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Where we share our weekly news debriefs and discussions with industry experts. These are lo-fi recordings aimed at giving our readers more opportunities to engage with our analysis and a view into some of the conversations that shape it.
Martin: Uh, we are going
to welcome our first guest.
Uh, his name is Amit.
He's calling in from Denver.
Amit, welcome to the show.
We are so excited to chat today.
I feel like, you know, you at Virta,
you all at Virta have been focused on
metabolic disorders since before they
became all that anyone could talk about.
I'm wondering if you could kind of
start and, and kind of give us a little
bit of that, that backdrop of saying
like, "We were focused on metabolic
disorders before they were cool.
We're now in the GLP-1 era."
W- w- wh- what's that story been like,
and what's that experience been like?
Amit: Martin, I'm gonna give you the
tr- the, the, the triple threat here.
We were focused on metabolic disease
before it was cool, we had AI before it
was cool, and we were, um, prescribing and
de-prescribing GLP-1s before it was cool.
So, um, uh, I, we got
the triple threat here.
Um, just so your listeners know, if
you haven't heard of Virta, we're
on a mission to reverse metabolic
disease in a billion people.
We combine medical care, personalized
nutrition, and tools like GLP-1s,
uh, to help people sustainably lose
weight and reverse diseases like
cardiovascular disease and type 2
diabetes, and we deliver all of our care
via a continuous remote care platform.
It leverages AI to bring to bear great
technology and human clinicians in order
to help people sustainably make change.
We partner with, um, with, uh,
plan sponsors and help them save
money by making people healthier.
And so that was a mouthful, uh, but again,
it, it goes back to the triple threat.
We started our, our clinical trial
in 2015 in Indiana with patients that
had type 2 diabetes and pre-diabetes,
and through publishing, um, uh, you
know, 90-day, uh, one-year, two-year,
and five-year data, um, we have shown
that we can fundamentally, using a
nutritional, personalized nutritional
protocol, reverse- Their disease.
Um, and, uh, and what that means is
that we help people manage all of these
symptoms of metabolic dysfunction.
So symptoms of metabolic dysfunction are
high blood sugar, high, uh, cardiovascular
risk, um, liver disease, kidney disease,
uh, weight, you know, weight gain.
And so we are able to help people
do that using a nutritional
protocol that we deliver, um,
that we deliver via, via our app.
Um, I, of course, wanna get into a ton
more detail, but would love to, uh, love
to partner with you on how to do that.
Kevin: Amit, I'd be curious to hear how
conversations with employers and the
plan sponsors have changed over the last
several years as, uh, yeah, it seems
like culturally GLP-1s have taken off.
I assume every customer of yours
is thinking about how, like what
are we doing in terms of GLP-1s,
offering them to our employees?
How do we navigate the cost of GLP-1s?
What's the impact of all of this?
Why do we need nutritional
programming on, on the side of GLP-1s?
Like, can you walk through what
the conversation is like with
customers today, how that's
changed kind of pre-GLP-1s to now?
Amit: Absolutely.
I'll start with where we are
today, and then I'll do a
little bit of, uh, the history.
Uh, where we are today is you, you
both are absolutely right in your
first two questions, where GLP-1s
dominate a lot of the conversation.
They dominate a lot of the
conversation and the mind share,
um, for a couple of reasons.
Number one is they're a huge
driver of cost, as you both know.
Uh, and number two is that they, y-you
know, they seem like they are something
distinctive and new to help with a
problem that a lot of people have.
Uh, let's frame the problem
that a lot of people have.
About 93% of people in America
have some, adults in America have
some metabolic dysfunction, have
met- some metabolic disorder.
Ninety-three percent,
that's almost everyone.
Uh, and the, one of the most common
ways that shows up is obesity.
And so somewhere, depending on what,
you know, what source you look at,
it's 60% to 70% of people have obesity.
And so when you have a drug that they're
marketing as can help with that problem,
it ends up being on everyone's radar.
If you're a plan sponsor,
you're thinking about this.
And so that is the most common current,
uh, version of the conversation, and
what that means for us is that we,
we feel like we're in a great spot.
Again, we've got over a decade
of working with these drugs.
Just so people know, GLP-1s, and I
think most people on this call will
know this, GLP-1s were initial-
initially type 2 diabetes drugs and
have been so for over twenty years.
