Our guest this episode was Lorne Segal, Co-Founder and Director of Operations at the Bariatric Medical Institute and Co-Founder of Constant Health, who discussed with Reuben Hall the background and creation of BMI, the expansion to pediatric obesity and partnership with the Ottawa Hospital, the introduction of technology and the need for the Constant Health app, the role of dietitians in the app, the integration of AI, the expansion of Constant Health across Canada, success stories and the impact of Constant Health, and future plans for the company.

“…They saw it was raining, but again, they remind themselves they want to be adventurous. And so she put on her rubber boots, she put on her rain jacket, she went outside, and then she started splashing the puddles. And she wrote to the dietician how fun it was for her and how she didn’t care if anyone was watching, but the joy she had, just sitting there and splashing the puddles, and how great she felt about herself.” Lorne Segal on Constant Health success story

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Constant Health is a remote weight management program that leverages technology to support behavior change.
The Constant Health app is a tool for clinicians to use in conjunction with their patients, providing insights and facilitating communication.
The app allows for the tracking of experiments and hypotheses, helping patients change their beliefs and behaviors around food and exercise.
Constant Health has expanded its reach across Canada and continues to evolve and improve its program and technology.


00:00 Background and Creation of Bariatric Medical Institute (BMI)
03:09 Expansion to Pediatric Obesity and Partnership with Ottawa Hospital
05:29 Introduction of Technology and Need for Constant Health App
10:50 Description of Constant Health App and Patient Experience
14:22 Role of Dietitians in Constant Health App
20:25 Integration of AI in Constant Health
23:30 Expansion of Constant Health Across Canada
26:34 Success Stories and Impact of Constant Health
29:46 Future Plans for Constant Health

Read Transcript:

Reuben (00:05.282)
Welcome to the MindSea podcast series, Moving Digital Health. Our guest today is Lorne Segal. Lorne is the co-founder and director of operations at the Bariatric Medical Institute and co-founder of Constant Health. Thanks for joining us today, Lorne.

Lorne Segal (00:21.906)
Thanks for having me Reuben.

Reuben (00:24.456)
To start, maybe you could tell us a bit about your background.

Lorne Segal (00:27.374)
Sure, I will try to make this as brief as possible, but giving you a little bit of highlights in terms of where I’m coming from. And so I guess go back probably around 2002, I was working for an international development bank. I was also studying for my third level CFA at the time and my brother-in-law, Yoni Friedhoff, had recently graduated med school. And so he was working in private practice and like any family physician does, realizing the challenges of being a family physician. And I had a friend who was struggling with obesity and I asked Yoni, like, what should he be doing? And Yoni correctly answered me at the time, he had no idea.

It was something that was never studied in med school, it was never discussed, it really wasn’t a focus at any point. And so it really couldn’t give me any advice for what my friend should be doing to help manage his weight. And so, you know, that question, I think, started weighing in on Yoni a little bit more as time went on. He really started noticing in his own practice how many of his own patients were struggling with comorbidities related to weight. And again, there really wasn’t anything out there. At the time, it was really just a lot of quackery that was involved in weight management.

And so Yoni took it upon himself to start really thinking of what could be done differently for his own patient population. And he quickly realized that if he wanted to do a good job with what he wanted to do, he would need to have a lot more manpower than just himself behind it. And so he started envisioning what might be required to have the truly interdisciplinary team. And so that got us to talking about what could be done to really make things happen. So, you know, I was lucky enough at that time, even though I was planning to be an investment banker, that I went to a few dinners with investment bankers.

I quickly realized that investment bankers are typically one of two things that are either miserable or they’re assholes and sometimes they’re both. And I realized that unfortunately I have a very good propensity to be the latter. And so I realized that it’s probably not the career choice for me to go down. And that’s largely because I just think that when you’re driven by money, which is really all you’re gonna get out of that type of a career, that is your end goal is to make as much money as possible. There’s nothing wrong with that. Just it generally doesn’t fulfill people’s level of happiness. And so…

Lorne Segal (02:16.978)
I realized luckily early on that was not the right goal for me to continue going down and so I still wanted to finish my CFA, which I did, but I also really wanted to start a business because I had the opportunity when I first graduated to work for a commercial mortgage bank in California and I really got to see the development and the joy that small businesses can give people. And so basically I told Yoni, like, look it, you figure out what you need to have the best possible practice that we can for a weight management clinic and I’ll figure out if I can make the numbers work.

