The year was 1961, and Jean Nidetch was fed up with dieting. She was 38 years old, five foot seven, weighed more than 200 pounds. She said she had tried everything pills, hypnosis, fad diets, but she struggled to lose the weight. And even if she did lose weight, she struggled to keep it off. So she started her own support group and invited friends to her New York City apartment once a week to share dieting tips. But what Jean didn't know is that this small support group would eventually become a diet and weight loss empire.

Brand new woman! Is this Weight Watchers?

Weight Watchers' new 1988 Quick Success program is helping people lighten up.

Weightwatchers has 23 entrees. That's more deliciousness than anybody else. 23 including chicken, sweet and sour, southern fried or cacciatore..

No one puts delicious in a diet like paper to WeightWatchers can. WeightWatchers. Its success skyrocketed by preaching a message of discipline, moderation and peer support. In fact, Weight Watchers founder Jean Nidetch's guiding philosophy was this quote, "it's choice, not chance, that determines your destiny." But that was then, and this is now. The way that we think and talk about weight and weight loss has changed a lot since the 1960s.

It's on us to recognize where we got it wrong and where we have been a part of the the narrative that it is a matter of willpower.

That's current Weight Watchers CEO Sima Sistani. She is changing the way the company does business. What does that mean? Less calorie counting and more embracing of weight loss drugs like Wegovy.

We've helped millions of people lose weight or maintain weight, or adopt healthy habits through behavioral modification. But for every member that we helped, there were members who struggled on our program or struggled to keep the weight off. And what we know now is that those members needed more support: a clinical intervention.

'When Sima took control of the company in 2022, the Legacy Diet brand was on track to lose about $250 million. The company has struggled in recent years to keep up with the body positivity movement and changing health and beauty standards. Sima realized that something had to change. Today, the 44 year old CEO is leading the company through a series of changes that includes things like ending many of the in-person Weight Watchers meetings, closing storefronts, even acquiring a telehealth platform to connect patients with weight loss drugs. On today's Chasing Life, I sat down with Sima to talk about Weight Watchers' evolution and why she thinks embracing weight loss medications could mean the end of diet culture. I'm Doctor Sanjay Gupta, CNN's Chief Medical correspondent, and this is Chasing Life.

I'm wondering if you can tell us, how did you arrive here at Weightwatchers as CEO?

Well, you know, I joined two years ago as the CEO, but I joined as a member, in I guess it was 2013. And so my first experience with WeightWatchers was after I had gained 60 pounds with my first child and I was really struggling. And my mother is a registered dietitian. She actually has her PhD in food science, and she just had it with me and said, "look, if you're not going to listen to me, try Weightwatchers." And I thought..

You've got to love mom. Moms are so, to the point. Yes.

'Yes, you're absolutely to the point. And so that was my first experience. I thought, really, Weight Watchers? I think I had a misconception, as as many people do, about what that program meant. And the behavioral program worked for me. The community worked for me, the accountability. And I was able to get back to, well, let's not say the pre-baby. I don't think that that was, actually something that was attainable for me. But I continued to use the program. It kept me on my healthy habits. And, I always loved it. But I thought as a product person, I kept looking at this at this program and thinking, gosh, there's so much more we could be doing here to have it be from a digital first perspective.

'A little background here. Sima was no stranger to online digital platforms. Before she was the Weightwatchers CEO, she was co-founder and CEO of a social networking site called Houseparty.

So it was around the pandemic time. I was building an app called Houseparty, and our goal was to be the most human way to be together when physically apart. I would take these walks around the block to help end my day. And I'm listening to Oprah's Super Soul podcast, and she was interviewing Tina Fey, who's a longtime WeightWatcher.

And there's now an app. Yeah, there's something called connect.

Yeah. People get into some personal stuff and connect like it gets deep and direct.

Yes, but you don't go deep. You're just on there.

I just am like, "you can put Cool Whip on bananas, guys." That kind of stuff.

And so I thought, wow, here I am, spending all this time trying to build a safe way for people to connect. And it exists behind this paywall around a shared interest of of weight health. And people are are being their most vulnerable selves, which is allowing for this kind of unique reciprocity that we all try to achieve and social. And it it just turned my entire perspective of the program around, and I started realizing it's the OG social network. And that is what I've spent my career doing, is digitizing social relationships. And I ended up reaching out to the CEO at the time just to offer my thoughts as a member, because I love the program so much and it was working for me. And two years later, I received a call from the board to interview to be the CEO. And, I couldn't believe my luck.

That's an incredible backstory. You said there was these misconceptions about what Weight Watchers was when your mom was asking you to maybe consider this. What were those misconceptions in your mind?

