WeightWatchers CEO Sima Sistani talks TikTok, Telehealth Deal on GLP-1/Ozempic and Why She Took the Job 54:07

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Hi, everyone, from New York Magazine and the Vox Media Podcast Network. This is cable news with 100% fewer presidential perp walks. Just kidding. This is On with Kara Swisher, and I'm Kara Swisher. And I'm Naeem Araza. We're back to covering his every move. I just know. I didn't watch it all day. Let me give you the brief. It was like the O.J. Simpson car chase, just 100% slower. I don't want the brief. I don't want perp force one. I don't want any of it. I don't want any of it.

No, thank you. At some point, you know, we're going to have to cover this. You know what I watched? I watched the comedy people and they were very funny. What I liked was the 43 couples who were trying to get married at the courthouse that day. Well, New York Magazine's Olivia Nuzzi sent me pictures of them. She was there. She sent me very lovely pictures of this one couple getting married that was just adorable. Well, she's great. Her coverage on Trump has been great. And I think she's guest hosting Pivot. She is. People should check that out. Yes.

Well, I'm very excited for our guest today. Seema Sastani is the CEO of Weight Watchers. It is the perfect time for this interview because Weight Watchers has just announced last month that it's forking over $132 million to buy Sequence, a telehealth company that prescribes GLP-1 drugs to

That includes drugs like Wagovi, Manjaro, Trelicity, and of course the one everyone knows, Ozempic, the diabetes drug, which is being used off-label to treat weight gain. It's a big deal, $132 million big, but also a big deal because for decades Weight Watchers has been all about personal responsibility and lifestyle changes and not about medical intervention. So what do you make of the shift? Well, it's a really interesting issue because...

There's just a lot going on here. I have a lot of people I know that are on it. They don't want to be made fun of. They've struggled with weight for years. And this has become the silver bullet for them. And so they don't want to be judged about it. At the same time, you know, fitness is really important just for state of mind. But a lot of people just can't, you know, lose that last minute. I'm one of them. You know, I don't think I would take a Sembic, but I wouldn't not consider it for sure. Yeah.

I feel it's a uniquely American solution where, like, a relatively under-regulated pharma industry is coming in to deal with another relatively under-regulated industry, which is corn storage, food manufacturers, et cetera. Because obesity here is, like, you know, 40% versus...

25% in the UK or 15% in Europe. Well, their numbers are ticking up. They are. Or 4% in Japan, let's say. But there's something in our food supply, something about our sedentary lifestyle. Michelle Obama was trying to get on this. Sure. Now we have a drug for that, so it seems like there's no reason to solve the underlying issue. Well,

I don't know. Look, some of this stuff is genetic, right? And so I think some of this stuff can be treated medically the way you take statins for cholesterol. There's certain drugs that maybe will help a little bit and get you into that zone where you don't eat as much. Because the fact of the matter is, is the reason is we eat too much and we eat too much shitty stuff. Yeah. And we don't move enough. It is odd, though, when you go shopping in an American supermarket. Like, I love Fruity Pebbles, and they like to advertise Fruity Pebbles as gluten-free.

Whatever. And I'm like, what? Like, why don't you advertise it as full of sugar and diabetes? Yeah, gluten-free, slapdunk things. Exactly. Yeah, you know, I don't know what to say. People in America like to eat bad food, and it's been a problem for a very long time, and we've exported it around the world, our bad food. Yeah. And there's so much linked to health problems, you know,

that it's just a cascading effect. So I don't wanna immediately be like no to this because there's so many more ensuing health problems that I wanna look for solutions here. And if it's a pill, it's okay. If it works, if it's not damaging, sure, why not?

It was an injection, but I agree with you. It's not useful to be no because it's actually where the puck is heading because something is happening. Our obesity epidemic started 50 years ago. Our genes didn't just overnight change probably. And so these broader issues of like exporting bad health culture. Yeah. I don't know. Yeah.

Scary world. I've had dinner with people with Ozempic and they don't eat. No, they don't eat. Me too. Yeah. Everyone's guessing who has Ozempic. I was at a breakfast this morning and I was like, three people here had Ozempic. I could see. I watched them not eat and they lost an enormous amount of weight in a very short amount of time. And I was like, and of course, no one wants to say so, but I do. I was like, obviously, Ozempic. They're like, what?

Well, I was like, why are you hiding? Like, it's fine. Just talk about it. It's fine. Yeah. Have you ever done Weight Watchers? Oh, yeah. Do I have the baby? Like the point system? No, I just, all of them. I found new, useless Weight Watchers somewhat useless. They're not useless. I just don't, they didn't work. How's that? You know, what worked is you don't eat as much. And I guess keeping track of them felt like I had some mode of control. Yeah.

But I don't know. They work for a lot of people. There's a new one called Prolon. Do you know Prolon? No. I have it right now in my house. I haven't done it. It's a five-day fast, basically. It mimics a fast for your body, which is ironic that it's like the month of Ramadan. I have Prolon. Why are you – you're so skinny. See, here's the thing. Why are you doing a fast? Because I think there's been all this –

and content around cleanses. And so I have done many cleanses, juice cleanses. That was a trend. Broth cleanses. Useless. I can't get my head around doing Prolon because they're all useless. The soup comes in like a plastic package that looks so sad. I cannot bring myself to do it. I can't believe you're doing that. Please don't. Please go out and play the pasta. It's been in the house for three months. I haven't done it. Yeah. I think all of those things. I've done the juice thing.

