Many Americans turn to the latest big idea for weight loss—fashion diets, exercise frenzy, ill-suited drugs and herbs, bariatric surgery, and so on. everyone dreams.
Now, a wave of startups is offering access to a new drug along with in-depth behavioral coaching online. But concerns have emerged.
These startups, fueled by hundreds of millions of dollars in funding from blue-chip venture capital firms, have signed up over 100,000 patient and possibly millions more. These patients pay hundreds, if not thousands, of dollars for access to new drugs, called GLP-1 agonists, along with online training to encourage healthy habits.
Early startups position themselves on lofty terms. “This is the ultimate weight loss program you’ll ever try,” a 2020 marketing analysis by startup Calibrate Health said in a message designed to reach one of its target demographics. surname, “Working mother”. (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 reality isn’t cumulative enough: They say they get boxed advice and clinicians don’t. response — and some reported that they were unable to receive the latest medications.
Calibrate Health, a New York City-based startup, reported earlier this year that it 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 a year, excluding drug prices, which can add up to nearly $1,500 monthly without insurance, according to drug price savings website GoodRx. (Insurers reimburse for GLP-1 agonists in limited circumstances, patients said.) Found offers a six-month plan for nearly $600, a company spokesman told know. (That price is inclusive.) generic medicinebut not newer GLP-1 agonists, like Wegovy.)
According to data from Crunchbase, an archive of venture capital investments, the two companies are the beneficiaries of more than $200 million in venture capital combined. The companies say they are at the forefront of weight care, both citing the influence of biology and other scientific factors as key components of their approach.
There is likely to be a large market for these startups. According to the Centers for Disease Control and Prevention, more than 4 in 10 Americans are obese, increasing the risk of cardiovascular diseases and Type 2 diabetes. Effective medical treatments are elusive. catch and hard to reach.
Centers that provide this special treatment Dr Fatima Stanford, an obesity medicine specialist at Massachusetts General in Boston, a Harvard-affiliated teaching hospital, said it was “overwhelming”. Her private clinic has a 3,000 waiting list.
Stanford, who said she has advised some of these telemedicine startups, is optimistic about their potential.
Scott Butsch, director of obesity medicine at the Cleveland Clinic, says startups can provide care with less judgment and stigma than their immediate colleagues. They are also more convenient.
Butsch, who learned about the model through consultants, patients and colleagues, wondered if startups were working “to figure out how patients respond to the drug.” any or not.” He says they should work well with behavioral specialists, as antidepressants or other drugs can cause weight gain. “Obesity is a complex disease, and there are treatments that match its complexity,” he said. “I think programs without multidisciplinary teams will be less comprehensive and in the long run less effective.”
Startups marketing a product have two directions: first, a new type of GLP-1 agonist. According to the manufacturer Novo Nordisk, although these drugs are effective in stimulating weight loss, Wegovy, one of only two drugs in this class approved specifically for this purpose, is in short supply due to difficulty. towels in production. Others in the category may be prescribed off-label. But doctors are often unfamiliar with the drugs, Stanford says. In theory, startups could bridge some of those gaps: They provide clinicians with more specialized knowledge.
Then there’s another prong: change behavior. Companies use remote visits and online messaging with nutritionists or coaches to help patients incorporate new diet and exercise routines. Weight loss figures achieved by clinical trial participants for new medicine—up to 15% of body mass—is associated with such changes, according to Novo Nordisk.
Social media sites are flooded with ads from these startups, everywhere from podcasts to Instagram. A search of Meta’s ad library found 40,000 Facebook and Instagram ads between the two companies.
Complementary advertising to people’s own posts on social media: Many Facebook groups are devoted to the new drug—some even focus on helping patients manage side effects, like change their bowel movements. Rumors are quantifiable: On TikTok, mentions of the new GLP-1 agonist tripled from last June to this June, according to an analysis of investment bankers at Morgan Stanley.
Currently, the customer group of startups is having a fever, an expected craving for these drugs. Alexandra Coults, a former consultant pharmacist for Found, recalls: Patients often complained that their friends bought drugs they were not offered. Coults said patients may have noticed some sort of decoy and switch when, in fact, clinical reasons — like drug contraindications — guide prescribing decisions.
Coults said patient expectations influence care. Customers come in, she says, with ideas shaped by trendy diet culture and New Year’s resolutions. “Quite a few 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 have said intake — starting by filling out a form and going online with a doctor — is perfunctory. When they started taking the drug, requests for advice about side effects were slow to be answered, they said.
Jess Garrant, a Found patient, recalled that after she was prescribed zonisamide, a generic anticonvulsant shown to help with weight loss, she felt “completely weird”.
“I’ve been up all night and my thoughts are racing,” she wrote in a blog post. She had sores in her mouth.
She sought advice and help from the Found’s doctors, but their response, she told KHN, “wasn’t quick.” Non-emergency communications are routed through the company portal.
She said it took a week to complete the drug switch and have a new prescription arrive at her home. Meanwhile, she said, she went to an urgent care clinic for mouth sores.
Company executives said in an interview that Found routinely prescribes generic drugs — often off-brand — rather than just new GLP-1 agonists. Found says older drugs like zonisamide are more accessible than GLP-1 agonists advertised on social media and their own website. Both Butsch and Stanford say they have successfully prescribed zonisamide. Butsch says rapidly increasing the dosage can increase the risk of side effects.
But Dr Kim Boyd, medical director of competitor Calibrate, said older drugs “didn’t work.”
Patients from both companies have critiqued online and in interviews about the behavioral care of startups — which panel experts say is indispensable for treatment. successful weight loss. But some patients feel they simply have boxed advice.
Other patients said they had ups and downs with their trainers. Dana Crom, an attorney, said she has gone through many coaches with Calibrate. Some are good, effective cheerleaders; Others, not so good. But when kinks in the program arose, she said, the coach was unable to help her navigate them. While coaches can report problems with pills or apps, those reports don’t appear to be any more effective than messages sent through the portal, Crom said.
And what about when her full year subscription ends? Crom said she would consider continuing with Calibrate.
The relationship with the coach, driven by the need for behavior change, is an important element of the business model. Dr Rehka Kumar, Found’s medical director, said patients’ outcomes depend “on their compliance with lifestyle changes”.
While startups offer care to a larger geographical footprint, it is unclear whether the demographics of their patient populations differ from the demographics of the traditional model. Calibrate’s patients were predominantly white; more than 8 out of 10 people have at least a university degree; According to the company, more than 8 out of 10 people are women.
And its previous marketing strategies reflected that. The September 2020 “segmentation” document outlines three types of customers the company can hope to attract: premenopausal or postmenopausal women, earning between $75,000 and $150,000 a year; working mothers, with similar incomes; and “man.”
Isabelle Kenyon, CEO of Calibrate, said the company now hopes to expand its reach to partner with large employers and that will help diversify their patients.
Patients will need to be convinced that this model – more affordable, more accessible – is right for them. For her part, Garrant, who no longer uses Found, reflected on her experience, writing in her blog post that she hopes for more followings and a more personal approach multiply more. “I don’t think it’s a helpful way to lose weight,” she says.
Kaiser Health Bulletin 2022.
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