Well, the misconceptions for me were, first, that it was something that you had to do in person and that it involved some sort of like packaged goods that I had to order its food or. And that's because that was a part of the WeightWatchers past. But the present day WeightWatchers, 80% of our membership, they experience our program through the app. And so that was really the misconception for me. Also, that everything is on the menu. It's not a diet of restriction. It's about helping you find the healthy habits and budget in the same way someone might think about their financial budget. I am very known for saving my points for wine, for instance. And it's really about helping people pull together the right frameworks in a livable way to help them reach their weight health goals.

When you have done an interview with CNN in the past, you said this phrase, you said "we got it wrong" when it came to weight loss, referring to WeightWatchers. And I and I read the interview, I listened to it. I just want to make sure I understand. What exactly did Weight Watchers get wrong?

So I started by telling you my successful story with WeightWatchers. Our points program, it's backed by science and clinical research, and we've helped millions of people lose weight or maintain weight or adopt healthy habits through behavioral modification. But for every member that we helped, there were members who struggled on our program or struggled to keep the weight off once they had been successful on our program. And what we know now is that those members needed more support, a clinical intervention, because they had a chronic condition. And it's on us to recognize where we got it wrong and where we have been a part of the the narrative that it is a matter of willpower. So I think that this is just about expanding the toolbox. You still need it's not to take away. And I and I have members who reach out to me who are upset when I say this because they say it worked for me. I'm here. I'm proof I lost, you know, 60 pounds, 200 pounds, 150 pounds on this program. What are you saying? And the thing is, that program works. It absolutely works for you. But there are people that it didn't work for because they needed a compliment. It's not that we're saying don't use the program. You should absolutely use the program. You need to adopt lifestyle intervention alongside medications. But there are some people who are going to need medications. It's like going to somebody with diabetes and just say, you know what? You grin and bear it. You got this. You don't need insulin. And so if you left our program thinking it was your fault, that you didn't succeed and you were somebody with a chronic condition, the way for that person to advocate for themselves and to change is to hear from us: it wasn't their fault.

Look, I think these two points that that you're making are so critically important. First of all, we can say obesity is in and of itself a disease, and it needs to be addressed just like you would any other medical issue. But the second thing, which I think is really critical, is that it's not a monolithic necessarily disease. Just like with other diseases, you have subtypes of these diseases. So you may have a subtype of obesity that responds really well to these lifestyle changes and the sort of original, if you will, platform of Weight Watchers. You have people who do not respond well to that, but respond really well to medications. You may have people who don't respond well to either one of those and frankly, need to have some sort of surgical intervention or that would be the most beneficial for them. And there are probably subtypes that are overlapping with all of those, with all of those things. That is the nuance of this conversation that I think often times has been lost. So are there people who for certain people it is just a question of willpower? Yeah, probably. Do we know who those people are? No. It's hard to identify those people. So what does that all mean now for WeightWatchers going forward? If it's not one monolithic disease, how does Weight Watchers start to address that?

'Right. And that's where the nuance is so important. And we're missing it in all the clickbait that is out there. You know, what we'll say is there's the behavioral program which underpins every one of our solutions. If you are someone who needs a clinical intervention, we can help provide those medications, but you still need the behavioral program alongside of it. What the medications do is quiet the food noise, so that you finally have the opportunity to adhere to these changes that eluded these members for so long. So it isn an "and" not an "or." And the same can be true for somebody who might need a functional pathway. And there is our tried and true points program. So that way we can move people through the spectrum. They will come in on the behavioral program and see their success. And if they're struggling, we can move them into the clinical program. There are these options. And now our points program, we developed a different version of it, a specifically a GLP-1 program, because there are different needs for somebody who's on those medications. That assistance will in order to make sure the outcomes are better. If you're on medications, you need to be eating more protein, for instance, you need to avoid certain foods to not have as many symptoms while you're on the medications. For instance, you want to stay hydrated. And it prioritizes those types of behaviors. So, you know, to your point is there's many different phenotypes. And we're trying to provide a full spectrum of solutions. And why I think the, the, the telehealth model is so great because there is this constant calibration that needs to happen. This isn't the same as like an ED med that you can take and get on, you know, through telehealth and have it shipped to you every month and like close your eyes and forget about it. Every week, every month you're working through this condition. And in order to ensure that you have the right outcomes. For me, for instance, it's my thyroid. And that is also something that is constantly present for me. And we we find is having a care team in your pocket makes it so much easier to have better outcomes and to constantly calibrate both, not only the program, but also the medications if needed.