It was stupid. And as it turns out, and I drink, I make a kale smoothie almost every day, but it's just ridiculous. I still have the glasses from it because they were so beautiful. The thing I think is good is like paleo or Whole30. I also don't have the discipline to do any of those, but that's just like avoiding. I've done, I didn't do paleo. I did Whole30. That was terrible. Did it work? No. No.

No? They just, they do and then they don't. You know what worked? I'll tell you what I lose weight when I break up with someone. Oh yeah, me too. Someone's like, I said I just lost 130 pounds. But I lose weight when I break up with someone. Yeah. I do too. That's why I'm sitting, I'm sitting in care. I'm perpetually breaking up. I just think.

Yeah, that's exactly when I lose weight. I get ready for the next one, I guess. I don't know. Yeah, I gain weight when I date because I'm so happy. Yeah, well, that means I'm going to be fat because I'm very happily married. Yeah.

Anyway, enough of this love-weight correlation. Let's get back to our guest, Seema Sistani. She's only been the CEO of Weight Watchers for about a year, but she's a techie with roots in Silicon Valley. She worked as Yahoo's first head of media under Marissa Mayer, someone you know very well. And more recently, she co-founded the House Party app, which was super popular at the beginning of the pandemic. I'm sure you were just house partying all over the place, Kara. Yeah.

No. Playing wards with friends. Yeah. No, I'm not a house party kind of gal. Uh, no, uh, I, I, those were fine. I just thought all of them would crash and burn after everybody got to be outside, but you know, they worked during it. I mean, it was interesting. Um,

You know, there was a bunch of them. What was the one? Clubhouse. Clubhouse was the big one. You weren't on that. That was Marc Andreessen's terrible ground. No, they yelled at journalists the whole time. Why would I be on that? They told journalists they were scum. But it's worth billions. It's worth billions, Kara. Yeah, I should have gone to prepare for – no, it's not. It's not at all. I should have gone to prepare for what Twitter has become, but I didn't do that.

But do you know SEMA? Not really well, no, I don't. And it'll be interesting to talk to her about it because, you know, people, even though we were sitting joking about weight loss, people talk about it a lot. This is an issue that's really an important one and tech has tried to attack it in different ways. So I'll be interested to see what she has to say. All right, let's take a quick break and we'll be back with our guest, Weight Watchers CEO, Seema Sastani. ♪♪♪

On September 28th, the Global Citizen Festival will gather thousands of people who took action to end extreme poverty. Watch Post Malone, Doja Cat, Lisa, Jelly Roll, and Raul Alejandro as they take the stage with world leaders and activists to defeat poverty, defend the planet, and demand equity. Download the Global Citizen app to watch live. Learn more at globalcitizen.org.com.

Just very briefly, explain how you got to Weight Watchers. I was a member first, 2014 actually. And well, my mother, she's a registered dietitian and she actually has her PhD in food science. I grew up with healthy habits in my life. I feel like I understood what I needed to do. And when I had my first child, I gained almost 60 pounds and I had a really hard time losing it.

And I tried probably every snake oil and fad that was out there. And my mom was like, if you're not going to listen to me, just go on Weight Watchers. And I thought, what? Which snake oils? What's that?

you know, what the juice diets and fasting and paleo and all, you know, there's all kinds of things. But ultimately, you know, none of it worked for me and none of it held me accountable. And so I found Weight Watchers really kept me on track through the community, through the accountability. And also I

realized during that time that I was suffering from a thyroid condition. But anyways, between the two things, it worked. But being a product person, I also wanted to throw my phone against the wall. I didn't think it was a compelling user experience. Fast forward to 2020, it's the middle of the pandemic, and I was very deep in all things house party. And

And it occurred to me, I started to- Explain House Party for people that don't know what it is. House Party is a group video chat. I mean, that's the most simple way to describe it, but we were trying to solve empathy in online communication. I wanted my kids to know the right facial response to happiness, sadness, not just the right emojis. We were leaning into synchronous forms of communication as a way to be the next best thing to IRL.

And we had started House Party way before COVID, but that was a time where people really leaned into video communication and it catalyzed what we were doing. Right. So explain what happened to House Party. Because these people have been trying to do video get togethers for a while. Talk about the difficulty of building community because it goes in and out, whether it's a chat roulette. I mean, there's so many of them. I've forgotten all the ones I've covered.

There's so many. Look, it's network effects at the end of the day. And now we have really, really big networks out there that when they see the new feature, which a lot of these networks, you come for the tool, stay for the network, are built on some sort of tool. And for House Party, it was group video chat.

