Patients complain that some obesity treatment startups offer pills and not much else

Patients complain that some obesity treatment startups offer pills and not much else

Many Americans are turning to the latest big idea to lose weight - fad diets, fitness craze, shady herbs and pills, bariatric surgery, to name a few. They are rarely the magical solution that people dream of.

Now a wave of startups is offering access to a new category of drugs coupled with intensive online behavioral coaching. But concerns are already 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 get access to new drugs called GLP-1 agonists, along with online coaching to promote healthy habits.

The startups initially positioned themselves pompously. “This is the last weight loss program you will try,” a 2020 marketing analysis from startup Calibrate Health said in a message aimed at reaching one of its target demographics, the “working mom.” (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 it falls short of reality: They say they've gotten canned advice and unresponsive clinicians — and some report that they haven't been able to get the latest medications.

Calibrate Health, a New York startup, Reported earlier this year it had served 20,000 people. Another startup, Found headquartered in San Francisco, has treated 135,000 patients since July 2020, CEO Sarah Jones Simmer said in an interview. Calibrate costs patients nearly $1,600 a year, not counting the price of the drugs, which can reach nearly $1,500 a month without insurance, according to the drug price saving website without insurance GoodRx. (Insurers do reimburse GLP-1 agonists in certain circumstances, patients said.) Found offers a six-month plan for nearly $600, a company spokesman said. (This price includes generics, but does not include the newer GLP-1 agonists such as Wegovy.)

The two companies are said to be beneficiaries of over $200 million in combined venture financing Persecution from Crunchbase, a collection of venture capital investments. The companies say they are at the forefront of weight management, both citing the influence of biology and other scientific factors as key parts of their approaches.

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

Centers that offer this specialized care “are overwhelmed,” Dr. Fatima Stanford, an obesity specialist at Massachusetts General in Boston, a Harvard-affiliated teaching hospital. Her own clinic has a waiting list of 3,000.

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

Dr. Scott Butch, director of obesity medicine at the Cleveland Clinic, said the startups can provide care with less judgment and stigma than in-person counterparts. They are also more comfortable.

Butsch, who learned about the model from consulting firms, patients and colleagues, wonders whether the startups are working to “strategically figure out which patients respond to which drug.” He said they should coordinate well with behavioral specialists because antidepressants or other medications could drive weight gain. “Obesity is a complex disease and requires treatments commensurate with its complexity,” he said. “I think programs without a multidisciplinary team are less comprehensive and less effective in the long term.”

The startups are marketing a two-pronged product: First, the new class of GLP-1 agonists. While these drugs are effective at provoking weight loss, Wegovy, one of two in this class specifically approved for this purpose, is in In short supply due to manufacturing difficulties, according to manufacturer Novo Nordisk. Others in the category can be prescribed off-label. But doctors generally aren't familiar with the drugs, Stanford said. In theory, the startups can fill some of these gaps: They offer more specialized, knowledgeable clinicians.

Then there is the other aspect: behavioral changes. The companies use televised visits and online messaging with nutritionists or trainers 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 bound by such changes, in accordance with 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 posts on social media: Numerous Facebook groups are dedicated to the new type of medication - some even focused on helping patients cope with side effects such as changes in their bowel movements. The excitement 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.

There is now a feverish appetite for these medications among the start-up customers. Patients often complained that their friends had been given a medication that was not offered to them, recalled Alexandra Coults, a former pharmacist consultant for Found. Coults said patients may have perceived a kind of bait-and-switch when in reality clinical reasons - such as drug contraindications - guide prescribing decisions.

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Patient expectations influence care, Coults said. Customers came in with ideas informed by the culture of diets and New Year's resolutions, she said. “Quite a few 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 began with filling out a form and led to an online visit with a doctor - was superficial. Once the medication began, they said, requests for advice about side effects were slow to respond.

Jess Garrant, a Found patient, recalled feeling "absolutely weird" after she was prescribed zonisamide, a generic anticonvulsant that has been shown to help with weight loss.

“I was awake all night and my mind was racing.” she wrote in a blog post. She developed sores in her mouth.

She sought advice and help from Found doctors, but her answers, she told KHN, "didn't come quickly." Non-emergency communications are routed through the company's portal.

It took a week for a medication change to be completed and a new prescription to arrive at her home, she said. In the meantime, she said, she went to an emergency clinic because of the sores in her mouth.

Found often prescribes generic drugs - often off-label - rather than just the new GLP-1 agonists, company executives said in an interview. Older generics such as zonisamide have been found to be more accessible than the GLP-1 agonists promoted on social media and on their own website. Both Butsch and Stanford said they have successfully prescribed zonisamide. Butsch said quickly increasing the dosage can increase the risk of side effects.

But Dr. Kim Boyd, chief medical officer 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 say is an essential part of successful weight loss treatment. But some patients felt like they were simply getting canned advice.

Other patients said they had ups and downs with their trainers. Dana Crom, an attorney, said she went through many trainers with Calibrate. Some were good, effective cheerleaders; others, not so good. But when kinks arose in the program, she said, the coach couldn't help her work through them. While the trainer can report problems with medication or the app, these reports do not appear to be more effective than messages sent through the portal, Crom said.

And what if your one-year subscription ends? Crom said she would consider continuing with Calibrate.

Relationships with trainers are a critical element of business models given the need to change behavior. Patients' outcomes "depend on how well they adhere to lifestyle changes," said Found's chief medical officer. Dr. Rehka Kumar.

While the startups offer care for a larger geographic footprint, it's not clear whether the demographics of their patient populations differ from those of the traditional inpatient model. Calibrate's patients are predominantly white; over 8 in 10 have at least a bachelor's degree; More than 8 in 10 are women, the company said.

And his previous marketing strategies reflected this. The September 2020 “segmentation” document laid out three types of customers the company might hope to attract: perimenopausal or menopausal women with incomes between $75,000 and $150,000 per year; working mothers with similar incomes; and “men”.

Calibrate CEO Isabelle Kenyon said the company now hopes to expand its reach into partnerships with large employers, which will help diversify its patients.

Patients 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 and wrote in her blog post that she hopes for more follow-up and a more personal approach. “I don’t think it’s a helpful way to lose weight,” she said.

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