And so that’s what we did. Like he came back to me and he was, I believe at the time, the third physician in Canada to get ABOM certified, which is from the American Board of Bariatric Medicine. And so, you know, he basically created what we thought would be the best program involving medical doctors, registered dieticians, personal trainers, psychologists, and we built BMI. And that was a lot of fun because at the time there was really nothing like it in Canada.

And he became a real advocate for both the treatment of people struggling with obesity, but also evidence-based treatment for obesity. Calling up things like the Canadian Food Guide, which at the time was really an atrocious guide that all dietitians thought was gospel. And so it was a really fun journey for us. And then, you know, so we started off focusing on behavioural weight management for adults. That eventually led the Ministry of Health Ontario, Ministry of Health and Lungroom Care, reaching out to us and saying if we want to do an adult program. We actually were reluctant at the time. We said no when they first asked us, for a lot of reasons, but the biggest one is we didn’t think the outcomes for a free program would be what we thought was a reasonable delivered program. We wanted to have better outcomes than we thought would come out of just a free program offered to the general public. And so what ended up happening is shortly thereafter, this is around 2012, Yoni came across a study out of Israel actually that was talking about pediatric obesity, which we of course didn’t know much about, but it was looking at parents treating the children of, or sorry, dealing with the parents of children who are struggling with obesity and overweight. And so

Basically what the studies show is that working with the parents of these children, you can have outcomes as good as working with the kids themselves without the potential self harm to the child, right? So it’s not talking to the child about them doing anything wrong, but rather working with the parents about corrective actions. Really with the parents being the drivers of the bus and the children being the passengers. And that was something we could get behind. That was something we were excited to try. And so we pitched the idea to the ministry, then he got behind us, we got to do a three year pilot, and we had really good outcomes. We still have really good outcomes.

Lorne Segal (04:33.458)
And so that was sort of our first little bit and that gave us a foray into dealing with the child aspect without directly dealing with the children of struggling with obesity. Eventually that also led to us working with the Ottawa Hospital for pre and post bariatric surgical care. So we developed a solid enough reputation with the ministry at that point that they thought we were a reliable partner that led to the next partnership. And so we started doing, and we still do about 20% of the pre and post surgical care for bariatric patients in the Ottawa region.

And so that really allowed us to get an incredible breadth and depth when it comes to treating obesity. That was about 2016, we had that started with our office. And one of the things that has always driven me is trying to put us out of business and trying to think of what could we be doing better that somebody else is gonna be doing eventually if we don’t do it ourselves. And so that’s where technology started to come into play, where I realized that we had these great programs really working on the behavioral change aspect, but there was a lot of stuff that was taking place in between those appointments that we weren’t getting insight to.

And so that’s kind of where my mind started thinking, okay, how do we do better? Technology was becoming more affordable at the time. Still expensive to build things, but you know, 2017, 2018, it was becoming a little bit more doable to start building things on your own. There was a company called Twine at the time. They kind of, what they were supposed to do was kind of work on the behavioral kind of goals and check marks that you could apply in between. So it wasn’t something like, my fitness power was just calorie related, it wasn’t a video, but it was supposed to integrate things on the back end, right, imagine where you could set goals up with clients or patients.

and then you’re able to monitor those goals in real time and they check them off and you can tell if they can’t do them, you get this dashboard. At the time, that was revolutionary. That was a huge change from what we had ever seen technology-wise. And so we had tried to do a study with Twine, working with Skype and working with my fitness pal. We basically duct taped this three piece app together. We threw clinicians on it and we tried to test pilot with the company to see if we could help their employees who are struggling with obesity. And as you might imagine, it went awful.

Not awful for the employees because we were still able to deliver relatively decent service. We knew how to work with people who were struggling with obesity and weight, but what we didn’t know how to do was utilize technology in the way it should be utilized. In part because trying to bundle three apps together, as you may imagine, and I’m sure you know, does not work out very well. But also the clinicians having the ability to utilize those apps doesn’t work very well. And this is again pre-pandemic. This is when nobody was doing video. And so even trying to get somebody on a Skype call uncomfortable with that idea of having a video call was a really foreign idea.

