by Adam Brown and Alasdair Wilkins
Last November, high-tech entrepreneur Jeff Hyman and a team of leading weight-loss experts launched Retrofit, which offers one-year programs designed to help people lose 10% to 15% of their body weight. The company provides each Retrofit client with his or her own dietitian, exercise physiologist, and behavior coach – all of whom offer their guidance over weekly Skype sessions, meaning they’re available anywhere and anytime. We’ve written before about how impressed we are by Retrofit’s approach (see from the editor in diaTribe #41), and as the company approaches its first anniversary, we decided to check in with Mr. Hyman.
He visited our San Francisco headquarters to provide an in-depth explanation of how the Retrofit program works. Acknowledging the program is a significant investment for many who might be interested – the one-year Retrofit membership costs between $3,000 and $4,000 – he discussed how employers, insurance companies, and eventually the government could work to make it more affordable. While Retrofit doesn’t feature a diabetes-specific program, Mr. Hyman said it has helped people with diabetes and prediabetes lower their weight and glucose levels. He closed by explaining why exercise is vital not only to short-term weight loss but keeping weight off long-term.
For more information about Retrofit, check out the company's website at Retrofitme.com. As an exclusive offer to diaTribe readers, Retrofit is offering all diaTribe readers a special discount of $500 off its weight loss program. When purchasing a plan on the website, simply enter the exclusive discount code “OCTOBER” into the box marked “Referrer” to get this great savings. This code will expire on October 31, 2012 and cannot be combined with any other offers.
What Is Retrofit?
Adam Brown: To start, could you give us a quick background on how you came to Retrofit and started the company?
Jeff Hyman: I put on two pounds a year like a typical American. I’m 44. And I got to a point where I just was fed up with that. I tried everything – I would lose weight, gain it back, lose weight, gain it back. My wife eventually dragged me to a wellness destination resort, which changed my life. I worked with therapists, dietitians, and exercise physiologists. For me, it was a transformative experience.
But the problem is that it’s $1,000 a day. So last year, I started thinking about how to make it scalable using technology. Retrofit is a one-year behavior change program delivered entirely online. There’s nothing magical or mystical about it, other than it works because it’s a very intensive, robust, and multi-dimensional program. It includes, of course, nutrition and exercise. And we believe most uniquely, behavior change. In our view, this aspect is responsible for about 50% of weight loss between the ears. The last important thing Retrofit includes is third-party accountability to a dietitian, exercise physiologist, and a behavior change expert.
The customer meets with their team of experts via Skype video conference. They arrange the day and time, from 6 AM until midnight, seven days a week. Each person gets their own registered dietitian, a behavior coach with ten years’ experience and a Master’s degree, and an exercise physiologist with ten years’ experience and Master’s degree. You work with those three people for a full year. It’s not a random rotation call center type. It’s literally three people. They’re on your speed dial. And each week you meet with one of them on a rotating basis for a half-hour session (e.g., my dietitian this week, my therapist next week, etc.). Between Skype sessions, you have unlimited access to your team for questions, comments, and concerns. So if you’re going to this restaurant in New York, your dietitian will download the menu, and tell you what to order. It’s a very high level of personal service with a lot of technology behind it. We have 65 of these experts now across the country that cover all states and all time zones. And our clients are across the country even though we’re based in Chicago.
In addition to your team, you’ll receive two wireless devices. The first is the Withings Wi-Fi scale. You connect this to your Wi-Fi network at home, you step on the scale, and it instantly sends your data to your team. We require customers to weigh in once a week. Our average customer weighs in five times a week. They get very addicted to the data and the progress, and half our clients are men.
You also get a wireless pedometer (Fitbit) that tracks the steps you take, miles per day, and calories per day. At night, it tracks how long you sleep and how well you sleep, which is a huge issue for a lot of customers. People need to sleep at least six and a half hours a night in order to really be able to lose weight. A lot of our customers will only sleep three hours a night, so with the pedometer, we can find it out and begin behavior coaching work to figure out what’s going on.
All this data is wirelessly uploaded to us. You get your own private dashboard that your team is looking at every single day, and it’s a very high accountability program in a very supportive way. They’re not looking to catch you doing something wrong, and we don’t expect perfection. The truth is we find we don’t need to be perfect. We try to lose one pound a week, very slow, steady progress.
Adam: Many would call this just a high-tech “diet.” What would you say to those individuals?
