The Science and Supply of GLP-1s
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People have no idea what's coming and how big of an innovation this is going to be. One of my earliest experiences in health care was my pediatrician telling my bomb that I should go to fat cam, a specialist obesity training. They're typically missing a few days. The average one will have four hours of training and obesity and medical school, we're actually all users of top ones. So G, L, P, one is a hormone that we all have.

Obesity, a choice or a condition. Well, regardless of what you believe, this chona disorder continues to impact millions of americans, with nearly seventy percent of americans fitting the description of overweight or affected by O, B, C D.

And moreover, fifty five percent have cancelled appointments due to the anxiety of being wait, at least according to node, while node well is a company trying to rethink obesity medicine and its founder in CEO, broke boy joins A C, C, general partner, a together they discuss, but I will really take to change some of these statistics and how new technologies is like G, L, P ones been into this mix. But herself, self has personal experience in this domain as a former patient with obesity, having even been told by her pediatric that he has to go to a fat camp. Now she's using that fuel to rethink obesity care herself.

Now this episode was also part of our sister podcast, raising health G L P one series. And if you've been paying attention over the last year, job e ones went from being an honest ming acronym to a familiar classic drugs that some recent studies have even packed, as many as one in eight americans trying. The recent adoption of these drugs has also spring ported companies like novels, the manufacturer of olympic, to the largest company in denmark.

So if you, like many others, are interested in learning more about G O P ones, they should tune into the rest of the series on raising health. You can find a link to the show or the full series in our show notes. Let's get started.

Hello, and welcome to rising health, where we explore the real chAllenges and enormous opportunities facing entrepreneurs who are building the future of health.

I malaya.

And i'm Chris. You're joining us for the second episode in our deep dive series on the science and supply of glp ones. Last week, we heard from Carolin jassim, chief medical officer at a moto health. If you haven't listen to that, one is a great primer on glp ones from a clinical experience.

Today we will hear from brook boyar, sky prat, the founder, and CEO of known well, next to week episode will be with chronic mental less of U P M C health plan on the pharmacy implications of gp ones.

Brook talks with vanna agro, a general partner of a teen, by on health, about the value of obesity, specific practitioners, patient centric medical homes and how he thinks the meta lic health space will evolve over a time.

If a patient is given a choice, they prefer a medical, and that's what we've seen with our patients. So we've seen a lot of patients leave point solutions because they say, well, you can also do my primary care. I can occasionally see one person, you are a real doctor who I talk to and why of a charity I know in respect. So I think that really important particularly isn't related to simply management.

You are listening to raising health from sixteen by on health.

I am incredibly excited to welcome to the raising health pod today, brook boyar, ski pat, founder and CEO of an incredible company called known well that we've had the the real privilege of partners with recently Brooks here to join us to share a little bit about how she's looking at the obesity medicine space as a whole, the role that he hopes known well will play there and a little bit about why she's building the company at a personal level. So brook, i'd love for you to just introduce yourself and share the story behind this company has .

such a pleasure to be here. Thank you so much for meta, for having me on. I am a patient. I mean, that's really what brought me to known while and ultimately LED me to founding IT. I'm someone who's been in a larger body in my whole life.

You know, one of my earliest experiences in health care was my pediatrician telling my mom that I should go to account and that really, you unfortunately started the process of how I viewed interacting with the health are system when I came to my body size, and as I got older and sort of, you know, had different educational and work opportunities, IT LED me to move a lot. And every time I moved and reestablished primary care, I felt like I was needing to reestablish the idea that I was a thoughtful person, took my health care seriously, not for any fault of the primary care doctors I met with. They just have a lot of patients every day, and i'm sure it's frustrating for them to see so many patients struggling with the same disease day.

So I was reading, going to the doctor, and he was even harder when I was actually looking for treatment, for my metaphor health, to find something that was accessible to me. And in my very last move, when I was walking to my new pcp for the first time, I started getting curious about if other people feel that same dread you other people who were like me. And I was overwhelmed by the research. And i'll just say briefly, that was kind of the nights and weekends I started pursuing this passion of, could we really create a patient centered home for people with overweight and obesity?

Well, in the venture world, you know, investors talk about founder market fit, and I cannot imagine a more compelling and more deeply connected founder to build a company that's going after tackling not only the bias and access and comfort issues that patients face, but also the care quality.

