Obesity, General Health

TOWARD a metabolic health intervention demonstrates robust 1-year weight loss and cost-savings through deprescription

The TOWARD program –  Text-based communications and messaging, Online interactions, Wellness coaching, Asynchronous education & community support, Real-time biofeedback and remote monitoring, and Dietary modifications – was designed to manage type 2 diabetes and obesity through a cost-effective, sustainable lifestyle approach. This 12-month study assessed its effects on weight loss, medication use, and cost savings among employees at a self-insured manufacturing company.

Among the 50 participants enrolled in the study, the average BMI was 43, and 64% had prediabetes or type 2 diabetes. The intervention included remote interactions and monitoring by clinicians and health coaches, community support, continuous glucose monitoring, blood glucose and blood ketone testing, and dietary modifications emphasizing TCR and optional intermittent fasting.

Although nutrition advice was tailored to individual preferences and needs, all participants were directed to initially limit total carbohydrate intake to under 30 grams in order to sustain nutritional ketosis. Participants underwent regular virtual follow-ups and received educational resources on topics such as hunger, stress, and sleep hygiene. Baseline and quarterly assessments measured weight, metabolic markers, and medication usage.

Results:

🔷 Weight loss:

→ Average weight loss was 42.9 lbs (19.5 kg) equating to 15.5% of total body weight.

→ 92% of participants lost at least 5% of their body weight, 70% lost at least 10%, and 30% lost more than 20%.

🔷 Medication changes:

→ 96 medications were deprescribed––including 18 for diabetes or prediabetes, 9 for gastroesophageal reflux disease (GERD), 26 for hypertension, and 4 GLP-1 agonists–– while only 8 new medications were added.

→ Patients discontinuing GLP-1 receptor agonists maintained or continued their weight loss.

🔷 Cost savings:

→ Annualized savings from medication changes totaled $83,285, equivalent to $1,700 per participant.

🔷 Program adherence:

→ 41 of 50 participants completed the one-year program (retention rate of 82%)

→ Reasons for dropping out included non-work-related issues and family obligations.

The TOWARD intervention achieved significant weight loss comparable to GLP-1 receptor agonists while reducing medication costs through deprescription. Combining TCR, telemedicine, and personalized support, it offers a cost-effective alternative for managing obesity and diabetes.