It’s been more than a decade since the results of the multi-clinic Diabetes Prevention Program (DPP) study were published in the New England Journal of Medicine. If the outcome in February 2002 were a football box score, it might have been summarized as “DPP — 50; Glucophage (Metformin) — 0.” In other words, a decisive victory for moderate weight loss and exercise over the most commonly prescribed diabetes medication. The results were so clear-cut that an independent advisory board cut the trial short by a full year.
Sean Duffy was just beginning high school when the DPP results were published. Ten years later, he’s co-founder of Omada Health (www.omada health.com), a small company with a potentially huge impact on a problem of national importance. The DPP results show that reducing weight by five to seven percent, coupled with consistent exercise like walking, dramatically reduces the potential of getting Type 2 diabetes. That would be good news, if only more people who need to take this preventative action would heed it. Over the last 10 years, the number of people diagnosed with Type 2 diabetes has grown by millions, and the pre-diabetes population has ballooned to an estimated 79 million. If even half of these people turn into full-blown Type 2s, the impact on our health care system, and the financial cost of treatment will be catastrophic.
Losing Weight: The Real American Pastime
Forget about football or baseball. Losing weight, or trying to, is the real American pastime. Studies show that each year, six out of 10 Americans try to shed pounds. Many people do lose weight, but fewer than two in 10 succeed in maintaining their new levels. Weight loss is a multi-billion dollar industry with spectacularly unsuccessful outcomes — unless you count the profits made by those in the weight-loss business.
Omada (a Greek word for “group”) thinks it can succeed where others fail. The company’s specific targets are people diagnosed with pre-diabetes, a state where fasting blood glucose is higher than normal but not high enough to classify the person as diabetic. The vast majority of people with prediabetes are overweight. Omada’s formula mixes technology, physical goods, step-by-step structure, coaching, peer pressure, and group dynamics — in a program spread over 16 weeks — to help people help themselves. The company does not offer a product, but rather a comprehensive program. And the company aims to offer the program either subsidized or free to individuals who are looking to reduce their risk of Type 2 diabetes. “We’ve built a Web translation of the Diabetes Prevention Program,” Duffy said. “ It’s a lifestyle intervention aimed at weight loss for people at risk of diabetes, but down the road it won’t be limited to that audience.”
After more than a year of trials and good results, Omada expects to unveil its program to the public late in 2012 or early in 2013. Here’s a preview of what’s to come.
The Power of Peer Pressure
Omada’s goal is to work with employers, health care plans, and medical centers to identify people already diagnosed as pre-diabetic. People who accept an invitation to join the 16-week program give Omada an email and mailing address, their height, weight, age, and a photo. All the information except for a first name or screen name, and profile picture, remains private. Groups of about 12 are organized using first names and photos only. Using the information collected during the set-up process, Omada forms groups based on criteria such as a candidates’ ages, locations, and Body Mass Index (BMI) numbers. (BMI is a person’s weight, divided by his or her height, squared.) The National Institutes of Health (NIH) now defines weight as “normal,” “overweight,” and “obese,” using BMI. Overweight is a BMI of 27.3 or more for women and 27.8 or more for men. Obesity is a BMI of 30 or more for either sex (about 30 pounds overweight). A very muscular person might have a high BMI without health risks.
Putting people together based on BMI is very important, according to Duffy. “Going through the program if you have a BMI of 40 is very different than if your BMI is 28,” he said. “The emotions are different, and so are the weight loss trajectories.”
Each group is assigned to a health coach — often someone who has been through the program. Coaches provide the group with a new lesson every week, and are there for help, encouragement, or problem solving. This is not “The Biggest Loser.” There’s no yelling, no humiliation, no boot camp mentality. Progress towards one’s own goal as part of a group goal is a participant’s incentive to perform.
Scales that automatically transmit weights to Omada are sent to each participant.
The Scale In The Mail
Before the first week of the program, a scale is delivered to each participant. This isn’t an ordinary scale. It comes with a cellular chip that wirelessly transmits the weight of the user to Omada, completely without human intervention. “Nothing to install, nothing to program,” Duffy said. “It’s quite magical.”
While weights are transmitted each week through the scale, the information is shared only between each participant and his or her coach. There is a group weight loss goal established at the outset, but individual progress over the length of the program is based on what percentage of his or her own goal has been reached. The individual’s actual loss in pounds is not reported to the group. Omada counts on group dynamics and peer inspiration to motivate each individual help the team achieve success together.
The Lesson Plan
Once a week through the course of the 16-week term, participants log on and complete a new lesson, which takes about 20 minutes. There is a group message board where they can contribute ideas, mention obstacles, and ask questions that that anyone in the group can answer. Although there are no conference calls or Webinars, Duffy said he’s been pleasantly surprised by the degree of openness and sharing exhibited in the pilot groups. “You go through the program together and you can see progress toward your weight loss goal amongst all of your peers,” he said. “Everyone can be on the same page. There’s social support and accountability built in.”
The scale delivered at the outset is just the first of a variety of physical props that arrive to support phases of the program. In week five, for instance, the lesson focuses on physical activity, and a pedometer arrives in the mail. When participants open the lesson, they find a new widget on the home page that allows them to record their steps. “We think it’s pretty important to have that physical touch point in someone’s life,” saod Duffy. Food journals and other support tools are also delivered throughout the program.
Graduation and Follow-up
When the program concludes at the end of 16 weeks, participants graduate into what Duffy called “the sustain program.” Those who hit their goals can choose to maintain their new weight, or to set a new weight loss goal. Those who didn’t hit the target the first time around can try once again.
At this point the health coach disengages and moves on to a new group of beginners, but Omada encourages graduates to keep interacting through their website and to work toward healthier behaviors. Participants are also invited to consider becoming an Omada coach, which is a salaried job, allowing people to work from their homes. Of the 230 people who participated in a recent pilot program, 40 said they were interested in coaching. “The interest level far exceeded our expectation,” Duffy said. He knows there is nothing so powerful as a person who has changed behaviors and seen results.
Examples of Omada progress reports
Can Omada succeed where others have failed? The program is based on tried-and-true behavior modification research using group interaction, and no one need look any further than Alcoholics Anonymous for proof that it’s an effective method. The key to the business, though, is the financial value applied to avoiding a problem rather than treating it once it blooms. Duffy and Omada have to hope that insurers and employers adopt a “pay now or pay later” model aimed at Type 2 diabetes prevention.