And the moment that the bigger networks see something taking off, they embrace it and they push it forward. And, you know, in a lot of ways, I think that's great. What we tried to set out to do was to get people to build these tools into their networks. And so we did the same. You know, we sold our company to Epic Games. We took a lot of all the best parts of House Party and we built them into Fortnite so that we could build a more empathetic, trusting metaverse like Third Space. And so, yeah,

That ends up being the outcome for a lot of the new ways of connecting, engaging people is that they make the networks that are already out there, you know, better. But just to take a step back here, I was listening to Oprah's podcast and she was interviewing Tina Fey. Just so you're aware, Oprah bought a 10% stake in Weight Watchers in 2015. Yes, she's on my board. And

In that podcast, Tina Fey, who is a lifelong Weight Watchers, talks about how she's not on any social media and how she was in Weight Watchers Connect. And that's where she posted. That's where she went to like fill her tank. And it just was like this huge aha moment for me that was like, oh my gosh, here behind a paywall, because people are coming together with this huge vulnerability and a shared interest in weight loss.

that this was the true empathetic social network, what I've been trying to work on and build. And so I actually reached out to the company and I thought, you all must be trying to figure out this digital era, especially in the midst of COVID, where the retail IRL workshops are closing down. Can I be of service? How can I help? I had no interest in leaving House Party. So I reached out to the company. I was interested in joining the board. You know,

The timing wasn't right for me to join, and two years later, they called me about, "Hey, are you interested

in the CEO opportunity. And it was the perfect timing for me. And it was a moment for me to take all of what I had built around digitizing social relationships and apply it to health outcomes and to help people through community, through accountability, achieve better weight health. All right. So you thought you'd be on the board of Weight Watchers, but so you, and you decided, I think I'll take it because it's, it

It's an analog company, really. It's still, even though they use an app, and I agree their app is terrible. I think that that's the misconception, is that it is still an analog company. In a lot of ways, that's why I'm here, is because we were still being run like one.

And the biggest change here, and I said this when through the process of considering this role is with the board who was interviewing me, is if you choose me, you're choosing to put a disruptor in the seat. You're choosing the strategy, and the strategy is going to be uncomfortable at first.

And this company was founded 60 years ago by a woman, Jean Neidich, and it has all of the dynamics around what we consider to be some of the leading ways people connect, right? It's got repeat encounters. It's got reciprocity built in. It's got gamification in the way the point system manifests. It's got all of these ways to really help people with health outcomes. But

it wasn't showing up in a digital first way. And that's what I was focused on is like, let's double down on the things that we do really well, coaching, community, our nutrition and lifestyle therapies, but let's like turn over the whole thing such that we're taking a digital first approach and we're more like a growth company than anything else. Right, so that you need growth, you need a different generation. What are the numbers now of Weight Watchers? What is the amount of members do you have? Yeah.

Well, we guided in March that we would end Q1 at around 4 million members. And age range? Oh, and our age is somewhere between, you know, we say we talk about our HER, majority women, between the ages of 30 to 55. Okay. Now, everyone uses digital. I don't want to assume. But is the goal to stay relevant in a TikTok world?

generation situation, I guess. I would say it's less about that landscape. It's more about taking the things that we already do and doing them with a more modern lens. Also in just how we run the company. There wasn't a ton of technical debt when I arrived. It was more organizational debt. It was like, are we going to take the best ways of the ways growth tech works with the

Data-informed, agile development, being able to be truthful about what's working, what's not, postmortems, all the sort of things that we take for granted, I would say, and apply it to this business, this industry. So we, you know, the first thing we did was shut down a bunch of features and product lines that weren't working. Such as? Digital 360, our, you know, e-commerce business internationally, consumer products, you

So that's selling Weight Watchers food, right? That kind of stuff? Exactly. And so the strategy has been... And why wasn't it working? Low margins. Ultimately, I think that it was driving the company into a bunch of different directions versus our critical North Star of connecting people through healthy habits.

And so what the company needed was focus. And if we don't take a digital first approach, the life cycle is that we'll let others outside of our business disrupt us versus us taking the first steps. The Blockbuster example is the one I like to give. It's not like the Blockbuster CEO at the time didn't see Netflix coming. They were just too scared to take the hard decisions of getting rid of late fees because

because it was a big part of their operating income. But had they done that and moved to subscription, maybe they would have had a different story. And that's what we're doing right now. We're making those hard, short-term decisions for the long-term health of the business. So is it too scared or too comfortable? Because a lot of people, I'm just working on my memoirs, and I have a quote with

Bob Iger told me way back when he took over at Disney, he said, if someone's going to eat our lunch, it might as well be us because he knew it was coming. But is it too scared or too comfortable when you're shifting? Because you could be seen as, oh, God, the tech ladies here. It's both. Tell us we suck.

It's both. And we don't suck. That's the important thing is there's so much of what we're doing. There's a reason why it's the number one doctor recommended program. We have a legacy of people that we've helped succeed. And that's part of the business model is when people succeed, they leave our program. But in the old days, because people were coming in

in IRL workshops, they continued to come because it was social, because they had a peer group. That's what we're investing in for the third space, our digital space, how people are going to continue to connect and stay in the program. But the Bob Iger example is exactly right. People forget that Disney was a turnaround in some respects when he joined. Disney animation was failing. It was because he embraced Pixar, new ways of work, that allowed him to then go look at Marvel and Lucas and really pull together an entirely new strategy that

took the core of then Disney animation and made it better and uplifted that thing. It wasn't a pivot. It wasn't a move to try to do something that isn't what Disney does best. It was seeing what was out there and not letting it eat its lunch. And that's what we're doing. Okay. And of course, you're not eating lunch because it's Weight Watchers, but no, I'm teasing. You're eating a healthy lunch, the biggest threat to Weight Watchers right now. We are for people who love food.

