Why you should care
Because staying fit shouldn’t just be a Western obsession.
As the director of sales and development for electroCore, a medical device company in New Jersey, Jillian Bridgette Cohen traveled often to Malaysia and Jordan. There she noticed women struggling with their weight — in fact, 65 percent of women in the Middle East are either overweight or obese — but unlike women in the U.S., they have very limited access to nutrition and fitness information.
“Working out is really difficult for them because of Sharia law,” Cohen says, referring to the religious law dictating appropriate behavior for women living in Islamic countries. For instance, women must obtain permission from a male guardian to travel, and they may be asked to provide guardian consent to access health care. Combine those restrictions with a country where the average temperature can easily top 100 degrees — and where most health care is centered in cities, while the majority of the population lives in remote rural areas — and it’s no surprise that advice about diet and exercise is hard to come by.
[VHP has] a business model that could prove particularly effective in emerging markets like the Middle East, where fitness and lifestyle apps are just finding a foothold.
In 2015, when Cohen founded Virtual Health Partners, an on-demand virtual platform offering live classes on nutrition, fitness and behavior modification, she wanted to make the service available to women living in Middle Eastern countries too. The trick, the 38-year-old says, was adapting the content so it would be culturally acceptable in Saudi Arabia and Jordan, as well as more conservative countries like Kuwait and Qatar. That meant finding nutritionists and fitness instructors who speak Arabic and creating menus built around local ingredients like eggplant, dates, pistachios and pomegranate seeds. What’s more, Cohen says, fitness routines couldn’t appear overly suggestive — female instructors had to cover their shoulders, legs and décolletage — and male instructors couldn’t even participate in videos produced for female clients.
Vetting exercise videos was certainly not what Cohen imagined her job would entail. She grew up in Franklin Lakes, New Jersey, the daughter of a physician father (her mother ran his medical office). With an interest in marketing and business, Cohen graduated from Rutgers University and moved into medical device sales after landing her first job at Ethicon Inc., part of Johnson & Johnson.
Since its launch, VHP’s app has 10,000 subscribers worldwide and the platform has raised $3.5 million in Series A funding. Besides individual subscribers, it’s also used by gastroenterologists, bariatric surgeons, plastic surgeons and fertility specialists, who grant patients access to the live one-on-one consultations with nutrition specialists; virtual classes; on-demand videos for exercise, meal planning and cooking instruction; and 24/7 messaging with health experts. While many apps offer on-demand content, Cohen says VHP is one of the few to offer live content combining fitness, nutrition and lifestyle modification. And because VHP doesn’t employ doctors or provide health advice, it’s not subject to the rules — or competition — faced by telehealth services.
“One of the smartest things VHP has done is partner with traditional medical service providers rather than slog it out acquiring users in a highly competitive app category,” says Chandra Bajpai, vice president of product marketing for Skyscape, a provider of medical information. Bajpai says it’s a business model that could prove particularly effective in emerging markets like the Middle East, where fitness and lifestyle apps are just finding a foothold. As an example, he points to a MsFit app made specifically for Saudi Arabian women that has only 15,000 downloads — one-tenth the downloads for a similar U.S. app. Whether there’s a huge upside potential remains to be seen, however, since the low adoption rate could simply be the product of deep-rooted cultural differences that will continue to dampen the popularity of so-called lifestyle apps.
In December 2017, VHP partnered with Bader Sultan & Bros. Co., a health care provider in the Middle East offering noninvasive weight-loss procedures. Emad Al-Zaben, general manager at Bader Sultan, says these procedures “are known to have the strongest results when diet, exercise and live touchpoints are part of the treatment paradigm” — all offered by VHP, which “is at the patient’s fingertips on their phone when[ever] it is convenient.”
Ease of access is key, but economic circumstances can be the biggest hurdle to staying fit for Arab women, says Dr. Reem Sharaiha, a Jordanian gastroenterologist specializing in bariatric procedures. “You might be able to afford the procedure, but then you can’t always afford the aftercare that will help you to not regain the weight,” she explains.
Obesity rates in the Middle East exceed those in the United States, with 45 percent of the population in the Gulf Region classified as obese versus 35 percent of Americans, Sharaiha says. “If you don’t live in one of the major cities, you don’t have access to health care, and travel is difficult,” she adds, noting it can take hours to cross the desert to visit a doctor or nutritionist. The population is also consuming more fast food as chains like McDonald’s and Wendy’s spread across the region, delivering meals that are cheap but also high in fat, sodium and calories.
Since partnering with Bader Sultan, VHP has added more than 500 Middle Eastern subscribers, but signing up is no guarantee of success. “The abandonment rate for fitness/workout apps can be as high as 70 percent after the first day,” Bajpai says, “and the retention rate after 30 days can be as low as 2.3 percent.”
For now, Cohen, who stays fit while traveling by using VHP’s exercise videos, meditation classes and food diary, is focused on expanding the platform even further. In the next few months, she says, the company is looking to expand into Brazil, which has the world’s third largest overweight population — “as well as Canada, and then Australia and more of Europe by the end of the year.”