Enzymes: A New Frontier in Health Supplements

Jan 12, 2023 | Medical Nutrition & Consumer Health

Enzymes: A New Frontier in Health Supplements

Within the rapidly evolving market of health supplements, enzymes have emerged as a powerful way for brands to distinguish themselves from competition. This type of innovation is crucial since consumers are increasingly discerning about ingredients and health impacts. This opportunity continues to grow rapidly – the dietary supplements market alone is projected to reach $340 billion by 2030¹. Incorporating enzymes can be a challenge, however, since their benefits are not always intuitive to consumers.

Enzyme supplements have a wide range of health benefits including alleviating digestive issues and boosting immunity. For example, consumers who can’t metabolise lactose in dairy, can take lactase supplements to avoid bloating and diarrhoea. Alternatively, they can help elderly consumers to increase their absorption of key nutrients from foods to prevent malnutrition (or sarcopenia). Malnutrition creates opportunities for infections and diseases, therefore enzymes can be critical for developing robust immunity. This can also apply to consumers keen on wellbeing and fitness since enzymes can increase nutrient absorption from meals and help them to achieve their goals. In short, enzyme supplements come with the promise of significant impacts on consumers, but their value proposition and the correct mode of use needs to be expressed clearly and convincingly.

Without clear communication, consumers can get confused or even get dissuaded from using enzyme supplements. Our research shows that when it comes to enzymes, most consumers are struggling to fully understand their benefits, their mechanism of action, and even how to consume them. This confusion can directly affect consumer perception of whether they are receiving the desired results from these products. We identified three common complexities faced by consumers and also draw inspiration from marketing strategies of successful businesses leveraging the science of enzymes in an increasingly crowded supplements market.

Taking the Pulse of the Consumer Experience around Enzymes

Figure 1: Instagram – “You don’t need digestive enzymes. You are just wasting your money on false claims”

A thorough understanding of the unmet needs and challenges faced by consumers is critical for marketing and business development teams. We monitored and analysed the opinions of consumers that use enzyme supplements across digital social platforms to identify how the enzyme supplements are received by consumers. Our research shows that many consumers in this space are primarily driven to test enzymes out of some digestive discomfort they experience. And among these consumers we were able to identify their key concerns around efficacy, directions of use, and perceived potential risks.

A common hesitation of consumers around using enzyme supplements stems from a general concern about their efficacy. There are two parts to this problem: Firstly, there is limited awareness on how the enzymes work, and secondly there is limited scientific evidence showing health benefits. Consumers struggle to fully understand the benefits of enzymes. While the “good bacteria for gut microbiome” tagline helps put benefits of probiotics in layman’s terms, our research found that the consumer experience is not the same for enzymes. The issue is further complicated when Healthcare Professionals chime in on social media to highlight that there is limited clinical evidence on the effectiveness of enzyme supplements.

Figure 2: Twitter – “I do take lactase enzyme pills, but they don’t work very well. I usually just try to eat cheese in moderation”

Owing primarily to a poor understanding of how enzymes work, consumers struggle to interpret labels on enzyme supplements. Since there are no regulated “daily values” (DV) assigned for enzymes, consumers can make assumptions about the optimal amount and use frequency for enzyme supplements. While some consumers express that they take their enzymes before/after an occasional risky meal, others state that they take them on a daily basis to boost their immunity or to build tolerance. Information such as the source of enzymes and “fillers” used to stabilise capsules are among the key information on the labels confounding consumers. And while some of this information can be found in technical details on the labels, consumers end up lost in the jargon.

Figure 3: Reddit – “Thank you everyone for your input!!!! I have a better overall opinion now due to everyone’s thoughts. I will still use enzymes because they do help me on a daily basis, but they aren’t an excuse to have whatever I want whenever I want. I will try fodzyme perhaps but I know that I cannot lean on that.”

Figure 4: Reddit – “My understanding is that the enzymes, including fodzyme, beano, lactaid, are meant to be used only on the occasional meal.”

Figure 5: Twitter – “I wish it said the individual doses of the ingredients. If it has a huge dose of serrapeptase I know some people have bad reactions to that. It’s up to you. The individual ingredients look good and I like the enteric coating.”

Consumers are also often hesitant to take enzyme supplements because they believe there is a risk of negative side effects, or a worsening of their condition. For example, although enzymes can be useful in treating bloating or irritable bowel syndrome (IBS) symptoms, some consumers worry that enzymes only offer a temporary relief or that they could worsen present symptoms with additional pain and cramping. In extreme cases, consumers fear that the enzyme supplements could induce acid reflux or even severe pain as a side-effect.

Enzyme supplements are primarily seen as digestive aids by consumers, and this perspective has constrained the expansion of these products to mass clientele. The prospect of expanding the consumer base beyond this segment is further hindered by the technical complexities explained above. Ignoring these concerns can foster uncertainty and consumer distrust.

How Can the Businesses Build Winning Propositions?

Neglecting or miscommunicating the health benefits of enzymes could mean failing to capture otherwise interested consumers. Effective consumer communication is dependent on good consumer research and a clearly defined and scalable consumer segmentation. As part of our research, we identified some ideas and best-practices from firms leveraging the science of enzymes:

Figure 6: Facebook – “It’s Official!”