Let's talk for just a second about your professional background now because it's also really interesting that while you ve had that patient journey and patient connection to the obesity medicine space, you didn't come from health care. So you look a little different than some of our other health care portfolio, C E O S and leaders in the healthcare space, but you're remarkably profited. I'd picked IT up so fast and are so compelling now. But what made you jump? You know you had a background in in finance and consulting yeah you .

know very traditional kind of business background of pen and harvard business school and Cindy and worked at a commercial real estate company. So certainly not in healthy. I joke that i'm sort of glad I didn't know what I was getting myself into when I jumped into known well and creating the company.

But ultimately, I had always hoped that I would one day find something to work on that I felt was my life's work. And before known well, what I was always drawn to was doing a good job delivering for client and being the best colleague and boss I could be in terms of the people I worked with. But if I am being honest, there wasn't a day that I woke up and thought, I am so passionate about commercial real estate today, you right? I mean, I was just something that was important to do well and to deliver for people.

But as I started, i'd always been drawn to health care, like just of a health care industry, because I always felt like how could you have a more direct impact on people than in healthcare? And i'd always joke with my physician friend that they made the right decision going into health care. So I always sort of came together naturally that as I started to feel like there was an opportunity here to really touch eight group that had been underserved, even though it's business deep learning process is sort of felt natural, that I found my way to health care.

Consider me one of your physician friends. It's very happy to have you join the forces in in health care. Let's talk a little bit about what obesity and overweg management and medicine actually as we ve actually we've already use the term a few times.

So let's back listeners for second and just, you know, make sure we're all on the same page. What is obesity medicine like that? A specialty.

What is IT? IT is a specialty. So if we take a step back you to overweight and obesity is defined by BMI, we could have a whole podcast about how that's not the best measure to use, but it's the best in sort of easiest measure we have today to to diagnose the disease, right?

So this is really about living in a body where your weight is higher than your height would suggest on a bell curve. And that put your window over way. Obesity and IT was not long ago.

I mean, the reason medicare, for example, doesn't cover obesity treatment as they see IT as a cosmetic disease. And IT wasn't long ago that that tell everyone viewed overweight, obesity. You in twenty twelve was the first ever your board certification in obesity, so that how recently this disease state has been really viewed as something in the medical community.

And obesity medicine is really about comprehensive treatment of the state of obesity and overweight. And if a person is interested in intentional weight loss, really helping them on that path, both to address the obesity and also potentially other medaba health conditions such as diabetes, hyper lip dema, that second sometimes go with these diseases. So typically, a clinton who practices obesity medicine is a primary care doctor from their medical school and residency days, though not always.

You can see cardiologist in A O B G Y N who do have aboard certification and obesity. And nowadays we have fellowships. So some folks go and do an obesity medicine fellowship.

And then we also have a board certification, and i'll know to actually the fastest growing speciality in the us. And then there's something called the obesity medicine association, which is the largest association of clan clinic to practice obesity. And we're really fortunate that my cofounder in our c mo, Angela fitch, the president of IT.

so what is not a primary care doctor like me who has an over way or obese patient who am really trying to figure out how to serve to help us understand the bridge between and all primary care of physicians in amErica and the subset of physicians who are trained to deliver obesity medicine current and certified to do so, given that we have a situation where over forty percent of all americans actually fit that definition totally.

And you, as we mentioned earlier, everyone doing their best, right? So what? I don't think the differences between a prime amErica doctor who practices and doesn't is how much they wish to help the patient.

So you a cp who doesn't have a specialist obesity training, they're typically missing a few things. The average one will have four hours of training and obesity in medical school. This is an unbelievably complicated disease, right? So very little formal education on obesity, typically very little continuing education on the innovation they are coming onto the market.

So in addition to talk more about that, in addition to the education issue though, they're also typically lacking the resources where they practice. So to practice really great obesity medicine, we also want things like dieticians, health coaches, a movement program, ideally behavior, oral health and even like a good prior authorization process if you're incorporate antti obesity medications. So more most prime work are doctors are practicing without any of those additional services.

And what we'll say to us all the time as look, I suppose I can prescribe something. I don't even really understand them and I don't understand how to get them approved. And the truth is I know the patient needs more help and I don't have the services to help them. Where someone who's been in whose obesity specialize not only has the formal education and the continuing medical education, but they are typically part of weight centres or other groups that have the rap around services.