Okay. What is to you when you thought the biggest threat to Weight Watchers right now externally? Is it the gym, Ozempic, and we'll get into that, all those weight loss drugs, or the meal plan business or businesses like Noom? There's a lot of different places. They've certainly come in and had been very popular, especially among young people, for example. I think that the biggest threat to Weight Watchers is Weight Watchers. So, you know, we... Well, that's it. That's the answer the CEO would say. Go ahead. Okay.

No, but it's actually exactly right. I mean, we can get in our own way. It's suicide, not murder. We have to make sure that we continue to evolve and change. I would say that if anything outside of us is getting in the way of us being able to

really continue to be the leaders in the weight management space, it has to do with social, honestly, because every other person now is an expert in this space on YouTube or Instagram or TikTok. And there's a lot of misinformation. And that's difficult to manage, certainly. But, you know, look, at the end of the day, it's how we show up in the world. And we have a lot of control. This is very different than when Marissa came to Yahoo and tried to turn it around. Yahoo is behind the curve.

in mobile, on the social internet. We're still the leaders in this space. So it's ours to lose. It's not the other way around. So one of the things is I always wondered why, you know, one, that you let Noom get so big. Like, obviously, new brands are attractive to people, so there's nothing to be done about that. But one of the things I always thought was why not use video more? When you saw all those social influencers, and I did, whether they're on TikTok, on Reels, like, why not embrace the good ones into it? Because this is how people were

Taking in content, right? I thought content was always the weakest part of Weight Watchers. It was so static, the content, which is, I think, very important. You want to learn about the latest thing or the latest food or the latest nutritional thing because people are very attracted when it comes to diet to the next thing or at least they want to know about it.

People are always looking at our industry is unique in that way. They are looking for the shiny object. You know, remember South Beach? Remember Atkins, right? There's always been a, you know, a new shiny object. And the reason we've been around for 60 years is because we haven't hopped on those fads. We've always been evidence-based. And I think content is...

is an important part of how we deliver the curriculum and the education and that there's plenty that we can do to better that experience. And we've been working on it both, not just within our app behind the paywall, but also how we show up just individually

On our own social media and more broadly, I think we've really started to invest in our brand in that way and being more relevant and part of the zeitgeist. Look, we had a program, Digital 360, which was more that one-to-many model, and it didn't work.

Explain what it did. Explain what Digital 360 did. I mean, I would describe it more like a Peloton-style approach where there were coaches that were delivering sort of broadcast-based content. So live and also live to tape, and people could access that content.

But what true accountability brings and where true networks are created is not when a bunch of people follow one person. Like I love Allie Love on, you know, in Peloton, but I'm not really connected to other people who love Allie Love. The way people with weight loss, they need to get connected to peer groups. And I think that there's something to be said for within that group, for

for those people to be able to share more content with each other. So the relationships are about the member to coach, the member to member, and creating that dynamic so that it's more of a few-to-few model than one-to-many. I see what you mean. But I got to tell you, your app sucks. So does Noom's app, honestly. All the apps suck. The inputting thing? You're preaching to the choir. I mean, that's what I'm changing. But the app...

the UX, if you haven't tried it in a while, it's better, but it's going to be a lot better in the second half of the year. We're introducing a bunch of new features. I got to tell you, all of, I haven't seen an app that I think is good yet that I just, that are so, you know, compared to a music app or any app. And I'm like, this just sucks. Searching for things, adding them in yourself. You're exactly right. And like,

think about what AI can do. You can start to take pictures and take a picture of your fridge, tell you exactly where a five-point food can come from. I mean, those are the kinds of things that we're building in. And that's where when I took this, because I watched Marissa do all the things that didn't work at Yahoo, and I thought about

Is this a challenge I want to take on? The difference is we're ahead of the game. And so we literally just have to change the culture of how we build and think about this. It was a marketing-led company. And now we are like solving problems. And it's like, I hate to say it, low-hanging fruit.

So now we've brought in like our new head of product is from WhatsApp. Our head of marketing is from Maisonette and Birchbox. Our new head of people is from Patreon. It's just a totally different culture that we're infusing into the company while also keeping all of what makes it special because you don't come to a company like Weight Watchers unless you've had personal experience with this. So we got a lot of passionate people who, you know, we don't want to

freaking move fast and break things because that's not what you want to do with people's health. No, not at all. But you announced that you would acquire Sequence, which is described as a, quote, platform for clinical weight management for $132 million. They prescribe GLP-1 drugs, basically a Zempik. Talk

Talk about the impetus for this deal. These are these drugs, semiglutide, something like that. That's correct. Semiglutide. And they make you not hungry, essentially. I'm not... My brother, the doctor, will go crazy when I say this, but essentially that's what they do, is they quash cravings and things like that. It's a huge market. Talk a little bit about why you did this, because your philosophy has been centered on, as you were saying several times, personal accountability and not medical intervention. So walk me through...

this deal and why you bought it. Yeah. So semaglutide or semaglutide, both are correct. It essentially mimics the natural occurring hormones that help our body regulate appetite. And it's a game changer. Like doctors, scientists, they will all say these drugs are

And as the global leader in weight management, I felt, you know, one of the first things I did was, again, look at new modalities and what are the evidence-based treatments that are out there.

behavioral change is our crown jewel, but I see clinical and functional as both being pathways that we can, that we should give our members access to. And that doesn't mean that everybody should be on these medications. Absolutely, that's not the case. There are certain people where it's medically appropriate and others where it's not. But