And so when I say we started our
clinical trial in 2015 and worked
with patients with type 2 diabetes,
many of them were on these drugs.
Uh, at the time, they were
called Ozempic and Mounjaro.
They're still called Ozempic and
Mounjaro if you're, uh, if you're
prescribing them for type 2 diabetes.
They're just also called Wegovy
and Zepbound if you're prescribing
them for some of these other
indications, uh, like obesity.
And so we actually have data to show
how patients, uh, uh, uh, how, how
we work with patients on these drugs.
And the, what I like to say is that
we're the best solution before,
during, and after GLP-1 use.
Before, it turns out that 65% of
people that wanna lose weight wanna
do so without the use of a drug.
Um, and the wonderful part about Virta
is that we have shown our nutritional
approach provides the same weight loss at
one year out to two years as these drugs.
And our n- and our weight loss, by the
way, is on an intent to treat basis, so
it's on a, it's across the population.
It's not what the, what is p-
what is published for these
drugs, which is, um, just on the
people that stayed on the drug.
Um, okay.
But that's okay.
So before, so, so on the way in, on
our, on p- on people's way in, we
counsel them to take the nutrition
pathway, and on, and are honestly about,
um, about as successful, 60% to 70%,
as the population would indicate in
getting people to choose that pathway.
In terms of during, it'sâ¦
GLP-1s are a wonderful tool, and
because we're a national provider,
we actually prescribe them
Number one is around comorbidity.
Again, for comorbidities, it would
make sense to prescribe them.
And number two, for people who are
very, um, concerned about starting
the nutritional protocol, we
find it a great way to kickstart
their weight loss journey.
In addition, when the FDA approved
GLP-1s, it said you have to pair it
with weight, with, uh, with a lifestyle
change, and Virta is the proven
lifestyle change that you can do with it.
And so we find it to be a great kickstart.
It does bring down food noise,
but by the way, so does our
nutritional protocol over time.
What you, what you hear is that people,
um, reduce their food noise and eat right.
And then after, again, the only company
with peer-reviewed published data to
show that we maintain weight loss out
to 18 months post-discontinuation of
GLP-1s, again, done safely, uh, in
partnership with our provider group.
So, so anyway, that's the key
discussion that's happening today.
Um, you know, that obviously saves money.
One of our Fortune 100 clients,
we recently were able to show
them we saved about 50%, um, GLP-1
spend over the course of a year.
Again, uh, 50% while making their
people healthier, not just by provid-
providing friction, but by actuallyâ¦
and utilization management, but by
actually making people healthier.
Um, Kevin, you asked about
the evolution over time.
I'll answer that very quickly
and then, uh, allow you to, allow
you to direct me to what's next.
Um, the evolution over time, I
would say, is, again, 10 years ago
when we first were selling toâ¦
We actually didn't really start our
commercialization, commercialization
in earnest until about kind
of six or seven years ago.
But when we first were selling to these
plan sponsors, um, w- you know, we, we
initially would tell them about all the
metabolic diseases we could solve, and the
one they were most interested in was type
2 diabetes because it drove a lot of cost.
Um, what GLP-1s have successfully done
over the last few years is provided a new
price point and cost point for a disease
that a lot more people have, like obesity.
And so while our, our earl- our
earliest customers, US Foods, for
example, was one of our early customers,
they actually covered Virta for
pre-diabetes, uh, and obesity early on.
Mm.
Um, but it wasn't something that
was a huge part of our business
until GLP-1s, um, took the stage.
And, uh, and so anyway, so that's
how the conversation has changed.
And now they are the dominant piece of the
conversation is what your GLP-1 strategy
is, specifically in the employer space,
a little bit different in health plans,
um, but, but in the employer space,
that's a big piece of the conversation.
Martin: One of the things I found
really fascinating is you've been
publishing a lot of stuff recently,
serious liver disease, pancreatic
cancer, chronic inflammation, stuff
that intuitively I don't think of as
metabolic disorders or, or diet related.
I'm curious, you know, where does the
Virta approach work outside of, outside
of just the sort of what we would
conceive of, of metabolic disorder?
Amit: Yeah.
Martin, we love that question.
The wayâ¦
I'll go back to that 93% number.
I believe that was a Swiss Re
report from last year that, that,
where, where I pulled that from.
