From Medication to Motivation: How Employers Can Lead the Weight Management Charge

Dr. Adonis Saremi and Cody Fair from Noom join this to discuss the significant impact of GLP-1 medications on weight management conversations within the employer space. Cody, the Head of Commercial Healthcare at Noom, shares insights into how these medications are elevating the importance of weight management in employer health programs. Dr. Saremi, Noom’s Interim Chief Medical Officer, emphasizes the collaborative effort at Noom in integrating clinical protocols, safety, and quality into their offerings.

Cody highlights the rising interest in GLP-1s, especially weight management overall, stressing the need for comprehensive weight management solutions.

"GLP-1s have put weight management near the top of the list of issues employers need to address." – Cody Fair

Dr. Saremi elaborates on the effectiveness of GLP-1s when combined with lifestyle changes, underscoring the importance of adequate support and guidance for patients.

"The combination of lifestyle changes, education, and medication works synergistically to create better outcomes." – Dr. Adonis Saremi

The discussion examines the role of employers in ensuring employees receive the necessary medical support and the holistic approach Noom takes in addressing both physical and mental health aspects of obesity care.

Key Takeaways

  • Elevated Importance: GLP-1 medications have propelled weight management to a top concern for employers.
  • Comprehensive Support: Effective weight management requires a combination of medication, lifestyle changes, and ongoing support.
  • Mental Health Integration: Addressing mental health is crucial in the context of obesity care, with Noom incorporating depression screening and comprehensive medical history assessments.
  • Holistic Solutions: Noom aims to provide a seamless integration of weight management solutions within existing employer health benefits, focusing on prevention and chronic disease management.

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Episode Transcript

[00:00:00] Nicole: Welcome back to Healthcare on the Rocks, Employee Benefits with a Twist. I'm Nicole Belles, SVP of Product at Springbuk.

[00:00:10] David: And I'm David Pittman, the Senior Director of Marketing here at Springbuk. Today, we have two incredible guests from Noom. First is Dr. Adonis Saremi, who is the Interim Chief Medical Officer, and Cody Fair, who's the Head of Commercial Healthcare. Welcome, gentlemen.

[00:00:28] Cody: Thank you for having us. We're glad to be here.

[00:00:31] David: Yeah, great. Great to have you.

Cody, some of our audience might recognize you as a former Springbuk employee. We're happy to have you back and, you know, finally, give you your airtime here on the podcast. Why don't you tell us a little bit about what you do over at Noom?

[00:00:48] Cody: Yeah, I appreciate it and I'm glad that you all finally let me on the podcast. I had to circle back. Uh, yeah, so at Noom, I am our chief commercial officer, so responsible for marketing, sales, customer success, and then our biz ops and strategy teams here.

[00:01:06] David: And Dr. Saremi, how about you?

[00:01:09] Adonis: I serve as the interim chief medical officer at Noom,  work closely with our clinical team, of course, in terms of clinical protocols, safety, and quality, and also work collaboratively, with Cody and the B2B team, product team, you know, operations team, um, and yeah, I must say it's a collaborative effort here at Noom.

[00:01:31] Nicole: Well, let's dive right into it. I'm really excited to have Noom with us to talk. So, Cody, let's, let's start with you. GLP-1s, they are the hot topic. Um, how have these changed the weight management conversation with employers?

[00:01:50] Cody: Yeah, to, to your point, um, it is a hot topic like I've never seen in my career. Um, it is dominating the airwaves. Um, you know, pretty much everything right now where I would say it's what it's changed from an employer standpoint is it's put weight management, um, near the top, if not the top of list of issues that they need to take care of.

Even for employers that may not necessarily be covering GLP-1s right now, certainly not all employers are. It is still putting the conversation up there where they need to do something around weight management, um, and put a solution in place. So it's, it's really, you know, I think in years past mental health, telehealth, SDOH, which certainly are all things that are very important, but it's really kind of leapfrogged the weight management category to a level that it previously was not.

[00:02:42] David: Yeah, indeed.

[00:02:44] Nicole: I was going to say Oprah even did an ABC News special.

[00:02:48] Cody: I mean, yeah, Oprah's out there talking about it, right?

