Kevin Kumler
We saw over the last 60 years, insulin use skyrocketed. That actually hurt obesity rates because it’s very hard to lose weight while you’re on insulin. And now we’re seeing the same thing with these GLP-1s where people are looking for an easy button and honestly, I think the group that appreciates the easy button most is the medical community. You’ve got really overworked primary care physicians who are seeing more and more of their patients coming in with these diseases. They don’t know how, with their very limited time to see that patient, they’re going to impact their lifestyle, and so they’re resorting to prescribing meds. The downstream implication of that is it’s bankrupting a lot of our healthcare.
Narrator
That was Kevin Kumler describing a couple of the main challenges facing the healthcare industry as the use of GLP-1s continues to climb. Kumler is president of Virta Health, a telehealth company that works with employers and health plans to try and manage type 2 diabetes and obesity. But instead of relying on medication, Virta’s program is based on lifestyle changes, education and coaching.
Kumler acknowledges that GLP-1s have proven successful in helping people lose weight, but he worries that that cost growth associated with their popularity is unsustainable. He also points to studies showing that people tend to regain weight once they go off the drug. Oliver Wyman’s Sam Glick talks with Kumler about that cost question, as well as the role that traditional healthcare systems and public health officials can play in curbing the obesity epidemic.
The Oliver Wyman Health Podcast is brought to you by the global management consulting firm Oliver Wyman. For more insights on the business of transforming healthcare, visit our online publication, health.oliverwyman.com. And now we’ll pick things up with Kumler talking about the personal experience that ultimately led him to work at Virta.
Kevin
It’s a personal journey for me as I’ve shared with some others in public settings before. I unfortunately had to witness this firsthand. We’re closing in on four years without my father, who passed from complications from type 2 diabetes and he struggled with obesity.
Sam Glick
I’m sorry.
Kevin
Thank you. He struggled with obesity and eventually diabetes, and he got the usual care, which was being told that this is a chronic progressive disease and maybe we can use medications to slow it down and a little bit of lip service to lifestyle. And just after he passed, I was catching up with the founder of Virta, and he was sharing that they now had five-year data from their clinical trial showing that there was another way, a way to actually reverse the disease, get people off of meds, and restore their metabolic health. And in digging real deep into the data, which is my background, I saw he was right, it does work, and it is sustainable. And so I’ve been here the last three years trying to help increase access to it.
Sam
And what is that other way? Tell us about Virta.
Kevin
Yeah, it’s really changing people’s relationship with food. Obviously, obesity and diabetes have gotten a lot of attention around the country, largely due to our heavy disease prevalence, and it’s sort of mind-boggling that we’ve become numb to the level of prevalence we have. Three-quarters of adults have type 2 diabetes or obesity or are overweight at this point, closing on 80%. So the vast, vast, vast majority of us. And we’re not really hearing a lot about potential solutions other than maybe medications.
For Virta, we are trying to change the food that people eat and we’re supporting them along the way. The main reason why most diet and exercise programs historically haven’t worked is people aren’t getting that support, that education, and that ongoing help. They might see their primary care physician twice a year for six minutes. What can you really change about behavior in that amount of time? Or if they have a slightly more generous benefit program and they get access to a nutritionist, the typical program is 24 weeks, where you see the person for a half hour every two weeks, but we’re making hundreds of food-related decisions in that amount of time.
That’s why in our program, the person has a coach and a physician who are in their pocket, on their phone, and they’re honestly interacting with them two to four times a day, especially in the beginning, trying to get support on all of those food decisions so we can help them get onto a healthier path.
Sam
That’s terrific. Kevin, as I have — and admittedly I’m not as expert at it as you are — but as I look at the long arc of society’s relationship with obesity and certainly this country’s relationship with obesity, it seems like for a long time we viewed obesity, frankly, as a character flaw, right? It was a moral issue, and you didn’t have enough willpower. In recent decades, we’ve made some progress, I think, to get most people to realize that it’s a lifestyle issue and how you exercise makes a big difference, and that’s easier for some people than others. We’ve certainly drawn the connection to things like type 2 diabetes and a host of other conditions.
