Personalizing Weight Loss Management With GLP-1 Agonists

Delve into the rising demand for anti-obesity medications, the complexities of obesity management, and the importance of personalized approaches in improving cardiometabolic health in this insightful interview.

Please share your name, title, and an overview of your professional history. 

I'm Dr. Teja Kompala. I'm an endocrinologist by background and have a practice in obesity and diabetes. And at Teladoc, I lead our clinical strategy for cardiometabolic health. So that's a long title, but it means that I'm really deeply focused on our chronic condition management programs. And I always like to say too that I love my job because it's really marrying my clinical practice and staying really closely to evidence-based treatment guidelines, but with the best of the best in digital health. So a really great opportunity to leverage my expertise to a really wide reach to help individuals who have health problems that are really common. 

And at Teladoc, we're really focused on whole person health. One way we do that is through chronic condition management, which is really my focus. But I think what's a really amazing opportunity is that 1 out of 4 people in the US have access to Teladoc programs through their health plans or employers. And really just speaking to digital health having a really big potential for helping many.

Why is there a rising demand for anti-obesity medication such as glucagon-like peptide 1 (GLP-1) agonists? 

Yeah, it's a really good question. GLP-1s, you can't avoid them. They're everywhere, talked about all the time. And really, it's because weight management and obesity is common and it's also hard, right? So in the American population, 40% of American adults have obesity and that number is even higher when we think about overweight populations as well. So that's really a condition that impacts a very significant portion of our population. And understandably, people are looking for solutions and for options to treat it.

And I also say as an endocrinologist, it's really important to understand that weight loss and especially sustaining weight loss over time is hard. And that's because it's physiologically hard. There are so many underlying reasons hormonally, what's going on in the brain, et cetera, that make it really challenging. And I think part of the reason why there has been so much of a bright light on the GLP-1 conversation is weight loss is hard and for the first time in a long while, we have a medication that can really help people to be successful. Especially compared to some of the other older generations of weight loss-promoting meds, the GLP-1s are a lot more tolerable and really more effective than some of their predecessors. So that's why I think there's a lot of attention. Common problem and a pretty effective solution. 

Why is obesity management increasingly complex and costly? 

First, I want to talk about why obesity is complex. And really we've had in the past couple of decades a shift in thinking more about obesity as a disease. You've probably heard that. The Obesity Medicine Association and other professional groups have really wanted to get alignment around the fact that obesity as a disease means that it's not really just something for vanity or a failure of willpower. There are a lot of serious potentially complex results of having obesity. And I think that's part of why it's complex is that obesity itself; there's a lot that we really need to pay attention to then support someone with optimal health. 

I think the other reason why it's complex is that it's socially complex. It's really as much about the individual as it is about health care systems and policy and drug coverage and a whole bunch of other issues. And that's another layer of complexity. And then I think also perhaps unlike other conditions, obesity is a really visible condition. And because of that, it really brings it to attention or really a discussion point in a broader way than what we would do for other types of conditions. 

So I think the complexity is because though we've had a big advancement in our scientific and clinical understanding of obesity, there are a lot of players, as I mentioned, who need to be on board for us to think about obesity, prevention, treatment, and management. And managing expectations and understanding for all of those various players is also really hard. 

For costs though, obesity right now is costly because we're talking about GLP-1s, and GLP-1s as a new med class are expensive. But I would just encourage everyone to remember there are a lot of other costs to consider, especially for untreated or unmanaged obesity. So the downstream impacts on other health conditions, a great example is diabetes or obesity or heart disease that might be related to excess weight. And then other factors too, right? So we talk about absenteeism, presenteeism. So there are a lot of costs to be considered just in general. And I think part of what's a good thing is that it's really so much more central in the conversation because there are some more options for treatment. 

How can employers and health plans better manage the rising demand for anti-obesity medications? 

Well, I like to say demand is a good thing, right? So really, I think the demand for anti-obesity medications is helping bring to the center health, right? It's bringing health and bringing weight management to the center of the conversation. And when I think about a person who might be seeking a GLP-1 or anti-obesity medication, to me It's really signaling, “Hey, I'm really interested in improving my health. I'm really interested in potentially working on my weight and what support can I get for that?” 

And I think employers and health plans have a really nice opportunity to think about how they can support individuals with those goals. And yes, they may be seeing it as, hey, a lot of our members are seeking out anti-obesity medications. And I would say, let's zoom out and take a more holistic and long-term view. These are people who are seeking support, and we have the chance to really be thoughtful and intentional about the way we can go about providing that support. 

So one of the things that I think is really key, and I encourage folks to pay attention to, is are we supporting people with that really comprehensive holistic approach? And our model, I'll speak to that because I really helped to bring my clinical expertise in designing it. But our model really focuses on the lifestyle factors that are within one's control. Nutrition, activity, sleep, and stress are the 4 key pillars that we often talk about. But on top of those pillars, it's appropriate to also give people the access to the clinical support that they need. And access to providers who have obesity medicine experience and who know how to safely manage children, GLP-1s and a broader set of the other anti-obesity meds as well. I think this flexibility and this foundation really help make sure that employers and health plans can help support the individual with really the personalized treatment that they need. 

What advice would you give employers and health plans to support safe and sustainable weight loss and overall cardiometabolic health improvement for patients? 

