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Ask A Digital Health CEO: How Has Coronavirus Changed The Wellness Industry?

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Ask A Digital Health CEO: How Has Coronavirus Changed The Wellness Industry?

 

For many people, the coronavirus pandemic has changed their nutrition and exercise habits. One app helping people track their food and lose weight is called Lifesum. The company has scaled rapidly to 45 million users and boasts partnerships with Amazon (NASDAQ:AMZN) and Nike (NYSE:NKE).

Fool.com’s Healthcare and Cannabis Bureau Chief Corinne Cardina chatted with Lifesum’s CEO Henrik Torstensson about the digital health and wellness space.

Corinne Cardina: Hello, Henrik, how are you?

Henrik Torstensson: Hi, I’m good. How are you?

Cardina: I’m so good. I am Corinne Cardina. I’m the Bureau Chief of Healthcare and Cannabis on fool.com. Fools, I’ve got with me today Henrik Torstensson, CEO of Lifesum, a digital health service. Henrik, did I say your name right?

Torstensson: It’s Henrik, it’s good.

Cardina: Great. We are going to talk about Lifesum today, but we’re also going to talk about investing in the digital health space and what investors should know about the intersection of technology and wellness. I do want to let our viewers know that we’re testing out a Q&A service called Slido. We use it at The Fool internally, we think you’ll really like it. You can open up Slido in your browser or the app and the code is MFlive. You can submit questions, upvote other people’s questions that you want to see us answer. Let’s start out with learning about Lifesum. Henrik, could you give us a brief history of how you co-founded this company, what it is, what inspired you to start Lifesum and what stage of growth your company is in today?

Torstensson: Absolutely. Thank you for having me. We got started back in 2013. For us, digital health has been a couple of years and always exploding this year. What we do is that our mission is to improve lives through better eating. We help people eat better and manage their weight, and we have 45 million members. The U.S. is our biggest market, and we help people manage their weight and eat better by providing a digital service in apps for iPhone, Android phones, Amazon Halo, and other mass-market digital services.

Cardina: Great. We’ll talk a little bit more about Amazon Halo later, a very exciting development there. But for our investors who are familiar with the digital health industry, I’d love to put Lifesum in context with some of the names that we are familiar with. There’s traditional weight loss companies like Weight Watchers, and we like to give the takers when we’re talking about public companies. I’m just going to put that in the chat. There’s Weight Watchers, it used to be people would show up to the clinic. There was definitely an in-person social component. They’ve certainly pivoted more digitally in recent times, now it’s called WW International (NASDAQ:WW). Then there are digital-first psychology based weight loss apps, and I think Lifesum falls more on this side of things. The one I’m familiar with was Noom. I’d love to hear what is unique about Lifesum and where does it fit in the digital health, and specifically the weight loss side of things?

Torstensson: What we’ve built is something that’s popular both in Europe and the U.S., which is quite unique, 45 million members, and what we built is a service that allows our users to take a personalized approach to how they eat, so that might be that you want to eat a balanced diet, you want to have a high protein diet, you want to do intermittent fasting. We think that’s really key to attract the millennial and Generation Z audiences where we do care No. 1, and so what we’ve done, we’ve built a service with great design, a brand that has built a lot of trust and destigmatized actually changing how you literally eat better and healthier. That’s one of the things with millennials and Generation Z, it’s not the weight watchers of 20 years ago, it’s really about eating better, and the drivers of that are many.

Cardina: Yeah, that’s so true. How has the health and wellness industry evolved over the last couple of decades, and more recently, how has the coronavirus pandemic impacted how people view their health and the role of technology?

Torstensson: Healthcare and wellness is obviously an enormous part of the economy. It’s $2 trillion in the U.S. alone. It’s probably maybe the biggest market we have. In digital, it’s been ramping up, but it’s been a fairly slow start because it’s a complex system. You have individuals, you have insurance companies, you have state governments, federal governments that all have interests. It was picking up speed. This year with COVID and Corona, that really the same way we all ended up on Zoom for most of the year, and that really made having virtual meetings really a default way of operating. Healthcare is coming in the same way that it’s really taking a step from, OK, this is happening a little bit at the edges, to becoming this central thrust of healthcare and the overall market.

Cardina: Yeah, great point. We’ve seen digital health disrupting a lot of historical industries like pharmaceuticals and health insurers. What do you think investors should know about traditional healthcare companies as they invest for the future?

Torstensson: I think investors should think that this is an enormous market, digital is really happening now, it’s picking up speed, and it’s growing quite fast, especially for such an important — and for good reasons — regulated industry. You have telemedicine, you have online pharmacies, you have across-the-board, really, digitalization coming both on the traditional aspects and doing things that couldn’t be done before technology, that if you were a doctor 10-15 years ago, you would probably pinch yourself that do I actually have access to this type of data that consumer products like Apple Watch or Amazon Halo has today? If you look at other industries, media, commerce, they were far further along, obviously they also got a bump this year from COVID with the lockdowns, but it’s the same thing happening to healthcare and wellness, and it’s just an enormous industry. I think that’s the big thing to think about.

Cardina: Absolutely. Do you think we’re just starting to see how technology can disrupt the healthcare industry? Are we in the early stages?

Torstensson: I think we are in the early stages. Obviously, how technology is used within healthcare is probably still going to be regulated even if it feels disruptive, maybe for many participants. But it’s also that the technology that was only available for hospitals 10-15 years ago in a reasonable user-friendly way is moving out to our phones and to our watches and blood oxygen levels, etc., that you’re actually getting for very standard home electronics or smartphone devices.

