TOWARD A Metabolic Health Intervention Demonstrates Robust 1year Weight Loss and Cost-Savings through Deprescription

Laura Buchanan ¹ Matthew Calkins ¹ Tro Kalayjian ¹ Nicholas G Norwitz ² Nina Teicholz ³ David Unwin ⁴ Adrian Soto-Mota ^5*

• ¹ Private Practice, Tappan, United States
• ² Harvard Medical School, Boston, Massachusetts, United States
• ³ No affiliation, New York, United States
• ⁴ Edge Hill University, Ormskirk, United Kingdom
• ⁵ National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico

Background: Cost, scalability, and durability represent major challenges to the implementation of intensive lifestyle treatments for obesity and diabetes. We previously reported pilot data from a 6month intervention in which a self-insured manufacturing company partnered with a metabolic health clinic that utilizes therapeutic carbohydrate reduction (TCR), asynchronous monitoring, and a community-based approach to treat employees with metabolic disease. This manuscript presents weight loss and cost-savings from deprescription at the 12-month time point.Methods: 50 employees, mean BMI 43.2 ± 8.7 kg/m2, 64% with prediabetes or type 2 diabetes, were enrolled in the multimodal TOWARD telemedicine intervention, which includes: Text-based communications, Online interactions, Wellness coaching, Asynchronous education, Real-time biofeedback and remote monitoring, and Dietary modifications that emphasizes TCR.: 41 completed the one-year intervention. Mean weight loss for the 50 subjects in the intention to treat analysis was 19.5 ± 11.4 kg, corresponding to 15.5% total body weight loss with concomitant deprescription of 96 medications, while starting only 8 medications. In patients who discontinued GLP-1 receptor agonists, weight loss continued or was maintained. Annualised cost savings from the TOWARD approach were approximately $83,285.00.The TOWARD approach represents a scalable metabolic health intervention that demonstrates robust improvements in weight while simultaneously allowing for deprescription leading to substantial cost savings. TOWARD could serve as a scalable tool to facilitate intensive lifestyle intervention with efficacy on par with GLP-1 receptor agonists.