You mention doctor fetch, that's exactly her background. SHE set up weight centers in multiple you know, places in the country, both held system affiliated and and now at known well. And she's president of the obesity medicine association. But if you could sort of channel, you are thinking, you are thinking known wells, thinking on this topic, what are the key pillars of comprehensive evidence based care for patients with overweight, obesity?

So there's something called weight norm ative medicine and wait inclusive. And it's a way we practice using the broadway here, wait Normative, as you should be. I five four, you should be one hundred and fifty pounds.

And every time you come to the office, i'm going to tell you, you should be one hundred and fifty pounds IT. Turns out patients actually gain more weight when they have experiences like that. The other approach is called weight exclusive, which is hay brook.

I recognized or not one hundred and fifty pounds today. Let's work on the wellness goals and actions you can take inclusive of your current body size. Was really interesting, is the research suggest that actually leads to much Better health outcomes, right?

So at its core is the approach around how do we work with patients. Then there are multiple pillars of the actual action we take. So typically, though not always in the entire obesity medication will be used. We'll talk more about those. Typically, a nutrition program is used either one on one coaching with a dietician or group classes.

You want to address sleep and stress, my engagement that could go as far as someone to undiagnosed left back here and could be as as a light of an intervention as meditation and write in other things that we work on with patients. Ideally, you would include a movement program, which we do, health coaching and remote patient monitoring. So allowing that connective ness to the clinic of having a scale at home if you have hard disease, having a blood pressure coffee home, a connected blue comedy and working with a health coach. And lastly, really a behavioral health, right? So to the extent that a patient is interested in working on their behavioral health in addition to the other medical components, those taken together are really considered red, the core comprehensive program for obesity.

amazing and and referrals to surgeries and other innoventions as me around that rap around the medical care of the right interventions have been matched to the right patients as with all of medicine. Um and I also note that one of the things i've learned from you all. Is just kind of a Better awareness of how much of an adolescent problem we have as well in this country and around the world.

But we've got fourteen million american children and teens also living with obesity. And so this isn't just an adult medicine or adult primary care chAllenge in front of us, is really one that affects the pediatric community. That's a community that's even less um trained on the whole in managing conditions and commodities ties associated with obesity and overweight.

So I think it's just we have a really important opportunity ahead of us in our health care system to get this right, to get obesity and other way evidence based care right and to do IT at scale. So incredibly excited about what your building let's double click on one of the pillars that you mentioned, which are obesity medicines. And not a day goes by at this point where G, L, P ones are not headlining news stories, whether it's around cost access, new new drugs, new therapies or al versions of the therapies. You know anyone reading healthcare news at this point is basically in unladed with G L P one headlines. What are glp ones .

ah you know we're actually all users of G L P ones.

Very good times .

of G L P one is a hormone on that. We all have IT has a lot of different functions, but IT helps with insurance regulation as we eating, consume food. IT affects the speed of digesting after we eat, and IT also affects the feeling of fullness.

So kind of the signals that go to our brain. So what A G L P won, you know, therapy is going to typically want to do is mimic the hormone that we have naturally occurring in our body. And then you'll hear about things like dual and try aga ones, which is, you know, as these drugs get more, they are mimicking additional hormone pathway.

So you are simply just kind of sacking on top of each other. More of the pathways that we believe impact obese as well of as, of course, diabetes. And you know what i'll mention with G, L, P wants in what Angela would say if you on the phone of us.

Doctor fridge is they've been around a really long time where the first L P. One was approved by the fda in two thousand and five. So we often talk about IT as if these came out of thin air. But the truth is especially and ocho logic and physician to have been in the obesity space for a long time, have been using these medications.

When did you first learn about these medications and their potential? And what role did they play in your conception of impact at known? Well, two thousand .

and eighteen was a big year for me because first IT was the first time I i'd ever heard about obesity medicine, had never heard of IT as a sub special tea, and I had seen a prime mary, her doctor in philadephia. And SHE knew I was struggling with my weight. And he said, what you should see, doctor jane collo, she's A A leader in the field in philadelphy and SHE practices obesity medicine.

And I was like, there are people who could just help me so I saw her. And he was the first person who talked about exempt with me. And I thought I was just absolutely wild.

I was like, there's an injectable and IT helps with weight, of course, at the time was being used just to treat diabetes. So that was the first, first time I had heard of the obesity medicine physicians. We're using IT off able at that point to talk about to treat obesity.

