New Study: 100% Lost Weight—AND Saved Thousands!

The Metabolic Health Clinic took on this challenge, more potent than any scientific study. It's like having your cake and eating it too, but in this case, having your weight loss and your money too. Average weight loss of 15.5% body weight loss, or 43 pounds per patient over the year. That's really impressive, but what's perhaps even more impressive is Is the keto diet unsustainable? Are GLP-1 medications ushering in a new era for obesity medicine? And in the best-case scenario, which is a more powerful weight loss intervention? In this video, I promise to answer these questions and more, but not in the way you'd expect. There will be twists and turns and nuance. And I also promise I'll culminate with a message that is moderate but provocative, and inclusive, not blaming or dividing. But first, I want to take you on a journey of data and science.

I'm going on an adventure.

Our story centers on a new paper that colleagues and I recently published covering a 1-year study in which a self-insured manufacturing company approached a metabolic health clinic in seek of support for their medically in need employees. The Metabolic Health Clinic enrolled 50 employees, and because of the clinic's capacity, they selected the employees that will be enrolled in the program with the greatest medical need, or based on greatest medical need, factoring in the presence of metabolic syndrome, diabetes, obesity, and the number of medications the patients were taking. This is called polypharmacy. The average starting BMI of the 50 enrolled subjects was 43.2, or 271 pounds, and 64% had type 2 diabetes or prediabetes. Now, these patients had near universally tried and failed lifestyle treatments and diets before, which is a common plight for middle-aged Americans and often leads to learned helplessness. And a disheartening resolution that this is just how it is. I have obesity. There's nothing I can do about it. Now pause for a moment and consider if you or someone you know has ever found themselves in this valley of diet despair. Okay, sadness over. The Metabolic Health Clinic took on this challenge and enrolled 50 participants in an intense multimodal lifestyle change program abbreviated TOURD, and I'll unpack that in a moment, but it centered on patients consuming a ketogenic diet with fewer than 30 grams of total carbohydrates per day. But patients were explicitly told not to attempt caloric restriction and instead eat according to their subjective hunger. Okay, now what is TOURD? It stands for Text-Based Communications and Messaging. Online interactions, wellness coaching, asynchronous education and community support, real-time biofeedback, and diet, focusing on a ketogenic diet with or without time-restricted feeding or intermittent fasting. Basically, in addition to the ketogenic diet, patients were given access to a messaging platform where they could contact members of the healthcare team in real time to get their questions answered. I'll tell you, drawing from experience with my own coaching, this form of support is invaluable. Imagine when a patient or a client is shopping, for example, they might have a question about an ingredients list or a nutrition label on different products they pick up at the supermarket. Being able to inquire with these questions to a trusted support can facilitate rapid, progressive, and cumulative learning of practical dietary knowledge. And once clients and/or patients have developed a hunger for learning, it's best to provide them with a buffet of information. In this study, the buffet was provided via a smartphone application with a multimedia curriculum focusing on the science of hunger and appetite, food addiction, as well as the role of stress, sleep, and other variables related to metabolic health. It's a pretty broad category. But if you really want to empower people, going beyond educating them via text message or asynchronous education, you want to empower people by putting their own data in their own hands. And with the emergence and availability of continuous glucose monitors, or CGMs, ketone blood meters, and more metabolic health monitoring tools on the horizon, we can now provide members of the general public with real-time biofeedback tools. If you have a soda and see your blood sugar spike to 300 mg/dL, that is a teaching moment more potent than any scientific study for the individual in their real lives. This metabolic health clinic indeed used these tools—continuous glucose monitors and ketone monitors as well. In summary, this wasn't just an isolated dietary intervention insofar as the people, the patients, weren't just given instructions and let off into the world. It was a dietary intervention buffered by education and community support. And I'll get to the pros and cons of this when I discuss limitations, but first let's reveal the stunning results. And I do mean stunning. All 50 patients, 100% of the participants, lost weight, with an average weight loss of 15.5% body weight loss, or 43 pounds per patient over the year. That's really impressive. But what's perhaps even more impressive is, did you catch I said all 50? In a 1-year diet and lifestyle study like this, it's inevitable there will be some dropouts. So these impressive results I just revealed are even more impressive when you consider 1, the pretty incredible retention rate of 82%, i.e., 41 of the 50 participants were still enrolled at 12 months of this rigorous intervention. And 2, that in the intention-to-treat analysis, which I just revealed, which included all 50 participants, the body weight loss was 15.5%, including the dropouts. And in the per-protocol analysis, looking at those still enrolled at 12 months, health improvements and weight loss were even greater, with 16.6% body weight loss on average over 1 year. But it gets even more interesting. Some patients were on GLP-1 receptor agonist weight loss medications. Weight loss in these patients was actually comparable to those not taking the GLP-1s. And of the dozens of medications deprescribed, 4 patients were taking off GLP-1s and did not gain back the weight, which is counter to the common knowledge that the fat returns when you terminate these GLP-1 medications. In other words, the fat's like, "I'll be back." See what I did there? And what is another big advantage of deprescribing medications? Can you think of it? Cost savings. From net deprescriptions and medication changes alone, cost savings were over $83,000 or about $1,700 per patient per year. By contrast, the annual cost per patient of common GLP-1 medications is $13,000 per year. So returning to the title, Keto versus GLP-1: New Study Reveals Advantages of Lifestyle. Well, not only did the multimodal lifestyle intervention with ketogenic diet stick for 82% of patients and lead to slightly more average weight loss over a year than GLP-1 medications tend to, but the medical cost went in the opposite direction—down, not up. It's like having your cake and eating it too, but in this case, having your weight loss and your money too. Pretty good deal. Now, let's talk about the limitations and strengths of this study, which are actually kind of the same. This was a multimodal intervention study, meaning it wasn't just diet. From a scientific point of view alone, this is a limitation, insofar as one can't claim from this study the keto diet was the magic bullet. And no one's claiming that. It's also notable there wasn't a control group, and it would be interesting to know what the results would have been if an identical clinic provided similar care but focusing on a different dietary intervention, like a vegan diet or a standard higher-carb Mediterranean diet. That's true, and I'd love to see that study. However, I actually feel the multimodal intervention in this study was its greatest strength because it helps make the key point that we can't just give people dietary guidelines and rules and expect them to succeed in this modern food environment. The developed world is saturated with bad nutrition information and dietary booby traps. People need supportive communities and education to make diet change and lifestyle change sustainable. And when these are provided, as in this study, we can achieve consistent, progressive, and sustainable results. I myself am 100% convinced of this fact. Firsthand, through my metabolic health coaching experience, and secondhand, through my engagement in the metabolic health space broadly, I've seen people demonstrate incredible life transformations, so shocking most people can't believe it. In the current world, these people are outliers. But what we must ask is what makes these people outliers? What makes the outliers outliers? And how can we generalize their results to the general population? This study is paving the way and offers a glimpse of a solution that is sustainable both in terms of weight loss and economic viability. I am pumped. I am optimistic about the future, and I also want to challenge you to be the outlier in your community. Start by educating yourself about metabolic health. Translation: subscribe to my channel and start binge-watching. And get your data in your hands. I'll provide some resources in the video notes below. Together, let's raise a metabolic health army and make metabolic health mainstream. But before you sign off, here are some words from some of my co-authors. Hear what they have to say about this study and what it means for these patients, for you, and for the future of metabolic health. Stay curious. I hope you enjoyed this story.