But it's amazing to see the way that they are able to help people adhere to the healthy habits that they've tried to access their entire life. And we're just starting to realize that, yes, there's like the hungry brain, but there's also the hungry gut. And these medications help address that. And I think that...

it's a lot like, you know, the way we might think about hypertension in the 70s is like, we got recognized as a disease. And then in the 80s, there were these medications and ACE inhibitors that people could take. But it wasn't till really the 90s where it was finally like, okay, there are combination therapies. Yes, you need to have a low sodium diet. You should stop smoking. You should do all of these lifestyle changes. Behavioral changes. Behavioral changes. But there's

Also, people who need the medication alongside to have the best outcomes. And that's what we're seeing now. You're doing an and thing. I mean, this idea is definitely an and. This was in a Gia Tolentino piece, but I think this says it right, that metabolism and appetite are biological facts, not moral choices. But what's happened, though, it's gotten sort of hijacked by celebrities in a lot of ways and people who...

either don't really need to lose weight that much or are using it for massive weight. Elon Musk has used it. Allegedly, all kinds of people are using it. Some people talk about it. Some people don't. Some people are suddenly quite thin who had weight issues. Talk a little bit about weight.

how that's happened. Does it look like you're jumping on a bandwagon here? And I know these drugs have been around for a long time. There's also the problem of people with type 2 diabetes not getting these drugs because everyone else is taking them to lose that last 20 pounds. So talk about the confluence of real trend and group of people that maybe aren't the best ambassadors for this. That's exactly it. I think that it's unfortunate that it's become the kind of the

clickbait headlines and the attention is being put on, quote unquote, weight loss drugs versus these are medications for chronic weight management. Those are two very different things. And the attention on sort of the celebrity of it all is taking away from the real possibilities to solve public health issues for not just Americans, but the

the globe. And I think it has a lot to do with our society and the stigma around obesity. I mean, if we had said we found these new medications and they're going to address Alzheimer's or cancer or Parkinson's or something, wouldn't

everybody be talking about access and how do we increase access and embracing these medications? It's because of the stigma around obesity that has become such a clickbait issue. I mean, mental health is another great example. It took a global pandemic for

for the private sector and for society to adequately acknowledge and invest and innovate on mental health. We used to call it mental illness. It was a condition. And then, you know, really COVID forced us to confront the issue and understand that it was under-resourced and that there's more that we can be doing. I mean, I think that the same is true for obesity and weight health is just one of the most neglected problems. But who do you

think should take these medicines? What is Weight Watchers thinking about anyone who wants them? Or how are you going to think about that? Oh, I mean, absolutely not. We are following the FDA regulations here. It's like, if you have a BMI over 27 plus another weight-related condition or a BMI over 30, that happens to be a

Yeah.

a patient with clinician, we are in the business of the subscription, not the prescription. If the doctor has decided that is medically appropriate for the person to be on a medication, whether that is GLP-1 or otherwise, then they would, uh,

be moved into sort of this care team model. And I think that's really what people are missing is with the sequences, why it's so exciting is it's doing two really important things. One is this insurance layer that this pre-auth engine that it allows people to be able to get insured.

Because it's expensive. People don't realize how expensive it is. Yes, it's expensive. It's $1,000 a month when not covered by insurance. Correct. And so you have this automation engine. And then secondly is they've built a really great platform for both the clinician and the member. So it's like being in a WhatsApp group with a whole care team. This isn't like...

Well, although a lot of people can. A lot of people just are doing that. It's almost like when they used to get weed different ways. You'd go in and say, I've got a headache. And, you know, in California, now everyone can get it anytime. But it is available easily for most people.

You can get it right in the mail by just saying, I feel like I need it. Well, it's not medically appropriate to get it that way. And also, by the way, it needs cold storage. I've been hearing some crazy stories of, you know, it's...

It's not actually even one of the brand names. It's a compounded who knows. There's a lot of bad actors in the space right now. But part of the reason we're now taking a vocal stance here is to address the misinformation, is to get ahead of bad actors, is for people to understand when it is medically appropriate or not. And if they are somebody who the doctors have deemed medically appropriate, that they have a full care team around them because they're not going to be able to do anything.

The titration of these medications and the care that needs to go around to make sure to manage the symptoms throughout the weight loss journey is very high touch. It requires a lot of support for people to do it well. Well, people are just grabbing it anyway, like a lot of things. But you don't just go on and off them.

For people who don't know that, the side effects can include nausea. It doesn't last necessarily, but there's nausea, dizziness, fatigue, diarrhea, and constipation. Some people get a gray tinge to their skin. Some people gain as much weight back as soon as they stop taking a drug. It could be a lifelong drug that you take. How do you look at it? Is it a temporary tool or a maintenance drug like statins? I'm on a statin, for example. And that's exactly it. Is there medications for chronic malnutrition?

management. And so similarly, I'm on Synthroid and I will be for the rest of my life. And if I come off of it, then I will bounce back to all of the symptoms and issues I had before I went on the medication. And if you end up on these medications, you could titrate the dosage certainly, but you'll be on these medications likely for the rest of your life. We'll be back in a minute. This episode is brought to you by Shopify.