Why not just leave this in the hands of the doctors, Sima? You know, why did WeightWatchers decide to get into this idea of being involved with the medications? And was there hesitation? I mean, when you when you talk to the board about this, were there people who raised their hands and said, "Wait a second. We should be clear about what we stand for, and maybe we're not the company that stands for being involved with medications."

'Yeah, well, I think the important thing is we are leaving it in the hands of the doctors. But we've now acquired the telehealth business such that we can make it a seamless experience. So to your point, it's not one-size-fits-all. People are coming to Weight Watchers for their weight health, and we wanted to have a full spectrum of solutions for them, one of which would include the ability to visit with the doctor and more importantly, make that a much better experience, we think, than the typical one. Because most doctors have no training in obesity management or nutrition. My brother, he's a doctor and he had one nutrition class. He had one nutrition class for his entire tenure at medical school. And so we wanted to ensure that we were providing the right type of expertise. As you know, there's a certification. You can get ABOM certification that is specific for obesity management. Now we're providing our version of training to these clinicians so that they can give the right support. Now the other part of it is going back to the whole in-person versus online. We are living our lives more and more online. And for something like this that requires a high touch experience to ensure you have good outcomes, you want to be able to ask the questions as they happen. And making an appointment and going, into a doctor's office for each time that happens. It's not sustainable for the patient, nor is it sustainable for the doctor. Whereas online, we can handle that in your pocket. So once you have met the clinician, you've done your panels. It's determined that you're somebody who qualifies to be on a GLP-1. We're handling the insurance process for you. You're on the meds now. You have a ton of questions. Should I be feeling this way? Is this normal? Am I ready to titrate the medication? Because you move through various doses throughout the journey and all that is able to happen in a very simple chat UX, like a WhatsApp with your clinician, with a fitness expert, with the nutrition expert. So we're able to provide a much higher touch, support and care. And I think that's the future of health care. Now, that being said, most people will still go to their doctor and not unlikely that the most people will adopt this through telehealth. And so for those people, we still wanted to be able to support them. And that's why our GLP-1 program is something that they can utilize, whether or not they get the prescriptions through us. We are in a subscription based service. We are not - we don't make money from the prescriptions. We send those prescriptions to their local pharmacy. And so we are still able for those people who do get the medication from a doctor who are seeking more support to provide the behavioral complement on its own.

We're going to take a quick break here, but more of my conversation with Sima is coming up in just a moment. And I'm going to ask her specifically about the challenges of making such a massive pivot.

So as you can imagine, the conversation from a business perspective, to acquire a telehealth company and obesity management had to come hand in hand with the acknowledgment that we didn't think that our existing program provided enough of the support that we were looking to provide our members. And so that was a difficult conversation.

Much more to come.

'The changes that Sima Sistani is making at WeightWatchers are a huge shift. As we mentioned at the beginning of this episode, WeightWatchers really began and then grew out of a single in-person support group with methods that preached willpower and moderation. So I was curious to hear how the Weight Watchers customers, and even the board members inside the company are responding to this pivot.

Was that a slam dunk? Sort of did everyone agree with this or what were those conversations like?

So as you can imagine, the conversation from a business perspective, to acquire a telehealth company and obesity management had to come hand in hand with the acknowledgment that we didn't think that our existing program provided enough of the support that we were looking to provide our members. And so that was a difficult conversation because we had a we have a lot of people who had been with our company for a long time, not just at the board level, but at our leadership level. And the way that we were able to really make this transformation through this acquisition was to acknowledge the science. And so the science was irrefutable. We have a scientific advisory board, and there are clinicians on that board who had been providing these medications. And they said, you know, this is a game changer. We finally have a way to help people. And so with that data, it was much easier to bring our team along and our board along and have them understand why this was an important part of transforming our business and transforming the narrative culturally around not just being known for the weight people lose, but for the health that they can gain.

Do you have any context in terms of just what percentage of of WeightWatchers members are likely to end up taking these medications?

Well, it's such a personal decision, but what I can say is that we have over 70% of our membership. When they start with us, their starting weight is at a BMI that could qualify them to be on these medications. And you have 50% who are at a BMI of 30 or higher, but you have some 70% who have a BMI of 28 or higher, and who potentially with alongside with comorbidities would qualify them. It's such a personal decision that we just want to provide the solutions and leave it to our members to decide whether this is something that they want to do.

You have 30% of your members, roughly, that do not have a high enough BMI, or would not qualify for these medications. If they say, hey, look, I still want to lose weight and I'm not. You know, what's happening right now is not working for me. I'd like to try these medications. What would they be told?

