Weight Loss Startups Offer Access to New Drugs, But Do They Provide Good Care?

Many Americans are turning to the latest great idea for losing weight: trendy diets, fitness crazes, gimmicky herbs and pills, bariatric surgery, to name a few. They are rarely the magical solution people dream of.

Now a wave of startups is offering access to a new category of drugs along with intensive online behavioral coaching. But concerns are already emerging.

These startups, powered by hundreds of millions of dollars in funding from blue-chip venture capital firms, have registered over 100,000 patients and could reach millions more. These patients pay hundreds, if not thousands, of dollars to access new drugs, called GLP-1 agonists, along with online coaching to encourage healthy habits.

Startups initially ranked high. “This is the last weight loss program you will try,” said a 2020 marketing analysis from startup Calibrate Health, in a message designed to reach one of its target demographics, the “working mom.” (Company spokesperson 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 falls short: they say they have received prepackaged advice and doctors who do not respond – and some report that they have not been able to get the drugs. latest.

Calibrate Health, a New York-based startup, reported earlier this year that it had served 20,000 people. Another startup, Found, based in San Francisco, has served 135,000 patients since July 2020, CEO Sarah Jones Simmer said in an interview. Calibration costs patients nearly $ 1,600 per year, not counting the price of drugs, which can reach nearly $ 1,500 per month without insurance, according to drug price savings site GoodRx. (Insurers reimburse GLP-1 agonists under limited circumstances, patients said.) Found offers a six-month plan for nearly $ 600, a company spokesperson said. (That price includes generics, but not new GLP-1 agonists, like Wegovy.)

The two companies benefit from more than $ 200 million in combined venture capital funding, according to monitoring by Crunchbase, a venture capital investment repository. The companies claim to be at the forefront of weight management, citing both the influence of biology and other scientific factors as key ingredients of their approaches.

There is potentially a large market for these startups. Just over 4 in 10 Americans are obese, according to the Centers for Disease Control and Prevention, increasing the risk of cardiovascular disease and type 2 diabetes. Effective medical treatments are elusive and difficult to access.

The centers that provide this specialized care “are overwhelmed,” said Dr. Fatima Stanford, an obesity medicine specialist at Massachusetts General in Boston, a Harvard-affiliated teaching hospital. His own clinic has a waiting list of 3,000.

Stanford, which said it has recommended many of these telemedicine startups, is bullish about their potential.

Dr. Scott Butsch, director of obesity medicine at the Cleveland Clinic, said startups can offer care with less judgment and stigma than peers in person. They are also more affordable.

Butsch, who learned about the model through consultations, patients and colleagues, wonders if the startups are working “to strategically find which patients respond to which drug”. He said they should coordinate well with behavioral specialists, as antidepressants or other medications could gain weight. “Obesity is a complex disease and requires treatments that match its complexity,” she said. “I think programs that don’t have a multidisciplinary team are less comprehensive and, in the long run, less effective.”

The startups market a twofold product: first, the new class of GLP-1 agonists. Although these drugs are effective in causing weight loss, Wegovy, one of two in this class specifically approved for this purpose, is in short supply due to manufacturing difficulties, according to its manufacturer, Novo Nordisk. Others in the category can be prescribed off-label. But doctors are generally unfamiliar with medications, Stanford said. In theory, startups can fill some of these gaps: they offer more specialized and competent clinicians.

Then there is the other pole: behavioral changes. Companies use televised visits and online messaging with nutritionists or coaches to help patients incorporate new eating and exercise habits. Weight loss data achieved by participants in clinical trials for the new drugs – up to 15 percent of body mass – were linked to those changes, according to Novo Nordisk.

Social media sites are full of ads from these startups, everywhere from podcasts to Instagram. A search in Meta’s ad library finds 40,000 ads on Facebook and Instagram between the two companies.

Ads complement people’s posts on social media: Numerous Facebook groups are dedicated to the new type of medication, some even focused on helping patients manage side effects, such as changes in bowel movements. The buzz is quantifiable: on TikTok, mentions of new GLP-1 agonists have tripled from last June to this June, according to an analysis by Morgan Stanley investment bankers.

There is now a feverish and waiting appetite for these drugs among the startup clientele. Patients often complained that their friends had gotten a drug they weren’t offered, recalled Alexandra Coults, a former consultant pharmacist at Found. Coults said patients may have felt some sort of decoy when in fact clinical reasons – such as contraindications to drugs – drive prescribing decisions.

Patient expectations influence care, Coults said. Customers came in with ideas shaped by trendy diet culture and New Year’s resolutions, she said. “Many people would sign up for a month and not continue.”

In interviews with KHN and online complaints, patients also questioned the quality of care they received. Some said the hiring – which began by filling out a form and proceeding to an online visit with a doctor – was superficial. Once the drugs started, they said, requests for advice on side effects were slow to be answered.

Jess Garrant, a found patient, recalled that after she was prescribed zonisamide, a generic anticonvulsant that has shown some ability to help with weight loss, she felt “absolutely weird.”

“I was up all night and my thoughts were racing,” she wrote in a blog post. She developed sores in her mouth.

He asked Found doctors for advice and help, but their responses, he told KHN, “weren’t quick.” Non-emergency communications are routed through the company portal.

It took her a week to complete a change of medications and get a new prescription at her home, she said. In the meantime, she said, she went to an urgent care clinic for mouth injuries.

Found often prescribes generic drugs – often off-label – rather than just the new GLP-1 agonists, the company executives said in an interview. Found said older generics like zonisamide are more accessible than GLP-1 agonists advertised on social media and their website. Both Butsch and Stanford said they have successfully prescribed zonisamide. Butsch said increasing the dosage rapidly can increase the risk of side effects.

But Dr. Kim Boyd, medical director of competitor Calibrate, said the older drugs “just didn’t work.”

Patients from both companies have criticized the startups’ behavioral care online and in interviews, which experts across the board believe is integral to weight loss treatment success. But some patients felt they simply had canned advice.

Other patients said they had ups and downs with their coaches. Dana Crom, a lawyer, said she has followed many coaches with Calibrate. Some were good and effective cheerleaders; others, not so good. But when kinks occurred in the program, she said, the coach was unable to help her resolve them. Although the coach may report problems with medications or the app, those reports appear to be no more effective than messages sent through the portal, Crom said.

And when does your annual subscription expire? Crom said he would consider continuing with Calibrate.

Relations with coaches, given the need to change behaviors, are a critical element of business models. Patient outcomes depend “on how adherent they are to lifestyle changes,” said Found Medical Director Dr Rehka Kumar.

While startups offer assistance across a broader geographic footprint, it’s unclear whether the demographics of their patient populations differ from that of the traditional mainstream model. Calibrate’s patients are predominantly white; over 8 out of 10 have at least a degree; more than 8 out of 10 are women, according to the company.

And his previous marketing strategies reflected that. The September 2020 “segmentation” document foresaw three types of customers the company could hope to attract: perimenopausal or menopausal women, with an income of between $ 75,000 and $ 150,000 annually; working mothers with similar income; and “men”.

Isabelle Kenyon, CEO of Calibrate, said the company now hopes to expand its reach to partner with large employers and that will help diversify its patients.

Patients will have to be convinced that the model – cheaper, more accessible – works for them. For his part, Garrant, who no longer uses Found, reflected on his experience of her, writing in his blog post that she hoped for a greater following and a more personal approach. “I don’t think it’s a useful way to lose weight,” she said.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with Policy Analysis and Polling, KHN is one of the three main operational programs of KFF (Kaiser Family Foundation). KFF is a gifted non-profit organization that provides information on health issues to the nation.

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