But it's really interesting that I feel like I actually had ended up hearing about IT much earlier than that sort of came on to the mainstream. But it's not a surprise that people knew who knew what they were doing. I knew how big of a deal that was. And i'll say when I first started talking to doctor frg and twenty, when IT was a little bit more getting into the public eye, SHE was just like people have no idea what's coming and how big of an innovation this is going to be as these get more obesity indications approved by the fda. So you certainly unfortunate.

yeah, the way last data was staring us in the face in the in the diabetes trials. So IT is all the dates you just mention twenty, eighteen, twenty, twenty or well in advance of kind of the current moment in time when when G, L P one recept agonists have reached peak public awareness. But this is interesting to reflect on that.

That data was sort of steering us in the eyes. What maybe wasn't as obvious just because the studies hadn't been done specifically in patients who do not have dialed but have obesity. What was not obvious was just the role that they would play outside of diabetes, specifically for the indication of weight loss. But um at this point in time, they're in the arsenal. What are some of the biggest maps about G, L, P one drugs?

You one, is that there a miracle that works for everyone? They are our most effective treatment, right? That is that is no no question.

But when you look at the date on the magnetize flashes and backlight, forty percent of patients will lose twenty percent of their body way. So that means sixty person of patient will lose at leeds twenty twenty percent of their body ight. So that's a lot of folks and the data get to Better as you get with newer medications.

So to reappear, ted, sixty percent of patients lose to twenty percent of their body weight. 我 still into a forty percent who done。 And the reason I think that's so important to call loud is wanted, important.

You get the right medication with the right patient, which is not always A G L. P, when they may not be a responder. And the second is, boy, for the patients who fall in that sixty percent or at forty percent, unfortunately, they can feel like a failure.

You know, folks who have already felt like failures of this whole time with their wait often times. And then when they don't turn out to be a responder, I think that what we need to improve the education so that there isn't this shame and stigma around the disease state in the person. The second thing I would say is that there's a myth around the tolerability of these drugs.

So you see a lot of P, B M data and other data sets that show, you know after one year, forty only forty percent of people are still on that the drug. And that often used to show there's a lot of waste. There's a lot of issues with the first.

Sometimes the data are not always is confounded by the fact that people lose access to the medication right from their insurance are then we've jobs or whatever. But even for the people who stay on, what we have found in our clinic with our own research is well over ninety percent of our patient to stay on the medication. And we think the difference is really too fold.

One is Better understanding the patient before you put them on the medication, full health history, family and right, are you putting the right person on the right medication? And then the second is actively managing the symptoms of those patients. So we know exactly what to expect for certain archetypes of patients when they start a medication, whether it's vender, mine or you know majora.

So we are able to say, like hey, we expect in three days you could start to experience na actually eating small meals and making sure you start in the morning even if you're not hungry, will help curve that. Not sure, right? So things you can do to really Better educate the patient and actually reduce those side effects over time.

So I think those are kind of two important myths. I would say there is one last one that doesn't come up quite as often, which is around food quality. A lot of times, people say the food quality no longer matters.

Patients can really eat whatever they want if they are on these medications because they're so effective at reducing and curbing appetite. The last thing i'd say about that is actually, we have pretty good research to show that maintaining or increasing protein intake is unbelievably, it's more important on these medications. It's actually more like having head berry atrix surgery. So when we work with our patients, we have such a keen focus on things like protein and take, even if that means having to supplement and occasionally with a protein borrower shake because IT can be really dangerous to the to long term health to have them you to losing a lot of muscle.

especially there are muscle mass. Yeah exactly. Think sometimes that detail gets lost in the headlines. So let's come back to that. Forty percent of patients who even enter appetite do not sort of hit the weight loss goal that they might have set jointly with, with their doctor. Can you just educate us on what some of the both medical and non medical interventions that we might be able to offer that subset of less responsive patients are?

absolutely. So as I first mentioned, there actually could be a medication met Better for that patient. You know, interestingly, you'll find sometimes that patients who are high responders to fender mine, by the way, and drug that's like ten dollars a month if you get a generic, are Better higher responders than patients for G O, than that patient would be for A G L P.

One part of that, we think is the biological process around what's driving the obesity that they actually respond Better to different medication. So first is make ensure that we're trying different medical therapies and combination therapies to see if there is a more effective medication for them. I actually you're starting with that therapy and moving up to delp ones.