[00:02:51] David: Yeah, that's great. So, Cody, I'll start with you. I want both of you to respond to this one, though. What role do you think employers can play in helping to ensure that their employees do receive the, the adequate medical support and guidance on, um, using these medications?

[00:03:10] Cody: Yeah, I will, so to start out, you know, I would say there, there's certainly concerns on where you're getting the medications, right? There's a lot of places that you can get GLP-1s right now. But I think even more importantly is the support that's coming alongside that. You know, we all know that primary care physicians are incredibly busy.

Yeah. And they don't necessarily know what happens outside of those four walls. Um, so you may have a script for a GLP-1, but not receiving the support you need alongside that per FDA label, should be used as an adjunct to diet and exercise. And that's really where the employer can come in and help and make sure that the, their members are essentially receiving the support outside of just the medications.

[00:03:57] Adonis: That was well said, Cody. I really echo those remarks. Of course, these medications are highly effective. GLP-1s is a new class of what we call highly effective anti-obesity medications, you know, these lead to reductions in weight, you know, 15%, even up to potentially 25%, um, which naturally, you know, is associated with reduced mortality, morbidity reductions in, you know, hemoglobin A1Cs in terms of diabetes or prediabetes, reductions in blood pressure, but it's not the medications alone.

I think it's critical for you to have a companion, essentially, you to help guide you in between those visits in order to really implement sustainable lifestyle changes such as diet, exercise, and when you're taking these medications, there's a potential risk for, you know, muscle loss or loss of muscle mass.

So in ensuring that you're implementing a resistance training, taking adequate protein intake learning how the medications work, learning about the potential side effects. And I think the combination of lifestyle changes, education and the medication together work synergistically to kind of create better outcomes.

 that's kind of what I would have to say about that.

[00:05:02] David: Okay. Well, let's let's dig into that one just a little bit, Dr. Saremi. The literature that Noom has out on your website and other places does talk about the tailored lifestyle and behavior change. You just mentioned it's a lifestyle change. So can you maybe explain for all of us what those terms mean a little bit more and especially when you're talking about obesity care?

[00:05:30] Adonis: Certainly, yeah, thank you for that clarifying question. When I say lifestyle change, what I mean is things like dietary habits, physical activity levels. Of course, as Cody alluded to, these medications, this new class of medications, GLP-1s, should be used as an adjunct in combination with lifestyle changes, such as, you know, again, reducing your saturated fat intake, improving your lean protein intake, reducing your carbohydrate intake, also implementing activity, you know, at least 150 minutes a week is what's typically recommended.

But certainly, in the setting of GLP-1s, you know, when you lose weight traditionally through lifestyle measures around 20 percent of your weight loss is due to loss of muscle.

The additional 80 percent is due to loss of fat. When we're talking about GLP-1s and the robust effect reducing, you know, weight by up to, you know, 25%, what happens is that you have a higher propensity to lose muscle mass. So around 30 to 40 percent of that weight loss is due to loss of muscle mass.

So again, implementing resistance training, educating patients, really advocating for the appropriate amount of protein intake become really critical because what could happen potentially is once you stop the medication, you could regain weight and that weight could essentially be fat, and you'd lose that protein and what we call sarcopenic obesity, which has its own potential negative implications.

[00:06:56] David: Yeah, they are doing miraculous things, but they are not truly miracle drugs, that is, use it and you're, you're set. You have to keep working at it.


[00:07:07] Nicole: One thing that comes to mind too, that often people with chronic conditions also have a mental health comorbidity. I know we find that in our data a lot. How important is it to address mental health in conjunction with physical health and exercise as part of a weight management program?

[00:07:24] Adonis: Yeah, absolutely. I think these go hand in hand. There's a lot of overlap. You know, we see patients that are overweight or obese, or suffer from obesity, tend to have underlying mental health problems. Sometimes, you know, things like depression in and of itself could lead to obesity due to lack of motivation to make healthy lifestyle choices in terms of physical activity, um, eating the right things.

 In addition to that, you know, GLP-1s have a black box warning that it could potentially increase risk for depression or suicide. And so we just want to monitor that closely. So at Noom, we ensure that all patients during their onboarding or during their intake, we do a PHQ 2, which is a well validated depression screening tool that we use to help gauge, you know, if patients are feeling depressed or whatnot.

