Perspectives across metabolic and obesity care – 1/22

Dear Friends,

Hope you are having a great weekend; here is my Sunday run-down of all things metabolic/obesity care over the past seven days.

Please feel free to connect and reach out on anything that sparks your interest, and also to send me additional articles I may have missed, and indeed new ones you come across next week too.


  • Hot on the heels of JPM, yours truly was quoted in a Kaiser Health News review article of the JPM conference; my favorite sentence of the article was that ‘The buzzy conference had just as many words about profits as about patients.’ For me, as a first-time Founder, it was humbling to be mentioned alongside Hemant Taneja of General Catalyst, Jon Cohen of Talkspace, Ugur Sahin of BioNTech, and Karen Lynch of CVS. I am honored that the reporter, Darius Tahir chose to reiterate my comments that financiers were focused on silver bullets, and investors were looking for simple solutions to health problems, especially with respect to GLP-1 agonists where bankers were ’thinking about the dollars attached to the pill’.
  • In addition, the Davos 2023 conference was in full swing this week. This article on obesity as the root of cardio metabolic disease, written by Isabelle Kenyon, CEO of Calibrate, reiterates upon a number of well-known facts, i.e. obesity rates are increasing, willpower and calories are not enough, and that the obesity pandemic will bankrupt healthcare systems around the world. The focus upon obesity as a chronic disease that is highly stigmatized is important, though the determination of GLP-1 medications as game-changers is likely overstated.


  • Elaine Chen at STAT Health News penned a concerning news article regarding alternative compounded products that mimic GLP-1 agonist drugs; Daniel’s story is recounted of online ordering a vial containing white powder that he mixed with sterile water, and then injected into his lower abdomen, based upon the online chemical supplier’s claim that the product is semaglutide. Similar websites are said to offer what they say is tirzetapide. Daniel was quoted ‘I’m willing to take the risk if it means I can get it.’I guess this is worrying but very real; Jaime Almandoz at UTSW puts it well in that ‘people are desperate to have better health.’
  • Nature published a News Feature titled ‘The ‘breakthrough’ obesity drugs that have stunned researchers.’ In my mind, the most important sentence in the article states ‘The ability to melt weight away by tweaking biology gives credence to the idea that obesity is a disease’. And second is the call-out is ‘…whether people will need to take these medications for life to maintain their weight. A subset of clinical-trial participants who ceased taking semaglutide and stopped the study’s lifestyle interventions regained about two-thirds of their lost weight after one year.’ And third, is ‘…who will respond to these drugs – and who won’t.’ A great article worthy of an end-to-end read.
  • A new weight-inclusive healthcare company knownwell, was launched with the usual fanfare of $4.5M seed funding round. The mission is to ‘…disrupt the healthcare industry by providing comprehensive, empathetic health care – at any size.’ I applaud the focus upon weight bias, with specific reference to anxiety, stigma, barriers and explicit bias. Angela Fitch, MD and President of the Obesity Medicine Association is Co-Founder and Chief Medical Officer, with an intent to ‘recognize(s) obesity for what it is: a chronic and usually life-long disease’ and to deliver ‘inclusive, compassionate healthcare’ that is ’…seamless and accessible’.
  • The Departments of Health and Human Services [HHS] and Agriculture [USDA] announced the appointment of 20 nationally recognized nutrition and public health experts to service on the 2025 Dietary Guidelines Advisory Committee. The Committee ‘… will examine the relationship between diet and health across all life stages, and will use a health equity lens across its evidence review…’


  • CNBC reports on the ‘…billionaires and celebrities’ including Elon Musk and Michael Rubin of Fanatics that have sung the praises of GLP-1 drugs. More interesting to me is the reported launch of Ro Body, from telehealth company Ro. The tagline is to ‘lose weight with GLP-1s’ and followed up by ‘Lose 15% of your body weight’, with an offering of GLP-1 drugs and personal coaching for obesity, as per Zachariah Reitano, co-founder and CEO of Ro. Mr. Reitano was featured in a slot on Jim Cramer’s Mad Money this week. Nothing new here, apart from the fact that Ro is looking to monetize the GLP-1 market; my prediction is of many more telehealth companies soon to enter this market too. I am concerned on the issue and focus upon weight loss per se, and no mention of improvement and resolution of chronic disease to liver healthier lives.


  • A new study from Clarify Health iterates a well known fact – surgical volume is a key determinant of healthcare quality, or as the authors put it ‘Pump up the Volume.’ The research report analyzed over 175K hip/knee replacements performed in 2021, akin to 1 in 7 of all such cases in the US annually. They found that higher procedural volume for hip and knee replacements was associated with better outcomes, i.e. lower rates of readmission, revision surgery, ED visits, inpatient days and orthopedic specialist visits. This related to $2,800 and $1,500 lower costs of care for total hip and knee episode costs, respectively, when performed by a high-volume versus a low-volume surgeon. What is novel here is ‘…that, all else equal, joint replacement surgeries completed in OP and ASC settings are associated with better or comparable outcomes with IP surgeries, with higher patient satisfaction and at substantially a lower cost.’ Importantly, the authors note that ‘..the general public, to the extent that it is even aware of the impact of surgical volume on outcomes, has few resources to proactively identify high-volume surgeons.’
  • The above study was also covered by STAT News to underpin ‘…the importance of the adage “practice makes perfect,” especially when it comes to surgery.’ I would love to see a similar study on the 260K bariatric surgeries performed annually in the US too, and here is an academic paper I published on the topic over 10 years ago.
  • The Journal of the American Heart Association published this week an article on ‘Association of Eating and Sleeping Intervals With Weight Change Over Time. They studied 547 participants over a six month period who recorded on a mobile application the timing of meals and sleep for at least one day. Mean interval from first to last meal was 11.5 hours and was not associated with weight change, and thus does not support a time-restricted eating schedule. Number of meals per day was positively associated with weight change – an increase of 1 daily meal contributed to 0.28kg of weight change. The authors conclude that ‘The frequency, rather than the timing, of meals is a stronger determinant of weight change over time.’ though I would conclude that the degree of weight change is clinically non-significant to put credence to this approach.

Kind regards, Raj


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