Cardina: Yeah, absolutely. Your company has scaled incredibly fast; you said 45 million users. I think in the recent months, you guys saw 700,000 downloads. What is your guiding philosophy about leading a rapidly growing start-up?

Torstensson: It’s really to start building a great product for users, because the thing that really drives any start-up in any companies is that you’re serving customers; but with that as a focus, hire great people, trust them to do great work, and then find out great partners to really give an extra boost to the growth and reaching out to consumers.

Cardina: Yeah, definitely. Partnership has been a big strategy for Lifesum. The company has developed some really impressive partnerships with big tech companies, notably Amazon recently. Can you tell us more about Amazon Halo?

Torstensson: I’m very happy to be one of the nine launch partners for Amazon Halo, which is Amazon’s new health device and program that is coming this fall. They’re really interested in taking a very holistic approach to health and we are their nutrition partner on the lab side.

Cardina: Great. What does that mean? How does that work in practice?

Torstensson: With Amazon Halo, when you want to change your approach to nutrition and food, they have a part of the service called labs where we’ve made the content and the program that the subscribers and users of Amazon Halo are using to actually go on and change how they eat.

Cardina: Okay. It’s an education component?

Torstensson: It’s an interactive education component. You pick something you want to do and then there’s this daily guidance to actually help you do that.

Cardina: Awesome. That’s super exciting for you all. The Amazon Halo, it harnesses artificial intelligence to inform what we know about our bodies. What excites you about artificial intelligence in the healthcare space?

Torstensson: What I think is so fascinating and really promising is that there’s this great amounts of data, and we collect hundreds of millions of data points every month from our 45 million users, and with artificial intelligence we are able to personalize the experience for individuals and actually dig out what we will learn from others to actually make it easier for everyone to live healthier lives.

Cardina: Great.

Torstensson: Get sick or get really on the preventive side, which is probably the best thing if you get it right.

Cardina: Yeah, absolutely. What might you say to folks who are skeptical that tech companies will protect their most private data, their biometrics, their health information?

Torstensson: I can only speak for Lifesum and we always start with users’ rights and privacy. We collect the data that the user gives us to actually provide a service, and if they want us to share that with other services to make their lives better, we think that’s fine, but it’s not for us to go and share that data without user consent.

Cardina: Great, very important. I enjoyed looking around that Lifesum social media. It looks like social media is an important component of your strategy, really educating folks on some timely wellness trends, education. I saw an explainer on intermittent fasting, which is something I’ve been really interested in recently as well. What do you think about social media and the role it’s playing in Lifesum’s success?

Torstensson: To us, it’s a digital service, and as eight years old, as a digital-native company with the millennial generation, it’s obviously a core part of what we do and how we interact with our membership. It’s important, but there are our partnerships as we discussed before. So it’s really the mix of finding a great product, great social media, great partnerships, to make the magic source.

Cardina: Absolutely. How do you envision the future of digital health? What trends do you think will continue to gain momentum once the coronavirus pandemic subsides?

Torstensson: I think one thing that I’m really excited about, what we’re doing is actually one of the AI-driven products, it’s predictive tracking. By looking at everyone else that’s used Lifesum and what you have done before as an individual user, we can actually predict what you’re going to eat and that really creates this magical fluent experience. That level of being a daily part of a user’s life is really exciting. I think that one segment of digital health that really got this pushed, which I think will stay with us and continue to grow is really telemedicine. I think that’s going to stay with us because it’s just more convenient for a lot of interactions with our doctors.

Cardina: Yeah, absolutely. Lifesum is all about eating, right? Eating is a big part of our lives. When you’re ready to make a big change in your life for your health, food has a really big part of that. How does Lifesum help users change their way of living for the better as it pertains to food, nutrition, and eating?

Torstensson: We’re all about food and nutrition and what we’re saying is we want to improve lives through better eating; nutrition is the numbers aspect, but it’s really about emotions and actually how we were brought up, our culture that impacts what and how we eat. What we do is we help users and we say it’s really about the user. It’s about being personalized, which way actually works for each individual. It might be intermittent fasting that you’re interested in, that is something that you want to go down that road. Then we bring in the best knowledge, build a great experience, actually make that really, really easy.

Cardina: Excellent. What does the interface of Lifesum look like? Is it planned menus? Is it for people to track what they’re eating and look at calories and the macro breakdown? I’d love to just hear about it from a user perspective.

Torstensson: It’s a mix of that. We have a food tracker and you can search, you can use our barcode scanners or our image recognition to actually take a photo of what you’re eating to pick that up, and then we’ll give you individual feedback on that. That feedback differs depending on what your goal is, if you’re trying to lose some weight or if you’re trying to eat healthier or if you’re trying to build muscle or gain weight, depending on if you’re on intermittent fasting or high-protein or a balanced diet, actually what you want is very different feedback and that’s what we built with our food rating algorithms. Then we also have recipes. We have plans that tell someone gets going. What we know is that if we look at 30 days of using Lifesum, you really moved. Even if you start out with very little understanding of nutrition and food and how what you eat impacts your health, after 30 days, you have taken an enormous step in understanding that.

Cardina: Yeah. I love looking at the data on all of my different wellness apps. When I go for a run, I love to see, did I go a little bit longer, a little bit faster than the last time? I think that touch point probably makes the product really sticky so your users continue to use the app for a long period of time. They don’t just forget about it and move on. Is that right?

Torstensson: Yeah, absolutely. We have very loyal users. Sometimes people use it for a while. They use it to understand. We’re nutrition partners of Nike, and as an example, really, if you’re going to run a marathon or longer race, understanding what you eat and how you eat and how that impacts your performance is really critical.

