THE TRUTH IN BARIATRIC PRACTICE MARKETING: WHAT REALLY WORKS AND WHY!
Most physicians don’t make a business of dieting; they tell their patients to eat less and exercise and leave it at that. It’s the self-proclaimed obesity specialists — the bariatricians — who are really cashing in on the medicalization of obesity. They realize there are enormous profits to be made if all the Weight Watchers in the world decide they have a disease and go to their doctors for treatment instead. At least that’s how it seemed to me when I attended an annual meeting of the American Society of Bariatric Physicians, which began with a two-day marketing seminar, “The Truth in Bariatric Practice Marketing: What Works and Why!”
Steve Cooper, a public relations consultant, makes his way through a hotel meeting room with a microphone like he’s a talk show host. He taps one man on the shoulder. “Why are you here, sir? Why did you come?”
“To make money,” answers the man, and the audience laughs uneasily. Physicians aren’t supposed to be so blatant about their desire to make money.
The participants at this seminar, many of them family physicians or general practitioners who have recently opened weight loss practices, are here to learn how to sell their diet programs by such means as print advertising, discount coupons, sales brochures, free body fat composition tests at local gyms, and TV and radio spots. They’re finding out, too, how to market their weight loss practices as “wellness” programs in order to attract health maintenance organizations and large companies to their waiting rooms. “Wellness is the way to go,” says Cooper. “You’re going to see a wellness facility in every mall in America.”
Many of these doctors offer weight loss programs as a sideline to their regular practices of stitching up fingers and diagnosing strep throat. Their patients usually pay out-of-pocket, see them regularly (for about $50 a week after an initial $100-$300 visit) and purchase weight loss products, such as protein powder shakes and fiber cookies, at a comfortable mark-up. One income prospectus for the Medifast liquid diet program promised doctors they’d bring in an extra $22,000 per year treating just twenty weight loss patients with just one visit with the doctor each (the rest is handled by support staff). Nearly half of bariatric physicians eventually stop practicing regular medicine altogether, and some open several satellite diet clinics around town. “Bariatric physicians are definitely going to be the leaders in the weight loss industry,” says ASBP executive director James Mercker. “Even though we’re practicing medicine, we are an industry.”
And it’s a growth industry at that. Membership in the American Society of Bariatric Physicians rose 15 percent last year, to over 600. One of the reasons more physicians are going into bariatrics is that at a time when it’s more difficult to get into specialties, becoming a bariatrician isn’t very hard to do. Any doctor can hang an official-looking ASBP certificate on the office wall for the price of attending a few meetings and a promise to follow the society’s voluntary treatment guidelines. They don’t need to have years of formal training in nutrition, much less endocrinology, as a really well-qualified physician who treats fat people would. They don’t even need to have completed an internship or residency at all. For physicians who have difficulties passing their board exams, or who are disinclined to do more training after medical school, bariatrics is an attractive and lucrative alternative. There’s no shortage of patients for them to treat. “More people are considering physicians as an alternative,” says diet industry analyst John La Rosa. “The advantage medical programs have over commercial programs is that they have more credibility — they’re not just viewed as salesmen who are pushing diet food on them.”
But in this marketing seminar, away from any patients, Steve Cooper is trying awfully hard to get these doctors to view themselves as salesmen. In a black suit and square wire glasses, Steve strolls with his roving mike among the tables of physicians, many of whom, I’m surprised to see, are fat themselves. I noticed at breakfast that for at least some of them, “wellness” includes eggs benedict with bacon and fried hash brown potatoes on the side. “And why are you here?” Steve asks another physician.
“I want to learn how to market my business,” the man says, more soberly than the first physician.
“Outstanding!” says Steve. “In medical school they never talked about business. Business, money. Does that sound like medicine?” He nods his head vigorously. “Well, it is.”
Cooper’s wife, Sharon, a brightly-made-up woman with a shiny black bob and a tight purple suit, takes the mike. She works the crowd, shaking hands and asking people their names. “Hi, Jim,” she says. “Everybody give Jim a welcome.” The physicians all clap, reluctantly. This is not like a usual medical meeting. “You know,” she muses, back up at the podium. “There are three types of people. How many of you are pessimists?” A few docs raise their hands. “Optimists?” Several more lift their hands. “Then there’s opportunists,” says Sharon. “And the opportunist is the real winner.”
There is no lack of opportunity in the medical weight loss field, she assures the group. There are fifty million adults in the United States on commercial weight loss programs, and all are potential patients. An average bariatric patient pays $1,000 to $2,000 over the course of treatment. “Gosh, that’s a nice pool to market,” she says. “Capturing customers is what it’s all about.”