Hi everyone. I just wanted to emphasize that this paper has real-world data, and this is very important. Because we know that all treatments, all interventions have a smaller effect in real-world conditions. This is because the ideal conditions that a highly controlled clinical study creates are just not replicable in most places around the world. And we know from reports from many different countries that the real-world weight loss effect of GLP-1 drugs ranges between 3 kilograms and 7 kilograms of weight loss after 1 year. However, the weight loss we observed in these patients was larger than that, with and without GLP-1 medications. And this highlights that the real treatment is lifestyle changes. GLP-1s are very useful in some cases because they help people change their dietary behavior through the effect they have on gut motility and how it influences satiety. They facilitate lifestyle changes. However, they are not the only nor the cheapest option we have for facilitating lifestyle changes. Carefully designed and followed-up programs like the one we described in our publication can achieve the same clinical benefits. And more than that, they can save money by allowing deprescription of many other drugs, including GLP-1s. And after stopping them, as one of our theories show, you can still observe continuous weight loss. So I just wanted to bring everyone's attention to this point in our publication. And thank you for your interest.

Do you understand what it means for these patients' lives you to understand that their lives have changed. You know, we have, uh, Greg, who shared a story, uh, in the Times in New Orleans of his 100-plus-pound weight loss, how his joints feel better, how he's going to the gym. We have Tammy, who shared her story of amazing success. And, you know, we've recorded several of these stories, and it's just husband and wives losing weight, coming off medications. It's just an absolute honor to be able to help these patients and their families truly heal, change their lives through diet, through lifestyle, through nutrition, and through good old-fashioned, good quality medicine, except it's now delivered with technology, you know, remotely with text messaging, online visits, convenient care, no more waiting. They don't have to wait in a waiting room. They don't have to take a day off work. They just get the text message. They can do an online visit and they don't need to go into an office to get a blood pressure check. They have a cuff, a scale, a glucose meter that connects directly to us. And I can't tell you how valuable that is for the clinical team to be able to make quick changes. As they're losing weight and they're getting healthy, we want to stop those diabetes medications real quick, and we want to stop those blood pressure medications very quickly so that they can do this safely. It's been an absolute honor. And now, you know, we've expanded with this particular company to over, over 120 patients, and we have countless people from this company using our app. Utilizing our CGM program. We've now expanded to 5 other companies where we deliver the same great care using CGMs for screening, you know, using, utilizing our app and our webinars for all of the employees in those companies and offering metabolic care to the patients in those companies who have diabetes, prediabetes, who are overweight or obese or have metabolic syndrome and are looking to make a change. And the best part is, you know, working with everybody in those companies, all the way up from the CEOs and the C-suite, you know, to the managerial level, all the way down to the, to the level of the manufacturer, the frontline workers, the janitors, the, the carpenters, the fencing, uh, uh, you know, ground employees, the, you know, the lumber company lumberyard workers, you know, the trucking company truckers, you know, the reinsuring, you know, sort of office workers. I mean, all of these settings, such disparate settings, we're finding the same results. And it's just an absolute pleasure and honor to be able to bring metabolic health to these various workplaces.