Um, 93% of people have
metabolic dysfunction.
It turns out the root cause of
many of these issues is the same.
So let's back up.
When we think of high blood sugar,
a disease of high blood sugar, um,
we think t- di- prediabetes, type 2
diabetes, and we try to, our approach
is try to manage that symptom of
high blood sugar with medicine.
Then we think of, uh, high blood pressure,
try to manage that with medicine.
Then we think of, um, liver disease,
MASLD or MASH or NASH or however,
you know, I think the latest
is MASLD, try to manage that.
There's one drug on the market for that.
Um, you think of, um, a kidney
disease, multiple drugs on that.
It turns out that our healthcare system,
as you both know, and, and I heard part
of your previous conversation you talked
about this in different ways, is really
ma- it's about managing those symptoms
Um, and so, a-and, and, and, and a lot of
the training that we go through is, uh,
that our physicians go through is about
managing each of those individually.
And what we've discovered at
Virta is that the root cause of
all of those things is the same.
It's what you eat.
And so, um, what weâ¦
So over the last 10 years,
we've been working on that.
We've got the only scaled program where
we can deliver the results based on
helping people change what they eat.
Um, and so we just started
looking at the claims datasets
around those, around that data.
Again, we've got hundreds of
thousands of patients over a decade.
And so as we started looking at the
claims datasets, that's where we
were able to start really connecting
all of these different conditions.
And so we looked in claims
data and we said, "Hey, when
you solve what people eatâ¦"
By the way, everybody that was enrolled
in Virta over this period, not everybody,
the vast majority, over 90% of the
people were in the Virta treatment
for type 2 diabetes, pre-diabetes,
or obesity or, or overweight.
Is those are the three conditions
you enrolled in Virta for.
When we looked at the claims, um, uh,
at the claims for the intervention
group, the Virta group, compared to
folks that were similarly matched, so
started with those same, uh, with similar
conditions, and over the course of time,
we saw a re- a significant reduction
in, um, the, uh, in cardio- in, uh,
cardiovascular risk, uh, specifically
a 54% reduction in major adverse
cardiovascular events and death, MACE.
Um, significant reduction.
And so again, you solve that root cause
of the problem and people are dying
of cardiovascular disease a lot less.
Um, same thing in CKD.
We looked at the incidence of CKD
and CKD progression over, over in our
group versus the other group, and it
turns out that, like, it got better.
By the way, we have additional
data on improvements in eGFR.
So it's not just that the outcomes got
better, we could actually now speak
to some of the underlying processes
that got, that got better or the
underlying biology that got better.
Um, same in MASLD.
Uh, same, and I, you know,
I could go down the list.
Um, recently you, you, as you mentioned,
we've just pu- uh, released a paper
on inflammation markers and the
significant improvement in inflammation.
And so I, I guess the, what, you know,
when you solve the root cause of that
issue, all of those symptoms get better.
Uh, and at this point, we have
peer-reviewed published papers on
essentially all the ones I mentioned,
depressive symptoms over two
years, improvements in knee pain.
Again, you lose weight, uh,
musculoskeletal gets better.
Uh, and again, it comes from solving
the root cause of that problem.
Kevin: So one of the fascinating parts
of this conversation to me, if I think
about nutrition as the root cause of
the problem, getting people to eat, eat
healthier, eat better, um, solving these
various symptoms, that like the theory
of that case makes total sense to me.
It also seems much easier societally
to convince people to just inject
themselves with medication that,
that solves it without changing the
way they eat, so on and so forth.
And, and, and that seems like a, a
cultural moment that we're in today.
But I also notice the, the broader kind
of maha conversation, more focus on food
supply, more consumer cultural awareness
of, of what we're putting into our
bodies, and our overall kind of general
health and wellness is part of that.
And I'd be interested in yourâ¦
Ha- have you, have you seen any tailwinds
from a nutritional perspective, from
conversations about food, what people
are eating in the consumer world from
this kind of maha sentiment that, that
we've been talking about food supply
so much more in recent months, years?
Amit: Kevin, there are like a couple
questions, uh, uh, uh, layered in there.
So I'm gonna- Yes, for
sure ⦠do my best.
Uh, the, the fir- the, the, the last
question you asked was around tailwinds,
and I would say we've absolutely
seen tailwinds over the last decade.