'So for those individuals who it is not FDA approved for them to be on the medications, that is why we have our behavioral program and the full spectrum solutions. Now, that being said, BMI is a, a tough metric. And one that the American Medical Association has already said that BMI is not an appropriate metric. And unfortunately, the indication for these medications is based on that. So and until we have a, a better measure, I don't think that we have an ability to make that assessment as a business. But on a personal level, I think that it is worth revisiting, and we can work hand-in-hand with the medical community to figure out: what is the right metric? Should we be talking about weight, circumference, for instance? Should we be talking about different labs that actually help determine this? Because, for instance, there are people living with PCOS who who have this same condition, who could benefit from these medications, but if they don't fall into that BMI range, we cannot prescribe. And so it's a tough question to answer because we are constrained by the policy. But there's more work to be done here. And and we're, you know, actively helping and utilizing our data to help run the trials and to figure out better solutions and paths forward. But if the clinical pathway is not appropriate, we do have obviously the functional and the behavioral pathway.

I get the impression you don't think this is a flash in the pan, these medications. Is this, do you think forever going to change, not just Weight Watchers, but just how we look at weight? Like, how big a deal do you think these these new medications, relatively new medications, are to this entire movement?

I absolutely think that this is a transformational time for the way we think about weight management. And it's a paradigm shift. We want to talk about weight health. And it's really important that we talk about the degree to which weight impacts your health and quality of life, that it's not about an arbitrary number on the scale. It's not about looking a certain way. It's about finding your best weight. The point where you're eating, you're exercising in ways that make you happy and healthy. And by the way, that number and that weight health, that is something that changes as you age and as you grow. And so I think that's a shift that is happening across our not just our industry, but culture.

In our last few minutes. Let me just ask something that you brought up earlier, just this, this again, this nuanced point of saying, hey, look, the old Weightwatchers model, if you will, you know, the idea of of really leaning into these lifestyle changes, learning about good nutrition, healthy food choices, peer support, all of that. In combination with these medications, that's what you're sort of talking about. But at the same time, you've also said these drugs could be the end of diet culture. I believe that was the quote. Are these drugs the end of diet culture as we know it?

I believe they are, because what these drugs are showing us is that this is not a matter of vanity. This is not about an aspirational body type. And that's what diet culture was about. Media, books, zeitgeist. There was a preoccupation with thinness. And what these medications are allowing us to do, finally, is to have a different conversation, a healthier way to talk about weight. Because it is a matter of health. And I believe if we do that and we we change that discussion and we change that narrative, that we're going to shift our language. So that diet goes back to being a word that describes habitual nourishment. And not a word that implies, I'm trying to get thin.

It's kind of full circle for you. I mean, that's kind of where we started this discussion. When Oprah comes out and talks about being very open about these medications, because she's talked about her weight for for years. What happens? What do you make of this? What does it do overall to the conversation?

I think her talking about these medications, it's important I hope more people do. It's such a personal decision. But that's how we lift stigma. It's to say, I'm not ashamed that I take these medications or this is something to acknowledge and be okay with. And, you know, she's been a terrific advisor to our company and has championed this transformation that we're undertaking.

What a pleasure to speak to you. Thank you for your time. Really appreciate it.

Thank you for having me. And thank you for having this important conversation and giving it the time and the space it needs to have the nuanced conversation.

That was my conversation with Weight Watchers CEO Sima Sistani. Coming up next week on the podcast, we're going to continue this season all about weight with the topic that hits very close to home, even for me: kids and weight. What's considered a healthy weight for most kids, and what's the best way to talk to kids about health and nutrition? I got to tell you, even though I'm a dad and I'm a doctor, the idea of talking to my teenage daughters about weight, that makes me kind of nervous. I think a lot of us feel that way.

I think that conversation is so hard to navigate because it's like, okay, do we talk about like, healthy habits to lose weight and get to a healthy BMI? Or do we talk about just loving yourself and owning the way you are?

I hope you'll join us next week.

Chasing Life is a production of CNN audio. Our podcast is produced by Eryn Mathewson, Jennifer Lai, and Grace Walker. Our senior producer and showrunner is Felicia Patinkin. Andrea Kane is our medical writer and Tommy Bazarian is our engineer. Dan Dzula is our technical director. And the executive producer of CNN Audio is Steve Licktieg, with support from Jamus Andrest, John Dionara and Haley Thomas, Alex Manessari, Robert Mathers, Leni Steinhart, Nicole Pesaru, and Lisa Namerow. Special thanks to Ben Tinker, Amanda Sealy and Nadia Kounang of CNN Health and Katie Hinman.