Jeff: It’s not a diet, and we don’t use the word “diet.” We don’t believe in starvation. We don’t believe in restricting people from all their favorite foods. That’s not sustainable, right? We can teach balance and portion control. Why am I eating a gallon of ice cream at night if I’m not hungry? That’s not a food issue. That’s a behavioral issue. Is that stress eating, emotional eating, binge eating, eating out of boredom, eating out of depression? We have all these reasons that we all turn to food – what we believe is almost an addiction. So we do this little by little over 365 days, and that’s the program.
We were lucky to recruit Dr. Robert Kushner, who runs the obesity program at Northwestern, and Dr. Jim Hill, who runs the program at the University of Colorado. With Doctors Kushner and Hill, we have developed a protocol that 500 clients are on. If you do it in a sustainable way for enough time, changes take hold. The average diet is going to last nine weeks. This is not a diet. It’s true commitment. It’s a one-year program. After you have joined, we lock the door behind you. And so that alone, I think, weeds out people that aren’t serious.
Adam: How successful are people at losing weight while on Retrofit?
Jeff: Ninety-five percent of our customers are losing weight on the program. The majority of our customers are on track to lose at least ten percent of their weight. Experts have told me this has never been seen before in the industry. It’s transformative. But it’s not rocket science. We’re just keeping people on the straight and narrow for a year. We’ve got many, many hundreds of people who are slowly but surely succeeding on the program. Time will tell if they keep the weight off over time. But what gives us confidence is that based on our advisory board's experience, most people fall off the wagon after two to three months. So the fact that we’ve now kept these people on for six, nine, coming up on 12 months next month, is in and of itself remarkable because most people will have failed.
Adam: You mentioned that the behavioral side of Retrofit is one aspect that makes it unique. Can you talk about that approach?
Jeff: The protocol that we use is really interesting. Dr. Kushner, who has over 30 years of experience, identified 21 distinct personality types that prevent you from losing weight. He calls them lifestyle patterns, which he summarized in a very good book called Dr. Kushner's Personality Type Diet. Couch potato, meal skipper, constant muncher, midnight snacker – all these are different eating patterns. And sure enough, you’ll read it and say, “Yeah, that’s me.” Dr. Kushner developed a 50-question quiz that identifies your lifestyle patterns. It’s on our home page and 15,000 people have taken it. We email results to people totally free. And then if you choose to join Retrofit, that becomes the basis of your protocol.
It’s a very, very personalized service, which is why you get better results than a group meeting where you often must dumb it down to the lowest common denominator. It’s not possible to personalize because you have twenty people in the room. We have clients who have diabetes or are vegetarians or travel all the time. For the latter, as an example, you’d have to figure out how to exercise in their hotel room.
Paying for Retrofit
Adam: Is it possible you could obtain reimbursement either in the United States or in the UK or other countries?
Mr. Hyman: Yes. Right now, half of our business is direct to consumers. They come to the website and just put it on their credit card. The other half is through employers and most of that is subsidized. A recent study found that 59% of employers are now contributing or giving employees some money to apply to wellness and weight loss. They understand that that’s way less expensive than treating diabetes later, especially self-insured employers. Now that we’ve got some outcome data, we are starting to get calls from insurance companies. That is the next level, and we’re still having those discussions.
Insurance companies spend hundreds of millions of dollars treating all the diseases that are caused by obesity. Medications, gastric bypass, the list is endless. We’re starting to engage in those discussions with insurers. It’s my premise that eventually, the US Government will have to do something about it. I can’t say when. But if you look at the numbers, if we keep going at this rate, in 25 years our healthcare system is in trouble.
So it strikes me that, at some point, the government will get involved. And in addition to starting to curtail this food advertisement to kids and a bunch of other things, I believe that the government will start to offer some kind of support, financial support, for effective programs. The programs will have to work, which is again why I’m maniacally focused on outcomes. I’m not trying to be the cheapest program. I just want to have the best outcomes, because ultimately, someone will pay for it, either the consumer or their employer or the insurance company or the government.
Retrofit and Diabetes
Adam: What about people with diabetes? Can you talk about that aspect?
Mr. Hyman: We have a number of people with diabetes on the program, and quite a few people with prediabetes, where their physician has told them they’re on the wrong path. And we paired them up with dietitians who have expertise in diabetes, and with behavior coaches that have expertise in diabetes. So while it’s not a diabetes-focused program, we leverage that expertise. We’re always evaluating if we should have a diabetes-specific program, and maybe we will one day.
Adam: From an insurer perspective, it would be very compelling to show that Retrofit slows or halts the progression from prediabetes to diabetes.