Cardina: Yeah, absolutely. Are there any other partnerships beyond Amazon Halo that Lifesum has created that you’d like to talk about?

Torstensson: We’re very proud and happy of being the nutrition partner of Nike, which we’ve been now for a little bit more than a year and obviously, an iconic company, then we are very happy with more of maybe relationships and partnerships with Apple (NASDAQ:AAPL), Google (NASDAQ:GOOGL) (NASDAQ:GOOG), and where we were part of the presentation on the WWDC Developers Conference this summer with our new widget which is part of the latest iOS.

Cardina: Awesome. We did get a question in from Andy pertaining to how the app works. What is the technology used to build menus for participants and the database of foods? It sounds really cool. You take a picture of food and the app recognizes what it is. How does that work technologically?

Torstensson: When you take a picture, then you’re using actually artificial intelligence to do image recognition, and there are a few different ones depending on the platform, what you use; then, on menus, etc. that you find in the app, we have our in-house staff of nutritionists and a chef that helps us build that out so it’s both healthy and delicious.

Cardina: Awesome. We have a user named Jayful who said, “I haven’t heard of Lifesum. How do people first find you?” You said it’s available on iOS.

Torstensson: iPhone and Android, you just go to the App Store and search for Lifesum and download us. Most people hear about us through word-of-mouth. For the U.S. market, we just got started four years ago and we’ve been operating for eight, but it’s already our biggest market, so we’re still in a growth phase in the U.S.

Cardina: Awesome. I’d like to talk a little bit more about the U.S. market in digital health. On Fool.com, we’re investors, so we love to look at some of the public companies and the digital health companies, particularly in telehealth, that’s been a big buzzword this year, we have been on a pretty wild ride since the pandemic began. The telehealth pioneer, Teladoc (NYSE:TDOC), is at more than 200% since the start of March, reflecting its record setting number of telehealth visits. There’s Veeva Systems (NYSE:VEEV), which sells cloud software for life sciences companies, that’s up 300% since March. Primary care chain One Medical, their parent company, 1Life Health (NASDAQ:ONEM), IPO’d earlier this year, it’s up 30%. So, I’m loving all of your insight on the digital health industry and I would love to know, what do you think about these types of stocks? Are they overhyped? Are they fairly valued? Or do you think we’re just seeing the beginning and so they’re really trading at a bargain still?

Torstensson: I think that’s obviously the million-dollar question. I can look at it as an operator. The healthcare market is enormous in itself. Digital is really happening. As with any market, when you have those two combinations and through demand from users and consumers, payers, there’s going to be winners and losers. So then, you need to go in and look at individual companies. I have spent 110% of my time on operating Lifesum so I can’t go in and say, this is going to be the winner, this is not going to be the winner. But I’d be extremely surprised if there aren’t multiple winners in this sector.

Cardina: Absolutely. One question is, this is from Mike Migliore, “How does your technology compare to the tech used by Fitbit?” This viewer says that they seem similar on the face.

Torstensson: What are you saying, developed for Android or iOS? I can’t really speak on exactly how Fitbit’s technology is built.

Cardina: Yeah, I hear you. Fitbit seems like it’s more in the exercise side of things, and Lifesum is more about the nutrition. It sounds like together they could be excellent tools for someone who is trying to really take charge of their health and have better outcomes.

Torstensson: We support Fitbit integration within Lifesum. So, I think that’s correct that they are more on the exercise movement side and we’re 100% focused on delivering a really great experience, some food and nutrition.

Cardina: Awesome. So, I’m curious to hear about your personal nutrition journey. Is there any type of food that you love to eat that keeps you healthy? I’m a big foodie and home chef myself, so I love to hear ideas.

Torstensson: So my problem, and that’s part of why I got involved with Lifesum, is I really love food, great food. So I probably eat a little bit too much. But I think it really goes back to finding a daily rhythm for at least most of the week for me to stay healthy, and it’s about being a little bit smarter through breakfast, lunch, dinner, especially during the week. I have a sweet tooth as well, bread is my weakness, so for me, it’s a lot about moderating that side to become a little bit healthier.

Cardina: Yes, absolutely. No one says you can’t have bread, but maybe not bread with every meal every day.

Torstensson: No, but I think, and that’s a lot around health and food, that it’s actually not these enormous changes or crash diet approach, which is actually very hard to sustain. It’s about finding a balance that’s healthier than the one you have now if you’re unhappy with your current health status.

Cardina: Right. A lot of the progress really happens on the margins if you can just get 10% better in a lot of ways, it can have an outsized impact. That’s what I’ve found in my own health journey as well.

Torstensson: It will be a little bit like investing, that you have these compounding returns. You find the right balance and then it just builds.

Cardina: I love that connection, that’s so true. So, to get back to investing a little bit, what is one thing our viewers should know about their own wellness in light of the pandemic? Do you have any favorite takeaways to share, whether it’s about work-life balance, self love and acceptance, education, or even just that it’s OK to have cake every once in a while? What do you think?

Torstensson: I think one of the takeaways from the pandemic specifically is actually that being overweight or obese actually seems to be one of the clear risk factors of getting a worse COVID experience. It’s actually a good thing to think about, what am I eating, how is that impacting my health? Because that’s one of the things we actually can impact seemingly when it comes to the pandemic.

Cardina: Yeah, that’s so true. I think for a lot of us, the pandemic has made us feel very out of control. What I love about digital health apps as it pertains to exercise or nutrition is it can really make you feel in control and really give you your power back in a very stressful situation.