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So how important is the line between medical need and aesthetic desire? You're going to get a lot of people who just want to lose that 20 pounds, right? That last five pounds. I've, I still have the weight right above where I had a cesarean. It's never going away. It's, it lives with me. I've named it. You have a new set point. Yeah, I've named it. It's, it's who I am. And it,

No matter what I do, it's there. Even when I lose weight, it's there. So talk about the medical need and aesthetic desire because I have a lot of friends recently who are doing a lot of either Ozempic or surgeries, something I would never consider. But talk about that because some days you're like, I cannot lose that 20 pounds. Why not just have an easy way to do it rather than behavioral exercise therapy?

the right eating, et cetera. I think that if you have 10 to 20 pounds to lose,

You should be on a behavior change program. You should be working towards lifestyle therapies. You should be trying fitness or you should be accepting your body. I'm the same way that I got to. I mean, there's just a new set point for my body post babies. It is what it is. And this is the great thing about, you know, our body positivity movement and the shift towards really, you know, what our body does for us and not trying to aspire to some aspirational goal.

conform to some idealized version of our bodies. And so, no, these drugs are certainly not for getting yourself into reunion shape or ready for a summer vacation. They are for the management of a chronic disease and condition. And I think it's unfortunate that the click

attention has been put on the vanity of the medications because it's making it harder for us to actually address the public health concerns and what these medications can actually be doing. Well, that's been the whole diet industry. Every month there's a book that, okay, if you only eat pork chops, that's the way to go. Or, you know, you've seen all those books and everyone grabs them, the lettuce diet, the keto diet, the Whole30, all of which have elements of good things, right? Like,

in many ways, stop eating the bread kind of thing. Low carb, no carb, fat free, fat full, you know? So this is what the whole diet industry lives on, doesn't it? That's why it's even more important to recognize that the movement to embracing clinical

It's not a trend. This is an innovation. It's a complete paradigm shift in our industry. But I want to take a step back, and what you were saying I think is really important in terms of diet culture, and just acknowledge for a minute that diet culture is just...

It's culture. You know, in the 60s, the ideal was British, wave-like, twiggy, right? Then it was toned legs, sun-kissed skin in the 70s. And 80s was like the hard body, aerobics. And the 90s was heroin chic. Like this, it's culture and it permeates all aspects of society. And that is...

That is something that we all need to be aware of and fight back in some ways. It's like the shift that has happened over the past few years and things in part, and this is one of the positive sides of social, is social and people having a voice and really opening up the floodgates around body acceptance.

There's so much good in that, but there doesn't have to be a false dichotomy between those cultural conversations. Like, you should be able to accept your body and also look for weight health, and those things can coexist. Is the culture now ozempic thin? Is it becoming that? Is that you were talking about? You named all the different trends. You forgot the juice trend in there.

There was a store. Oh, that was more Silicon Valley, if you recall. Yeah. What was the company there? Soylent? Is that what you're thinking of? Soylent. Oh, God. That was so stupid. That was time-saving. That wasn't weight loss. And then the tech bros were all the fasting people, the fasting timing. The biohackers. Biohackers. Whatever. Go for it. You're still a terrible person. Yeah.

is what I used to think. But when you think about it, what is the culture now? Is it that idea that there's a pill for that? Is it a zempic thing? Because one of the things that I've noticed really is people cannot stop talking about it. And I get that these things, they couldn't stop talking about keto, they couldn't stop talking about this and that. Does that pass? And what safeguards are you putting in place as people clamor for what you have to offer? I think that what's happening in

society today is all of these are sort of symptoms and reflections of us living these two-dimensional lives, right? We're stuck in these reels to, I don't know, not use that word on purpose, but we're stuck in these feeds and reels of people living like these unattainable, face-tuned lives. And that makes it harder for everyone to sort of find acceptance and happiness. And so, you know, I don't

I don't know the answer to that. I think it's a hard one. It's one that I worry about as I, you know, look at my kids and think about, you know, what their future might look like. But I think that part of our job right now is to switch the conversation and to try to move it away from the vanity aspects of these medications versus all of the real amazing, you know, scientifically proven health benefits that could come from, you know,

Right, sure. Preventative, right? Our whole American healthcare system is based on a disease model. And we have medications now when if we get them into more and more people's hands, we have two-thirds of Americans who are living with overweight and obesity. We could get in front of

heart disease, hypertension, diabetes, arthritis, some cancers. Like this is, these are life-changing and that's the conversation that I wish we were having. It's just not what people want to click on. Right. So how do you do that? Because social media is fueled with Ozempic. It's everyone's favorite game to figure who's on it and who's not. Social media is fueled, obviously, body image issues that, which has been going on for a long time, especially for women and girls who are bombarded with images of the ideal body. How do you counter that at

Again, what are the safeguards that you're thinking about when you're messaging this stuff? From an overall standpoint, I would say that we're trying to lead the conversation in terms of healthy eating. And if you look at word clouds for diet, for instance, it's all associated with so many negative words of deprivation. And, you know, what we want to do is...

