founders of new devices, applications/games and expert networks who are addressing a growing need that creates possibilities but also impacts tens of millions of lives or more in the process. In countries like India, youth are clearly an enormous asset for the country, and without addressing the underlying health and lifestyle habits, these same youth will grow into a potentially massive liability for the country. I certainly hope to do my part in catalyzing this technology-enabled health and wellness category.
(Mohanjit Jolly is the Executive Director, Draper Fisher Jurvetson India. Views expressed are strictly personal.)
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