Lorne Segal (06:55.654)
And so despite it going miserable, like just, you know, not miserable in the sense again, like the end user was upset with the technology, but they were happy with the services being provided. But realizing that how many things were breaking down and us trying to deliver the care that we want to deliver. I realized that the only option left was for us to try to build it ourselves. And so that was the next step. And so that’s when we eventually started reaching out to different agencies and we stumbled upon YC, which was a blessing.

Reuben (07:22.918)
Cool. Appreciate all the context. And for the listeners, full disclosure, so MindSea worked with Lorne and Constant Health to build that MVP version of the Constant Health mobile app a few years ago. And actually, Constant Health and building that app and the experience is one of the reasons that MindSea pivoted to specialize in digital health as well.

A lot of that had to do with the impact that our team saw that it had on the end users and how rewarding it can be to work on apps that improve people’s health. And that really was one of the main projects that set us off in that direction a few years ago. So, I appreciate that you reached out to us, Lorne.

Lorne Segal (08:16.93)
No, absolutely. It just made a lot of sense for a lot of reason. I think probably, if I look back at it, aside from looking at some of the quality apps that you guys had already done, I think it was the fact that you are, again, this is pre-pandemic, that you were already working on a remote basis where you had developers all over Canada, sometimes around the world as well, and then knowing that your ability to communicate with people on that platform. Because that’s a big challenge and we knew we were creating a remote company. And so you really did have the expertise before most, even considered it to have a truly remote workforce.

And that was something that really, you know, being able to lean into that for a company that was already doing that. So we experienced not just the pain of us trying to build our own company remotely, but also trying to work with clients all across Canada. Cause that’s exactly what you guys were doing with us. That really, that made me appreciate, you know, what type of partner you would be. Cause you, you obviously would emphasize to what our clients would start going through themselves.

Reuben (09:06.082)
Well, appreciate that. So let’s go back to bariatric medical institute days for a second and just EMI for short. And it sounds like a pretty unique model. Were there other people in other provinces doing that or that was something you need?

Lorne Segal (09:23.274)
At the time, no, like that was completely unique to us. So truly in 2004, when we opened our doors, nobody was doing what we were doing, at least not in Canada. There’s a few now that have started doing something similar per se. I remember when we first opened the doors, people would tell us the worst possible thing we could do was start a fitness gym while we were trying to treat obesity at the same time. Like having that as part of our office, just because of the added cost, the exercise that was required for our office to have that. And it turned out to be probably one of the best things that we did, because it was one of, you know,

the reward that people get by exercising, while it won’t help them lose weight, it really does make them feel better about themselves. Right? And so there’s a lot of endorphins that are released. And so one of the things that would get people coming back was the gym, because they’d be coming three times a week for the gym to utilize it. I remember like seeing Yoni chasing people down the hallway, asking them to book an appointment while they were off to their gym class. They’d be pulling up their pants because they haven’t bought new shorts. But you know, it really, it was one of the things that worked out incredibly well for us. And so at the time we really went against what other people were saying. This was…

Lorne Segal (10:20.074)
Again, from Yoni’s research where he said, look, if we’re gonna build the best possible thing, this is how I wanna do it. And we just followed that model. Evidence has changed, things that we thought were great or less great, things that we’ve doubled down on other things, but at the time, and it still is, where we use the latest evidence available to us to try to build the best program we can.

Reuben (10:38.626)
Yeah, so maybe you could talk about the Constant Health app a little bit and describe what the experience is for one of your patients to use that.

Lorne Segal (10:50.346)
Yeah, sure. And so, you know, the Clostrn Health app really, we’ve built it from the day one as a tool for clinicians to leverage. It’s not something ever meant to replace clinicians. So it’s not like a new or some of the other programs where you’re working with the chat bot. This is really, it’s a behavioral intervention technology that allows clinicians to kind of see in between what’s happening and allows the client to also reflect upon what they’re working on. And that’s really the basic premise of the app. And like everything else, it’s evolved. You know, the name Clostrn Health really is from us constantly evolving.

