[UPDATED at 5 p.m. ET]
Many Americans turn to the latest big idea for weight loss – diet, exercise craze, dodgy herbs and pills, obesity surgery, just to name a few. They are rarely the magical solution people dream of.
Now, a wave of startups is offering access to a new drug along with in-depth behavioral coaching online. But concerns have emerged.
These startups, fueled by hundreds of millions of dollars in funding from blue-chip venture capital firms, already have more than 100,000 registered patients and possibly millions more. These patients pay hundreds, if not thousands, of dollars for access to new drugs, called GLP-1 agonists, along with online training to encourage healthy habits.
Early startups position themselves on lofty terms. “This is the ultimate weight loss program you will ever try,” said a 2020 marketing analysis by startup Calibrate Health, in a message designed to reach one of its target demographics. their, “Working Mother”. (Company spokeswoman Michelle Wellington said the document does not reflect Calibrate’s current marketing strategy.)
But while doctors and patients are intrigued by the new model, some customers complain online that reality isn’t cumulative enough: They say they get boxed advice and clinicians don’t. response — and some reported that they were unable to receive the latest medications.
Calibrate Health, a New York City-based startup, reported earlier this year that it served 20,000 people. Another startup, Found, based in San Francisco, has been serving 160,000 patients since July 2020. The cost of patient calibration is close to $1,600 a year, excluding drug prices, possibly. up to nearly $1,500 monthly without insurance, according to drug price savings website GoodRx. (Insurers reimburse for GLP-1 agonists in limited circumstances, patients said.) Found offers a six-month plan for nearly $600, a company spokesman told know. (That price includes generic drugs, but does not include newer GLP-1 agonists, like Wegovy.)
According to data from Crunchbase, an archive of venture capital investments, the two companies are the beneficiaries of more than $200 million in venture capital combined. The companies say they are at the forefront of weight care, both citing the influence of biology and other scientific factors as key components of their approach.
There is likely to be a large market for these startups. According to the Centers for Disease Control and Prevention, more than 4 in 10 Americans are obese, increasing the risk of cardiovascular diseases and Type 2 diabetes. Effective medical treatments are elusive. catch and hard to reach.
Dr Fatima Stanford, an obesity specialist at Massachusetts General in Boston, a Harvard-affiliated teaching hospital, said the centers providing intensive care were “overcrowded”. Her private clinic has a 3,000 waiting list.
Stanford, who said she has advised some of these telemedicine startups, is optimistic about their potential.
Scott Butsch, director of obesity medicine at the Cleveland Clinic, says startups can provide care with less judgment and stigma than their immediate colleagues. They are also more convenient.
Butsch, who learned about the model through consultations, patients, and colleagues, wondered if startups were working “to figure out what strategies patients respond to.” or not”. He says they should work well with behavioral specialists, as antidepressants or other drugs can cause weight gain. “Obesity is a complex disease, and there are treatments that match its complexity,” he said. “I think programs without multidisciplinary teams are less comprehensive and less effective in the long run.”
Startups marketing a product have two directions: first, a new type of GLP-1 agonist. According to the manufacturer Novo Nordisk, although these drugs are effective in stimulating weight loss, Wegovy, one of only two drugs in this class approved specifically for this purpose, is in short supply due to difficulty. towels in production. Others in the category may be prescribed off-label. But doctors are often unfamiliar with the drugs, Stanford says. In theory, startups could bridge some of those gaps: They provide clinicians with more specialized knowledge.
Then there’s another aspect: behavior change. Companies use remote visits and online messaging with nutritionists or coaches to help patients incorporate new diet and exercise routines. According to Novo Nordisk, the amount of weight loss that participants in clinical trials of the new drug achieved – up to 15% of body mass – is tied to those changes.
Not a Modern Healthcare subscriber? Sign up today.
Social media sites are flooded with ads from these startups, everywhere from podcasts to Instagram. A search of Meta’s ad library found 40,000 Facebook and Instagram ads between the two companies.