When it comes to enzyme supplements, efficacy or correct use concerns can be addressed by building consumer trust with scientific evidence. One strategy for achieving both of these can be partnering with universities. For example, Fodzymes received “Monash University Low FODMAP Certification,” which adds credibility to their health benefit claims. The company (Kiwi Biotech) also announced that it has plans to conduct more peer-reviewed clinical studies with universities. Not only do these studies and certifications help with gaining consumer approval, but they can also offer persuasive evidence for Health Care Professionals. Since the FDA does not regulate the dietary supplements, organisations such as United States Pharmacopeia (USP) can provide a verification mark to confirm the claims on the labels of supplements which can help build consumer trust. Naturemade CoEnzymes is among enzyme supplements that have received this verification.

Figure 7: Wheat Rescue

Another way to demonstrate efficacy and build consumer trust can be by offering “mixed supplements” that include enzymes complementing probiotics or vitamins. This approach offers something patients can recognize while they are gradually acquainted with enzymes. This can be particularly attractive for businesses that already offer a spectrum of vitamin products. Since enzymes can increase the absorption and digestion of the complementing nutrients, these “mixed” supplements would also allow consumers to maximize the health benefits from the product. Some businesses are already taking this approach to target consumers that are interested in improving their “gut health.”

Figure 08: Facebook – Fodzyme AMA

To address any perceived risks, businesses should be ready to address these concerns directly with their customers. Successful businesses understand that being attuned to unaddressed consumer needs is critical for research and innovation. By holding “Ask Me Anything” (AMA) sessions, or offering short explanatory videos, businesses can educate their customers about the health benefits of their products. Listening on the online conversations on platforms such as the Reddit, can help businesses determine a coordinated communication approach that can effectively engage target customers in a dialogue. This would provide a real-time opportunity for businesses to hear and engage with the “voice of the customer.”

Figure 9: Reddit – Fodzyme AMA

When consumers find labels confusing to follow, they can miss out on the intended benefits. In absence of scientific evidence and standardised labelling requirements, businesses can evaluate the existing labels to alleviate the confusion over the amount and frequency of use. Addressing this challenge can also mean an opportunity for product development and allow a newcomer to innovate their way into the supplements market. For example, rather than relying on capsules that can be used before or after meals, FODZYMES comes in powder form sachets which is sprinkled over food and consumed with meals.

Reaching New Customer Segments

Businesses have an opportunity to capture additional consumers through clear and direct communication. Each consumer challenge can hold opportunities to win market share from competitors and also to grow the market size by shaping consumer habits. Furthermore, it creates opportunities for product development in ways that address consumer concerns.

Sector & Segment partners with businesses to better understand the challenges and opportunities presented by consumers globally, and build go-to-market strategies accordingly. Our research experience is tailored to capturing the needs to consumers and patients in both consumer health and healthcare spaces, including:

Segmenting and sizing their consumers by need
Conducting competitive research to understand best-in-class practices, and
Delivering primary research with consumers, key decision-makers and healthcare professionals to develop informed marketing strategies.

Marie-Élisabeth Maigre

PRNewswire

Embracing the Complexity of the Gut Health Market

Oct 21, 2022 | Medical Nutrition & Consumer Health, Pharma & Biopharma

Embracing the Complexity of the Gut Health Market

Executive Summary

The market for digestive health products has grown to ~$44Bn, driven largely by increased evidence and awareness surrounding the microbiome and probiotics. That said, a healthy digestive system requires more than just a healthy microbiome, and a multitude of other factors outside of the microbiome can influence digestive health. Increased consumer demand for holistic health products means consumer needs also extend beyond the microbiome. Probiotics are therefore in competition with a vast array of other products. The result is a fragmented market with a large number of companies marketing various solutions all claiming to aid gut health.

In such a fragmented market, companies can employ various different strategies to differentiate. These include 1) creating combination products of multiple in-demand ingredients 2) marketing superior quality and evidence, particularly towards healthcare professionals. Creating a successful differentiation strategy will require more in-depth customer research and segmentation than traditional approaches.

What is gut health? Beyond the microbiome

Gut health, or digestive health, is a hot topic right now. A 2022 survey by the IFIC (International Food Information Council) of the American population found that one in four Americans considered gut health to be the most important aspect of their overall health¹. Commercially, a report by Grand View Research valued the global digestive health market at USD 44.4 billion in 2022 and predicted it to grow at a CAGR of 8.2% until 2030². Academically, a search for the term “gut health” on google scholar now produces over 70,000 results.

This begs the question, what is gut health? Despite increased interest, there exists no consensus definition, commercial or academic³. In popular discourse, the term is often considered synonymous with maintaining healthy and stable levels of gut bacteria, collectively known as your microbiome.

To nurture one’s microbiome, it is recommended to consume products containing “biotics”, either in the form of supplements or functional foods. Traditionally, these recommendations were limited to probiotics and prebiotics, but recent advancements in microbiome research have led to increased buzz around post-, para-, and synbiotics (a full explanation of these terms can be found below)*. There exists a growing body of evidence that consuming biotics is linked with a large range of GI health benefits⁴.

