I personally struggled with stress eating for 6 years. During that time, I was at Cambridge University, then built and sold my first company working with the UK government. It was tough, and poor eating habits as a teenager became a coping mechanism as an adult.
Fella first started as a "CBT+community" product to help men battling stress eating. It resonated due to the stigma around men's eating struggles. But we realized we were only half-serving most of our customers: even when no longer stress eating, most guys weren't getting to a healthier weight.
So we started researching effective, evidence-based treatments for obesity. When I say "we", I really mean my co-founder Luke. He studied medicine at Cambridge University, developing a patented AI approach to detecting cancer at a YC bio company, before moving to Microsoft Research. He parses bio papers better than me...
Obesity treatment is about to radically change. This is thanks to a breakthrough medication — NY Times called it a "game changer" in Feb 2021 [1]. The medication was approved by the FDA in June 2021 [2]. It leads to an average 15% decrease in body weight, efficacy close to bariatric surgery [3]. However, medication-assisted treatment for obesity is still stigmatized by family doctors and therefore hard to access.
Moreover, only 10% of those using weight management services are men, despite men representing 50% of those with obesity. This is because almost all programs market to women, placing too much emphasis on looks and not enough on health for a male audience. Stress eating is widespread among bigger guys, but mostly ignored — with too much focus on willpower and "eat less, move more". This needs to change.
So we pivoted to the Fella you see today: a telehealth experience with a board-certified obesity doctor for FDA-approved medication, combined with personalized health coaching. We went live in Texas in July, and are soon to be live in California and New York. Fella is a 12-month program and costs $149/month, paid quarterly. We’ll bring costs down over time to improve accessibility.
We still have lots of difficulties ahead. The main one could be insurance reimbursement: the latest wave of medications are expensive and insurers don't like to cover them [4].
We’re excited to hear your ideas, questions, concerns, feedback — and maybe any personal stories. I’ll be responding to comments all day, or feel free to shoot me an email at richie@joinfella.com.
[1] https://www.nytimes.com/2021/02/10/health/obesity-weight-los...
[2] https://www.fda.gov/news-events/press-announcements/fda-appr...
[3] https://www.nejm.org/doi/full/10.1056/NEJMoa2032183
[4] https://www.bloomberg.com/opinion/articles/2021-07-19/weight...
It's fair to say your avg HN reader is very different to your avg American. For example, you seem already somewhat clued up about Semaglutide. You're likely interested in the biology behind it, and probably aren't afraid to parse the journal article about it.
I really wanna emphasize how different this is to your avg American.
So it's more my bad for not tailoring our language enough for a HN post.
I understand that the hustle is a part of the marketing. But medicine is not the area where you should lean on it. At least not on it alone. If you don't give me full and verifiable information about what you have, I won't be interested. Too many scams around and too high risk, especially with the new and yet unproven stuff.
You've probably heard the story about Head & Shoulders shampoo? This is taught in a lot of marketing classes. The year it launched there were other shampoos launching that also included selenium disulfide and piroctone olamine and therefore could have sold themselves as anti-dandruff shampoo, but the other shampoos instead went after the general market and they almost all failed. Head & Shoulders started with a niche and eventually became a giant:
"By 1982, it was the "number one brand" of shampoo, and it was noted that "No one hair care brand gets so many ad dollars as Head & Shoulders, a twenty year old brand, and no other brand matches its sales", despite it being a "medicated" shampoo."
https://en.wikipedia.org/wiki/Head_%26_Shoulders
I am average American.
They’re just taking the same medication and using it at lower doses for weight loss instead of diabetes control.
And frankly, as a fat diabetic, I strongly suspect it’s doing the exact same thing in both cases, and the reason it works for diabetics is that it helps them lose weight.
It’s definitely on my list to discuss with my endocrinologist.
Couple things:
Injectable Semaglutide was first FDA approved in 2017 as Ozempic. Wegovy is also injectable Semaglutide. The key difference is the approved dose: Ozempic is 1.0mg, Wegovy is 2.4mg. The FDA approval is also very important for future insurance remibursement.
Semaglutide is a GLP-1 RA. These medications stimulate a receptor in your body which results in three main effects: 1 - Slowing down gastric emptying so food stays in your stomach for longer (this is thought to be why there is sometimes nausea when starting the medication) 2 - Making you feel full by working on your central nervous system 3 - Managing glucose control (which is why it's used for people with diabetes too)
[1] gives you a great summary of the field up to now and how it works.
[1] https://blogs.sciencemag.org/pipeline/archives/2021/02/15/gl...
TRT clinics are grossly overpriced, charging $300+ A month for $5 drugs, so there is almost certainly room to disrupt that market. I’d be willing to wager many obese men display hypogonadism too.