Ads that complement people’s own posts on social media: Many Facebook groups are devoted to the new drug – some even focus on helping patients manage side effects, like changing their bowel movements. Rumors are quantifiable: On TikTok, mentions of the new GLP-1 agonist tripled from last June to this June, according to an analysis of investment bankers at Morgan Stanley.
Currently, the customer group of startups is having a fever, an expected appetite for these drugs. Alexandra Coults, a former consultant pharmacist for Found, recalls: Patients often complained that their friends bought drugs they were not offered. Coults said patients may have noticed some pattern of decoys and switching when in fact clinical reasons – such as drug contraindications – guide prescribing decisions.
Coults said patient expectations influence care. Customers come in, she says, with ideas shaped by trendy diet culture and New Year’s resolutions. “Quite a few people will sign up for a month and not continue.”
In interviews with KHN and in online complaints, patients also questioned the quality of care they received. Some say the intake – starting by filling out a form and going online with a doctor – is perfunctory. When they started taking the drug, requests for advice about side effects were slow to be answered, they said.
Jess Garrant, a Found patient, recalled that after she was prescribed zonisamide, a generic anticonvulsant that has been shown to help with weight loss, she felt “completely weird”.
“I’ve been up all night and my thoughts are racing,” she wrote in a blog post. She had sores in her mouth.
She sought advice and help from Found’s doctors, but their response, she told KHN, was “not quick.” Non-emergency communications are routed through the company portal.
She said it took a week to complete the drug switch and have a new prescription arrive at her home. Meanwhile, she said, she went to an urgent care clinic for mouth sores.
Not a Modern Healthcare subscriber? Sign up today.
The company’s executives said in an interview that it’s common to prescribe generic drugs — often off-brand — instead of just new GLP-1 agonists. Found says older drugs like zonisamide are more accessible than GLP-1 agonists advertised on social media and their own website. Both Butsch and Stanford say they have successfully prescribed zonisamide. Butsch says rapidly increasing the dosage can increase the risk of side effects.
But Dr Kim Boyd, medical director of competitor Calibrate, said older drugs “didn’t work”.
Patients from both companies have critiqued online and in interviews about the behavioral care of the startups – which panel experts say is indispensable for treatment. successful weight loss. But some patients feel they simply have boxed advice.
Other patients say they have had ups and downs with their trainer. Dana Crom, an attorney, said she has gone through many coaches with Calibrate. Some are good, effective cheerleaders; Others, not so good. But when kinks in the program arose, she said, the coach was unable to help her navigate them. While coaches can report problems with pills or apps, those reports don’t appear to be any more effective than messages sent through the portal, Crom said.
And what about when her full year subscription ends? Crom said she would consider continuing with Calibrate.
The relationship with the coach, driven by the need for behavior change, is an important element of the business model. Found’s medical director Dr Rekha Kumar said: “Patients’ outcomes depend on their compliance with lifestyle changes.
While startups provide care to a larger geographic range, it is unclear whether the demographics of their patient populations are different from the demographics of the traditional model. Calibrate’s patients were overwhelmingly white; more than 8 out of 10 people have at least a university degree; According to the company, more than 8 out of 10 people are women.
Download Modern Healthcare’s app to stay informed when there’s breaking industry news.
And its previous marketing strategies reflected that. The September 2020 “segmentation” document outlines three types of customers the company can hope to attract: premenopausal or menopausal women, earning between $75,000 and $150,000 a year; working mothers, with similar incomes; and “man”.
Isabelle Kenyon, CEO of Calibrate, said the company now hopes to expand its reach to partner with large employers and that will help diversify their patients.
Patients will need to be convinced that this model – more affordable, more accessible – is right for them. For her part, Garrant, who no longer uses Found, reflected on her experience, writing in her blog post that she hopes for more followings and a more personal approach multiply more. “I don’t think it’s a helpful way to lose weight,” she says.
[Correction: This article was updated at 5 p.m. ET on Nov. 15, 2022, to correct the spelling of the name of Found’s chief medical officer and update the number of clients the company has served.]
Kaiser Health News is a national health policy news service. This is an editorially independent program of the Henry J. Kaiser Family Foundation not affiliated with Kaiser Permanente.
