Weight loss startups offer access to new drugs, but do they provide good care?

Many Americans are turning to the latest big idea to lose weight – fad diets, fitness crazes, dodgy herbs and pills, bariatric surgery, to name a few. They are rarely the magic bullet that people dream of.

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

These startups, spurred by hundreds of millions of dollars in funding from blue-chip venture capital firms, have recruited more than 100,000 patients and could grow into millions more. These patients pay hundreds or even thousands of dollars to access new drugs, called GLP-1 agonists, as well as online coaching to encourage healthy habits.

Startups initially positioned themselves on lofty terms. “This is the last weight loss program you’ll ever try,” said a 2020 marketing analysis by startup Calibrate Health, in a post designed to reach one of its target demographics, the “working mom.” . (Company spokeswoman Michelle Wellington said the document did not reflect Calibrate’s current marketing strategy.)

But while doctors and patients are intrigued by the new model, some customers are complaining online that the reality is running out of accumulation: They say they’ve been given canned advice and unresponsive clinicians — and some are reporting that they couldn’t get the latest drugs.

Calibrate Health, a New York-based startup, announced earlier this year that it had served 20,000 people. Another startup, Found, headquartered in San Francisco, has served 160,000 patients since July 2020, CEO Sarah Jones Simmer said in an interview. Calibrate costs patients nearly $1,600 a year, not including drug prices, which can reach nearly $1,500 a month without insurance, according to drug price savings site GoodRx. (Insurers reimburse GLP-1 agonists in limited circumstances, patients said.) Found offers a six-month plan for nearly $600, a company spokesperson said. (This price includes generic drugs, but not newer GLP-1 agonists, like Wegovy.)

The two companies have more than $200 million in combined venture capital funding, according to tracking by Crunchbase, a venture capital investment repository. The companies say they are at the forefront of weight care, citing the influence of biology and other scientific factors as key ingredients in their approaches.

There is potentially a big market for these startups. Just over 4 in 10 Americans are obese, which increases their risk for cardiovascular disease and type 2 diabetes, according to the Centers for Disease Control and Prevention. 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 people.

Stanford, which said it has advised several of these telemedicine startups, is optimistic about their potential.

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

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

The startups are marketing a two-pronged 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 may be prescribed off-label. But doctors aren’t usually familiar with the drugs, Stanford said. In theory, startups can fill some of these gaps: they provide more specialized and knowledgeable clinicians.

Then there is the other component: behavioral changes. Companies are using televisits and online messages with nutritionists or trainers to help patients adopt new eating and exercise habits. Weight loss figures achieved by participants in clinical trials for new drugs – up to 15% of body mass – were linked to such changes, according to Novo Nordisk.

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

The ads complement people’s own social media posts: Many Facebook groups are devoted to the new type of drug, some even focusing on helping patients manage side effects, such as changes in their bowel movements. The buzz is quantifiable: on TikTok, mentions of new GLP-1 agonists tripled from last June to this month, according to an analysis by investment bankers at Morgan Stanley.

There is now a feverish and impatient appetite for these drugs among the startup clientele. Patients often complained that their friends got a drug they weren’t offered, recalls Alexandra Coults, a former consultant pharmacist for Found. Coults said patients may have perceived some sort of bait and switch when in reality clinical reasons — like drug contraindications — were guiding prescribing decisions.

Patient expectations influence care, Coults said. Customers came up with ideas shaped by fad diet culture and New Year’s resolutions, she said. “A lot of people would 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 said the intake – which started with filling out a form and continued with an online visit with a doctor – was superficial. Once the medications started, they said, requests for advice on side effects were slow to be answered.

Reunited patient Jess Garrant recalled that after being prescribed zonisamide, a generic anti-seizure drug 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.

She sought advice and help from Found’s doctors, but their responses, she told KHN, “weren’t quick.” Non-emergency communications are routed through the company portal.

It took a week to complete a change of medication and get a new prescription to arrive at her home, she said. During that time, she said, she went to an urgent care clinic for mouth sores.

Found frequently prescribes generic drugs — often off-label — rather than just the newer GLP-1 agonists, 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 own website. Butsch and Stanford reported successfully prescribing zonisamide. Butsch said rapidly increasing the dosage can increase the risk of side effects.

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

Patients from both companies have criticized online and in interviews the startups’ behavioral care – which experts across the field say is an integral part of successful weight loss treatment. But some patients felt they simply had canned advice.

Other patients said they had their ups and downs with their coaches. Dana Crom, an attorney, said she has followed many trainers with Calibrate. Some were good, effective cheerleaders; others, not very good. But when problems arose in the program, she said, the coach was unable to help her navigate it. Although the trainer can report problems with the medication or the app, it appears that these reports are no more effective than messages sent through the portal, Crom said.

And what about the end of his one-year subscription? Crom said she would consider continuing with Calibrate.

Relationships with coaches, given the need to change behaviors, are a critical part of business models. Patients’ outcomes depend “on their degree of adherence to lifestyle changes,” said Found’s chief medical officer, Dr. Rekha Kumar.

While the startups provide care to a broader geographic footprint, it’s unclear if the demographics of their patient populations are different from the traditional brick-and-mortar model. Calibrate patients are predominantly white; more than 8 in 10 have at least an undergraduate degree; more than 8 out of 10 are women, according to the company.

And his past marketing strategies reflected that. The September 2020 “segmentation” document defined three types of customers the company could hope to attract: women in perimenopause or menopause, with incomes ranging from $75,000 to $150,000 per year; working mothers, with a similar income; and “men”.

Isabelle Kenyon, CEO of Calibrate, said the company now hopes to expand its reach to partner with large employers, which 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 uses Found, reflected on her experience, writing in her blog post that she hoped for more following and a more personal approach. “I don’t think it’s a helpful way to lose weight,” she said.

CORRECTION: (November 15, 6:56 p.m. ET): A previous version of this article misrepresented the number of patients who had used Found. It has served 160,000 patients since July 2020, not 135,000. The article also misspelled the first name of the company’s chief medical officer. She is Rekha Kumar, not Rehka.

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