[UPDATED at 5 p.m. ET]
Many Americans turn to the latest big idea to lose weight fad diets, fitness crazes, dodgy herbs and pills, bariatric surgery, just to name a few. Theyre rarely the magic solution people dream of.
Now a wave of startups offer access to a new category of drugs coupled with intensive behavioral coaching online. But already concerns are emerging.
These startups, spurred by hundreds of millions of dollars in funding from blue-chip venture capital firms, have signed up well 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.
The startups initially positioned themselves in lofty terms. This is the last weight loss program youll try, said a 2020 marketing analysis by startup Calibrate Health, in messaging designed to reach one of its target demographics, the Working Mom. (Company spokesperson Michelle Wellington said the document does not reflect Calibrates current marketing strategy.)
But while doctors and patients are intrigued by the new model, some customers complain online that reality is short of the buildup: They say they got canned advice and unresponsive clinicians and some report they couldnt get the newest drugs.
Calibrate Health, a New York City-based startup, it had served 20,000 people. Another startup, , headquartered in San Francisco, has served 160,000 patients since July 2020. costs patients nearly $1,600 a year, not counting the price of drugs, which can hit nearly $1,500 monthly without insurance, according to drug price savings site . (Insurers reimburse for GLP-1 agonists in limited circumstances, patients said.) Found offers a six-month plan for nearly $600, a company spokesperson said. (That price includes generic drugs, but not the newer GLP-1 agonists, like Wegovy.)
The two companies are beneficiaries of over $200 million in combined venture funding, according to by , a repository of venture capital investments. The firms say theyre on the vanguard of weight care, both citing the influence of biology and other scientific factors as key ingredients to their approaches.
Theres potentially a big market for these startups. Just , according to the Centers for Disease Control and Prevention, driving up their risk for cardiovascular conditions and Type 2 diabetes. Effective medical treatments are elusive and hard to access.
Centers that provide this specialty care are overwhelmed, said Dr. , an obesity medicine specialist at Massachusetts General in Boston, a teaching hospital affiliated with Harvard. Her own clinic has a waitlist of 3,000.
Stanford, who said she has advised several of these telemedicine startups, is bullish on their potential.
, director of obesity medicine at the Cleveland Clinic, said the startups can offer care with less judgment and stigma than in-person peers. Theyre also more convenient.
Butsch, who learned about the model through consultancies, patients, and colleagues, wonders whether the startups are operating to strategically find which patients respond to which drug. He said they should coordinate well with behavioral specialists, as antidepressants or other medications may be driving weight gain. Obesity is a complex disease and requires treatments that match its complexity, he said. I think programs that do not have a multidisciplinary team are less comprehensive and, in the long term, less effective.
The startups market a two-pronged product: first, the new class of GLP-1 agonists. While these medications are effective at provoking weight loss, Wegovy, one of two in this class specifically approved for this purpose, is in due to manufacturing difficulties, according to its maker, Novo Nordisk. can be prescribed off-label. But doctors generally arent familiar with the medications, Stanford said. In theory, the startups can bridge some of those gaps: They offer more specialized, knowledgeable clinicians.
Then theres the other prong: behavioral changes. The companies use televisits and online messaging with nutritionists or coaches to help patients incorporate new diet and exercise habits. The weight loss figures achieved by participants in clinical trials for the new drugs up to 15% of body mass were tied to such changes, according to .
Social media sites are bursting with these startups ads, everywhere from podcasts to Instagram. A search of Metas ad library finds 40,000 ads on Facebook and Instagram between the two firms.
The ads complement peoples own postings on social media: Numerous Facebook groups are devoted to the new type of drugs some even focused on helping patients manage side effects, like changes in their bowel movements. The buzz is quantifiable: On TikTok, mentions of the new GLP-1 agonists tripled from last June to this June, according to an analysis by investment bankers at Morgan Stanley.
Theres now a feverish, expectant appetite for these medications among the startups clientele. Patients often complained that their friends had obtained a drug they werent offered, recalled Alexandra Coults, a former pharmacist consultant for Found. Coults said patients may have perceived some sort of bait-and-switch when in reality clinical reasons like drug contraindications guide prescribing decisions.
Patient expectations influence care, Coults said. Customers came in with ideas shaped by the culture of fad diets and New Years resolutions, she said. Quite a few people would sign up for one month and not continue.
In interviews with KHN and in online complaints, patients also questioned the quality of care they received. Some said intake which began by filling out a form and proceeded to an online visit with a doctor was perfunctory. Once medication began, they said, requests for counseling about 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 developed sores in her mouth.
She sought advice and help from Found physicians, but their replies, she told KHN, werent quick. Nonemergency communications are routed through the companys portal.
It took a week to complete a switch of medications and have a new prescription arrive at her home, she said. Meanwhile, she said, she went to an urgent care clinic for the mouth sores.
Found frequently prescribes generic medications often off-label rather than just the new GLP-1 agonists, company executives said in an interview. Found said older generics like zonisamide are more accessible than the GLP-1 agonists advertised on social media and their own website. Both Butsch and Stanford said theyve prescribed zonisamide successfully. Butsch said ramping up dosage rapidly can increase the risk of side effects.
But Dr. Kim Boyd, chief medical officer of competitor Calibrate, said the older drugs just haven’t worked.
Patients of both companies have critiqued online and in interviews the startups behavioral care which experts across the board maintain is integral to successful weight loss treatment. But some patients felt they simply had canned advice.
Other patients said they had ups and downs with their coaches. Dana Crom, an attorney, said she had gone through many coaches with Calibrate. Some were good, effective cheerleaders; others, not so good. But when kinks in the program arose, she said, the coach wasnt able to help her navigate them. While the coach can report trouble with medications or the app, it appears those reports are no more effective than messages sent through the portal, Crom said.
And what about when her yearlong subscription ends? Crom said shed consider continuing with Calibrate.
Relationships with coaches, given the need to change behavior, are a critical element of the business models. Patients results depend on how adherent they are to lifestyle changes, said Founds chief medical officer, .
While the startups offer care to a larger geographic footprint, its not clear whether the demographics of their patient populations are different from those of the traditional bricks-and-mortar model. Calibrates patients are overwhelmingly white; over 8 in 10 have at least an undergraduate degree; over 8 in 10 are women, according to the company.
And its earlier marketing strategies reflected that. The September 2020 segmentation document laid out three types of customers the company could hope to attract: perimenopausal or menopausal women, with income ranging from $75,000 to $150,000 a year; working mothers, with a similar income; and men.
Isabelle Kenyon, Calibrates CEO, said the company now hopes to expand its reach to partner with large employers, and that will help diversify its patients.
Patients will need to be convinced that the model more affordable, more accessible works for them. For her part, Garrant, who no longer is using Found, reflected on her experience, writing in her blog post that she was hoping for more follow-up and a more personal approach. I don’t think it’s a helpful way to lose weight, she said.
[Correction: This article was updated at 5 p.m. ET on Nov. 15, 2022, to correct the spelling of the name of Founds chief medical officer and update the number of clients the company has served.]