Torstensson: I fully agree.

Cardina: Awesome. So, are there any exciting developments coming up for Lifesum that you would like to talk about, maybe new partnerships, anything along those lines?

Torstensson: So for us, it’s two months to the New Year, so we’re heads down building the new version of Lifesum and working on new things. But I spent 20 years in digital, learnt that you should not pre-announce before you’re actually done. I think that’s a hard-learned lesson from before. So we’re looking very much forward to continue to serve our users and add way more than 700,000 users per month over the next couple of months.

Cardina: Awesome. What is your marketing strategy behind that? Do you do most of the marketing on social media? Any thoughts there?

Torstensson: We always start with the product. I think for any digital product, that’s where you really need to start because word-of-mouth, especially online, is so powerful. But we use social media, we use paid advertising, we use partnerships and we think that actually doing all of them well is one of the things that have driven us to, soon, 50 million users.

Cardina: Yeah, absolutely. When something works, you want to tell everybody about it. You said you spent a lot of time in digital. What were you doing before Lifesum?

Torstensson: So, just before Lifesum I headed the consumer subscription business at Spotify. So, almost 10 years ago now, just when Spotify was starting out. So I ran that for three years, and before that, I was with the company called Stardoll that was the biggest gaming in community website for teen and tween girls globally.

Cardina: Cool. I feel like, with a lot of apps like Lifesum, there is a gaming component. Do you think you learned a lot there that you’ve brought to Lifesum?

Torstensson: Absolutely. I think there are a few key learnings that we brought from entertainment into digital health. One is that it’s about what the thumb wants to do, it needs to be fun. Also, it’s really about giving good feedback, which gaming is about; you do something and you get the feedback, that is fun and you want to do more, and that’s really part of great digital product design, health, wellness, gaming, whatever you’re trying to build.

Cardina: Right, it really activates that reward pathway. I eat a salad, Lifesum tells me great job, I feel better than if I had a cheeseburger, and you repeat the process. Does that sound right?

Torstensson: That sounds about right.

Cardina: Awesome. Well, thank you so much, Henrik. Is there any last thing you want to say?

Torstensson: Thank you for having me. If anyone that’s listening hasn’t downloaded Lifesum, please do so.

Cardina: Absolutely. I know I’m going to enjoy using it. Thank you so much. Well, have a great afternoon.

Fashion

The truth about fast fashion: can you tell how ethical your clothing is by its price?

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What is the true cost of a Zara hoodie? In April 2019, David Hachfeld of the Swiss NGO Public Eye, along with a team of researchers and the Clean Clothes Campaign, attempted to find out. They chose to analyse a black, oversized top from Zara’s flagship Join Life sustainability line, which was printed with lyrics made famous by Aretha Franklin: “R-E-S-P-E-C-T: find out what it means to me”. It was an apt choice, because the idea was to work out whether any respect had been paid to the workers involved in the garment’s production, and how much of the hoodie’s average retail price, €26.66 (£22.70), went into their pockets.

This was no simple assignment. It took several people six months, involved badgering Zara’s parent company, Inditex, over email, slowly getting limited information in return, and interviewing dozens of sources on the ground in Izmir, Turkey, where the garment was made. The researchers analysed financial results and trading data, and consulted with experts in pricing and production. It was, Hachfeld says on the phone, with dry understatement, “quite a huge project”.

Their research suggested that the biggest chunk of the hoodie’s retail price – an estimated €10.26 – went back into Zara, to cover retail space and staff wages. The next biggest slice, after VAT at €4.44, was profit for Inditex/Zara, at €4.20. Their research suggested that the textile factory in Izmir received just €1.53 for cutting the material, sewing, packing and attaching the labels, with €1.10 of that being paid to the garment workers for the 30-minute job of putting the hoodie together. The report concluded that workers could not have received anything like a living wage, which the Clean Clothes Campaign defined, at the time the report was released, as a gross hourly wage of €6.19.

When the research was covered by the media at the time, Zara said the report was “based on erroneous premises and inaccurate reporting”, that the €7.76 sourcing price was wrong and that the workers were “paid more than the amounts mentioned in Public Eye’s report”. But at the time and when I contacted Zara for this article, the company declined to set out in greater detail where the research was inaccurate.

Workers in a small garment factory in Istanbul
Workers in a small garment factory in Istanbul. Photograph: NurPhoto/Getty Images

What is clear is that trying to find out the true production cost of a garment is a tortuous and potentially fruitless process – even when assessing a major high street retailer’s flagship “sustainability” line.

Hachfeld points out that Zara is by no means uniquely opaque. It is doing more than many clothing brands and has long-term commitments in place to work towards living wages. “They are launching initiatives and consultations with trade unions. But the question remains: when will they deliver on it?” he says. Vanishingly few retailers guarantee living wages across their vast, complex supply chains. According to the not-for-profit group Fashion Revolution, only two of the world’s 250 largest fashion brands (OVS and Patagonia) disclose how many of their workers are paid a living wage – despite the kind of resources that make billionaires of founders. Forbes estimates that Zara’s founder, Amancio Ortega, is worth $77bn (£55bn) and that H&M’s founder, Stefan Persson, is worth $21.3bn; the Sunday Times puts the wealth of Boohoo’s co-founder, Mahmud Kamani, at £1.4bn.