We’re constantly looking at the data. We’re constantly trying to improve ourselves. We’re really fortunate in the sense that, you know, we have this circle where we have the app, we have the client, and then we have the developers. And so they’re always getting feedback from one another, right? So the, the

Lorne Segal (11:45.886)
And so same thing from the clinician, were they able to look from both perspectives, saying this isn’t working well for me on my portal side, or this isn’t working well for the clinician, or for the patient, sorry. You know, going back to your question of what’s the experience like, so really it’s a matter of onboarding the client from the very get-go, knowing that they’re working with the dietician, so they basically, they sign up for the program, they get a fairly lengthy questionnaire, looking at their weight and lifestyle and their history around that. From that, it’s entered into our portal, clinicians are able to see it.

And then from day one, it’s starting to work with the CBT framework. They’re trying to help them rethink their beliefs and their values about what they kind of perceive, and then work on building around that. And so, you know, we focus on what we refer to as their vision, which is kind of their what’s your why, you know? So it’s the easiest way I could explain it is, you know, often people come and say they want to lose, you know, some number of weight, whether it’s 30 pounds, 50 pounds, 55 pounds, doesn’t really matter at the end of the day. The question is why? How is that going to be any different if you lose 50 pounds versus 52 pounds versus 65 pounds? What’s going to be different in your life? And so really it’s about changing the conversation not around how much weight they want to lose, but what they’re trying to improve in their lives. And that’s really that value proposition that we’re trying to build from day one. And then that’s what we’re working towards, right? So we’re no longer working towards a number on the scale, which is just measuring gravity, but rather we’re working on how are we going to improve the quality of life by the time you are done the 15-week program? We do offer something called WeLab Prevention Program, but really what are we trying to build towards? And that’s the entire focus of the program. And so it’s just working on changing behaviors to reach that, what we refer to as your vision.

Reuben (13:22.491)
Excellent. And do you find that there are some, you know, whys that are more successful than others when people come to you?

Lorne Segal (13:31.338)
You know, I don’t think it’s a matter of why is being more successful. I think it’s a matter of what people are, I think that’s where the clinician comes in. So I think sometimes people have a harder time with the notion of looking for that why, right? So I do think it requires some self-reflection. So it requires, you know, really taking a step back and saying, why do I really wanna do this? Sometimes it’s a fairly easy thing to discover. You know, I wanna be able to get off the ground to play with my grandkids. When I get on the ground, I wanna be able to get up a laser. I wanna be able to go up a flight of stairs without being winded. Other times it’s something a little bit more complicated where they’re thinking of it from a…

I want to feel more comfortable in my clothes from when I go to a business meeting. I want to feel less discriminated against, right? But it’s diving in deeper to really trigger out what we’re trying to achieve and how we’re going to get there and mapping that out. And so, you know, again, where weight will be a byproduct of the actions that we take, but that’s all it is. It’s a byproduct. It is not the effort in and of itself of what we’re trying to achieve.

Reuben (14:22.554)
And maybe you could talk a little bit more about the role of the dietitians with the app because it’s not the kind of app where it’s self-serve, people just onboarding and they go through and essentially the app is leading through a journey. The dietitians and clinicians are still involved for that human one-on-one support as well.

Lorne Segal (14:45.382)
Yeah, 100%. And so, you know, really, I always kind of put in context of, you know, if you give me a piano, the best thing I could do is play chopsticks on it. But if you give it to somebody like Beethoven, they could, you know, that’s a symphony, it’s an orchestra. And so, you know, knowing how to utilize the tool, you are as good as their ability to utilize the tool, but the tool is an incredibly powerful tool. And so the job of the dietitian, their primary role is to leverage the tool to help expose areas of behavior change that people wouldn’t normally get insight to.

And so that’s usually looking at those midpoints, right? So that goes back to the original premise of what we were trying to do from the very get-go, which is how do we kind of create something where it captures the in-between data points? And so for us, maybe that’s how does eating protein in the morning impact your hunger in the afternoon? How does reducing carbs or increasing carbs impact your caloric intake, right? And so it’s trying to get a better understanding of what’s happening and why it’s happening so people could actually change their behaviors by no longer having an assumption about something, but rather having data about that thing.

