Telemedicine clinic Virta Health believes its members can achieve significant and sustained improvement in weight loss, even if a patient has stopped taking a GLP-1 drug, a newly released paper in Diabetes Therapy shows.
According to the company, it is a first-of-its-kind study offering an opposing viewpoint against clinical trials showing GLP-1 deprescription leading to weight regain. The results have potentially major implications for employers and plans looking to help its members improve health outcomes and fight obesity but that are concerned about rising costs amid increasing demand.
"This is unheard of," said Sami Inkinen, Virta Health CEO and co-founder. "To my knowledge, nobody has published or shown this kind of data to date."
The Virta paper looked at two groups of members with Type 2 diabetes—one group was deprescribed from GLP-1 drugs and the other remained on the drug. After one year, both groups had similar improvements in blood sugar control and weight loss, and those who quit taking GLP-1s did not regain weight.
In the retrospective study, GLP-1 deprescription members lost, on average, 13.6% of body weight. After one year, they still maintained 12.1% weight loss.
Prior research from Virta had shown similar weight loss results for people who had never started GLP-1 drugs compared to those who do take GLP-1 medications.
The secret? Nutritional ketosis achieved through carbohydrate-restricted therapy and highly individualized care, according to the company. Nutritional ketosis is when the body starts to burn fat primarily as a fuel, as opposed to sugar and carbs. Like GLP-1 drugs, this type of therapy is thought to reduce hunger and appetite to a similar degree and is manageable for the member.
"If you don't achieve (that), you are purely basing the dietary program on willpower and calorie restriction," said Inkinen. "And we have 40 years of evidence now to know that willpower runs out."
Inkinen is the former co-founder of Trulia, a real estate marketplace acquired by rival Zillow Group for $2.5 billion in stock in 2015. Several years earlier, he discovered he was prediabetic and on the path to Type 2 diabetes. The realization caused him, a triathlon age group world champion and Ironman competition runner, to rethink the stigma he placed on diseases like diabetes and obesity and to launch Virta Health. It has been prescribing GLP-1s to Type 2 diabetes patients for close to a decade and now does the same for obesity patients.
The company partners with employers and health plans to offer its services at no cost to the member. If paying out-of-pocket, a person can still access Virta and its in-house providers for $299 a month with a $250 initiation fee. Payers are reimbursed if patients do not achieve the guaranteed level of weight loss and if weight loss is not maintained following deprescription.
Through tailored nutrition plans, Virta urges members to follow an optimized plan. Daily biomarkers from blood glucose and blood ketones provide feedback multiple times a day. These track how many calories a member receives from fats versus carbs and studies how many grams of carbs are consumed a day. Typical Americans may consume 200 to 400 grams of carbohydrates a day, while Virta members could eat just 30 to 90 grams a day.
Generally, Virta stresses that its members should receive a moderate amount of protein, five servings of vegetables and a broad variety of foods. Sugar and starchy foods are largely eliminated. But this can be adjusted, and it never advocates counting calories, like previous clinical trials have studied.
"We don't want to know how many calories you eat," Inkinen said. "We don't even ask you to track them. We tell you what types of foods to eat."
If the patient is still hungry later, the next meal the plan is altered slightly, perhaps by including a higher quantity of healthy fats. More food iterations can take place if biomarkers are going off until a member is satisfied.
The company is willing to tailor plans based on ethnic differences and people from all walks of life. Inkinen shared examples of Virta clients that include vegans, pescatarians, white-collar investment bankers who eat lunch at the company cafeteria, truck drivers who may be forced to indulge in fast food, stay-at-home parents, veterans and Native American tribes.
Virta is then able to customize the plan based on the nearest grocery stores, and even provide recommendations on nearby restaurants. Inkinen said his favorite anecdote is a Texas resident who sent a message to a coach, asking for appropriate food options at a first-date restaurant spot the next day.
"So we do take it very, very far for individualization," he said.
He added that since people can eat until satiety, or until feeling full, members do not have the same hunger cravings as is common when tapering off a drug traditionally.
"This alternative to GLP-1s is something that individual patients, and of course payers, have been looking for the past year," Inkinen said. "We heard from payers that while people buy from online pill mills, they want to work with a responsible prescriber."