But the microbiome is only one piece of the puzzle. Although there is a large amount of evidence showcasing the role of the microbiome in gastrointestinal health⁵, it is not the only factor which determines whether an individual will experience gastrointestinal (GI) issues. For example, many autoimmune disorders can impact GI wellbeing independent of their effects on the microbiome⁶. An individual may also be genetically predisposed to be at a higher risk for GI diseases⁷ and symptoms, all without displaying any evidence of having a disrupted microbiome. Conversely, another individual may have an imbalance in their microbiome for years without displaying any symptoms. A comprehensive definition of gut health must therefore extend beyond having a stable microbiome.

Figure 1: displays a suggested mapping of four major categories with which we can think about gut health, whilst also acknowledging the interconnected nature of these categories.

The complex competitive landscape of all things gut-related

Consumer needs also extend beyond the microbiome. The shift towards a more holistic approach to health means that many consumers see gut health products as a means with which to achieve general health and well-being. The same IFIC survey found that, of the consumers who claimed to use biotics, only 51% cited “supporting their microbiome” as a reason for consumption*. Other reasons cited varied, but can broadly be classified into:

Promoting general wellness and health – namely through the absence and prevention of (GI) illness
Aiding digestion & reducing (GI) symptoms
Strengthening and supporting the immune system

*It is also likely that the 51% who claimed to use biotics for their microbiome do so in the hope of seeing tangible health benefits, such as preventing GI symptoms or illnesses in the future.

These are many of the same reasons consumers cite for the consumption of products more directly associated with gut health, such as digestive enzymes and fibre supplements, but also for products such as whole grains, fruits and vegetables, fermented foods, multivitamins, and other herbal supplements.

Recent research has also showcased the positive GI effects of a multitude of other ingredients. Notable examples include supplementing Vitamins D and B1 when managing inflammatory bowel disease⁸, the effects of supplementing both digestive enzymes and various herbal supplements (such as ginger) in treating a multitude of gastrointestinal symptoms^9,10,11, and the role of minerals such as zinc in improving immune function¹².

The result is a market containing a vast array of products, all with some degree of substitutability:

Figure 2: a non-exhaustive mapping of products competing in the gut health market by health claim, product category, and ingredients

Manufacturers looking to capture some of this rapidly growing market are competing along various lines including the health claim of their products, the ingredients, the product category (foods, functional foods, dietary supplements), and the distribution channel (supermarket, pharmacy, online). Despite some increased concentration in the supplement category due to high M&A activity, the market remains highly fragmented (notable transactions included Nestle’s acquisition of various Bountiful Company brands such as Puritan’s Pride and Nature’s Bounty, and Gryphon Investor’s acquisition of Metagenics). A large number of both regional and international manufacturers, many with an extensive portfolio of different solutions, are vying for market share.

This degree of fragmentation is what makes the market ripe with opportunity. With such a wide range of consumer needs, and a diverse set of products which are able to satisfy those needs, ample opportunities exist for manufacturers to differentiate themselves through their marketing, products, and channels. To do so requires a comprehensive understanding of the competition, the commercial landscape, and the profiles of their core customers.

To combine or not?

One attractive way for manufacturers to differentiate their products from the competition is through combining different in-demand ingredients into a single product. A notable example is the recent buzz surrounding synbiotic products, a combination of pre- and probiotics. Synbiotics are now projected to grow at a higher CAGR than the probiotics market^13,14. Seed Health, a synbiotic start-up known for being endorsed by Gwyneth Paltrow’s brand ‘goop’, recently received $40m in series A funding with which they aim to go beyond the gut.

Many of the largest supplement manufacturers have also started to combine their biotic products with other ingredients including vitamins, minerals, and digestive enzymes. The packaging on these products often mentions other facets of gut health, such as relief of specific symptoms. Concerning functional foods, Activia recently launched their Activia plus range, which added Vitamins C, D, and Zinc to their probiotic yogurt drinks. The marketing materials focus heavily on the interconnectedness between gut health and the immune system.

Figure 3: various large manufacturers have chosen to combine multiple ingredients

Combining ingredients has a lot of distinct advantages beyond being able to make multiple health claims. It can help combat the choice overload consumers face when presented with so many options for their gut health, as well as help remove doubts as to whether they have chosen the correct solution. It can also help combat “pill burden” – the efforts associated with taking numerous pills on a daily basis – including storage, organisation, understanding what each pill does, and keeping track of potentially unwanted interactions. Finally, such a product might be able to command a premium price, whilst still being more cost efficient for consumers.

Nevertheless, combining ingredients comes with its own set of challenges and risks. There is a limit to the quantities of ingredients one can combine into a singular product without impacting the pleasant taste of a yogurt or keeping a pill at a swallowable size. The more ingredients one combines, the lower the dosage of each ingredient and the lower the potential efficacy of the product. Moreover, too many ingredients can also deter consumers; a long ingredient list can make a product seem less natural and therefore less appealing.

Manufacturers therefore need to be very selective in which ingredients they combine. It is crucial to choose these ingredients in a way that aligns with the wants and needs of their consumers. This in turn requires manufacturers to acquire an in-depth understanding of their customer base. To ensure a successful launch of a new combination product, it is essential to conduct scenario analysis grounded in extensive consumer research.

The role of the healthcare professional

Another angle along which manufacturers can differentiate is by targeting healthcare professionals (HCPs). Although HCPs are unlikely to prescribe gut health products outside of certain medicines to treat GI symptoms, they can be a key influence in driving patients to purchase out of pocket. The IFIC survey found that 43% of consumers would first turn to their healthcare professional to learn more about biotics. Targeting HCPs may allow manufacturers to justify a higher price point if consumers are willing to spend more for a product endorsed by their HCP.