The second, of course, is very atrix surgery. There's a big belief in the market that buried ric surgery Y S going to tank. We actually we have a little bit of a contrary and view there. We feel so many more people are finally seeking treatment that for a period of time, we actually could see an an increase in badia ric surgery because people are finally having these conversations with physicians.

So the a bari atrix surgery, particularly for a higher BMI individual, especially if they aba commodity in today's world, maybe not with innovation ten years on the line, but in today's world, is a really effective treatment. And then there's like the thing is like the nutrition therapy, the behavioral health, this is such a complicated disease state. And what we found with all of our patient is there's generally not a silver bullet. So how do you work across these different modalities and really problems solve with the patient to understand what's going on?

What do we know about the long term impact of these drugs, especially in a world where so many patients are just getting on these drugs? But there exists, as you point IT out, in evidence space of patients who have been on, you know, this drug class since two thousand and five. So what do we learn from that body of data?

So from that earlier data, which of course, we talked to IT, it's gona be limited because it's certain types of patients who who are being tested back then, they seem pretty darned safe, right? I mean, there are a few things like potential risk of fires cancer that have been called out from animal studies, but i've never actually been replicated in human studies, right? Like when you look at real world in cynical trial data, you are not seeing an increased risk of fireworks cancer for patients to a bit on the medication for a long time.

So generally speaking, obviously, there are certain things that are coming out that are still being investigated like suicidal thought and and other potential side effects that they'll certainly keep following up on. But for the best data you appear reviewed, double minded studies that we have today, they're really aren't large concerning kind of pieces of evidence that we've seen in terms of launching ude. No data.

In fact, IT looks like cautious optimism, but IT looks like some of the long term benefits of the drug class over the longer term horizon for patients could be quite interesting with respect to Carry vu lar disease risk, with respect to treatment potentially even reversal of of fatty liver disease and and status sis, potentially even an in fact, on addiction states and other behavioral health conditions.

What do you what do you make of that? How does doctorph have those conversations with patients who come to known well in are curious about this range of yeah of impact. It's really exciting.

But I mean, like you said, they are earlier of the data. The more we want to be thoughtful about our excited around IT. But look, the select trial around cardio ashlar risk was pretty dar compelling was at one large trial.

Yes, right. So we're going to see more data. Obviously, the study that came out around patient tour H I D positive a couple of days ago with their reduction and fatty liver was extremely exciting. We're doing actually clinical trial and fatty liver, to your point, with things like addiction.

While it's early in the data, we see IT in spade in our patients, right? So if you ve talked to a doctor in clinical practice, they will say I would be shocked if the data doesn't end up proving out what we're seeing in our clinical practice. So the way doctor fridge generally talks about this is, again, we we always want to be cautiously optimistic when the data is early, but it's really compelling.

And an in myelinate, I see cancer survivors and obesity and overweight is not the most common complication in in cancer survivors who've been through pretty gressier therapy but sometimes these other states, uh, whether it's unexplained cardy meter olic profiles after a bone marrow transplant or fatty liver disease associated with with prior steroids therapy and things like that.

So there are all these indications that are popping up in places that I wouldn't necessarily have expected but are really encouraging and um make me optimistic about the drug class and the role will play in in improving health outcomes. Let's talk about access clinics like known well are playing an important role in figuring out how to scale access to these medications in a safe way and and in a way that's evidence based um and consistent with where we want these drugs to go based on the on the evidence that you outlined. So what is the best practice for prescribing these drugs? How does a provider determine if a patient is eligible?

Yeah so we think the best practice includes a few things. So patient medical records and know that i'm silly. But really, I mean, it's actually pretty rare in the G L P one space right now.

So understanding the long gitte de al health history of a patient, what are their commodity ties? When did those commodities ties start? right? So we get medical records on all of our patients.

For example, as we talked to the earlier of thorough kind of social and family history, because while the data on things like fireworks, cancer today aren't terribly compelling in terms of being nervous about IT, if you have an answer, a mom who has had a specific type of figured cancer, we're going to have a much longer conversation about of A G L P. One is the right answer for you, just given the data we have today. So thoroughly understanding the patient from those kind of medical perspectives, understanding to have the emotional and behavioral elements of the obesity for the patient.