We take a comprehensive medical history. Sometimes medications used to treat depression actually could lead to weight gain, such as, SSRIs, for example, notoriously associated with weight gain. So I think, to your point, I think we can't separate these two things. I think mental health and physical health, particularly, as it pertains to obesity is, one and the same, really.

So we're kind of addressing both when we're, we're tackling obesity and just really taking a holistic approach, I think.

[00:08:37] Nicole: Excellent. And with your experience in internal medicine and, and also clinical informatics, how do you see, digital health tools or apps evolving to support personalized obesity care.

[00:08:50] Adonis: Oh yeah, I mean, this is a topic that I'm certainly passionate about and excited about. I think you know, just having that connectivity to devices to be able to track your activity levels, your steps, being able to log when you're exercising, being able to, as I mentioned, track your protein intake, track your, your meals, you know, kind of ensure that your caloric intake is within, within that calorie budget so you're not overeating and, you know, gaining weight and you're also not under eating.

 In addition to that, logging your weights. Our app is extremely engaging, um, and I think the, the idea is that we want to really engage, patients in behaviors that really lead to better outcomes. And so, by tracking your activity levels, tracking your food, working with a coach one on one, meeting with a clinician, getting a diagnosis and getting treatment, and also having that content, all of this works together in an effort with the technology, of course, to provide better outcomes that you'd traditionally probably get at a brick-and-mortar practice.

And also, I think, you know, when we talk about obesity, there's a lot of stigma. So having the ability to speak to a clinician via telehealth, you know, over a video as opposed to sitting in a waiting room where other patients might be staring at you, I think that there's a lot to say about that as well.

[00:10:05] Nicole: The whole concept of being able to use an application to track either physical activity or manage your weight or diet can really become addictive too. I've found you almost get in competition with yourself. You want to do better. You want to, you know, want to exceed your goals from the previous day. So that's. That's awesome.

Um, Cody, can you share some insights on how Noom collaborates with employers to integrate weight management solutions into maybe some of their existing, um, health benefits and other solutions?

[00:10:36] Cody: Yeah, so the ultimate goal is to become a seamless part of their ecosystem of benefits. There's a number of different ways we can do that. We have relationships with many of the care navigators that exist in the marketplace, which again makes it kind of a seamless process. We'll be part of that. We do the same with some of the wellness vendors out there.

 We will also work with their plan and PBM. That can look for a number of different ways. It could be through claims billing. It could be a step edit process with the PBM to put some guardrails on who's getting the medications and making sure they're engaging in behavior change along the way. But ultimately, we just want to be a seamless part of their benefits ecosystem and fit in there and something that's easy to utilize for their members and not a disruption to everything else that they're doing.

[00:11:23] Nicole: Can you talk about any potential cost saving strategies or best practices? For managing program expenses.

[00:11:32] Cody: Yeah, so there's, um, a number of different ways that employers have decided to go about this. One just in our new med program, meeting with clinicians that are trained in obesity medicine is a very good start to make sure that those individuals are on the right medication at the right time. Typically within that program and, Dr. Adonis can go a little bit deeper into this. We will typically take a step therapy approach. So not every individual would start out on a GLP-1. There's other anti-obesity medications out there that they can utilize, that have meaningful results for them. So we do not always go to just the highest cost medication.

There's also employers that do want us to kind of integrate with that PBM to put that step at it in place where we require levels of engagement before they would get the medication. So some employers might want to say, you know, I want individuals to engage in Noom for 30, 60 days, whatever it might be before they have access to that medication.

And then they can also encourage ongoing engagement in the behavior change that Noom provides. There's different ways where we can show engagement levels each month that they have to hit to continue to get the, their Rx filled. And again, all of it is to make sure that they're changing their behaviors throughout that entire journey and not just relying solely on the medication.

[00:12:50] David: That's a great point. I, I'm going through some physical therapy for a pickleball elbow right now. And it, it's not progressing as quickly as I wanted, but I talked with the doc last week and he said, all right, here's the deal. I can inject you right now and it'll be fine for a while. But what we've learned is That's about 60 percent effective on its own.

We've also learned that if you just do therapy, that's about 60 percent effective. But if we combine those two things, then we're up to 85%. So similar concept here. You, you have to get the mindset and, and, and the routine, um, of whatever you're doing, or you'll just sink back to where you were, I guess.