Mr. Hyman: So many of our clients track their blood glucose numbers before the program, and then during the program they send us a copy of the report. We’ll actually liaise with their physician if they want with no additional fee. Their blood glucose numbers are transformed in six months. And they didn’t lose a ton of weight, but they lose enough to make a difference.
So what I’ve learned from the experts on our team is that an overweight person losing 10% of their weight reduces their risk of many diseases by 50% to 80%. That’s where you get the biggest bang for your buck. We get customers who lose 25 pounds or 30 pounds, but they’re not going to become a cover model anytime soon. However, it’s enough to make the difference such that their blood glucose numbers are transformed. They go off medications or they reduce them. That’s why we focus on losing at least 10% of body weight.
The Role of Exercise
Adam: We spoke with Dr. Arya Sharma, who’s a weight loss guru. [See our diaTribe dialogue with Dr. Sharma in diaTribe #45.] It is his opinion that if you go on a calorie restriction diet, you will lose a certain amount of weight. But in order to maintain that weight loss over a long period of time, you have to maintain the diet. Is that realistic for anybody?
Mr. Hyman: Just so I’m very clear, to lose one pound per week, you need to create a net calorie deficit of 500 calories per day (i.e., 3500 calories a week is about one pound of fat). That is roughly what we work with our clients to do. Some of them lose two pounds, depending on their story.
Over time, you start seeing the curves plateau as it becomes harder and harder to lose weight. To continue to lose weight, you have then to begin to increase the exercise. There’s no question about it. Dr. Holly Wyatt, in her research, has found that there’s a trade off. Initially, you do it with food. But to keep the weight off over time, it’s got to be through increasing activity, and more importantly, strength training. That’s really the engine that burns calories throughout the day. Most Americans have no idea – they think you just go onto the treadmill. While that’s great, you’ve got to do strength training twice a week. We teach clients how to do all that.
Once our customer gets to the goal weight, we’re just working with them to maintain. That is in and of itself another process. So of the one-year product, roughly half of it is weight loss, and half is weight maintenance. And we actually think weight maintenance is the harder part, because now we created that deficit.
Now, we need to teach you how to live within a band. You’re not going to be perfect, but it’s almost like a stock price chart that’s kind of going sideways. You know you’ve got some fluctuations. And what the National Weight Loss Control Registry – which Dr. Hill developed – shows is that people that keep the weight off over time learn how to live within this span. They weigh themselves regularly, a couple of times a week at least. And they notice that they’ve gained a little bit, and then the alarm bells go off. And they start to lose weight, and then they gain weight, and they live within this very tight range.
And that’s what we teach our clients how to do. It’s an energy balance and all about balancing your calories in and out. You can’t give an exact range, and it’s a little bit different for everybody based on your metabolism, your starting weight, your gender, your age, and your percent muscle versus fat. So we can’t just give people a number. We have to iterate to get there. But that’s what the second phase of the program is all about.
Adam: What I’ve heard at obesity conferences and reading the literature is that if people try to lose weight by just burning off calories with exercise, and not changing their eating habits, they end up eating those calories back again. But at the same time, anybody who’s sustained weight loss over a period of time has a very active exercise component. Could you talk a little bit about that?
Mr. Hyman: What your average person does is they go to the gym and exercise for an hour and a half and kill themselves. They think they burned a thousand calories – they’ve actually burned 300. And they go and have a bagel and a latte at Starbucks, right? We have to teach people you can’t out-exercise a poor diet. Most people don’t understand that very basic concept.
With that said, there comes a point in time where you just can’t eat any less, where you don’t want to eat any less. And so the only other option is starting to increase the exercise. The benefit you get from strength training is that it’s powering your engine – muscle burns more calories than fat. So you get this lasting burn of calories throughout the day as opposed to just during a cardio session.
But they’re both important. We generally tell people that exercise is necessary to keep the weight off. When a customer first joins us, on average, they take 2,000 steps a day. Dr. Hill has found that if you take 10,000 steps a day, it’s really hard not to lose weight. You’ve got to be eating a ton to outdo that.
So we notch them up from 2,000 to 2,500 a day, to 3,000 a day and kind of go from there. Just over the course of a few months – very gradual, and we’re not trying to drop them in a gym and kill them. But then by month four and six, they’ve lost some weight. We’re down this part of the curve. And now, we start to really introduce the exercise. They’ve got some self-confidence. They feel more energy. And then that becomes a huge part of the focus, and you’re just finding that balance.
Adam: Jeff, thanks so much for taking the time to speak with us.
Mr. Hyman: I enjoyed it very much. Thank you.