ARE WE WHAT WE EAT?

Do the new weight-loss drugs spell doom for companies like Weightwatchers?

The news that the company — now known as WW — has acquired Sequence, a telehealth provider that for a monthly fee can prescribe drugs like Wegovy and Ozempic, certainly suggests that today’s drugs pose an existential threat to companies focused on behavioral approaches to weight loss. And Insider reported that Noom, an app that helps users track their eating and exercise habits, has quietly started a service to prescribe weight-loss drugs to some customers.

As BMO Capital Markets analyst Evan Seigerman put it in a note to clients, “Today’s announcement by WW feels reminiscent of the demise of Blockbuster, whose business model was made irrelevant when digital streaming became a reality.”

WW says the acquisition simply follows the science. If you compare the weight loss effects of lifestyle modification (including WW users), bariatric surgery, older pharmaceutical interventions and the new class of drugs, the differences are clear, says Fatima Cody Stanford, an obesity doctor at Harvard Medical School and Massachusetts General Hospital. Wegovy handily beats intensive behavioral therapy across all levels of weight loss.

But there’s still a role for diet and exercise, and that’s what WW and Noom are banking on. Combining the new drugs with lifestyle changes provides (modest) improvements over the drugs alone. And obviously, what we eat and how much we exercise is critical to improving long-term health outcomes like lowering the risk of heart disease or diabetes.

And there could be more a practical upside to integrating apps that track behavioral changes and pharmaceutical interventions: It might help convince insurance providers to pay for these expensive drugs.

Currently, insurance coverage for Wegovy and its competitors is spotty to nonexistent. That’s a huge barrier when the regimen can cost more than $1,600 per month — and when patients must take the drug indefinitely to keep the weight off. WW said as much to investors, noting that the combination creates an approach that “may appeal to payors, employers, and health systems who bear risk to reduce total cost of care.”

And notably, the U.S. Food and Drug Administration approved the drugs with the proviso that they should be used as an add-on to behavioral changes, a position echoed in the positions doctors have taken. For example, when the American Academy of Pediatrics recently made the controversial (but, as I wrote, reasonable) call to include pharmaceutical interventions in its recommendations for treatment of children with obesity, the AAP was clear that drugs should only be prescribed alongside lifestyle changes, noting that “no current evidence supports weight loss medication use as a monotherapy.”

Beyond providing a potential way to convince more insurers that the drugs are worth paying for, the moves by WW and Noom could offer some other advantages for patients.

Today’s drugs pose an existential threat to companies focused on behavioral approaches to weight loss.

Telemedicine could improve access for people who live far away from obesity medicine specialists, or those who are on long wait lists to see one.

None of this means there aren’t plenty of things to worry about when it comes to the quickly changing landscape for weight-loss management, including components of this deal. For example, WW and Sequence have a responsibility to ensure the drugs are only prescribed to those who genuinely fall under their recommended use. If Tiktok trends and Hollywood fads are any indicator, misuse of Ozempic is already wildly out of control. The weight-loss industry needs to be clear that these drugs are not a temporary life hack, but part of disease management.

But the deal is tacit acknowledgment that even weight-loss companies understand that slimming down is about more than sheer willpower. The big question is whether insurance companies are willing to admit that, too.