I do know one thing about your space, from pure happenstance. I live in Texas and my wife is a fourth-year medical student here. One of her profs is a bariatric surgeon and she spent time in his clinic. One of the interesting things she learned was the correlation between weight loss for one adult and weight loss of a household. I don’t remember the exact stats, but this doc would have whole families weigh in at his clinic, before and after. The results were astounding. The person who got the surgery would often lose only the plurality of the weight, and sometimes not even that. It’s something to consider messaging around as you target men and try to get through the stigma to persuade them to seek treatment. You are doing something good for your family; this is about more than just you. Texan men in particular are likely to hold more traditional values about being the head of their household, however unfashionable that may be. Help these fellas— and help their families.
> "The person who got the surgery would often lose only the plurality of the weight, and sometimes not even that."
By this you're meaning the whole family lost weight after one individual had bariatric surgery?
I tried low carb and keto. It works fine for me, but selling my wife on a breakfast that consists of 6 eggs and a pound of bacon is a hard sell. So there’s always bread and pasta in the house, which makes it harder to resist.
It helps a lot that I do the grocery shopping, I try to avoid buying stuff that I'll be too tempted by - like regular carb tortillas or plain tortilla chips.
How the coaching works in the program is that we dive in at the start to really understand the 1-3 key leverage points where we can make the most impact - then focus all our coaching time on these.
Definitely interested in this!
As I am sure you are aware, obesity is a complex issue and many of the suggestions sufferers get such as eat less, exercise more, try fasting, go keto, etc. are simply not helpful in and of themselves. Neither is just prescribing the latest medications without other forms of support.
I hope your concept of telehealth, medical supervision and personal coaching is one that will get results. Obesity is a serious issue that is robbing society of people and potential.
People can argue until they're blue in the face but if you eat less calories than you burn you will lose weight. The problem is people with trauma plus a food addiction are not able to do this.
Is there any research around where you live and propensity for morbid obesity - especially living by the sea? I could only find one study which did support this theory but it was in the UK. I live in Bondi Beach where socialising is essentially exercising - surfing, swimming, kayaking etc etc and anecdotally I don't think I've ever seen a morbidly obese person in over 30 years (I know this sounds ridiculous and maybe it's because they never leave the house but it's true).
That said, important to state a psychological-only approach sadly isn't sufficient for the majority of people.
I've never looked for research on this, but the environmental & social pressures are definitely believable why they may produce this outcome. I also wonder how important selection effect is here for your Bondi Beach example.
What was the previous startup by the way? Always interested in improving my knowledge of the space!
Fella works just as well for younger guys. Any more questions I can answer?
I will say, don’t be too hard on yourself. My stress eating would spiral (and still does!) when I get too hard on myself. Set small goals and objectives (no eating after dark, be mindful of what you put on your plate, no second helpings, etc) because completing these always feels good.
The "small goals" is also critical to counter all-or-nothing thinking. We use a mix of behavioral & cognitive approaches to try to cement the improved habits & ways of thinking.
> So we started researching effective, evidence-based treatments for obesity
Fasting has a tremendous amount science supporting it [1], can you articulate why you're pursuing the prescribed semaglutide approach instead?
[1] Fasting: Molecular Mechanisms and Clinical Applications https://www.sciencedirect.com/science/article/pii/S155041311...
The issue is we're starting to have a more nuanced understanding of the metabolic resistance people face when they undergo dietary changes - basically the body fights hard against you as you try to lose weight by dieting.
So it's now industry-standard among obesity specialist doctors to see obesity as a "metabolic disease" which, for the vast majority of people, needs a medical approach which doesn't rely on willpower.
I used to weigh 310lbs, now I'm 215lbs. All I did was count calories to maintain a deficit and the results were essentially the same as predicted by the math. I was a bit hungry sometimes at first as I adjusted to it but that's really it. Prioritizing protein and fat over carbs helps with that.
What ways does the body tend to fight against people?
> basically the body fights hard against you as you try to lose weight by dieting
Anecdotally I think many folks would agree. Any citations or references you could provide on this point would be greatly appreciated - I'm struggling to find any solid literature with the phrase "metabolic resistance" in the context of dietary changes.
> So it's now industry-standard among obesity specialist doctors to see obesity as a "metabolic disease" which, for the vast majority of people, needs a medical approach which doesn't rely on willpower.
I agree that the current standard of care is largely focused on prescription medication. Is there strong evidence supporting the claim that the majority of people need treatment that doesn't rely on willpower? I'm particularly interested in the well documented association between obesity and mental health [1], and I think Fella would be especially compelling if a holistic approach to treatment was offered.
[1] The High Prevalence of Poor Physical Health and Unhealthy Lifestyle Behaviours in Individuals with Severe Mental Illness https://www.researchgate.net/profile/David-Scott-76/publicat...
Now I started losing weight by just balancing macro-nutrients; more protein, more vegetables, less carbs as opposed to absolutes "no" and "only" except for no sugary drinks and beer and deserts except in social occasions. Also big emphasis on weight lifting as opposed to cardio. Cardio helps with its own health benefits but is very poor for muscle growth and fat loss and should be seen as a compliment.
By using electrolyte powder I only really had one or two really miserable days this time round.
My point being: there is no "one size fits all" approach to weight loss.