And now with the rise of GLP-1s, the Ozempics and the like, more and more people are seeing it as a true medical issue and as something that can be treated with traditional, frankly, sick care medicine. And that seems to be a double-edged sword. On one side, it’s terrific that we have a new tool in the toolbox, but on the other side, the lifestyle modifications still matter for a whole bunch of other reasons, and these new drugs are really expensive. What’s your take on how the market’s evolving and how you think about where Virta sits?
Kevin
Yeah, you raised a bunch of interesting points there, Sam. I’d say to start with your point on, it’s no longer being viewed as a moral failing, I hope that’s a great thing. We agree obesity is a disease, diabetes is a disease, and as we said on the prevalence rates, if 75% to 80% of the US adult population is suffering from one of these diseases, let’s hope it’s not a moral failing because that would mean the vast majority of us are morally bankrupt, which isn’t the case.
There’s an interesting parallel to the original treatment for diabetes and insulin. And if you haven’t read it yet, Gary Taubes, the investigative journalist, put out I think his sixth book on the topic this last January called Rethinking Diabetes. And we were sitting down with him recently and he was talking about how, for diabetes, there had been two treatments originally. There was some with medication, but then mostly it was lifestyle first. And then with the advent of insulin, the medical community sort of stopped with the lifestyle coaching. And my sense is that’s because it’s hard, and if you’re a physician and you’re seeing a patient twice a year for six minutes, you maybe have more confidence that you can impact them with a medication versus trying to dig into the really hard topic of behavior change.
We saw over the last 60 years, insulin use skyrocketed. That actually hurt our obesity rates because it’s very hard to lose weight while you’re on insulin. And now we’re seeing the same thing with these GLP-1s where people are looking for an easy button. And honestly, I think the group that appreciates the easy button most is the medical community. You’ve got really overworked primary care physicians who are seeing more and more of their patients coming in with these diseases. They don’t know how, with their very limited time to see that patient, they’re going to impact their lifestyle, and so they’re resorting to prescribing meds.
The downstream implication of that is it’s bankrupting a lot of our healthcare. People don’t have money to cover this. There was a report that talked about the state of North Carolina, they’re spending $100 million a year on weight loss drugs for their 25,000 employees. That’s up from $34 million two years ago. So the expense and the growth rate, it’s just unsustainable. We need to find a way to take these drugs, which do work, get them in the hands of the people who most need them, but all around they need to be supported by real lifestyle change and that’s how it was intended to be when the drugs were created. It’s on the label. They’re an adjunct to lifestyle change, but they’re being prescribed as the main course for weight loss as opposed to an aid.
Sam
We know from all sorts of research, and I think all of us from personal experience, that getting somebody to change something that feels good in the short term but has a long- term benefit seems to be counter to human nature in many ways. What has Virta figured out about that? This is the same sort of challenges about why don’t people save, why don’t people do all sorts of things, right? Lifestyle changes related to weight and health are in that category.
Kevin
That’s a great question. I’d say a couple of things. Number one, I do think people fundamentally want to be healthy and they like feeling healthy. If you look at the amazing progress we’ve made in this country over the last 40 years on smoking cessation, smoking’s not totally gone, but dramatically fewer people smoke today, we’re seeing the health benefits of that.
Now, if you compare that to, again in this case, losing weight, what most people have been recommended to do is basically go hungry. It’s a calories in, calories out model, and that means we’re relying on their willpower to maintain results. And we would fundamentally say any system that’s built on willpower is going to fail eventually, and Virta is not really built on willpower. We tell our patients to eat until they’re full. We’re just helping them eat the right kinds of foods that will satisfy them and fill them up. The common example we’ll give, you could probably eat a whole bag of Doritos and still be hungry afterwards, but if you have a piece of cheese or some eggs or something that’s a little bit more satiating and satisfying, you may not be hungry for hours. And that’s the difference.
We’re surrounded by a food environment that has quick fixes to our hunger, and they’re made to be honestly slightly addictive. We keep eating them, but we never satisfy ourselves. And what the Virta team is trying to do is help people realize they can feel satisfied. They can eat foods they love, they can eat versions of the foods they’ve been eating their whole life, and they can feel a lot better. And that’s the other thing that I think we’ve seen is people pretty quickly, if they have type 2 diabetes, they’re coming down off their insulin, they’re losing weight for the first time in years, they’re getting more energy, they’re sleeping better. And through that, that gives them the real desire and courage to keep going and work through the setbacks that are inevitable, because as you said, we’re all human and we’re going to have ups and downs in the journey, but they see success soon enough and they see that it’s sustainable from the beginning so that they end up sticking with it.