Other physicians might not say so. Most doctors would rather mow lawns for a living than offer a free introductory exam to golf course members or advertise on the Rush Limbaugh show, as the Coopers recommend. The traditional wisdom is that aggressive sales techniques exploit the trust inherent in a good doctor-patient relationship. “By and large, physicians don’t need to market to be successful,” says Thomas Murray, director of the Center for Biomedical Ethics at Case Western Reserve Medical School. “These diet doctors may sincerely think they’re helping their patients, but it blurs the line between being a physician and peddling a product when you use the same marketing strategies you’d use to sell Veg-o-Matics.”
But squeamishness about sales techniques, many bariatric physicians assured me, is old-fashioned. Douglas Cook, a tall, telegenic Louisiana physician who makes a presentation to the group about his successful marketing techniques, tells me, “In a consumer market, you’re pretty much forced to participate. How can you invest all this money in an office, spending hundreds of thousands of dollars, and just put a little sign on the outside that says ‘Dr. Cook?’” He agrees ads must be done within certain boundaries of taste, however. “I wouldn’t say, ‘Bring a friend and get a pap smear free.’”
Cook, who also treats patients for anorexia and bulimia, opens up his presentation with a joke about the late serial killer Jeffrey Dahmer’s eating disorder. He soon gets down to the practicalities of building a successful practice. First is marketing the weight loss program to overweight patients who come in to your office for reasons unrelated to their weight — colds and allergies and such. You can put brochures in the waiting room, or gently suggest to them during the office visit that they might be interested in losing a few pounds. One physician in the audience questions whether that’s being too pushy; another responds that the health risks of obesity are such that you’re doing your patients a disservice if you don’t offer them help losing weight.
Cook describes various strategies to attract outside patients, including joining community organizations, doing radio health shows, producing newsletters, and offering patients mugs, gym bags and T-shirts bearing the office logo. Cook hired a public relations firm to create ads for his practice. “You want to evolve a response to an emotional need,” he says. One ad is headlined, “Do you eat for emotional comfort?” Another is more traditional: “Patsy lost 54 pounds in 4 1/2 months!” One is a bit frightening: “Bulimia Can Kill.”
He advocates the personal touch with patients to keep them coming in, by initiating phone calls and sending concerned letters when they fail to show up for appointments. He makes video tapes of himself offering encouragement to patients for them to view during their weekly appointments. “They see me on tape every week even though I’m not there personally.”
The diet doctors at this seminar are learning how to carefully manipulate their image. Their marketing techniques are becoming increasingly sophisticated, leaving their patients — who trust them, since they’re doctors — more vulnerable than ever to their questionable treatments. One presenter was very sympathetic toward fat patients, describing obesity as a condition they couldn’t help. He gave examples of the extreme prejudice and discrimination against fat people. But that prejudice, he said, was the best reason to convince patients they have to lose weight (this is the kind of logic that sells skin-lightening products to African-Americans). By seeming to take an enlightened, sympathetic attitude toward fat people, and by using language that talks about the “whole patient” and “lifestyle changes,” the diet doctors have appropriated the language of anti-dieters to sell their diets. Even their ads proclaim that “diets don’t work,” and that the real answer is long-term change with the help of doctors — who will inevitably prescribe a short-term weight loss regime.
After several other presentations on easy financing schemes, building “club loyalty” among patients, and tips for handling troublesome reporters, Sharon Cooper wraps up the seminar by telling the group that, like it or not, the trend in advertising is toward scary ads. “It takes more, with the proliferation of advertising, to get people’s attention,” she says. “You have to scare ‘em and grab ‘em.” Where, I ask her later, is this trend headed? “We’ll see ads that say, ‘Overweight can kill you,’” she says, then pauses, thinking hard. “Maybe with a tombstone.”
Doesn’t that kind of advertising give doctors an unfair advantage? I ask her. How can patients know they’re not being exploited? There have been, I remind her, a whole lot of quacks in the diet doctor business. “Well,” she says, blinking her heavily-mascaraed lashes twice. “It’s buyer beware.”
Indeed. At lunch, I struck up a conversation with a Southern California physician who is a member of the ASBP and asked him what kind of a diet program he works with. “I ‘work’ at a ‘weight loss center’ run by a lay person,” he said, drawing quote marks in the air. “His main business is building boats, but he has some clinics on the side where he makes a lot of money selling diet pills. Without me, he couldn’t be in business.” This “physician” — the quote marks are mine — explained to me that he’d been out of a job, needed money, and answered an ad for a diet doctor. “I didn’t know a thing about bariatrics, but I figured, why not?” He told me that he was hoping to get out of the operation soon, since he was just following orders from the boss, writing whatever prescriptions were required without actually seeing any patients. When I asked him to talk with me on tape, he clammed up. “I’m not sure of the legality of this,” he said. “I don’t want to go to jail, and I don’t want to ruin the business.”
© Laura Fraser