Many Americans are turning to the latest big idea for weight loss — fad diets, fitness crazes, absurd herbs and pills, bariatric surgery, just to name a few. They rarely dream of magic solutions people.
Now a wave of startups offers access to a new category of medicine combined with intensive behavioral coaching online. But concerns have already arisen.
These startups, fueled by tens of millions of dollars in funding from blue-chip venture capital firms, have signed up more than 100,000 patients and could reach millions more. These patients pay hundreds, even thousands, of dollars to access new drugs known as GLP-1 agonists, along with online coaching to encourage healthy habits.
Startups initially position themselves at the top. “This is the last weight loss program you’ll try,” says a 2020 marketing analysis from startup Calibrate Health, with messaging designed to reach a target demographic, 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 consumers complain online that the reality is less than the buildup: They say they’ve received canned advice and unresponsive doctors — and some report they can’t get new drugs.
Calibrate Health, a New York City-based startup, reported earlier this year that it served 20,000 people. Another startup, Found, headquartered in San Francisco, has served 135,000 patients as of July 2020, CEO Sara Jones Simer said in an interview. Calibrate costs patients about $1,600 a year, not counting drug costs, which can hit about $1,500 monthly without insurance, according to drug price savings site GoodRx. (Insurers reimburse GLP-1 agonists in limited circumstances, patients said.) A six-month plan is available for about $600, a company spokeswoman said. (That price includes generic drugs, but not newer GLP-1 agonists, such as Wegovy.)
The two firms are beneficiaries of more than $200 million in combined venture funding, according to tracking by venture capital investment fund Crunchbase. The companies say they are pioneers in weight care, both citing the influence of biology and other scientific factors as key elements of their approach.
There is probably a big market for these startups. According to the Centers for Disease Control and Prevention, more than 4 in 10 Americans are obese, increasing their risk of cardiovascular conditions and type 2 diabetes. Effective medical treatment is elusive and difficult to access.
Centers that offer this specialized care are “overwhelmed,” said Dr. Fatima Stanford, an obesity medicine specialist at Massachusetts General in Boston, a teaching hospital affiliated with Harvard. His own clinic has a waiting list of 3,000 people.
Stanford, who said he has advised several of these telemedicine startups, is bullish on their potential.
Startups can provide care with less judgment and stigma than private counterparts, says Dr. Scott Butts, director of obesity medicine at the Cleveland Clinic. They are more convenient.
Bush, who learned about the model through consultants, patients and colleagues, wonders if startups are working to “strategically figure out which patients respond to which drugs.” 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 treatment that matches its complexity,” he said. “I think programs that don’t have a multidisciplinary team are less comprehensive and less effective in the long term.”
The startups market a two-pronged product: first, a new class of GLP-1 agonists. While these drugs are effective for weight loss, Wegovi, one of two in the class specifically approved for this purpose, is in short supply due to manufacturing problems, according to its maker, Novo Nordisk. Others in the category may be prescribed off-label. But doctors generally aren’t familiar with the drug, Stanford said. In theory, startups could fill some of these gaps: They offer more specialized, knowledgeable physicians.
Then there’s the other prong: behavioral change. Companies use television and online messaging with nutritionists or trainers to help patients incorporate new diet and exercise habits. According to Novo Nordisk, weight loss figures achieved by participants in clinical trials for new drugs – up to 15% of body mass – were tied to such changes.
Social media sites are bursting with ads for these startups everywhere from podcasts to Instagram A search of the Metar ad library found 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 devoted to the new drug — some even focus on helping patients manage side effects, such as changes in their bowel movements. The buzz is measurable: On TikTok, mentions of new GLP-1 agonists tripled from last June to this June, according to an analysis by investment bankers Morgan Stanley.
There is now a feverish, anticipatory appetite for these drugs among the startup’s clientele. Patients often complain that their friends got a drug they weren’t prescribed, recalls Alexandra Colts, a former pharmacist consultant at FOUND. Coults said patients may experience some form of bait-and-switch in prescribing decisions based on clinical factors — such as drug contraindications.
Patient expectations affect care, Coults said. Consumers come with ideas shaped by the culture of fad diets and New Year’s resolutions, he said. “Several 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 said the intake — which began with filling out a form and progressed to an online visit with a doctor — was unconscionable. Once the medication was started, they said, requests for counseling about side effects were slow to respond.
Jess Garrant, a found patient, recalled that after being 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. He has sores on his face.
She sought advice and help from the doctors she received, but their answers, she told KHN, “were not in a hurry.” Any emergency communications are routed through the company portal.
It took a week to complete the drug switch and have a new prescription arrive at her home, she said. Meanwhile, he said, he went to an urgent care clinic for a mouth sore.
Found are often generic drugs — often off-label — rather than just new GLP-1 agonists, company executives said in an interview. Older generics such as zonisamide were found to be more accessible than GLP-1 agonists advertised on social media and their own websites. Both Boots and Stanford say they have successfully prescribed zonisamide. Increasing the dose too quickly can increase the risk of side effects, Butch said.
But Dr. Kim Boyd, chief medical officer of competitor Calibrate, said the older drugs “just didn’t work.”
Patients at both companies have criticized the startup’s behavioral care online and in interviews — which experts across the board maintain are integral to successful weight loss treatments. But some patients felt they had only canned advice.
Other patients said they had ups and downs with their coaches. Dana Croom, an attorney, said he went through many coaches with Calibrate. There were some good, effective cheerleaders; Others, not so good. But when conflicts arose in the program, he said, coaches couldn’t help him navigate them. Although instructors can report problems with medications or apps, those reports appear to be less effective than messages sent through the portal, Crome said.
And what happens when his year-long subscription ends? Crom said he would consider continuing to calibrate.
Relationships with coaches, in need of behavior change, are a critical component of the business model. Dr. Rehka Kumar, the foundation’s chief medical officer, said patients’ outcomes depend “on how compliant they are with lifestyle changes.”
Although startups offer care in a larger geographic footprint, it’s not clear whether their patient demographics differ from traditional brick-and-mortar models. Calibrate patients are excessively white; 8 in 10 have at least a bachelor’s degree; According to the company, more than 8 in 10 are women.
And its earlier marketing strategies reflected that. In a September 2020 “segmentation” document, the company can expect to attract three types of customers: perimenopausal or menopausal women, with annual incomes of $75,000 to $150,000; working mothers, with similar incomes; and “men.”
Isabelle Kenyon, CEO of Calibrate, said the company now hopes to expand its reach to partner with larger employers to help diversify patient populations.
Patients need to be convinced that the model – more affordable, more accessible – works for them. For his part, Garant, who is no longer using Found, reflected on his experience, writing in his blog post that he expects more follow-up and a more personalized approach. “I don’t think it’s a helpful way to lose weight,” she said.
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