We always talk about what was the age of what you started struggling with your weight, what's been your highest weight? Because, for example, someone who may eat emotionally could actually meet different kind of intervention from someone who actually just eats in access at different times, right? So there are different elements of how a patient relationship with food has evolved that may impact what their treatment should be.

So I think that is extremely important, something we spend a lot of time on. Third, of course, is what is the patient actually have access. The worst thing you could do is tea patient, after all of this evaluation, spending an hour with you live synchronously.

I think you'd be an amazing candidate for major for zipp bound. And then you find out their insurance doesn't cover IT and it's a formulary exclusion. So for us, we try to have that information on the patient before they even lock in the door. And in the last element is really that synchronous interaction, we think is helpful to occasionally see a patient in person, but we don't always but whether it's live or via video, again, IT sounds a little bit silly, but like being able to see the patient understanding their emotional responsible. You're talking about different and interventions we think is really important.

Couldn't get more. It's not necessarily how all G L P one recept agonist access is happening though today. no. And you're seeing IT. We're seeing IT patients are seeing IT there, emerging different channels through which medication access may become possible. They're still supply shortages and expense hurdles that make those channels not totally a turkey. Going back to comprehensive obesity medicine, how do you think about where that goes in a world where there are other avenues by which patients are understandable looking to access no medication that they think could really help them?

If a patient is given a choice, they prefer a medical home. And that's what we've seen with our patients. So we've seen a lot of patients leave point solutions because they say, well, you can also do my primary care. I can occasionally see when person you are, a real doctor who I talk to and who I have a care I know and respect. So I think that really important particularly isn't related to symptom management.

We come ability code manage to everything else.

And we'd had patient to say to us like, look, I was throwing up for four days. I ended up in the E. R. I couldn't get anyone in the APP to respond to me, right? So I think there's a real patient safety and patient comfort in going to something that more clinically oriented.

But I think to your point, look, patients are so desperate for access that there will always be a role to play, whether good or bad, in some instances of kind of this more direct proscribing with less interaction with the patient. But I think that there are core. Most patients, and i'll speak for myself, want to feel known well, right, like that if they can find that locally, who takes their insurance like that is their preferred method.

So I think both models will exist in the long term. The one thing I would add that was I do wonder if we'll see more spruit me around that proscribing. We have a physician who is joining us from another company who had said, like, look, the big reason i'm read leaving as a year ago, we stopped having any synchro visits with patients. I get a survey and I we all filled out by the patient and I meant to prescribe, but and i've never even seen or talk to that patient synchronous ly, i'm going to go out a yn, i'm not a doctor and say I don't know that that the best medical practice I could claim to be a seventy five old main and if you've never seen my medical record and you've never seen me so I do think we'll probably, at the most extreme end, will see some curbing of that kind of behavior.

What also will change with access going forward.

So it's really important to note that obesity is one of the only disease states that's not a standard benefon insurance. I bet you've never been up a part of a conversation that says is an employer or ensure going to cover breast cancer? It's expensive, but we cover IT.

Are we going to cover diabetes? It's expensive, but we cover IT, right? So I think your obesity ity is more a kindo.

What you've seen with fertility where IT was considered this carve out writer, and that puts employers in the really tough position of we know when they're self ensuring or when they're going to you going to payers and buying something off the shelf. It's not typically within the standard benefit. And that means they need to make a decision about if they're going to include IT or not.

And are they are onna raise their costs. So we think ultimately the most important thing for access and doctor fetch was on the hell on monday advocating for tra. It's getting throw a past which would have medicare cover obesity, which would really be the first step in establishing obesity as a standard part of any insurance benefit.

Until then, IT were left to each insurance company and each employer trying to navigate what's a really difficult solution. We a situation we do think over time, access in terms of insurance is going to continue to improve. We see more medicate state approving obesity treatment. We have never seen the momentum we currently see behind true as IT relates to medicare, and you are seeing your employees and patient to use their voice in getting their their insurance package to cover IT. So we think it's actually gonna be a good new story, particularly as more disease states seem to be treated by G L P ones.

And the argument around treating obesity effectively, having such a wide ranging impact on overall health, on concomitant conditions, whether that abeles, cardiff skate conditions, hypertension know the list goes on, is enormous. So that argument puts obesity in in a special category of something that patients want care for, something that providers want to deliver care for.

yes.