Pure Encapsulations, a vitamin and mineral supplement manufacturer recently acquired by Nestle Health Science, are a tangible example of a company successfully employing this strategy. A 2017 study by the Institute of Functional Medicine found them to be “the most dispensed premium supplement brand by healthcare professionals.” To achieve this, their business strategy has focused on the importance of scientific evidence to build authority and gain the trust of HCPs . The company’s marketing and communications strongly emphasizes the fact that Pure has published over 50 articles in scientific journals. The company also offers both live and on-demand courses and webinars, aimed at HCPs wanting to learn more. For pharmacists interested in stocking Pure products, they promise double the margins of the average supplement.

But convincing HCPs is no easy task. Although four out of five HCPs do prescribe supplements to their patients¹⁵, creating brand loyalty requires a manufacturer to demonstrate both quality and efficacy.

HCPs are aware of the less-stringent regulations placed on supplements compared to medicines, resulting in supplements often containing less active ingredient than advertised, or not containing any of the ingredient at all. To assure quality, manufacturers need to make sure they adhere, and ideally exceed, the manufacturing standards set by regulating bodies in each of the countries they operate. Being transparent about their production process also helps to instil faith.

RCTs demonstrating clinical benefits, such as a reduction in GI symptoms, are considered the gold standard amongst HCPs to demonstrate efficacy. These can be very costly to conduct, as well as take a long time to complete. Alongside manufacturers conducting their own research, they should also make HCPs aware of all the existing evidence available on the relevant ingredient(s), so as to let them make an informed decision.

Due to the relative difficulty of targeting HCPs, a well-defined sales strategy is paramount. HCP attitudes and needs in relation to a product are likely to vary both within and between healthcare specialties. The first step in defining a sales strategy should therefore be to segment these HCPs, so as to then identify, quantify, and rank their needs.

We have a gut feeling we can help

Finding the right points of differentiation to compete in a fragmented market can be extremely challenging, but Sector & Segment can help uncover those features which resonate most with consumers and HCPs. The team at Sector & Segment have extensive experience in researching and quantifying the needs, attitudes, and preferences of both consumers and healthcare professionals.

We can leverage this experience to help you:

Identify, segment, and quantity your customer base
Translate customer insights into improving your product offering, pipeline, and positioning
Define, refine, and stress test your marketing and go-to-market strategies
Conduct competitive analysis to identify competitor value propositions and market gaps

Don’t hesitate to contact us at

Christopher James Dewilde

*Biotics Explained

The term “biotics” is used to refer to any of the following:

Prebiotics – Molecules which selectively stimulate the growth or activity of microbes which are beneficial to health. The “food” for your gut bacteria.
Probiotics – Live microorganisms that, when administered in adequate amounts, confer a health benefit to the host. The gut bacteria themselves.
Postbiotics – Metabolites produced by the microbiome, which confer a health benefit to the host. What your gut bacteria produces.
Synbiotics – A combination of pre-, pro-, or postbiotics.

Sources:

International Food Information Council, 2022 Food and Health Survey, May 2022
GVR: Probiotics Market Size, Share & Trends Analysis Report (2021 – 2030)
Staudacher & Loughman (2021)
Pandey et. al (2015)
Durack & Lynch (2019)
Cojocaru et. al (2011)
Engstrand & Graham (2020)
Masri et. al (2015)
Ianiro et. al (2016)
Giacosa et. al (2015)
Lazzini et. al (2016)
A. Prasad (2008)
Mordor Intelligence: Synbiotics Market – Growth, Trends, COVID-19 Impact, and Forecasts (2022 – 2027)
Mordor Intelligence: Probiotics Market – Growth, Trends, COVID-19 Impact, and Forecasts (2022 – 2027)
Dickinson et. al (2009)

The Value of Segmentation in Healthcare

Aug 30, 2022 | Medical Devices, Medical Nutrition & Consumer Health, Pharma & Biopharma

The Value of Segmentation in Healthcare

A trend towards the personalisation of medical care

Over the past decades, healthcare systems have been progressively shifting towards a more integrated and patient-centric approach to care. One form of this shift is tailoring treatments to the specific characteristics of the patient (e.g., phenotypes & genotypes), as evidenced by the framework created under the International Consortium for Personalized Medicine (ICPerMed). Another form, however, and the focus of this article, is the development of care-plans, products, and services that meet patients’ lifestyle needs and personal preferences in addition to clinical needs.

“…the importance of ‘what matters to someone’ is not just ‘what’s the matter with someone’. Since individuals’ values and preferences differ, ensuring choice and sharing control can meaningfully improve care outcomes.”

This second type of personalisation is increasingly being recognized by healthcare services. “Personalised care” is one of the five major practical objectives laid out by NHS England in their 2019 long-term plan, recognising that “…the importance of ‘what matters to someone’ is not just ‘what’s the matter with someone’. Since individuals’ values and preferences differ, ensuring choice and sharing control can meaningfully improve care outcomes.” In short, healthcare services seek to improve patient outcomes by both being more responsive to patient needs and providing patients with more agency.