Sam
What do you think of the role of government and public health around this question? Because if we go with the smoking analogy, we had a multi-decade public health campaign to convince people smoking would kill them, to tax cigarettes, to literally sue the tobacco manufacturers. That was an effort on all fronts, which we haven’t seen on food in the same way.
Kevin
I would say that’s absolutely what we need. I don’t think anyone would look back at the anti-smoking campaign except for maybe RJ Reynolds and say that that was a mistake. It was a huge public health victory, and I know parts of the country at this point maybe have lost some faith in some of our public health and public policy groups, but we absolutely need this kind of bipartisan, cross-departmental cooperation to attack this because it is the food environment that’s killing us. I don’t think there’s any debate about that. The stats are pretty clear, just like they were with cigarettes, and we’ve seen some signs of hope.
The White House hosted a conference on nutrition and hunger just over a year ago, and Virta was invited to join. I was able to go to that and see a pretty large group of people who have been passionate about this concept for a while, but it was the first conference the White House had hosted on nutrition in 50 years. So you can imagine how much updating and work there is to be done, but we absolutely do need this kind of public health, public policy approach because it’s not going to be one group alone that solves this problem for us.
Sam
Kevin, I’m curious, the other part of the equation, and you mentioned it, people going to their doctors and getting six minutes, and a lot of physicians are doing their best, but you write a prescription and that’s what you do. Our traditional sick care system, which is pretty transactional, was not really designed to help people with lifelong lifestyle changes. And in fact, I think that’s part of why the Virta team designed Virta in the way it is. It’s a supplement to that system. But what role should the traditional system play in helping people with obesity, type 2 diabetes, and other lifestyle diseases? How do you think about the person in the white coat or the health plan in this equation?
Kevin
Yeah, I think they all play a role. We coordinate quite closely with our patients and our members, primary care physicians. Many of our members have multiple chronic conditions that they’re dealing with, many of which get better as they’re working with us because it turns out when you stabilize your blood sugar, you get off of medications that may have side effects and you lose a clinically significant amount of weight, a whole bunch of things get better, not just your blood sugar.
I think part of it is coordinating within their care system, and part of it is making sure that this is covered and incorporated by their health plan, which is increasingly happening. When we first started, we worked mostly with employers, and that’s still a large part of what we do, but increasingly health plans are seeing what Virta does as a way to help lower the total healthcare costs and drive improvement across the population.
So this certainly is multidisciplinary, and I think for physicians, I love the philosophy from Peter Attia whose book Outlive, published last year, was my favorite book of the year. He talked about our sick care system and talked about currently our system, described as medicine 2.0, which is really invasive and aggressive intervention, but too late in the disease progress. And he talked about a model of more medicine 3. 0, which is what Virta does, which is identify the risks and intervene aggressively early.
We started working with people with type 2 diabetes exclusively in the beginning, and those were people whose disease had progressed quite a bit. As of this fall, we’ve started enrolling more people every month for weight loss, which is often an issue on the journey to type 2 diabetes. And we have employers who are now investing in Virta’s program for their members who have overweight. And so we’re seeing that investment coming in a little bit early and that kind of medicine 3. 0 approach of you have these risk factors for heart disease, diabetes, cancer, dementia that can be ameliorated if you get involved in the disease a little bit earlier. And there’s no reason why that can’t be happening more and more often in primary care.
Sam
That takes me to my next question. Thinking now not so much about the offering or the public health challenge we have, but about the business of obesity. Virta’s done very well. You’ve grown pretty dramatically over the last several years. I remember that not that long ago when the diversity of diets offered to people was pretty wide. Most of them didn’t work. But the joke used to be that if you wanted to eat something on a diet, you just needed to find the right diet and it would be the great food diet or the low-fat diet or the Atkins diet or the whatever diet. It now feels like everybody’s gotten on the GLP-1 bandwagon and fast. That whatever you were two years ago, you’re now a GLP-1 company if you’re in this space.