Let people know that you can love the body that you're in. You can also want to lose weight, but that it's not about chasing a one-size-fits-all number on your scale or in your clothing size. Some of the ways that we actually build that into our program is through the assessments, both on sequence and in Weight Watchers core program, is to manage out people who have an eating disorder or under a certain BMI. We also...

ask them to set their own goals about what they're looking to achieve and what kind of metrics they want to be. We just now in January, we started giving everybody a smart scale so that it's not just about the weight, but it's also about muscle mass and bone density and hydration and giving people just like a holistic look at their health. I think more information, but also safeguarding again on the clinical side of things is that

The clinician is not employed by Weight Watchers or by Sequence. We're just the platform in between these two. We don't actually prescribe the medication, nor do we make any money from it. So those are all sort of the safeguards in place to make sure. So it's a service. It's a service you're providing. It's a service. It's a care team model. It's a curriculum. There's fitness, nutrition guidelines, all of the things to help you manage through the medication and everything.

And to map it to the behavior change, because here's another thing is like a lot of these clinical trials, what people are missing is you don't just like melt 15 to 20% of your weight. They're also doing it alongside a lifestyle program in every single one of the clinical therapies. When you get the script, the FDA recommendation is to do it alongside lifestyle change. So it's like if you're on a statin, you still have to have a low fat diet, right? So yeah, you can't just go to town. Exactly.

So I want to end talking about the idea of body imagery and how it's changed, because it doesn't seem like it's moved even slightly. Let me read you from Sam Anderson's New York Times Magazine piece last year, and I want you to sort of think about it. I poked around on my phone and downloaded a weight loss app called Noom. It seemed like a suddenly ubiquitous online popping up in tweets and banner ads and the random testimony from someone I followed on Instagram. I felt silly about it. So at first, I didn't tell anyone. Yes, I found it humiliating to be overweight, but I also found it humiliating to be worried about

being overweight. I wanted to lose the weight, but I didn't want to be seen as wanting to lose weight even by myself. How do you change the idea of the shame that is still... It's the only thing you can insult people about still to this day. Talk about how you then, when you're in Weight Watchers, get people past that and think that, if only I have a Zempik, I'll be skinny and then everything will be solved. Yeah. This is...

going back to the kind of the common thread of, of these of, of around body acceptance is that there's shame for gaining weight. There's shame for losing weight. There's shame for loving the body you're in. There's shame for wanting to change the body you're in. And what Sam was describing there is like, is a part of that shame right now is even being the moment that you start thinking about or wanting to address your weight health. People say that that's disordered eating. Well,

I felt that when I was trying to lose, you know, my weight and I started tracking, people were like, oh, well, that's disordered eating. I was like, how's that different from me tracking my, like, finances? You know, I need a budget and I'm trying to understand it. And by the way, that's coming from a really privileged place in a lot of circumstances.

where we grew up with understanding and education around what is healthy, what is not healthy. And we take for granted that everybody knows that. And we say, oh, you should just be intuitive about your eating. Well, for some people, they need help with what the intuition even is. So it's just this false narrative that continues to perpetuate the body shaming cycle that we're in. And what we're trying to do is work against it, but I don't have a good answer to that. I want my kids to embrace health.

Their bodies and to not even be focused on it. We even body positivity moved to body neutrality just because of that, because it was like even by being positive, you're telling me to focus on it in some way. It's like I just need I just want to exist in the world. And, you know, I think that that's that's a a.

a fraught cultural conversation, there's a lot of stigma against those with overweight and obesity. And because of that, it's also meaning that we're challenging the science around it. As opposed to having the discussion and being able to talk about improving people's quality of life and the prevention of future illness,

And just being happy for people who could find that through whatever pathway it might be, we start shaming people around it. I mean, going back to the celebrity of it all, you see that with celebrities as well. They lose weight and it's immediately like, oh, suddenly we love Adele and then we don't love Adele. It's hard for me to even put my

self in those shoes. It's like the anti-vaxxer conversation or something. It's a level of shame that exists in our society. And we all just, the more awareness we have around it and the more we speak to it, the hopefully that we can start getting in front of these like unrealistic, non-inclusive conversations.

All right. Last question. You've been in tech for over a decade. You've worked at Yahoo, worked at a house party is Weight Watchers, a tech company or a content company or what, how would you describe it? Cause everything's a tech company, I guess in a weird way, but how would you describe it?

We're a software company. We're providing a human-centric software. We're a tech company at our core. 80% of our members are experiencing us through digital. And I think that that's where the market is missing what we're doing right now because we're making a lot of hard decisions that are having short-term impact. But long-term outlook here is that one of...

growth tech. I mean, we're building a human-centric platform that is going to help people achieve these amazing health outcomes. And the thing that I know you are really interested in longevity, Kara, like one of the studies that I looked at before joining Weight Watchers and that I find is core to our vision is Dan Buettner's research on blue zones and where he has looked at the places in the world where people live to be 100 centenarians.

And it's not just how they move or what they eat.

both of which we address through our food algorithm and our program. But it's the social circles. It's the community. And so, I mean, we were the OG social network. And what I'm doing here right now is building us out into a third space, a digital first era. And that makes us, I think, inherently our DNA is as a tech company. All right. Seema Sistani, thank you so much. Thank you. It's on!

Okay, two things before we debrief. I love the throwback to Soylent. My ex-boyfriend in San Francisco used to eat that for every meal for a little while. Drink it. It was very creepy. Drink it. I don't remember. It was very sad. It was becoming a real tech bro. But can I ask, what did you name the weight you get? You said you named weight that you had gained. Barbara. Barbara? Barbara?

after Barbara Walters. It's either Walters or Streisand. Just Barbara. I don't know. I just like the name. I like the word. It never goes away if you have a cesarean unless you get it taken off and I have not done that. I think it's good to accept it and name it. There's nothing I can do about it. It will be with me the rest of my life.