Throughout fashion, the numbers just don’t add up. High-street clothing has been getting cheaper and cheaper for decades. A major reason why, according to Gordon Renouf, the CEO of the fashion ethics comparison app Good on You, is that so many western brands have “moved from onshore production 40 years ago to larger offshore production”. Often, the countries they have chosen have “much lower wage costs, weaker labour movements and laxer environmental regulations”. Of course, we know all this, but we have also become accustomed to reaping the benefits. Our perception of what clothing should cost – and how much of it we need – has shifted.

In 1970, for example, the average British household spent 7% of its annual income on clothing. This had fallen to 5.9% by 2020. Even though we are spending less proportionally, we tend to own more clothes. According to the UN, the average consumer buys 60% more pieces of clothing – with half the lifespan – than they did 15 years ago. Meanwhile, fashion is getting cheaper: super-fast brands such as Shein (which sells tie-dye crop tops for £1.49) and Alibaba (vest tops for $2.20), have boomed online, making high-street brands look slow-moving and expensive by comparison.

But the correlation between price and ethics is knotty, to say the least. The conversation about sustainable fashion tends to be dominated by expensive designer brands: at Stella McCartney, for example, a wool-cotton jumper costs £925; at Another Tomorrow, each $520 sustainable viscose carbon-offset scarf neck blouse features a QR code in the label that outlines every stage of its “provenance journey”.

On the high street, many who proudly opt out of shopping at Primark or Boohoo for ethical reasons may be unaware that most reassuringly mid-priced brands don’t guarantee workers living wages or produce clothing without using environmentally harmful materials. A garment’s price is often more about aspiration and customer expectation than the cost of production. Hachfeld points out that the Zara hoodie was priced higher in Switzerland (CHF 45.90; €39.57), where Zara is positioned as a mid-range brand, than in Spain (€25.95), where it is perceived as more mainstream and affordable.

Another Tomorrow scar-neck blouse.
‘Provenance journey’ … Another Tomorrow scarf neck blouse.

Online, debates about the price of clothing can get heated. The sustainable-fashion writer Aja Barber, for example, uses the phrase “exploitation prices” to refer to very cheap clothes, such as the 8p bikini offered by the Boohoo brand Pretty Little Thing last autumn. “Either the company or the garment worker is taking the hit, and most likely it’s not the company, because that wouldn’t be a profitable business model,” she says.

Barber has a personal threshold in mind when she buys an item. “Any time a dress is under £50, you really need to break down the labour on it,” she says. “Think about what you get paid hourly – think, could a person make this dress in three hours?” She doesn’t base this calculation on local wages in the global south, either, which are so much lower “because of years of colonialism and oppression”. She buys new clothes infrequently and tries to avoid polyester, which is made with fossil fuels and generally used in garments to make them cheaper.

Barber gets annoyed by the accusations of snobbery that ripple through social media when anyone criticises super-cheap brands. Largely, she says, these comments come from middle-class people “who want to participate in the system and not feel bad about it”. In her view, fast fashion is propped up not by those with very low disposable incomes, but by middle-class overconsumption.

The only way to tell if a garment has been ethically produced is by combing through the details on the manufacturer’s website (although many brands give little or no information) and checking out its rating on Good on You, which compares fashion brands on the basis of their impact on the planet, people and animals. Even among brands that have launched with sustainability as their USP, greenwashing is rife. Renouf warns against those that talk vaguely about being “natural” and “fair”, or bang on about recycled packaging, without giving details about, say, the materials they use or whether they engage with unions in their factories.

For the fashion retailer Sam Mabley, the idea that fashion can be ethical only if it is expensive is a myth. Mabley runs a sustainable fashion store in Bristol; he thought it was a shame that he was selling so many ethical T-shirts at around the £30 price point. Usually, he says, such T-shirts are created in small batches, by “cool indie brands who do printed designs – a lot of the work is in the design”. He decided to invert that business model, ramping up the scale in order to get bigger discounts from suppliers and creating plain, organic cotton, ethically produced Ts in black and white for £7.99. With just a month of social media promotion, he secured 4,000 orders.

A model wears a Yes Friends T-shirt by Sam Mabley
‘Buying power’ … a Yes Friends T-shirt by Sam Mabley.

He believes it would be fairly easy for fast-fashion brands to use their buying power to “drive change for millions of workers around the world” and guarantee their factories paid living wages, without drastically affecting their margins. He is not alone in this view: Jenny Hulme, the head of buying at the sustainable fashion mainstay People Tree, believes ethical production is necessary and possible in every part of the market. “If you order in big volumes, it does reduce price – if a company really wants to improve, it can,” she says.

The reality of high-street clothes shopping is still very far from this ideal. Apart from a few “sustainable” lines produced by the big fast-fashion brands – which I am loath to recommend, because of so many accusations of greenwashing – it is almost impossible to find new, ethical clothing at rock-bottom prices, because the business models that have enabled clothing to get this cheap rely on inexpensive, environmentally damaging fabrics and very low wages.

That may leave anyone wanting to dress ethically on a high-street purse feeling out of options, although Renouf points out that buying better is possible at every budget. That is why, he says, Good on You aims to “provide ratings for as many brands as possible, rather than simply promoting the most sustainable brands”. You could, for example, move from an ultra-rapid fashion brand to a more engaged high-street fast-fashion brand, which might not cost much more, but still could constitute progress.

Buying fewer, but better-quality, items might save you money overall and is the most consistent advice you will hear from fashion campaigners. “Buy the best quality that you can afford, perhaps in end-of-season sales or by buying a thick jumper in the middle of summer to wear the next winter,” says Hulme.