At the same time, as you mentioned, we know that obesity affects a whole range of health issues, both mental and physical, and we also know that these drugs potentially have an impact on other behavioral oriented issues like substance abuse, like gambling addiction, like all sorts of things. What happens to this space over the next few years? Do we see a bunch of consolidation because many of the players are the same? Do we see a broadening into behavior change well beyond weight and the kind of lifestyle factors we think of today? Where does it go?
Kevin
Well, I wish I knew exactly where it’s going to go, but I certainly have some perspectives. I think there’s going to be a lot of thrash in this space. There are a few things that are probably incontrovertibly true at this stage. Number one, these drugs work. People lose a significant amount of weight when they’re on these drugs. Number two, when the drug is removed, typically the gains get reversed. So that’s what we’ve seen in the clinical trials for the drugs themselves in almost all of the real-world data, and I’ll come back to the almost in just a second. So they’re highly impactful only while the people are on them and they’re extraordinarily expensive. We shared some data points earlier on the kind of cost this is having on health plans, employers, state budgets, et cetera. Because of that, there needs to be a holistic program put around this.
And when I said the weight comes back, the gains are reversed in almost all the published data. That’s because we published data showing that for Virta members who had a GLP-1 removed, we successfully deprescribed them, our members were actually able to sustain their weight loss at six and 12 months afterwards. And to our knowledge, this is the only publishing that has shown this. So it shows there can be life after GLP-1s and success after GLP-1s, which I think is critical because in the meantime, all of these companies that are coming into the space, in many cases, they’re diet companies and diet companies that are adopting GLP-1s to make their outcomes look better because they haven’t been able to help people sustainably lose weight, and get people to stay in their program. But for the payer, at the end of the day, this is a$ 10,000 a year per member program that looks like it’s indefinite. They have to find another way.
I think you’re going to see more companies trying to do what Virta is doing, which is sustainably change lifestyle over time. Same time, I think you’re going to see the pharma companies find more and more uses for these drugs. They’re now getting indications for cardiovascular treatment. I would expect some of the other areas you mentioned like mental health will also try to get indications for it. That is pharma’s business model. They develop a molecule and then they try to apply that molecule to as many people in as many conditions as possible. But again, the underlying cost and the prevalence we’re talking about, this isn’t a drug that’s going to be used for 5% of the population, this is a drug that they’re talking about using for the majority of the population. So we really do need to find another way, and I hope all of the competition is around, how do you help people lose and keep the weight off because ultimately that’s what’s going to make them healthier.
Sam
So Kevin, as we wrap up here, I’ll ask you the question that I ask all of my podcast guests. You spent a lot of time in this space. You’ve had experience with healthcare more broadly. You’ve had a personal experience with your father. If you had all the time, money, and influence in the world and you could do one thing to make healthcare better, what would you do?
Kevin
Oh, I would definitely attack the food environment, and I’d attack it everywhere. I don’t know when was the last time you were in the hospital, hopefully not recently. I had my appendix out in the fall, and the food they tried to give me was not consistent with the lifestyle I try to live while I’m at Virta. If you pass a vending machine in a hospital, you’ve got physicians who are running between cases and their only options often are candy bars. I visited health plans who have energy bars, which are essentially candy bars in the wrappers. If you go into the average school, they’re covering all kinds of stuff subsidized by our tax dollars that in most cases aren’t healthy for them. So I would certainly spend that money trying to pull together different groups to help impact our food environment, so we don’t need to intervene as aggressively with as much of the population as we do now.
I would love it if Virta was a niche company serving 5% of the population who desperately needed our help. And unfortunately, it looks like we’re going to apply to a much larger portion of the population, largely because of this food environment we’re all trapped in. If I were infinitely wealthy, I would attack the public health side of this personally. And in the meantime, we’re going to do our best to make sure there’s an option out there to help people be healthy that is not subscribing them to a lifelong drug regimen.
Sam
From your mouth to God’s ears, Kevin Kumler, thank you very much. I really enjoyed the conversation and keep up the good work.
Kevin
Thanks for having me, Sam. I really appreciate it. This was fun.
Narrator
The Oliver Wyman Health Podcast is brought to you by the global management consulting firm Oliver Wyman. For more insights on the business of transforming healthcare, visit our online publication, health.oliverwyman.com.
This transcript has been edited for clarity.