Reuben (15:42.89)
And what are some of the things about Constant Health that have changed over time? Because you launched the MVP, you brought on that first group of users, and then since then you’ve been iterating and evolving it. What are some of the learnings and adjustments you’ve made?

Lorne Segal (16:00.554)
Oh, I mean, it goes on and we’re still doing it. But, you know, let’s look at the first thing. So the first thing is we kind of took that model that we saw from Twine originally with the idea of, okay, let’s try to build towards goals. But that really goes contradictory to, you know, a CBT framework, which is what we’re really trying to do is work on, you know, experiments and hypotheses. So, you know, for instance, let’s go back to simple carbonology. And so,

Lorne Segal (16:23.982)
You know, some people will think rightly or wrongly that carbs really impact their weight, that they should avoid carbs at all costs, that they are the enemy. Sometimes it’s as easy as asking people why they believe that, right? And so maybe they’ve read an article about that and so it’s the dietitian being the experts that they are. They can say, okay, do you mind if I share some information with you? And they can actually just share information and that’s the easiest way. What we know though, for the most part, is that it’s generally not a lack of knowledge that leads to a lack of behavior change, right? It’s not that people know what to do, they can’t do what they know.

Lorne Segal (16:52.69)
And so often that comes down to a belief system. And so in this case, what we may want to do is experiment around it. So maybe somebody believes that if I eat carbs, I can’t control my caloric intake. And so what we could do is set up an experiment where we literally within the app, we have an experiment section and we’ll create the hypothesis of, if I eat carbs, will I exceed my caloric intake or will I be able to maintain my caloric intake? And then we can test, okay, today I wanna eat as the experiment, 20 grams of carbs at lunch.

I’m just throwing out that number. I’m not a dietician. I don’t know the exact number that they experiment with. Let’s just throw out that number, right? And then we can build off that, right? Because what we could then see is how much does that really impact the person’s caloric intake for that day? We could try the experiment for a few days in a row. We could then see how much that impacts their weight. But what the person could then do is look back by saying, by increasing or decreasing my carbs or maintaining this amount of carbs, it either impacted my hunger.

It didn’t impact my hunger, it impacted my weight, it didn’t impact my weight. We will define what variables we want to have an outcome measure, but it really gives them the data to reflect back and saying, yeah, this wasn’t as bad as I thought it would be. Maybe I can have some carbs with my meals and it won’t impact my hunger throughout the course of the day. I can maintain my caloric range that I was aiming for. And so that’s really the way that mind shift is saying, it’s not a goal of trying to eat less than 20 carbs or more than 20 carbs, but rather it’s an experiment seeing…

What are the outcomes that we’re going to get from trying this? What are we going to learn from this? And then let’s reflect back on that data. That’s a big change that we’ve done. And so a lot of the app has really been restructured in that format. So we have hypotheses and experiments. We have a summary section. So at the end of every session, clinicians provide the clients with a summary, or actually in the best case scenario, the clients write out their own summary. So those are the key takeaways. And that’s really nice as well. So if you can imagine as a client now, you’re able to scroll back of, these are all the key findings that I had through all my sessions, because they’re always running these experiments.

It’s a lot of data to learn from, right? It’s a lot of key points that you want to take away. So the goal for us is at the end of the 15-week program, they’ve had these nine sessions, they can really fight back on, these are all the learning points that they have. And what’s most important about that is we’re now helping them reframe their beliefs about things. And so if you don’t believe anymore that carbs are evil and you can now incorporate them to your lifestyle, that’s a much easier thing to maintain. And so a key premise, a basic premise of the CVT is, changing the way you think will change the way you behave.

Lorne Segal (19:04.754)
And so that’s what we try to work on is changing that thought process.

Reuben (19:09.454)
Yeah, I really love that model of the app is the tool or the framework that is there to support the patient journey and help in between those one-on-one sessions with the clinician or dietician, but it’s not on its own, right? It’s just a part of the puzzle of that kind of hybrid remote model where…

You know, there’s still, you have that human connection one-on-one that, you know, that expert that’s going to guide you through the process. So it’s kind of, you know, part patient support and part, you know, remote monitoring as well.