This new mindset adds complexity to patient care and delivery of solutions: more stakeholders (patients and their caregivers) are now involved in care decision-making and non-clinical factors must be considered across hospital and community settings. These non-clinical factors, such as patient lifestyles and preferences, are much harder to measure for medical professionals, especially given the budget and staffing shortages faced in many healthcare systems. On the other hand, these challenges represent an opportunity for healthcare companies to enhance their own offerings.

Manufacturers also have an opportunity to play a role in creating long-term value for patients through personalization of care. Thanks to developments in telehealth services, app and web-based patient programmes and the integration of smart technology in wearable medical devices, companies can reach patients across a variety of channels and extend their services and product offerings more efficiently. This presents an opportunity to become the “partner of choice” with patients and caregivers along their journey.

Patient segmentation is now more important than ever

To take advantage of this opportunity, medical players are increasingly moving from a product to a patient-centric mindset. This requires developing a deeper understanding of psychological and behavioural facets of patients, and using that understanding to tailor services, communication materials, and products to wider patient needs.

Building this understanding is especially important in the case of body-modifying surgeries or wearable medical devices that can have long term repercussions on a patient’s self-image, confidence, and social life. It is common for patients to experience stigmas associated with living with an insulin pump for diabetic patients, with aids following hearing loss, or with an ostomy bag following a bladder or bowel resection. Needless to say, these patients have a complex set of personal, medical, and practical needs that require HCPs to engage on a deeper level and on topics that go beyond the learnings of a traditional curriculum or patient-approach.

Going down the Direct-To-Consumer communication (DTC) route may not be a suitable option for all Medical Supply or MedTech companies. For example, some companies have made a deliberate strategic choice to focus all their go-to-market efforts on Healthcare Professionals (HCPs) and payers in order to establish strong medical credibility and/or differentiate from Over-the-Counter (OTC) players. In other cases, local regulations may be restrictive and not allow for much direct communication to patients.

Yet, even in these varied cases and circumstances, building a deeper understanding of patients still represents an opportunity to develop tailored tools and services to support the work of HCPs and drive prescriptions and/or recommendations to their patients. In the UK, the NHS notes that “creating genuine partnerships requires professionals to work differently, as well as a systematic approach to engaging patients in decisions about their health and wellbeing”. To this end, HCPs have become more open to ad-hoc training and support tools to facilitate “the conversations which help patients make the decisions that are right for them”.

What we have learnt from recent segmentation work in medical devices

Sector & Segment recently conducted a large multi-country patient segmentation for one of our clients working in the field of medical devices with the goal of supplementing previous segmentation research on HCPs.

While interviewing HCPs, we learned that while clinical needs were assessed on a patient-by-patient basis, many HCPs divided their patients in terms of 1. broad age groups (18-30, 30-60 and over 60 years old) to assess lifestyle-related needs and 2. underlying medical conditions (chronic, acute, and emergency patients) to assess needs related to the level of psychological support required. This in turn would be used to determine how they would approach patients in terms of time and attention paid to address patients’ personal needs. For example, we found that HCPs spent more time with younger patients and were more likely to provide them with support on selecting a product that fit their daily life or with information on wider topics. By contrast, HCPs spent less time with “older” patients and prioritized meeting medical and practical needs, often overlooking the rest.

What we learnt working with patients, however, is that grouping them using broad segmentation criteria throws only a partial light on the challenges that they face, their needs, and the type of support that they seek along their journey.

1. Patient preferences and behaviours are complex, and age is not the sole factor when seeking to explain or predict them

While it is true that there are patient needs associated with age, like planning for a family or building a career, as well as practical challenges such as reduced dexterity and autonomy, those needs are not the sole determinant of patient behaviour. In our study, patients willing to engage with others about their condition and be proactive in researching information and products were equally present across all age groups. This revelation disproved our initial hypothesis that more mature patients were more likely to follow their HCPs recommendations rather than playing an active role in the decision making relating to their care. In fact, when looking at the distribution of behaviours and needs by age, the 60–75-year-old bracket had a similar distribution as other “younger” groups.

2. Needs and behaviours resulting from an underlying condition are not “set in stone” but can evolve over the course of the journey

A patient’s underlying condition plays a key role not only in determining their medical needs but also in shaping their emotional journey. Depending on their condition, patients may take a different approach preparing for and accepting the same surgical procedure. For example, if we consider the same surgical procedure conducted on three different types of patients: one with a chronic illness, one with cancer, and one involved in an accident, we will see different initial attitudes and behaviours.

For the chronic patient, the surgery may be a step in a long treatment after enduring years of pain, and they may be more mentally prepared for this event
For the cancer patient, this surgery could be just the beginning of their battle with cancer and represent uncertainty about the ultimate outcome
For a patient who underwent the same surgery as a result of an accident or trauma their initial reaction is likely to be shock due to the unexpected outcome

These differences in reactions, attitudes, and behaviours, however, are likely to change as the patient progresses through their journey. What we found, for example, is that trauma and oncology patients developed a more positive attitude towards the same procedure by the end of the second year, while chronic patients who were initially more positive in relative terms, took much longer to come to terms with their new life and required more constant support. This evolution in needs indicates the importance of breaking down the patient journey into phases and approaching each phase as an individual journey. Ultimately, this allows for a mapping of how needs and behaviours evolve over time and an opportunity to target patients with greater precision.

