July’s start up of the month is a bit late – I’ve been starting foundation training at St Thomas’ Hospital on quite an intense acute rota. This month its an excerpt from an interview I did with Sean Duffy, CEO of Omada Health, while researching in San Francisco for an article. Their first product is Prevent, a digital behavioural change programme for the prevention of obesity-related chronic diseases, including diabetes.
The idea came from when was I at IDEO. I was interested in diabetes specifically because of the public health challenge it posed. A preventable disease had never spread so rapidly, and when I learned that more people were dying from chronic disease than infectious illnesses, I felt compelled to do something.
To start, I looked at what had already worked at preventing diabetes – I knew the literature around the Diabetes Prevention Program trial. This clinical trial involved a 16 week, high touch, face-to-face weight loss programme for people with pre-diabetes, aimed at reducing their weight using behavioural change techniques. It was so successful that it became the national standard of care.
But we understood that face-to-face programs aren’t always accessible to everyone, so this had to scale beyond just brick and mortar programmes. What we needed was an effective, sacalable, cost-effective digital solution that generated rseults. But you can’t just put a pdf of the programme online and say to people – go and do it!
So we not only digitised the programme, but we added the social dynamics and key features of engaging with groups that make programmes like this, and others such as Alcoholics Anonymous, work.
We place people in small groups based on social demographics like location, age, and BMI and then pair those groups with remote health coaches. We mail each person a digital scale, which has a cellular chip in it so it works straight out of the box – you don’t have to register it – and then we start them on a timeline for 16 weeks. They have a shared goal of 7% weight loss and weigh in together every Sunday. They have different lessons week-by-week, all based around behaviour change to help reduce dietary intake. On the dashboard, we show the profile photos of the others in your group, with progress bars, creating an interesting dynamic where people feel supported and accountable.
Have you had any success stories yet?
The bulk of people do manage to lose the 7% of their body weight that we set as the target. What’s even better is that we also get longitudinal data as most people continue to weigh-in years later on our digital scale.
There are some amazing stories of people losing 40 percent of their body weight, but there’s also a small subset of people who even gain a little weight – my hope is that they were on a steeper trajectory, and our programme at least slowed that down!
Recently the Veterans Health Association ran a study to compare the DPP with our service, and their own brick and mortar solution called MOVES, and found our service outperformed theirs in terms of engagement and outcomes.
Change can be hard to bring about in healthcare, how do you get around this?
Once we started publishing data we engendered a bit more trust. All digital health solutions that want to make impact and become big businesses need to take an evidence-based approach. I don’t think there’s a way to get adoption otherwise, and I don’t think we should – we shouldn’t be deploying things that have ‘reasonable’ chances of working! It’s hard because academic timelines are so long for a start-up. But I don’t think there are shortcuts, so we thought “okay, we’ve just got to publish, let’s put it into the development timeline.”
What is your goal for Omada Health in the next 10 years?
My goal is that programmes like Prevent become so ingrained in the standard of care that in 10 years time we will look back and be amazed that we didn’t refer people to digital lifestyle programmes for weight loss.
And 20 years from now I want epidemiologists to look back at that era between 2016 and 2025 and say “that’s interesting, what happened there? There’s a little bend in the curve, who did that?” I want that to be us!
And what about the future of healthcare in general? How will that look?
I think the thing that will happen most quickly is the concept of primary care as a specialty will dissolve. You’ll have a digital primary care centered around the individual, with most diagnostic tools and treatments in the home or the local chemist. There will still be room for a primary care doctor for the more complicated cases, and it’s hard to remove the person entirely from the system – even just for sample collection.
[Disclosure: I have no commercial ties with Omada Health]