I joined Virta in 2016, and I, um, a-
and look, this isn't an N equals one
conversation, but we'll make it w- we'll
make it so for, uh, for a minute here.
And I got on the Virta treatment
at the time just to try it out.
Uh, and now I have been
doing it for a decade.
I felt so good.
I lost about 20 pounds.
I feltâ¦
And just for me personally, when I
go to Costco and I go to the store,
finding things, I, I'm alsoâ¦
But, but not only am I low carb,
I'm also vegetarian, so finding
things has become a lot easier.
But that's just true a- across the board.
I mean, as we, uh, we have a
very active patient community.
People are, uh, are constantly
talking about what they've
seen, what they've heard.
I think, you know, a, a decade ago when we
would say things like sugar and processed
foods and, and processed carbs are, are,
are not that good for you, we had to doâ¦
That was an education point for people, I
think, and, and it took some convincing.
Uh, it doesn't take as
much convincing these days.
People are kind of like, "Yeah, I get it.
I see it.
I've heard that.
I've heard that through, um, I've heard
that not only from, uh, you know, social
media and Mahmoud, but from the doctors."
You know, like- Mm-hmm ⦠I
think more and more people are,
are accepting of that, of that
theory, um, and that approach.
And so I would say that the
broader acceptance, the-
broadly, we see tailwinds.
Um, now, uh, one of the things that you
mentioned that I think is a, I think
is a assumption that many people make
is that it's way easier to get people
to want to inject themselves, uh, or
to get people to want to take a pill
than it is to make a lifestyle change.
I actually don't think that is true.
Our- my experience is that
that has not been true.
Uh, and, and by the way, I think painting
any population with broad, with broad
brush strokes doesn't make sense.
So I'll go back to my data.
You know, is there a percentage
of people that would rather take a
pill or inject themselves or, uhâ¦
Sure, sure.
But I don't, I'm not sure
that's the vast majority of the
people that have this problem.
And I'll go back to the 65% of
people that wanna lose weight, wanna
do so without the use of drugs.
It turns out that the science that we've
been trying to treat these people with
has been wrong We've been saying eat
less and exercise more, starve yourself,
and then, and then feel good about it.
Well, it's not surprising that
that's actually not sustainable.
And so what we have proven at Virta
is that if you make the right changes,
if you change what you eat and not
starve yourself, actually just change
the macronutrient balance of what you
eat, shift your body to being way more
efficient at burning fat as its primary
fuel source, and eat to satiety while you
do it, it's actually quite sustainable.
Um, and when it becomes sustainable and
enjoyable, then I think more people,
more people are willing to do it.
And so, I mean, that's what Iâ¦
A- again, that's also my
n equals one story, right?
Like I, I, uh, I definitely, you
know, at the beginning thought it was
really hard, and then as it became m-
as I got more used to it, I loved it.
I mean, I feel so good.
I know I'm, I've been on it for 10 years.
And so that's kind of
where, um, where I thinkâ¦
W- what you just said is what,
um, is what, uh, I think o-
our, our system is trained in.
We're trained- Mm-hmm ⦠as providers
and, and, and as, as a health system
to do things fee for service, and
the things that we can most easily
do is provide pills, uh- Yeah
and injections, and it's
also what our pharmaceutical
companies are, are experts at.
You know, it's like, hey, like,
you know, here, all theâ¦
Again, I'll go back to
I- high blood sugar?
Take these four meds.
High blood pressure?
Take these two meds.
You know, liver disease?
Take these meds.
You know, and like that's
what our system is built for.
But if you think of changing behavior
as like something that can actually
drive this value, people wanna
do it, and they just need help.
They need to know how to do it.
They need the support, you know, the human
support as well as in the moment support
that we can provide, and when you do
that, I think you can drive big change.
Kevin: I'm excited to see more
Super Bowl ads from Virta talking
about- ⦠these sort of changes
versus all of the drugs that I
Amit: could take.
Is Health Tech Nerds gonna
give us a Super Bowl?
I'd love that, man.
Kevin: We'll, we'll work
on that for you, Amit.
Martin: The Health Tech Nerds Super Bowl.
Amit, this has been so great.
Uh, thank you so much for your time today.
We really appreciate it,
and we'll catch up soon.
Amit: Kevin, Martin, I'm
greatly appreciative.
Thank you so much, guys.