Lorne Segal (19:52.494)
That’s right, yeah, it really allows us to both, because the clinicians will get notified after an experiment, they’ll let them find it. And again, this is in judgment if somebody doesn’t complete an experiment. This is, I wasn’t able to learn from that piece, and that then falls back on us saying, okay, we didn’t set up a good experiment. If you’re not able to complete it, that’s not a failure on the client’s part. That means that we didn’t really walk through how this experiment can be completed, but the clinician will still get notified so they can reach out one way to say, okay, let’s tweak this.

to try a different experiment tomorrow. So that we can make sure that you do and we can still get the data of what we’re looking for. So it’s exactly what you said. It allows us the remote monitoring, but it also allows the client on the other side to really learn as they’re doing that.

Reuben (20:25.986)
And you were mentioning to me the other day as well that you’ve been experimenting with AI in constant health. Maybe you could tell us a little bit about that.

Lorne Segal (20:34.61)
Yeah, I mean, I’m sure as you guys are appreciating it, MindSea AI is really moving and it’s moving very fast. It’s almost impossible to stay on top of all the things that are constantly changing with it. But it’s one of these things that’s just amazing how much we’re able to get from it already. So whether it’s our dev team working with it as a co-pilot on GitHub, whether it’s me helping to analyze some of the data where I can upload things, or whether it’s working on prompts to help the clinicians do things a little bit easier, a little bit faster, right? And writing those prompts. So like we tried a hackathon where really the goal was just to get our team more familiar with it, where it was having our team sit down, the dietitians were paired up with engineers and then we were broken into different groups and it was just trying to work on a prompt to how to better answer questions from clients. This just gives the dietitian, again, another superpower. They can input a question into a large language model, they could see the answer, they restructure the answer but it’s partly working on that prompt to rebuild that answer the best way it possibly can be and then they can theoretically answer more questions at a quicker pace, right? With them still doing the work, right? So it’s not a matter of saying we’re getting a chatbot to answer, they still have to analyze, they still have to review, but they could also use it for things like if somebody wants a quick meal plan, which we generally discourage people from, but if somebody wants a quick meal plan for a couple days we can do it much faster now and so this thing goes back to the premise of we’re not using these machines or these tools to replace the clinicians, but rather to give them superpowers to make them faster, make them better at what they’re able to do. I think my favorite line around AI is Scott Galloway, where he’s a professor. And he basically said, you don’t have to worry about AI replacing you, you have to worry about somebody who knows how to use AI replacing you. And I think that’s really what it comes down to, that AI technology is gonna be one of these things that just gives us the ability to do our jobs better.

But you have to understand how to use it if you want to be better at your job.

Reuben (22:20.574)
Yeah, I totally agree with that approach. You know, AI is another tool in the toolbox that can help clinicians be more efficient, get more time with patients throughout the day because AI is helping them, you know, deliver faster and more effectively to a broader audience. So certainly the tools are there to be utilized and it’s on us to learn how to use them.

Lorne Segal (22:50.098)
Yeah, like another perfect example of something I’m incredibly excited for, and it’s a matter of when, not if, but chart notes, right? So right now, chart notes, clinicians are still inputting the chart notes manually, and they need to do that. But we record all of our sessions. And so the truth of the matter is, it’s a matter of time that you could have an AI add in the fields that you’re looking for your chart notes, especially because our sessions are very structured, right? That’s, again, a very basic CBT framework. But because we have such structured sessions,

It’s just a matter of time until those tart notes getting done. And that would save a clinician, you know, 15% of their time that they could then refocus on working with clients, answering their questions, answering their email, answering their texts, checking on their experiments. And so again, this is just a matter of making them better and faster.

Reuben (23:30.23)
That’s right. So thinking about the reach and how constant health has allowed you to expand geographically outside the previous area you were serving in Ottawa, you have patients all across the country now, correct?

Lorne Segal (23:49.642)
Yeah, that’s right. We’re just about to expand to Quebec, but we’re in, I think, 10 different provinces right now.