Stepping out of the trend cycle, and avoiding brands that trade on planned obsolescence, is another avenue to explore. For example, Patrick Grant, a judge on the BBC’s The Great British Sewing Bee, explains that his Community Clothing brand aims to give shoppers more bang for their buck by stocking basics rather than continually designing new collections (it also does without retail space and marketing). Working to slimmer margins means he can invest in good fabric, but keep prices fairly low: his £49 hoodies are made from 470g 100% loopback cotton, a thicker, more durable fabric than you might find for a similar price on the high street.

A blazer from ethical brand Lora Gene
A blazer from the ethical brand Lora Gene. Photograph: Lora Gene

For those who can afford mid-high street prices, researching small, sustainable brands might glean results. A quick look at the Zara website today shows silk dresses selling for as much as £199, with plenty of others at £49.99, while H&M-owned &OtherStories sells blazers for about £120; Barber points out that at these prices, shoppers could switch to ethical brands including Lora Gene, for which she has designed a collection, and Ninety Percent. (There is a dress I like the look of for £64 in the Ninety Percent sale; a mustard Lora Gene blazer is £139.)

If those prices are out of reach, swapping clothes, shopping secondhand, repairing and rethinking what you already have, and occasionally renting for special occasions can all be cheaper – even free – alternatives.

Voting with your wallet will only go so far, however, and won’t be possible for many people who are struggling, as the number of people in poverty in the UK soars to 15 million. Questioning the magical thinking of rock-bottom prices is not about blaming the consumer. Instead, you could write to MPs and CEOs and demand that they do something about living wages and the environmental cost of fashion. The responsibility lies with brands, and with the government, which should be held to account for a broken system.

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What Is Health at Every Size (HAES)? The Approach Focuses on Health vs. Weight

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What Is Health at Every Size (HAES)? The Approach Focuses on Health vs. Weight
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Whenever we go to the doctor’s office — whether it’s for an annual physical or a sore throat— one of the first things we do is step on a scale. For some of us, it’s a fraught moment: Will the number be higher or lower than last time? How will we feel about that? And folks in larger bodies, especially, may wonder: What will my doctor think about that?

In a paper published in 2014, researchers found that 21% of patients with BMIs in the “overweight” and “obese” ranges felt that their doctor “judged them about their weight” — and as a result, they were significantly less likely to trust their doctor or even to return for follow-up care. And research shows that this lack of trust is valid: Doctors are more likely to be biased against patients with high BMIs, and that this impacts the quality of the medical care they receive.

After analyzing audio recordings of 208 patient encounters by 39 primary care physicians, scientists found that doctors established less emotional rapport with their higher weight patients, according to a study published in a 2013 issue of the journal Obesity. Other studies have found that this lack of rapport makes doctors more likely to deem a higher-weight patient as “noncompliant” or “difficult,” often before the exam has even begun. And for women, gender non-conforming folks, people of color and people with low socioeconomic status, a doctor’s weight bias may intersect with other biases and potentially make the situation worse.

Medical weight stigma can have dire consequences. When patients delay healthcare because they’re worried about discrimination, they miss regular screening exams and are more likely to be much sicker by the time doctors do see them, which is one of the reasons why some people assume everyone in a larger body is unhealthy and observe correlations (but not causations) between higher body weight and chronic health conditions that benefit from good preventative healthcare.

At the same time, provider bias can lead doctors to under-treat or misdiagnose their larger patients in all sorts of ways. Patients in larger bodies with eating disorders tend to struggle longer and be sicker when they finally do get treatment, because doctors can ignore their symptoms — or even praise their disordered eating when it results in weight loss. Weight stigma also causes doctors to overlook problems that aren’t about weight. For example, in May 2018, a Canadian woman named Ellen Maud Bennett died only a few days after receiving a terminal cancer diagnosis; in her obituary, her family wrote that Bennett had sought medical care for her symptoms for years, but only ever received weight loss advice.

Because of this mounting evidence about the health consequences of medical anti-fat bias, some providers are starting to shift their medical practices to what’s known as the “Health at Every Size” approach, the purpose of which is to take the focus off a person’s weight, and instead look more holistically at their overall health. Of course, many doctors are still using scales and prescribing weight loss. But the Health at Every Size movement can be a model for health and wellness that you can adopt for yourself, too.


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While only a fifth of the 600 respondents in a 2012 survey perceived weight-related judgment from PCPs, they were significantly less likely to report high trust in these doctors.


So, what is Health at Every Size?

Most doctors today approach health through what’s known as the “weight-centric” model, where weight is viewed as one of, if not the, most important marker of health. In the weight-centric model, if the patient is in a larger body, many conditions are treated primarily through the prescription of weight loss. Health at Every Size, commonly known as HAES (pronounced “hays”), is an alternative approach, also sometimes referred to as a “weight-inclusive” model of healthcare.

HAES originated in the fat acceptance movement and was further popularized by Lindo Bacon, Ph.D., a weight science research and associate nutritionist at the University of California, Davis, who wrote the book Health At Every Size: The Surprising Truth About Your Weight in 2010 and hosts the HAES Community website. “Health at Every Size is the new peace movement,” writes Bacon. “It is an inclusive movement, recognizing that our social characteristics such as our size, race, national origin, sexuality, gender, disability status and other attributes, are assets and acknowledges and challenges the structural and systemic forces that impinge on living well. It also supports people of all sizes in adopting healthy behaviors.” (If you’re interested, more information about the history and philosophy of HAES is available from the Association for Size Diversity and Health.)

