Restoring Balance in Obesity Treatment

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Today, an increasing number of people are seeking treatment for weight management, but significant access barriers remain. While advancement in therapeutic options has been rapid and impactful, the broader care delivery infrastructure remains nascent—there simply are not enough providers to care for all of the potential patients. Innovative technologies and changes to how the disease is viewed could bring things back into balance. 

During our 2^nd Annual BMO Obesity Summit in New York, I sat down with Sloan Saunders, CEO and Co-Founder of FlyteHealth, and FlyteHealth’s Chief Medical Officer, Dr. Leon Igel, during our Obesity Care Innovations Panel to discuss how physicians, insurers and healthcare plan providers can leverage technology to enable effective, cost-efficient medical weight management.  

Sloan Saunders co-founded FlyteHealth, an online platform that connects medical professionals with patients seeking care for chronic weight management, with his wife, Dr. Katherine Saunders, M.D., Obesity Physician & Co-Founder of FlyteHealth, in part because they witnessed a supply-demand mismatch while she and Dr. Igel practiced at Dr. Louis Aronne’s Comprehensive Weight Control Center at Weill Cornell Medicine. 

“(At this rate), those supply-demand lines will never intersect,” Sloan Saunders said. A way to bridge that chasm? “Use technology to optimize what care is being delivered and how it’s being delivered,” he explained. 

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To deliver effective treatments, care providers must acknowledge the heterogenous nature of obesity, both in terms of causes and approach for treatment, including behavioural and therapeutic interventions. It’s essential to develop an intake process that considers an individual’s background. For example, it is critical to evaluate weight and sleep history, underlying medical conditions, cravings, and appetite, along with key data from metabolic analyses and broader health risk assessments.  

FlyteHealth does this by looking at the medications taken by patients that may cause weight gain, as well as calculating the severity of their disease, Dr. Igel noted. Clinicians then aggregate this information to develop patient phenotypes – sets of observable traits, or profiles, used to predict which medications and lifestyle interventions are most likely to help specific individuals.  

By considering these factors together, “we can predict (to a pretty good degree) who’s going to be at least reasonably responsive as long as the medication is tolerated,” said Dr. Igel. 

One of the biggest challenges in chronic weight management is the shortage of trained physicians and allied providers. Saunders and Dr. Igel stressed that drugs such as Ozempic, Wegovy and Mounjaro – which mimic the effects of the GLP-1 hormone to reduce appetite and blood sugar – don’t work for everyone. That’s why physicians need to be educated on obesity treatments beyond these medications.  

“Most residencies, most fellowships, don’t touch obesity management at all, even though 75% of the U.S. population are dealing with it,” said Dr. Igel.  

For those with an exceptionally high body mass index (BMI), diabetes, advanced heart disease, sleep apnea or other comorbidities, GLP-1 agonists are a reasonable first-line option, said Dr. Igel. But for patients predisposed to lower basal metabolic rates or who can feel full without excessive appetite, this class of drugs is less likely to help.   

“If someone’s coming in with a BMI of 27 and high cholesterol, I can [work to] get their weight back to normal without the ‘bazooka’ of the GLP-1,” he said, noting the drugs’ potency.  

Another apprehension for patients, insurers and health plan providers is the cost associated with widespread usage of GLP-1 therapies.   

“For many payers and self-insured entities, cost is still a big concern,” said Saunders. “And so how do you navigate that? How do you still use many of the other medications in tandem with the GLP-1s to bring down the average spend across the board?” 

Dr. Igel noted that one way to ensure these expensive therapeutics are covered by payers is by being judicious in their use and not prescribing them to all patients that need medical intervention to manage weight. A patient-specific approach that identifies who would be better-suited for alternative medications not only improves outcomes and adherence to treatments, but it could also reduce payer costs. 

FlyteHealth works with payers to analyze treatment costs and benefits at the program level. Recently, the State of Connecticut signed a multi-year partnership with FlyteHealth based on a successful pilot that provided effective and cost-effective medical obesity treatment to State employees and retirees.  

“We worked to optimize care and create a transparent way to deliver that care at the best level of clinical expertise,” said Saunders. Their next step? Proving it worked.  

“We’re in the process of publishing with a well-known actuary company the economic impact we’ve seen in a relatively short period: 86% adherence after the first 12 months and multiple millions of dollars in savings on the pharmacy side alone,” Saunders explained.  

Saunders speculated that the cost to treat patients could continue to decline, as algorithms better predict potential outcomes and as new medications come to market, and Dr. Iger agreed.  

“It’s an amazing time to be in this space. I’m incredibly optimistic seeing what’s potentially coming down the pipe because if we’re having success now, with the small number of options on the market, expand that, double it, triple it and then let’s see what the space looks like.”