Reuben (23:56.23)
And how have you seen that growth over time? Has it been kind of, yeah, what are, maybe talk about some of the struggles of growing and the transition from a bricks and mortar kind of model with BMI to a fully remote and more virtual service.

Lorne Segal (24:24.778)
Yeah, so I mean, I think it’s a double edged sword, right? So I think with BMI, which we still have, we’re limited by geographic region. BMI actually now does work with families across Ontario for a pediatric obesity program, Family Reset. But certainly we don’t work outside of Ontario because that’s the ministry covered program. For constant health now, we’re able to work all over Canada. And so with that, it allows extra reach, but there’s also extra competition.

But again, it’s one of these things where I, you know, obviously have a very big bias in this, but I feel we do what we do better than anybody else. I feel our dieticians get more training consistently than any other program, and I feel technology is better than any other program to leverage for our dieticians. And so, you know, I think it’s the challenge always is getting in front of consumers and make them understand what we’re trying to do and how we’re trying to do it, that we’re not a quick fix. But for those that get it, for those that sign up, they love us. And I think that’s, you know, one of the things that we track is, for instance, Net Promoter score.

which I don’t know. Are you familiar with that? Yeah. Yeah, so it’s one of the things that we track on both ends. And so it was really interesting. We used to, within our end of program survey, because we’re always curious to see how, not just looking at our outcomes from a weight management or adherence perspective or nutrition, but also just in terms of what people, how they value us. And so NPS, we asked both for the app and we asked for the program. And so the NPS for the program for the longest time has been really good. So we probably average around 73, typically.

Lorne Segal (25:47.779)
Yeah, it was really happy with the app. The app wasn’t so good at the beginning. The app required, as you might imagine, you start off with an MVP. There’s a lot of features that are missing. There’s a lot of features that you have to build. There’s that was around like 54, 55. And that’s just because you don’t know what’s gonna work. You don’t know what people want. And you have to constantly iterate on that. But now as we’ve had more experience and more time and more iterations of it, we’re hovering that around, you know, 68, 69. So they’re starting to align now. where the app and our program are. But yeah, the people who participate in our program, it’s a really lovely thing, especially when somebody’s able to not just change their beliefs around food and around healthy and around habits, but really where they’re able to realize that they’re living a better and a healthier life and that appreciation that they have is, you can’t compare it to most things in life.

Reuben (26:34.23)
Yeah, as I mentioned before, the team at MindSea really founded a rewarding project to work on. And part of that came through doing some of the user testing and having those individual conversations about what do people like, what do people not like, and what they got out of the app. And hearing some of the stories, the success stories, was really impactful. Maybe you could share a bit of anecdotes you know, how the lives that, you know, constant health has changed.

Lorne Segal (27:07.526)
Yeah, sure. I mean, it’s, I mean, they’re numerous. And again, like it’s, I always get to hear these second hand, so I don’t have to do any of the heavy lifting. I just get to hear the nice stories. I mean, I hear what somebody’s unhappy too, but I hear a lot more nice stories at the same time. And so, you know, I think probably like my, my favorite one, the one that really resonated with me is, is hearing about, I believe the woman was in her late sixties or the seventies, and she really came in with this, they’re all or nothing mindset, which is very common, right? A lot of folks come in of it’s either, I have to be a hundred percent. And if I’m not a hundred percent at everything, then I’m just quitting. I suck. doing. And so a big focus was trying to work on that belief system that it doesn’t have to be all or nothing. I believe for her, what she was hoping to get her vision was really just mobility was a big issue for her. So she wanted to be able to just be able to go explore and go on car rides again with her friends, like just having that ability to just at the drop of a dime, just go and be adventurous. And so that was really one of the focuses that the diet session worked on with her was not just around changing habits around eating.

That it doesn’t have to be all or nothing, that you don’t have to be perfect, but also around the way movement works in exercise. That wasn’t a matter of having to do an hour of exercise, but just actually getting outside to go for a walk. And so, there was this great story that the dietician shared where it was a rainy day, it was like gross outside, but they had enough conversations that it was just about getting outside for 20 minutes. That was your goal. That was all that really mattered. This is the experiment was just how are you gonna feel after and they had done it enough times where they knew that would feel better, right? So this is again, helping somebody change their beliefs about something.