And something that I think ultimately will lower overall medical expenditure in the quest to achieve great health outcomes, which is what we all want. So the for til logy is very interesting and also a big component of access to to great fertility care. The behavior health analogy is also interesting.

IT took some time for our collective communities to understand that that those are medical conditions. They have implications for other medical conditions and for overall patient while being patient cost, patient access, patient return to work. I don't want to lose sight of something you slipped in there, which I just thought I was so beautiful and important.

But you know this idea of building a medical home where patients feel. Known well or well known to their care team is just really beautiful, is something that I think every patient wants, every parent wants for their child know. Everybody wants their doctor to know them well, no matter how much technology is coming into health care.

You want your doctor to feel like they know you well enough to make the right choices when they have many choices, which is kind of the incredible around more entering in obesity and and your doctor is going to have many choices. And so choosing between those choices presumably requires knowing you well. So I just love that that mission, that name we could end.

This is amazing conversation on the topic of a building a company to execute on that mission. How do you scale that? How do you blow IT out to everybody who wants IT?

A lot of things have to go right, right? And they are, you know, one is, look, while obesity medicine is the fastest growing subsequent in the us, we still have like sixty five hundred lines, most of whom do practice obesity. Hundred and fifteen million americans continue to treat that.

So that certainly can't be we just hire every obesity medicine certified physician in the country. So the first thing we're doing is hiring you know APP and physician pcs, right, who have not had the training and obesity but are really excited to get IT and something we do as we train them in depth, in the best practices of delivering obesity medicine. This is actually something doctor fitch does across the country today with pcp.

We do that not only for our own PC, but Frankly, others in the community because we think it's so important for people to expand access for patients. So first is hiring non specialized in addition to specialist physicians so that we can treat more patients and deliver that carrot scale. The second is investing in the technology to help automate this stuff.

That doesn't matter, as you will know, so much of practicing medicine, and especially on the primary care side, so much of that is administrative vely burdensome, but not something that really deepened the relationship between the patient and the physician, right, is things like getting were fls done, getting the imagine the prior of out. So things that are just necessary for care. So we're investing a lot in making sure that those pieces of our process are more automated, that we can scale and leave physicians the time time to spend with their patients.

And that's the last thing I would say is really around physician clinical decision support and productivity. We are big believer s in to treat to serve the patient. You also have to serve the clinic. We know there is a huge burn out problem in the country, so how do we help clinic work to the top of their licensure? We're working on a lot of systems, processes and tools to really reduce step burden for so that they are able to see more patients and to spend time with those patients.

What's something that you've learned as a founder about standing up a business to do all those things and and kind of move closer to your vision around scale? What's something you've learned? They just don't teach in .

business school. You have to be the one who jumps. So i'll fare a little story with you.

I was in hawaii and I was adam, and i'd finally worked up the courage that I scheduled a meeting with my CFO and CEO at five pm that day, which was a big deal. I was on the people executive team to let them know I was going to step down. This is like your prior company.

This is at my prior company because i'm going to start known well and was dreading that conversation, because I love the company so much to love them. And at adam, right before I was going to head out to a farm, I got a text from doctor fetch that said, I know you're gonna quit today. Don't quit.

What if we can't do IT? This is many years ago now. And I, I, I was funny. I looked to my husband. I said, you know what? I'm always gonna have to be the one who jumps like someone. Some founder has to be the one who just says i'm going off the class because someone's got to be the first one to do IT and I call doctor viga SHE does not mind me sharing the story and I said, we're onna do IT and i'm going to be the first person who jumps and I know you'll lend .

up following me I and he did SHE SHE did and .

SHE jumped so I think like, I underestimated, and I don't mean that i'm not a military that or anything else. But I underestimated the amount of courage IT takes as a founder that you focus so much on like what's all the data stuff in the long hours in the building, the team. But it's like every day, you really need to be the person who says i'm all in and i'm going to set the cultural town that like we are going to get there and I just I didn't realize how important that would be on on the path.

I love that. Let's a great note to end on. IT is incredible what you're building in such an important space. On behalf of patients who want to access amazing comprehensive obesity medicine, thank you for joining us on the raising health podcast, and thank you for being all in.

Thanks for having me.

Thank you for listening to raising health. Raising health is hosted and produced by me, Christa, I ocean and me Olivia, a web with the help of the bio and health team at eighteen z. The show was edited by fill hegseth.

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