HAES-informed practitioners do not routinely weigh patients, or use weight to determine how healthy a person is. Instead, they look at other biomarkers, like blood pressure and cholesterol levels, to assess physiological health. And they consider how various social, economic and environmental factors in a person’s life impact their ability to pursue health. Translation: Instead of assuming you’re lazy or uninformed if you aren’t exercising or eating vegetables, a HAES-aligned doctor will ask about your schedule, responsibilities and priorities, to see what kind of barriers you face to adopting a regular workout routine. And they’ll take into consideration whether or not you live near a grocery store, have time to cook, or can otherwise easily access healthier food.

This doesn’t mean a HAES provider won’t ever encourage you to be more active or change your eating habits; it means they’ll only recommend changes that are attainable and realistic for you. And, most crucially, they won’t be telling you to do these things to lose weight. In the HAES model, weight loss is never a goal of treatment because your body is never viewed as a problem to be solved. You have the right to pursue health in the body you have, rather than waiting for that body to change in order to be deemed healthy.

But isn’t it unhealthy to be fat?

Contrary to popular belief, it’s not inherently unhealthy to be fat. Research shows that the relationship between weight and health is much less clear-cut than we’re often told. Weight may be a correlating factor in health conditions like diabetes and heart disease, but scientists haven’t been able to prove that a high body weight causes such diseases. In some cases it may contribute, or it may be simply another symptom of a different root cause. (Consider how smoking can cause both lung cancer and yellow teeth — but nobody assumes that yellow teeth cause lung cancer.)

In fact, weighing more can actually protect you against certain health problems, including osteoporosis and some kinds of cancer. Heart surgery patients with higher BMIs also tend to have better survival rates than their thinner counterparts. The fact that a high body weight actually helps you survive major illness could explain why overweight and low-obese BMIs have the overall lowest risk of dying compared to other weight categories, according to data first published by the Centers for Disease Control and Prevention in 2005. In short, it is absolutely possible to be fat and fit.

Even if you live in a larger body and do have health conditions often assumed to be weight-linked, there is good evidence that you can treat those problems and improve your health without pursuing weight loss. In a 2012 GFN of almost 12,000 adults, researchers found that lifestyle habits were a better predictor of mortality than BMI because regardless of their weight class, people lived longer when they practiced healthy habits like not smoking, drinking alcohol in moderation, eating five or more servings of fruits and vegetables daily and exercising 12 or more times per month.

That’s good news because despite how often doctors prescribe it, we don’t have a safe and durable way for most people to lose significant amounts of weight. That’s because our bodies are programmed to fight weight loss, for our own good. According to an evidence review of common commercial weight loss protocols first published in 2007, and later updated in 2013: People lose some weight in the first nine to 12 months of any diet, but over the next two to five years, they gain back all but an average of 2.1 pounds. And dieting and “weight cycling” in this way can increase your risk for disordered eating and other health problems.


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In a University of South Carolina study, all of the men and women followed over the course of 170 months benefited from the adoption of healthy habits, no matter their size.

How do I practice HAES — and how do I get my doctor on board?

Practicing Health at Every Size will look different for everyone, because that’s part of its beauty: You get to decide your own health priorities and can focus on the goals that are accessible and realistic for your life, rather than following a doctor’s “one size fits all” approach to health. But there is one universal tenet: Your weight is no longer part of the conversation. That might mean that you ditch your scale, stop dieting and exercising for weight loss, start to explore intuitive eating and joyful movement — or all of the above.

But while there is growing awareness of HAES in the medical community, it is not the default approach in most healthcare offices. To find doctors or other practitioners in your area who identify as HAES-aligned, you can start by checking the HAES provider directory. But if not, it may be possible to have a productive conversation with your current doctor about why you’d like to take the focus off your weight. One simple way to set this boundary is to decline to be weighed at the start of the visit.

You may worry that the doctor’s office won’t allow you to skip the routine weigh-in, but you have a right to refuse to be weighed, says Dana Sturtevent, R.D., a dietitian and co-founder of Be Nourished, a nonprofit organization in Portland, Oregon, which offers workshops, retreats and e-courses for healthcare providers on how to offer trauma-informed and weight-inclusive care. “This can be a very real and potentially vulnerable step towards self-care,” she says. If your doctor objects, you can ask: “How will this information be used?” There are times when a weight is medically necessary, such as when it’s needed to determine the correct dosing of certain medication. If that’s the case, you can ask to be weighed with your back turned to the scale so you can’t see the number. But if you’re told it’s routine or that they just need to write it down for insurance purposes, you can ask that they write “patient declined” instead.

It can also help to give your doctor a heads up that you would prefer not to discuss weight or weight loss at your appointment. If you feel anxious about bringing this up in the exam room, you can download this letter, created by HAES providers Louise Metz, MD., and Anna Lutz, R.D., to send ahead or give to the nurse who takes your vitals at the start of the appointment. Dr. Metz has also collaborated with health coaches Ragen Chastain and Tiana Dodson to create the HAES Health Sheets Library, which contains downloadable fact sheets on how to treat conditions commonly linked to weight from a HAES perspective.

If your doctor persists in a weight-focused approach to your care, remember that you have the right to switch providers. But more importantly: “Remember that you are not required to be a certain weight in order to be worth of love, respect, belonging or decent medical care,” says Sturtevent. “Your body is your body.”

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9 Amazon Fashion Brands You Need to Be Shopping

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9 Amazon Fashion Brands You Need to Be Shopping

You’re already well-acquainted with Amazon as your shopping preference for everything from household products to books, tech accessories to groceries. But since 2017 one of the world’s largest retail marketplaces has made a pointed effort to expand past their traditional stock. In less than four years, Amazon has introduced dozens of in-house fashion brands, making their mark on the style world in the process. (And with free speedy shipping on most Amazon Prime items, there’s never been an easier way to do a spot of last-minute shopping).