That conversation I thought was really good. The question still remains personal accountability versus medical intervention. Seema said they were in the subscription business, not the prescription business, but clinicians that Sequence partners with do have the ability to prescribe. Yeah. And that's why people buy the subscription in the first place. So what do you do? Did you buy that? Were you swayed?

Well, I think it's important for their business to have the solution. They can't avoid it. You know what I mean? Like to pretend it's not happening is stupid from a CEO point of view. So, you know, all these drug makers are making these drugs and they will be available to people. And so they're going to get it one way or the other. And it's, you know, a lot of people say that it gets you to better eating habits once you stop craving and binging. And so I do think they need to be in it. I don't think they have a choice.

I liked your weed analogy because I think that's a kind of slippery slope, right? It gets into the question, like, which is...

When something gets normalized, when you're dealing with insurance preauthorization, you're making something very accessible, how do you prevent a race to the bottom or just like a kind of free-for-all? Yes, exactly. Again, every drug maker is making one of these. So everyone will have them, right? And so what's the best way to do it? What's the best for you? Any way that makes medicine easier for people. I think that about One Medical. I think that about a lot of things. Yeah.

You love the medical. I know, but it's right because it's easy. But should it be easy? I'm not saying should it be easy because I want to shame individuals who are obese or have diabetes, and I certainly don't want to do that. But should it be easy for us as a society? Because when it's easy for us as a society to just treat the symptom, we're not going to address the underlying causes. Yeah, that's not going to happen. Well, sugar taxes. It doesn't work. It doesn't work. It's okay if there's a medical solution. Yeah.

There's some very good medical allusions to depression. Like, just get happier. Just work through it. Don't be so sad. But what do you mean it doesn't work? I mean, that's because companies are like, you know, lining up. That's not why. It's because food tastes good. Because it's really hard to resist this stuff.

And people have a relation with food, and there's a lot of it now. But cigarettes taste good to people who smoke them, and yet we were able to change behavior around that. I feel like that—isn't that kind of cop-out to say it's just what's going to happen? Well, there's a lot of interventions. There's a lot of medical interventions for people with cigarettes. I'm talking about regulatory interventions as well. No, there's a ton of medical interventions that allowed a lot of people to get off with the patch and everything else. So it's a combination of regulatory—you can't make—you can't regulate food. That was so stupid of—

Bloomberg to try to do the sugar tax? It was stupid. What do you mean you can't regulate? You can regulate food in Europe, but you could say what isn't food. You can regulate it, but you can't say don't drink big sugar drinks. No, but you can say we're going to tax it. I guess. That worked so well. It didn't work well for people who don't know. Bloomberg wanted to tax soda in New York City.

I think that you have to give people a range of solutions and medical should be among them. And it should be a systemic thing, like I said. Fixing marketing and labeling would be a great thing too. They've tried. Let's just have people stop eating this stuff. And maybe if this is the first step towards that, that's great. I don't know. I always love when people tell me the FDA recommendations of lifestyle changes along medicine. And I think about all the people I know who've like taken heart medicine and then eaten steaks because they can still. No, you don't do that. I know.

I take statin. I don't eat steaks anymore very much. Not very often, for sure. Seema said weight loss and shaming culture is the culture.

No, shame, no. The shame is a big part of it. Being fat is the only thing you can be insulted, like you talked about. It's the only thing you can be insulted about, you know, without. What do you mean by that? I think you can make fat jokes still. I think it's easy as someone who had a child who was a little bit overweight. I don't think you can still make those. I think kids do. I think they do. I think it's one of those areas that people can still make commentary on and you don't pay a price that you should pay for being cruel to people. Yeah.

And they also, listen, there's coverage after coverage. They don't listen to fat people when they have real health problems because they think they're lazy doctors. There's all kinds of stuff. It's like women shaming too. I mean, social media has done, I think, one good thing around all of a sudden the conversation has moved from skinny to strong. And I feel like in my generation, I love that. And I see people who have young girls now and talk about

getting strong, which is a much healthier kind of conversation, I think, than when I grew up. By the way, in Pakistan, you know what aunties say to you is, you look healthy when you gain weight. So they'll be like, oh, you're looking very healthy. And it's a real insult that they're giving you. It's worldwide. It's worldwide. It seems like Seema Sastani has a very interesting background. And I like her personal connection with the Weight Watchers. So let's see, she's navigating. I'm sure there'll be a ton of pushback. I'm sure there'll be some bad news stories. And

She's an interesting person to be at the helm. Yeah, it's nice that a younger person who has a background should be part of this. It's a good choice for them. Great. All right, want to read us out, Cara? Yep. Today's show was produced by Naeem Araza, Blakeney Schick, Christian Castro-Rossell, and Raffaella Seward. Our engineers are Fernando Arruda and Rick Kwan. Our theme music is by Trackademics. If you're already following the show, you get a plane ticket to a blue zone where you will live to be 100.

If not, it's a bottle of Soylent from the former Recode offices. It's only been there, I don't know, 10 years. Go wherever you listen to podcasts, search for On with Kara Swisher and hit follow. Thanks for listening to On with Kara Swisher from New York Magazine, the Vox Media Podcast Network, and us. We'll be back on Monday with more.