[00:13:37] Cody: Yeah, absolutely, and it's kind of the thesis behind Noom since the beginning. We're a behavior change company at our core. It's what we've done for 15 plus years. And just because the medication you might not be as hungry doesn't necessarily mean you're eating the right foods or a lot of those different things.

 One other thing that would add to my previous comment around controlling the costs. It's also getting in front of it from a preventative measure. Right now, GLP-1s are for those with a BMI of 30 or 27 comorbid, but we really encourage to put our standard weight program in place for those individuals that haven't hit those BMI thresholds yet and to get in front of that so they don't get to a point where they need, obviously, the costly medication.

[00:14:21] Nicole: I know when Springbuk first started working with Noom, my eyes were really open to, you're not just weight management, you're really around wellness. And I'm just wondering what, what role do you see Noom playing in the future of healthcare, particularly in the context of prevention and then chronic disease management.

[00:14:39] Cody: Yeah, there's a lot that we're looking at right now. We're continuing innovating of the product roadmap to make sure that it is a more holistic solution. Behavior change will always be the core of what we do. Um, but we would need to make sure that we're, we're doing the latest around nutrition, physical activity, mental health, stress, sleep, all of those different things.

And I think you'll see whether through partnership, whether through building, um, a number of different avenues that we'll continue to build those out. And also look at other cardiometabolic conditions, you know, hypertension, diabetes, and some of those things, where we have a full well rounded solution that employers can come to us and have one vendor in place that's taking care of all their needs.

[00:15:21] Nicole: You have me interested on this, the sleep topic now, too.

[00:15:26] Cody: It is, yeah, so there's, um, there's many pillars of it. There's, there's a lot of ways we're going about it and it's, it really is interesting because employers want a holistic solution, right? They don't want it for a small subset and they don't want to go to one vendor for fitness. They don't want to go to one vendor for nutrition and all those different things.

If they can go one place, you know, as we know, app fatigue is a real thing. If you've got to go to four or five different apps, engagement adoption is going to kind of drop down pretty significantly.

[00:15:56] David: Yeah, people really underestimate the importance of sleep too in weight management. Dr. Saremi, let's shift back to you for a little bit here. Cody was talking at the beginning about the just incredible rise in the demand for GLP-1s and interest around them. And he was talking there about some of the lifestyle change.

You both talked about the lifestyle changes. How can employers, what steps can they take to ensure that their weight management programs are proactive rather than, you know, purely reactive, to help them avoid some of the unnecessary spend and ultimately reduce their overall costs?

[00:16:36] Adonis: Yeah, certainly. And, and as Cody alluded to, you know, a lot of it comes down to prevention. At Noom, we have a weight, Noom weight. We have a diabetic prevention program, and then at the highest tier, we have Noom Med, which is for patients that are suffering from significant obesity and have potential complications and would benefit from the assessment of a physician and then to potentially get treated with a GLP-1 amongst other medications.

Disease prevention is critical. These conditions such as, diabetes, pre-diabetes, high blood pressure, they can potentially be prevented, if you catch them early, if you implement sustainable lifestyle changes, such as appropriate exercise, and healthy diet, you know, some of this stuff could be potentially prevented.

Now, in circumstances where patients are already, they have a BMI, let's say, above 27 and they have a comorbidity such as hypertension or, diabetes, pre-diabetes or even something like, PCOS or, active arthritis. Speaking about sleep, obstructive sleep apnea, of course, is a comorbidity.

And then also those that have, let's say, a BMI over 30. I think it's really important, when we assess these patients to kind of really risk stratify them. Some patients, let's say your BMI is 40, you have existing heart disease, you have type 2 diabetes. For that type of patient, you really, starting right off the bat, you know, of course, ensuring there's a step at it, ensuring that they're engaged in the app, that they're implementing some lifestyle changes prior to initiating treatment, but once you initiate treatment, they might benefit from long-term treatment just to reduce cardiovascular morbidity and overall actually reduce healthcare costs associated with that patient.

You know, treating with the GLP-1 might be cheaper than, of course, you know, a patient going into the ER with an acute MI or heart attack and being

[00:18:24] Nicole: Cardiac intervention.