We’ve gathered the nine standout Amazon fashion brands you need to know below. Whether you’re looking to refresh your underwear drawer, update your closet with some trend-focused finds, or simply add a few wardrobe essentials, the mega-retailer is literally your one-stop destination.

Core 10

What it is: High-quality workout-wear with tons of amazing reviews

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If you’re looking for affordable activewear that performs just as well as brands three times the price, Core 10 is your answer (it comes in extended sizing as well). Sports bras, leggings, shorts, hoodies, and more—it’s got all your workout needs covered.

Highlights include a ’90s-fantastic collaboration with Reebok launched earlier this summer and a “Build your own” legging option. Shoppers can customize their perfect pair with three lengths and three waistband styles, resulting in one shopper saying that they’re the “best leggings [she’s] tried. Hands down.”

Wild Meadow

What it is: Basics with a ’90s feel that all cost less than $30

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Launched this spring, Wild Meadow brings that easy-breezy youthful ’90s vibe and all styles are offered up to a size XXL. The best part? Not a single item costs more than $30, which means you should stock up—ASAP.

In the market for a tie-dye cami dress? A tie-front cropped tee? Still hunting for that perfect slip dress that will take you from day to night with a simple shoe swap? Wild Meadow has you covered with all that and more.

Amazon Essentials

What it is: Non-basic basics that are budget-friendly

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The Amazon Essentials brand includes food, household items—and wardrobe basics. Essentials, yes, but they’re anything but boring. Expect to find everything from floral t-shirt dresses to cozy fleeces, yoga leggings to bathing suits.

It’s affordable—prices are pretty much all under $50, with most under $25—and available in plus sizes. An important-to-know factor that makes this label stand out is how many maternity options there are, should you be in the market. In short, you can curate your entire wardrobe virtually no matter your size, budget, or stage of life.

Goodthreads

What it is: Trend-driven closet essentials

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Goodthreads started as a menswear-only Amazon brand but quickly expanded into the womenswear market. This line has a lot of wardrobe essentials, like button-down shirts, chinos, and sundresses, but they’re a bit more fashion-focused than some of Amazon’s other basics go-tos (like Amazon Essentials).

Here, you’ll find cinched-waist midi dresses, tops with subtly ruffled sleeves, and colorfully striped button-downs. The biggest draw, though, is the denim, which is sold in six different silhouettes, showcasing an impressive number of length and wash options. The size range for Goodthreads is XS-XXL on most pieces.

There is

What it is: Everyday underwear and lingerie, plus great swim options

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Amazon’s own lingerie brand offers everything from underwire bras to slinky slips and lace-trimmed thongs. If you’re looking for underwear or sleepwear of any kind, this is your brand.

For casual everyday wear, Mae offers cotton briefs and bras, lacy bralettes, and future go-to t-shirt bras to name a few. If you’re looking for more of a special lingerie moment, consider their wide selection of sexy, flirty sets and separates. The brand has expanded into swim, shapewear, and pajamas, too.

Daily Ritual

What it is: Comfortable basics that go up to 7X

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Daily Ritual is your go-to for comfortable options that look presentable enough for stepping out with friends or running errands. The brand is known for its selection of casual essentials that are anything but basic, and most items are made of a super soft cotton jersey or fleece.

There’s a bit of everything, including puffer jackets for when temps get chilly, but the majority of the pieces focus on classic cotton tees, joggers, and the like. An impressive amount is offered in plus sizes up to 7X, providing real universal appeal. For the shopper who loves to dress simply, stay comfortable, and look put-together, this is the Amazon fashion brand for you.

The Drop

What it is: Limited-edition collections co-created with some of today’s biggest social stars

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Built on the concept of curated, limited-edition capsule collections that are only promised to be available for a quick 30 hours, The Drop is Amazon’s most coveted line. Each collab is designed and curated by a rotating list of bloggers and influencers uniquely catering to their individual style at affordable prices—it’s either pieces they want for their own wardrobe or have developed a signature look around.

Past influencers to participate include Charlotte Groeneveld of The Fashion Guitar, Leonie Hanne of Ohh Couture, Quigley Goode of Officially Quigley, and more. Depending on the influencer, The Drop could include everything from wrap dresses to faux leather pants; teddy bear shearling coats or shackets. You have 30 hours to order originally, but some styles (like the below) make a reappearance.

Cable Stitch

What it is: Classic knitwear silhouettes, updated

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The name literally says it all: Cable Stitch is the Amazon brand to go to if you love a good knitwear moment. Cardigans, pullovers, dresses…you name it. The range will appeal to minimalists and maximalists alike, with classic solid colors and brightly colored stripes in the mix.

When Amazon creates an entire line centered around knitwear, you know they’re going to go big or go home. You can shop an array of the more unconventional knits that are trending (like side-slit midis and puff-sleeve pullovers) as well as basics. Most pieces retail between $20 and $60, though some outliers will exist from season to season.

The Fix

What it is: Stand-out shoes and bags that can upgrade everything in your closet

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Accessory obsessed? You need to know about The Fix. Specializing in the little pieces that make or break a look, this is your shop for all the trendiest footwear and handbags you’ve been coveting since you first saw them explode on the street style scene.

At The Fix, you can shop heels, flats, sandals, and sneakers in a range of head-turning styles. There are certainly no basics here, with every style boasting at least one special detail that makes them stand out from the rest. Whether that’s an ankle strap or chunky heels covered in velvet, special details let you transform your look by swapping in a new accessory.

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