Lorne Segal (28:35.106)
They had run enough experiments with the person and gone on enough walks that they knew, as long as they did it, as long as they put on their shoes and got out the door, they would feel better. And so this person did that. They saw it was raining, but again, they remind themselves they want to be adventurous. And so she put on her rubber boots, she put on her rain jacket, she went outside, and then she started splashing the puddles. And she wrote to the dietician how fun it was for her and how she didn’t care if anyone was watching, but the joy she had, just sitting there and splashing the puddles, and how great she felt about herself. And that’s what we want, right? That’s what we’re aiming for, is that better quality of life that’s not…

Reuben (29:01.754)
Yeah, yeah, that’s pretty amazing.

Lorne Segal (29:03.966)
Yeah, that’s not stuck on a scale. It’s not stuck on a number. Another lovely thing with the same client, I believe, is her goal, I think for 2022, this took place, was for 2023, not to want to lose any more weight, to be done with trying to lose weight. And that’s what happened. It wasn’t that she reached a magic number, but she was happy enough with where she was, that she knew the weight that she was at was a good enough place for her to be happy. And that’s really what we’re trying to achieve.

Reuben (29:26.454)
Yeah, yeah, that’s amazing. So I’m curious, any other plans on the roadmap for constant health, any other features or technology to adopt or different things to conquer there?

Lorne Segal (29:46.362)
Yeah, I mean, I think that is a never ending cycle for us, unfortunately. And fortunately, like I love it. I love looking at what’s happening, what we can do, getting the devs mad at me. Can I ask for something that I should never ask for? And what happens on a regular basis? Um, but yeah, I mean, truly, you know, going back, I just saw it the other day where you can now with, with tech GPT, you can integrate voice and you can have it talked back to you and somebody actually used it to grade them on their debating skills. There’s no reason that in the future, we won’t be able to leverage a conversation that a clinician has with a GPT model. Where we’re looking at their CBT skills and the skills that we’re trying to train them on, and we’re getting constant feedback. So it’s not just a matter of them working with live patients, but really practicing skills that we feel that they need to work on, you know, behind the scenes. And that’s one of the things that we really focus on is our training. And so we’ll both be able to analyze better conversations. Like I was talking before about chart notes getting uploaded. I’m sure that’s gonna be happening in the not so distant future. And we’ll be able to build models for training that we’ll be able to utilize. And then there’s just program components that we’re adding. We’re adding a GLP-1 program to our program.

Where patients can start working with nurse practitioners, get prescriptions when needed. And I’ll just be something that’s constantly evolving. It’s partially trying to figure out what’s happening, what’s on the horizon, and going back to that original premise that I have, which is trying to put us in a business, and me trying to do that to myself.

Reuben (30:58.842)
Well, good luck with that. No, seriously, thank you so much for joining me today, Lorne. It’s really great to hear the story and also your mindset behind evolving the product and just developing a really successful business around it. So thanks for your time to chat on the podcast today.

Lorne Segal (31:24.906)
No, thank you, Reuben. Thank you. Like truly, I mean, I know I’ve said this to you before, but there is no way constant health would be constant health if we didn’t have the opportunity to work with YNC way back when, when we first got started. The guidance that we got from YNC was, you know, fundamental to getting us where we are today. And that’s something we all would be appreciative of. So, so thank you.

Reuben (31:43.286)
Yeah, I appreciate that. And also that it’s developed into a long term relationship. I think there’s that initial phase where the MindSea team helped design the build and the MVP, and then we were iterating together under your leadership on the product and business side. And then there was this kind of hybrid phase where you’re both working together while you’re also building your internal team and making your first hires. And building the team that would carry forward. And then eventually at the right time, we kind of parted ways as friends and handed it off to you guys to take it from there. And I think that’s a great way to evolve a technology company and get it off the ground, build that team and then off to the races.

Lorne Segal (32:41.046)
Yeah, no, it’s been a lot of fun and the journey continues, so thank you.

Reuben (32:45.094)
Cool. Well, thanks for everyone for joining us today on the Moving Digital Health podcast. If you enjoyed this conversation, please go to movingdigitalhealth.com to subscribe to the MindSea newsletter and be notified about future episodes.

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