[00:18:25] Adonis: Right, right. On the other end of the spectrum, let's say you have someone with a body mass index of 27. And maybe they just have one mild comorbidity.

For that patient, maybe a GLP-1 isn't the right option. Maybe we can, you know, get away with something like Contrave. And in concert with lifestyle changes, we might even be able to put them on Contrave, let's say for nine months, potentially wean them down and even get them off. And now they've, you know, they've learned a lot of sustainable lifestyle changes in order to keep that weight off and they won't even require GLP-1.

So, so that's the way I think, you know, at Noom we approach it.

[00:19:00] David: Yeah, that's great. I need to put in a little plug here for Springbuk's Employee Health Trends report, because we have an extensive section this year about obesity and the importance of looking for and treating those comorbidities that you were just talking about. And there's that word that I can't say very well.

So just pretend like I didn't stumble over it. It'll be fine. We'll take it out in editing. All right, Cody, I want to go back to you. You have always had a talent for talking about the, the customers and the, and the stories of success that they have. Do you have any from Noom, any good data or case studies that, that maybe highlight some of the successful cost management for employers?

[00:19:46] Cody: I'm very fortunate to work at a company that's been doing this for a very long time. And we have an incredible amount of published studies. There's over 50 plus published studies, many peer reviewed and whatnot. Um, the one that I think I would point to, to, to kind of highlight here is we did a study, we released this in JMIR last year, I believe it was August.

Um, and this was just our standard weight program, right? So this is kind of the preventative program, not that clinical level. And what we did is we put, there were 65,000 individuals that were a part of this study, and we looked at their claims after they stopped using Noom. So two years after using Noom. And through that study found that they saved $1,219 on their healthcare cost after utilizing Noom, right, which is a testament to the overall behavior change, but ultimately how we're lowering costs from a preventative standpoint. Outside of that, we've got, you know, a number of case studies with different employers that we're working with and, um, although our new med program is fairly new to the commercial market, a lot of great early data is coming out of that.

One on, to the doctor's point, not everybody is getting a GLP-1. We have, a client that just started with us, I think, 11,000 employees or so that started with us, um, and, what was it, February of this year. And so far, close to 50 percent of those individuals are not being prescribed GLP-1s. So we're able to treat them without the costly medications, but get them the help they need and make sure they're losing the weight, to help them out.

[00:21:19] Nicole: Those are really, really great case studies. Really great success stories.

[00:21:24] David: Yeah. And I, I know personally, I can't go on to my social feeds without seeing somebody every month talking about their success on, on Noom or whatever program they're on. It's usually Noom.

[00:21:37] Nicole: oh yeah, at Springbuk, I have a bunch of team members who, who use Noom as individuals and rave about it.

[00:21:44] Cody: The neatest thing I would say in coming to Noom is when we go to conferences, whether it's HLTH, Conference Board, whatever it might be, the number of people that come up to our booth and say that we changed their life or a family member's life. And it's like, it is truly incredible and it never fails.

Wherever conference we go, or if I'm wearing my Noom shirt or backpack, whatever it might be, people want to come up and tell you, you know, how Noom's changed their life. And it's been pretty incredible to be a part of that. I would say very small part of that in, in the grand scheme of things, but it's certainly made it worthwhile.

[00:22:18] Nicole: you get up in the morning and go to work. That's really cool. Inspirational. Well, thank you, um, both Dr. Saremi and Cody for sharing your valuable insights with us today. It's very clear that Noom is making significant strides in the field of weight management as well as digital health.

[00:22:38] David: I have to tell you both you were excellent, really, really great responses here and thank you for sharing your expertise with us.

[00:22:48] Cody: Thank you for having us. It's great to see you both. I'm glad you finally let me on the podcast. Um, it took a little while, but I

[00:22:54] David: Yeah, well, you were okay. We, we may even invite you back. I, you know, I, no promises, no promises!

[00:23:01] Cody: That's fair.

[00:23:05] David: Yeah. All right. And I do want to give a thank you to our listeners for tuning in once again to Healthcare on the Rocks: Employee Benefits with a Twist. Please be sure to subscribe and your favorite podcast player so you don't miss any future episodes.

[00:23:15] Nicole: And don't forget to leave us a five-star rating or review and let us know what other topics you'd like Springbuk to cover. And thanks again for listening.