3. Furthermore, when patients present multiple comorbidities, behaviours/preferences associated with each condition may overlap or differ

A patient’s behaviours may not even be consistent when it comes to their approach to comorbidities. Our research has found that when patients have multiple comorbidities, they would often take on different behaviours and attitudes depending on the condition they are focused on, as well as prioritise one condition over another. This is commonly seen in chronic patients who often have several conditions or co-morbidities. For example, a diabetes patient may also have hypertension or cardiac disease, or a head & neck cancer patient may also have dysphagia. We have observed that patients with hypertension and diabetes are likely to prioritise hypertension because this represents the more serious condition which can lead to a heart attack, while diabetes has a slower progression and therefore a slower impact. In this case, a patient can be “proactive” towards their hypertension (engaging with HCPs, conducting their own research, connecting with other patients), while at the same time being “passive” towards their diabetes (not following the prescribed diet, not monitoring their glucose levels as closely, missing appointments). This further demonstrated the relevance of specific segmentations, since patients’ behaviours, attitudes and needs shift considerably between conditions and areas of care.

How not to lose a patient in 1 year

It probably doesn’t come as a surprise that over half of the patients in our research sample were dissatisfied with the level of information and support received from their HCP. They frequently found the support they received to be too generic or not relevant to their practical and emotional needs in that moment. Furthermore, they often did not follow their HCP product recommendation, switching to other manufacturers within one year from point of discharge.

From a manufacturer’s point of view, understanding who these patients are, why they stayed or why they switched and how they made this decision, can be paramount in setting out a sales and marketing strategy and developing detailed action plans.

Having well defined and quantifiable patient segments based on needs, channel of information and source of influence, as well as attitude and behaviours can help answer questions like:

What patient-segments should we prioritise?
What channels should we use to reach these patients more effectively and efficiently?
Do we already have products in the market to support these patients’ needs? How should we position our portfolio against patients’ needs? Should we prioritise some innovations over others? Do we need to rationalise our portfolio?
How can we offer more value to patients?

How we can help

Our experts can support your growth strategy by identifying and quantifying your customer segments, guiding your team to set priorities, develop tools and position your service and product offering for long-term success.

Contact Marie-Elisabeth Maigre (Consulting Director) at and Giada Garofalo (Director of Research) at to learn more.

Giada Garofalo

How India’s intense competition in the powdered health-food drink space will ultimately help Indian kids get better nutrients

Oct 31, 2018 | Medical Nutrition & Consumer Health

How India’s intense competition in the powdered health-food drink space will ultimately help Indian kids get better nutrients

Two important acquisitions in the Food & Beverage space are impending in India: H. J. Heinz’s Complan and GSK’s Horlicks and Boost brands¹. These 3 brands are believed to represent almost two-thirds of the Indian children’s Health-Food Drink (HFD) market that is estimated to be worth between US $ 860 million² and over $1 billion (70 billion Indian rupees)³ in annual sales. As a result, strong contenders are currently bidding to acquire these brands: global consumer-goods giants Unilever, Nestle and Coca-Cola for Horlicks and Boost, and Zydus Cadila Group (a leading Indian pharmaceutical company) for Complan.

The current position of the brands for sale is being shaped by mixed factors. On the positive side, Horlicks and Complan are market leaders with a lot of heritage in a strong category. But, on the negative side, they are quickly losing market share to a variety of contenders – both international premium and local affordable players.

Stuck in the middle, these heritage brands are being squeezed; keeping pace without carefully revisiting ingredients, tastes and pricing could be a challenge. Buyer beware.

Horlicks, Boost and Complan: Historic Leaders of the HFD space

The market of HFDs in India emerged in the 1950s with the introduction of Horlicks, a malt-based nutritious drink. Horlicks quickly grew in popularity, especially in South and East India where availability of milk was scarce³.

Other brands including Boost (also owned by GSK) and Bournvita (currently owned by Mondelez) followed. As the market matured, brand-extensions were launched including “Junior Horlicks”, a junior range targeting 2 to 6-year-olds, which was launched in 1995.

Capitalising on their uptake among Indian families, these brands worked hard to achieve a broader and broader distribution in the general trade (small store format), even in rural areas. This put them at the centre of health nutrition for children after breastfeeding and weaning.

The past 15-20 years were particularly prosperous for these powder-based malted HFDs. They saw a steep boost in sales driven by the emergence of an Indian middle class and their desire maximize the physical and intellectual development of their children. These parents regard nutritional supplementation as an important way to help their toddlers, pre-schoolers and grade-schoolers to reach their full potential – a belief positively reinforced by frequent marketing and advertising campaigns targeting these families, especially on TV.

But this context also accelerated the uptake of other types of child-nutrition solutions. Boosted by the growth of the modern trade (larger store format) and e-commerce, new competition was able to gain visibility and reputation among parents. The household names Horlicks, Boost and Complan are now being challenged by a variety of other national and international brands that take advantage of limitations among those household brands, such as high sugar content or limited amounts of growth-related nutrients in their formulation.

Challenger # 1: HFDs with better nutrients (e.g. Nutricia’s Protinex)

As a consumer segment, educated middle-class Indian parents are concerned with the amounts of what they consider unhealthy or desirable nutrients and are particularly keen on scrutinizing food labels.

