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

• Published in: Frontiers in nutrition (Lausanne) Vol. 12; p. 1548609
• Main Authors: Buchanan, Laura, Calkins, Matthew, Kalayjian, Tro, Norwitz, Nicholas G, Teicholz, Nina, Unwin, David, Soto-Mota, Adrian
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers Media S.A 2025
• Subjects: diabetes; GLP1; ketogenic; obesity; telemedicine; therapeutic carbohydrate reduction; carnivore diet; telemedicine; intermittent fasting; GLP1; diabetes; ketogenic; therapeutic carbohydrate reduction; obesity
• ISSN: 2296-861X; 2296-861X
• DOI: 10.3389/fnut.2025.1548609

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 6-month 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. 50 employees, mean BMI 43.2 ± 8.7 kg/m , 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. Annualized cost savings from the TOWARD approach were approximately -$1700 per patient, as compared to an annualized cost burden of roughly +$13000 per patient for a GLP-1 receptor agonist. 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.