As we just said, it's really about having a personalized approach. And there is no one size fits all approach to weight loss. That's true of many health conditions in general, and that's absolutely true for weight management as well. And I'd say employers and health plans should really be looking for programs, for solutions that can have flexibility in terms of treatment options and really address those foundational pillars. And what I mean by that is making sure that there's both that lifestyle modification support aspect, as well as having people on the team who really have the experience, have the know-how to be able to think holistically and have different types of options for different individuals.

I'd say too, like, though there's a lot of attention right now on weight management, and again, I think that's a really good thing, [with] weight management a lot of the time comes back to behavior change. And looking for both care teams and programs that have that track record and have that experience in behavior change, I think are some of the things that people should really be looking out for. 

Why are factors such as well-being, lifestyle, mental health, cultural preferences, and social drivers important to consider when treating obesity? 

Again, it's about personalization. But there's a mantra in nutrition that we say the best diet is one that you can stick to. And the underlying point there is nutrition aside, if we think about lifestyle modification approaches in general is we are all different. We all have different preferences, needs, and possibilities within our own context. And that is especially why having flexibility within the individual approach is so key.

And I think when you're thinking about cultural preferences, social drivers, in addition to physical and mental health considerations, you want to have flexibility in the approach. And I think that means flexibility in the tools and support that people have, as well as flexibility in the care teams approach too, right? And bringing it back to weight management and obesity care, two different people may need different focuses, right? So perhaps I might really want to work with the nutritionists to do a deep dive into calories and macros and let them be vegan-friendly. But another person might really need to actually work with a behavioral health specialist to focus on emotional eating or healthy coping mechanisms. And I think that's really part of the need for flexibility is you need to have all the people and the tools within the program, not necessarily that every single person needs all of it, but that for some folks more than others, we would dial this or that up or down. 

What technological advancements best support the use of popular obesity medications and overall weight management? 

I think obesity management can benefit from a lot of the same technology advancements that have benefited others, right? So in that, I'll first just mention virtual care connected devices, those help us with obesity care, but that's true of other conditions too. I won't even talk about virtual care too much, even though that's a main component of a lot of what we do, but we've all really seen that virtual care can do so much just in terms of convenience, access to care, and that goes a long way. But beyond that, beyond the virtual care, beyond connected devices that allow for seamless data exchange, I think the other thing that's really exciting right now as an advancement is our use of machine learning and predictive modeling. This has really transformed and improved the way that we are able to support individuals.
And just as an example as I mentioned a lot of behavior change is about day in, day out, daily actions over time. And that is hard to have that sustained engagement over time that you often need to be really successful with making changes. So we've had some really great work at Teladoc of using machine learning, using corrective modeling to help make the experience really personalized.

So you Hannah, or me Taja, what are the things that that I would really want to see in my email inbox or get nudged about that are going to be the most compelling to me to keep logging in day in, day out and keep working on it? So I think from an engagement perspective, that's really key to a lot of what leads to successful behavior change and successful weight loss outcomes. I'm really excited about the application of machine learning AI there.

Can you explain the trend of employers scaling back or eliminating coverage for weight-loss drugs? Do you anticipate continued coverage changes in the next few years? 

That’s a really good question. And again, it comes back to demand, right? There’s a lot of demand and I would encourage us all to interpret that as a signal that people are interested in emphasizing and focusing on their health and wanting support in that. 

So what I can say is that I know from a lot of conversations that I'm having is that employers and health plans are increasingly looking for solutions that can be highly personalized to the individual. I think that's been the key theme of what we talked about, this personalization. But people are looking for solutions that are highly personalized, and that can really address all of those program components. So those foundational pillars of cardiometabolic health, nutrition, activity, sleep, stress, as well as having the true clinical providers in that virtual room, who have the knowledge and experience. I think we're going to keep seeing that trend to continue. 

And then just one other point that I emphasize is, as a clinician who's been in this space for a while, it's a really dynamic space. Two points that I'd say is one, we have to keep watching the data, right? [There is] more and more data and research every single day with new indications. I expect that there's going to be new conditions that are covered in the future. This is a really dynamic area. 

And relatedly, I'd say as a clinician, I would continue to encourage employers and health plans to just make sure they have really strong clinical guidance. In the same way that we would look to clinical experts to weigh in on a new surgical benefit or cancer treatment, we should really take the same clinically grounded approach to obesity management as well. 

What are the current and potential implications for patients with diabetes as GLP-1 agonists are used by patients without diabetes? 

I think taking a big picture, long-term view, it's really exciting. I care for people with both diabetes and for people with obesity, but no diabetes. And I think just in general, it's really encouraging that there's more and more investment in this space. I think the more attention, investment, and research here is going to pay dividends to both patient populations, to both types of people, right? It will really have benefit to both patients with diabetes and also those with obesity in the long run. So I think it's a good thing. 
I think a final message that I'd say is we've talked a lot about personalization. And I think that flexibility, personalization in the individual approach is key. And just really encouraging everyone to think about it through a comprehensive lens. And I tell my team all the time [that with] weight management, obesity care, yes it is about the number on the scale, it's about the BMI. But if we really think about it, it's about health. And zooming out and thinking about health and all of the other impacts that weight management does have on other aspects of health, too. Keeping health top of mind is a message that I like all the listeners to walk away with.