For nearly half a decade, US obesity rates have been on the rise.

A complicated and sensitive subject, diet, genetics, lack of exercise, and social environment all play a role. But now, a growing number of digital health startups and biotech companies have emerged, promising to help prevent or treat weight gain.

From telehealth and personal coaching to prescription injections, are we closing in on an obesity cure? Let’s take a look.

Weight of the World

A leading cause of preventable deaths, second only to cigarette smoking, obesity in the US is a full-fledged public health crisis.

• In the US, 73% of adults and 35% of children are overweight or obese.
• By 2030, 50% of US adults will be obese, and nearly one in four will be severely obese.
• The impact of obesity on the US economy has eclipsed $1.72T, equivalent to 9.3% of the nation’s gross domestic product.

Hardly an isolated instance, in the 1990s, experts warned of a global obesity epidemic.

In the time since, the World Bank called the obesity crisis a “ticking time bomb,” while the World Health Organization said the twin epidemics of obesity and diabetes were a “slow-motion disaster.”

Making matters worse, the COVID-19 pandemic shined a spotlight on this escalating health emergency.

After old age, obesity is the second-leading risk factor for death among those who become infected and critically ill with coronavirus. Further, CDC data showed ~78% of people who were hospitalized, placed on a ventilator, or died from COVID were overweight or obese.

Beyond infections or deaths, COVID-related lockdowns exacerbated existing barriers to healthy eating and physical activity. As the Trust for America’s Health put it:

“Emerging data suggests eating habits shifted, physical activity declined, stress and anxiety increased, food insecurity worsened, and many Americans gained weight throughout the pandemic.” 

Quantifying the impact, the American Psychological Association found that 42% of US adults experienced unwanted weight gain during the pandemic.

Searching for Solutions

According to a Harvard Public Health report, federal policies, nutrition and food industry influences, social norms, and personal responsibility play a role in curbing obesity.

Losing weight is hard, and keeping it off is often unsustainable. A better approach, preventing excess weight gain (especially among children), is key.

• Healthy lifestyle behaviors, including not smoking, limiting alcohol consumption, maintaining a nutritious diet, and exercising regularly, have been shown to reduce all-cause mortality by 66%.
• If all adults aged 18–64 walked 15 minutes more a day, they’d extend life expectancy and boost the world economy an estimated $100B annually.

But, stemming the global tide of obesity will require a multi-faceted approach.

Outlining a “framework for action” on obesity prevention, the World Health Organization lists dozens of steps, including imposing a “fat tax” on caloric snacks, prioritizing health education, regulating food industry advertising, and increasing access to sidewalks and bike paths.

Another factor, The Lancet Commission on Obesity said Big Food is partly to blame for our bulging waistlines. As we detailed in Issue No. 127, the commission compared the food industry to Big Tobacco, suggesting it knowingly profits from unhealthy foods and beverages.

Complicating matters, experts often disagree on how best to handle this crisis.

On one hand, obesity specialists like Columbia University researcher Dr. Rudolph L. Leibel have conducted studies showing that obesity is a disease. Leibel tells patients obesity is “a chronic ongoing medical problem, just like diabetes.”

The hope is that, by classifying obesity as a chronic disease, doctors, patients, and the public will recognize it as a medical condition. As a result, new drugs and treatment options will emerge.

On the other hand, Zachary J. Ward, a public health specialist at Harvard, told the NYT:

“People who choose to blame genetics are fooling no one but themselves. Our genetics haven’t changed in the last 30 years. Rather, what has changed is the environment in which our genes now function.”

According to Ward, the real culprit is an abundance of highly processed food. His solution? Prevention is “the way to go,” he said, adding: “Changes in the food environment are needed at every level — local, state and federal.”

Ending Obesity

As the obesity epidemic intensifies, so does the market for weight management solutions.

• The US weight loss industry is worth more than $72B.
• Globally, the weight management market is expected to top $270B by 2024.
• Digital therapeutics for diabetes and weight loss are projected to reach $19B by 2024.

Taking notice, digital health startups and drug makers are hoping to make an impact and profit.

Noom. Valued at more than $3.7B, Noom raised $540M in funding this spring. The company’s digital health coaching and diet app has been downloaded more than 50M times, earning more than $400M in revenue last year. Now, Noom is reportedly preparing to go public.

Virta Health. A digital platform for diabetes management, in April, Virta Health raised $133M in funding. Peer-reviewed research evaluating Virta’s program showed 52% of patients achieved prediabetes reversal during a two-year period.

Calibrate. Founded in 2020, Calibrate has already raised more than $127M, including a $100M round this year. Combining FDA-approved prescription medication with behavioral therapy, the company offers coaching and weight management services.

Found. Last week, Found, a weight management startup, launched publically. Backed by Atomic, GV (formerly Google Ventures), and Define Ventures, the company offers a “personalized, medically guided” weight management program.

Fella. A telehealth clinic helping men achieve a healthier weight, Fella connects members to FDA-approved medication and lifestyle coaching. The company is backed by Y Combinator, BrandProject, and Global Founders Capital. Note: Fitt Insider is also an investor.

Ro. Last year, telehealth provider Ro began offering Plenity, an FDA-approved weight management prescription. Notably, Gelesis, the drug’s developer, is planning a $1.3B SPAC listing to scale Plenity’s commercialization.

The list goes on… Last month, digital diet app Oviva added $80M in funding. This summer, Form Health landed $12M for its remote weight loss program. And in March, telenutrition company Foodsmart secured $25M.

Next up. Driving innovation in the space, telehealth and prescription medicines are transforming weight management. Within biotech, companies like Novo Nordisk, Eli Lilly, and Versanis Bio are going all in.

This summer, Novo’s weight loss drug Wegovy received FDA approval. Eli Lilly has a similar drug called tirzepatide. And Versanis recently raised $70M to advance development of bimagrumab for obesity treatment.

An uphill battle, obesity drugs still face skepticism from patients, doctors, and health insurers voicing efficacy and safety concerns.

Punchline: From prevention to treatment and everything in between, countering the obesity epidemic should be a national priority. As Tom Vilsack, the US Secretary of Agriculture, put it:

“We cannot have the level of obesity. We cannot have the level of diabetes we have. We cannot have the level of chronic disease … It will literally cripple our country.”