International companies have seen this as an opportunity to launch new HFDs with additional nutrients or the same nutrients as traditional HFDs but in higher quantity. For example, Danone Nutricia’s Protinex was launched to fill a gap in HFDs with high protein content. Its “tasty chocolate” formula contains 8g of protein per serving vs. 3.9g for Junior Horlicks Stage 1 and 5.9g for Complan Jar Royale Chocolate. Furthermore, it also beats competitors on the concentration per serving of most other vitamins and minerals in the formula – making it a “no brainer” for label-reading parents able to pay a premium for a product with better nutrients (as Protinex costs almost twice as much per serving as Junior Horlicks).

Challenger # 2: Paediatric Nutrition (E.g. Abbott’s Pediasure)

In 2000, Abbott launched Pediasure, specially formulated for children aged 1 to 10 years old and conceived of as a full meal replacement for picky eaters. Together with Ensure (targeting adults but also frequently taken by children), Pediasure is estimated to have a 10% market share of the HFD market; and both brands continue to grow quickly².

This success is attributed to Abbott’s commercial strategy which capitalises on the critical role played by paediatricians in recommending nutrition formulas to parents. In order to boost recommendations, Abbot’s representatives visit these healthcare professionals (HCPs) and educate them about the important role of complete nutrition in a child’s brain and physical development. In parallel, the advent of a large educated middle-class of parents also resulted in a more hands-on approach to children’s health monitoring with regular routine visits to HCPs. And the fact that they could afford these premium products ultimately created a snowball effect for Pediasure and Ensure.

Abbott also promotes its products directly to consumers (D2C) and are widely available in mass distribution channels. This “double-hat” approach, both medical and D2C, is not specific to India but has been the trademark of Abbott Nutrition for market entry around the world: first Abbott Nutrition targets HCPs to drive recommendation of their brands, then after 5-10 years, when their medical reputation has been established, they introduce D2C communication and aim for mainstream distribution to encourage broader product adoption. As in many Asian markets, this approach is paying off in India.

Challenger # 3: Growing-up Milks (e.g. Mead Johnson’s Enfamil)

Parents’ concern with the ingredient content of nutritional option has paved the way for the growth of adjacent nutritional categories, particularly growing-up milks.

A large reason why malt-based HFDs had been so successful in India was the fact that milk was not easily available and, when it was, its quality was poor. In contrast, malt-based HFDs were both accessible and able to mask an unpleasant milk taste³.

These historic success factors, however, are losing their relevance. A variety of infant milk formulas are now accessible, and most of them have “follow-up” toddler versions. Mead Johnson’s Enfamil Stage 3 is a particularly strong player in the space and has adopted a message around physical and brain development, competing head to head with traditional malted HFDs who leverage similar marketing lines.

Growing-up milks are sold at a premium price point; for example, Enfamil Stage 3 is four times more expensive than Junior Horlicks on a one serving basis. However, urban middle-class parents are willing to pay that higher price to provide what they perceive as better-quality nutrition, in line with the child-feeding practices of North American and European countries.

Challenger # 4: Local affordable HFDs (e.g. Patanjali’s Powervita)

The 3 types of contenders that we have laid out all have in common that they are led by premium brands owned by international companies (Abbott, Danone Nutricia and Mead Johnson). But leading HFDs’ competition also comes from the opposite side of the spectrum where local, affordable brands cater to rural families and urban working classes with low incomes. For example, Patanjali’s Powervita has a similar packaging look to Horlicks and Bournvita but is cheaper – ₹ 7.8 per serving (based on Amazon India prices) vs. ₹ 15.1 for Horlicks Junior and ₹ 8.2 for Bournvita.

The differentiation of local HFDs is not just on price but also on the brand’s identity, ingredients and taste. For example, Powervita is inspired from traditional ayurvedic medicine and borrows its marketing terminology from that space: “Shatavari promote health energy level and boost immunity” and “Shankhpushpi & Brahmi [is] good ayurvedic remedy for memory and brain”. In fact, Patanjali was co-founded by a very popular guru, Baba Ramdev, and, as such, has a lot of appeal among families with strong traditional Indian values⁴.

Beyond ayurvedic ingredients, the adaptation to local tastes can also appeal to Indian consumers. “Badam” (almond in Hindi), present in MTR’s Instant Badam Drink Jar is a good example. The importance of meeting local tastes has even been recognised by international players like Abbott that now manufactures locally its nutritional products with Indian flavours – e.g. “kesar badam” (saffron & almonds) for Pediasure⁵.

Although local HFDs represent a small amount of the total value of the HFD market due to their lower pricing, there are successfully taking some volume shares from most established players, slowing down the adoption of traditional brands Horlicks and Complan among Indian families emerging from economic scarcity.

Final thoughts

While Horlicks and Complan’s brand equity should still continue to attract socially ascending families to its products once they can afford them, the growth will certainly be lower than would have been originally predicted based on pure socio-economic factors.

The long-term future of Horlicks, Boost and Complan will very much depend on the type of innovation they manage to bring to the market in both tastes and ingredients. A substantial increase in protein, vitamin and mineral content could certainly help them to stay relevant, ultimately benefitting Indian children.

