Noom is a behavior “modding” company. It takes a few paragraphs to properly describe Noom, so here goes.. On the surface, Noom is a health and lifestyle improvement app. Many people use Noom for dieting activities like setting goals, tracking progress, etc. But there’s a lot of fundamental research underneath this platform. I call it a platform technology because Noom offers different types of products / services that share a common thread – behavior modification. To be super clear, the company sells “behavior modification”.
To really understand Noom, we need to address the demand for behavior modification. But before we get to that, let’s unpack behavior modification, also referred to as “nudge science”. In this context, nudging means influencing a person to take a certain action. A simple example of nudging is when digital marketers design websites to increase clicks or subscriptions. But outside the context of internet sales, there are many important applications for nudging.
Think about how we might persuade a diabetic to go for daily walks, or attend a scheduled medical appointment, or take medicines as prescribed by a doctor. These small changes would carry significant health benefits, but simply explaining that to a diabetic is often not enough to promote a consistent lifestyle change. Just consider this survey of wellness programs – these programs educate patients on self care and disease management, but the outcomes rarely pass rigorous evaluations; they generally don’t work.
Noom is all about getting you to take action. It’s not clear if Noom disclosed its complete “secret sauce”, but the company’s website describes a combo of motivational interviewing, incentives, and habit-building techniques to achieve high rates of behavior modification. There is also a peer-reviewed article on the success rates of the Noom app, but this study is NOT a randomized control trial (RCT) which is the gold standard for determining whether a clinical intervention truly works.
Getting back to the demand for behavior modification, Noom’s potential customer base is wide and not limited to weight loss. The company is diving deep into population health by tackling lifestyle changes to support chronic disease management, in partnership with health plans, private employers, and health systems. Noom is also launching a prescription drug adherence program, presumably in partnership with pharmaceutical companies (according to a white paper available through their website).
The key takeaway here is that behavior modification can save big money in healthcare! If it actually works. It’s very important to understand what I mean by “actually works”. As I mentioned above, there is data showing Noom users can successfully lose weight. But that evidence is not based on any RCT, and therefore we don’t know the counterfactual. The counterfactual is a bit abstract, but it refers to what would have happened in the absence of ‘X’. Essentially, it’s possible that Noom users were committed to losing weight, prior to using Noom, and would have lost weight through any other approach.
My impressions of the Noom app. There are literally hundreds of reviews for Noom, so I will simply point you to these reviewer details on consumer affairs. But I do want to mention a couple aspects of the Noom app that struck me..
The Noom experience is primarily guided by coaches sending text messages to users. These messages are polite and informative, but not completely natural. I wonder if their messaging is mostly automated, built on AI with some human supervision.
Their pricing strategy is clever. The monthly subscription is not cheap – $60 per month as of this writing – but is discounted substantially if you sign up for longer stretches of time. And the bill cycles are pretty flexible – you can pick a recurring plan of 1 month up thru 8 months, or just go annual. Someone who is serious about losing weight understands the time commitment, and is apt to go longer than a month.
The nudge science market. Right now, the number of players in nudge science is pretty small. The most comprehensive nudge science group is the Behavioral Insights Team, formerly part of the UK government. Their work goes far beyond weight loss, and is broadly focused on informing and implementing public policy. You should definitely check out their work!
And Humu is another “up and coming” company to watch. This group integrates nudge science with machine learning to help companies improve employee performance, management and retention. These guys are newer, so there isn’t much in the way of success stories, but their management team has the right people, including Cass Sunstein, the NYT bestselling author of Nudge: Improving Decisions about Health, Wealth and Happiness.
I will keep adding nudge companies to this list, as I discover them.
Nudging in accountable care. What excites me the most about nudge science is how it may plug into accountable care. Accountable care organizations (ACOs) face the huge challenge of engaging patients for lifestyle improvement, while bearing responsibility for patients’ healthcare spending. ACO administrators can engage their primary care doctors to enhance the quality of care, but engaging patients is much more difficult. Nonetheless, if ACOs can sway some portion of their diabetics to eat healthy greens several times a week, or take their medicine on time and as prescribed, then hospitalizations should decrease along with healthcare spending.
The blindspot of nudging. I do see one big risk for the nudge movement. As it stands, using nudge science to arrange choices in a way that prompts people to do what’s in their best interest is all good. But, in certain cases, the best choice for people may not be very clear. Sooner or later, someone will use nudge techniques that set people up to make choices which turn out bad for folks, in a major way. As more companies and governments turn to nudge science, a bad outcome is bound to happen. And when that happens we might see a pretty serious public backlash, and some people will call out nudge science as pure manipulation. So that’s what my crystal ball says 🙂
~ James