Marie-Élisabeth Maigre

¹ https://timesofindia.indiatimes.com/business/india-business/coke-zydus-to-bid-for-krafts-brands-complan-glucon-d/articleshow/65694532.cms

² See Redseer’s publication “Health Food Drinks on the Road to Transition” (http://redseer.com/wp-content/uploads/2018/06/health-food-drinks-hfd-market-in-india-on-a-road-to-transition.pdf)

³ https://economictimes.indiatimes.com/industry/cons-products/food/whoever-buys-horlicks-must-reckon-with-better-informed-consumers-in-a-rs-7000-crore-market/articleshow/63560169.cms

⁴https://www.india-briefing.com/news/ayurveda-india-fmcg-market-consumer-preferences-natural-organic-products-17395.html/

⁵https://www.business-standard.com/article/companies/abbott-to-launch-nutritional-products-in-indian-flavours-114101600800_1.html

Does more complexity mean more value for Medical Nutrition?

Jul 23, 2018 | Medical Nutrition & Consumer Health

Does more complexity mean more value for Medical Nutrition?

In the past 10 years, the Medical Nutrition (“MN”) sector has shown significant evolution of its sales and marketing approach. For a long time, this sector targeted dietitian teams based in hospitals with relatively simple product lines segmented by age groups (paediatric vs. adult), product formats (enteral vs. sip) and flavours.

But the context changed as hospital budget constraints driven by national government cuts put pressure on the costs associated with MN, which has often been regarded by payers and healthcare professionals (“HCPs”) as a mere commodity.

In response, MN manufacturers started adopting a different go-to-market approach, focusing on specific therapeutic areas and bringing some disease-specific innovations to the market in order to fight back commoditisation. Disease-specific MN products are intended to be so uniquely suited for a specific patient group that they can justify a premium price and still obtain better payers’ subsidies, provided they are supported by enough scientific and health-economic evidence.

By offering something uniquely suited to a disease rather than a generic nutritional solution, Medical Nutrition Companies hope to gain broader hospital recognition (including from specialist doctors) instead of being systematically referred to the “Dieticians’ floor” or “the kitchen”. This subsequently increases their chances of becoming core components of treatment protocols alongside pharmaceutical drugs.

Where do MN companies stand today against the adoption of a “disease-specific” model?

By analysing the way the top 4 global MN manufacturers present their product portfolio on their global websites we can see a concerted shift towards a “disease-specific” model (see table below).

Among these companies, Nestle Health Science and Nutricia Advanced Medical Nutrition appear to be leading the shift toward a disease-specific approach; they are broadly spread across numerous adult and paediatric pathologies.

Fresenius seems to have opted for a narrower pathology focus, maintaining a more holistic positioning of MN, except for a few “star” therapeutic areas.

Finally, Abbott has maintained a more traditional segmentation by age group, which leads to a list of products which offer minimal mention on the underlying pathologies they target. This positioning is interestingly in exact contrast with Nestle’s and Nutricia’s although they cover a similar breadth of medical conditions.

Our analysis shows that none of these companies rely today on a broad malnutrition concept suitable for undefined sets of therapeutic areas. This exposes the (perceived) necessity among industry leaders of increased specialisation to cope with hospital budget pressures.

What does it mean for sales and marketing organisations?

The shift toward a disease-specific positioning of MN has many consequences on the way marketing and sales teams of MN companies operate.

First, marketers and sales representatives of MN companies should align their internal structure to the therapeutic areas they intend to play in. In sales, medical expertise becomes as critical as nutritional knowledge and commercial flair. This most likely entails hiring new talents with a pharma background and/or a medical degree. The cost of the sales force may subsequently increase to align with the pharmaceutical industry.

Second, it requires the addition of Medical Affairs team members dedicated to proving the health-economic benefits of an innovative disease-specific product vs. a more generic one; this is because, nowadays, few medical products and solutions, as effective as they may be, will get adopted by payers and HCPs without solid health-economic evidence proving better or quicker therapeutic outcomes and shorter hospital stays.

Finally, it adds layers of complexity to marketing teams’ portfolio management strategy at the country level. On one hand, they need to continue to serve their current markets, and on the other, they are expected to prioritise the adoption of therapeutic areas based on the incidence-based opportunity these represent. As a result, it wouldn’t be a surprise if marketing managers struggle to decide how to update their product mix without putting at risk the health of their P&L.

Balancing the future “Perfect” and the current “Good” is possible

These are some of the questions that may arise in these marketing organisations:

What medical conditions should we prioritise?
- In which ones can we offer more value to patients?
- Which ones are easier for us to support based on our current set-up, the current level of medical awareness and protocols and the structure of the medical channels they relate to?
- As a result, which ones truly offer the best combination of patient value and capability fit, and should therefore be our priority number one?
Do we already have products in the market to support these medical conditions?
- And if not, does our global company have adequate products that are not currently present in the target country that we could add and launch?
Assuming no incremental budget, can our team prioritise these disease-specific initiatives whilst still serving our current customers and the bestselling products in our existing portfolio?

In fact, there is often a fear that shifting the focus onto a specific pathology or new product can undermine the many efforts over the years by sales and marketing teams to develop their existing portfolio and sales.

But standing still is never a solution so how to go about it?

Can we help?

Sector & Segment can help MN companies to navigate through these complex issues and come up with solutions that measure the pros and cons of different portfolio “scenarios”.

Over the years, our team has conducted 80 strategic projects in 25 countries across 12 therapeutic areas of Specialist Nutrition, helping its clients to develop product and disease specific propositions.

For more information, please contact me at