Jumping into the healthcare space wasn’t something Isabelle initially set out to do. But after a ski accident where she broke her pelvis and back, she was inspired to be a part of fixing the healthcare system. “Every touchpoint I had during my care was fundamentally broken,” she says. “The quality of care can be incredible in the US, but the delivery of that care is still medieval.” She declared it her mission to fix these gaps, and she left the world of e-commerce to become a founding team member of the pharmacy start-up Capsule. There, she worked to build operations, sales, marketing, and partnerships.
Eventually, another experience with the healthcare system led Isabelle to start Calibrate, a telehealth company that combines GLP-1 medication with lifestyle intervention to improve metabolic health to drive sustained weight loss. True to Isabelle’s mission, Calibrate is designed to solve issues connected to quality care delivery (and sustainability). Here, she talks about how the program works, the results she’s seeing, and how people can move the needle on their habits to create lasting change.
How did you come to start the company? Where did the idea for Calibrate come from?
My mom asked me to help her get control of her weight and health when nothing seemed to be working. I helped her find a doctor in New York who told us about glucagon-like peptide (GLP-1) receptor treatment. This drug improves insulin release and reduces glucagon release, and can be extraordinarily effective for weight loss when paired with behavior change. (Glucagon acts as a counterpart to insulin in achieving glucose homeostasis—it drive up blood glucose levels.)
It sounded too good to be true. I went home and pulled a lot of research on GLP-1s. At the time, the research compared the impact of GLP-1s alone versus intensive lifestyle intervention versus a combination of the two. The research concluded that the combination of GLP-1s and lifestyle changes drove two times more weight loss than either alone. It also looked like the weight changes when people made lifestyle interventions were more sustainable, but the duration of the trials wasn’t long enough to prove this out.
How do you take it from an initial idea to developing an entire program?
I emailed the researchers asking how we could make their work available and accessible to the 200 million Americans like my mom. I wanted to know how GLP-1s work and what the lifestyle interventions entailed. That’s when I spent a lot of time with obesity medicine doctors and nutritionists, and we put together an amazing clinical advisory board and, ultimately, the program you see today.
Obesity doctors and nutritionists don’t come together all that often. So putting these experts together was powerful. We all genuinely believe that GLP-1s and intensive lifestyle intervention together drive long-term sustained results because they improve your underlying metabolic health.
In terms of weight loss, what happens when you improve your metabolic health?
Weight loss as a category is so fundamentally broken because traditional diets don’t work. This is because the body is programmed to defend its current weight (what we call its “set point”) in the face of significant changes. For example, when you start eating less, your body will store more energy as fat because the signal you’re giving it is that food is scarce. Metabolic health keeps your body in balance so that big changes don’t have this destabilizing effect. A way to think about this from your body’s perspective is that if you’re giving it inputs that meet its needs in a way it can understand, it will stay in balance versus go into crisis in the face of change.
It turns out that the inputs that improve metabolic health—whole foods, sufficient sleep, a way to get exercise, and tools to manage stress—and the hormonal impacts each of these pillars has on your metabolic system is what drives the underlying physiological change required for sustained weight loss. And GLP-1s can kickstart this process. This is why Calibrate delivers GLP-1 and lifestyle interventions together. The GLP-1s help our members begin to move the needle on their metabolic health as they learn the habits that they’ll use to sustain it for a lifetime.
There are, of course, still unanswered questions. For example, if you’ve just lost 20 pounds, what is your set point? If you’ve been on GLP-1s for diabetes treatment for a few years, how much more weight can you lose? Why do trials show that a small percentage of people gain weight on GLP-1s? We don’t know. We also didn’t know how these results would translate from a clinical research project to the real world.
So what does the Calibrate program look like?
Calibrate is a year-long program divided into four levels: learning, practicing, setting, and sustaining.
Each level cycles through what we call our Four Pillars of Metabolic Health: food, sleep, exercise, and emotional health. Every two weeks, members have a face-to-face video appointment with their coach and receive a multimedia class connected to one of these pillars. Each class contains a biweekly goal designed to build to one of four-year-long goals: eating more whole foods and fewer fast-digesting carbs; exercising 150 minutes a week and doing strength training twice per week; sleeping seven to nine hours per night, and engaging in a daily mindfulness practice of your choosing that helps you manage stress.
Walk me through how you inspire change across these lifestyle pillars.
Calibrate is entirely focused on sustainability. Our year-long goals are all simple things we know we should do, but they’re surprisingly tricky to put into practice. That’s why we build up to them through those smaller goals. In fact, “small wins create big wins” is a foundational element of our program. Through our coaching, too, we remind them that we want them to take things one step at a time.
How do you teach people to fit these lifestyle modifications in their lives?
Everyone knows you should eat and sleep better and exercise more. For us, it was fundamentally about breaking things down to put them into your existing routine. It’s not scanning barcodes and tracking every food you eat. It’s understanding the foods that help and harm your metabolic health—and then trying to eat more helpful and fewer harmful ones.
Awareness is the most critical piece here. If we can make you aware that you didn’t sleep well last week, that’s half the battle. You can double down and recommit to it this week. Our app is nothing fancy. It looks at a few key metrics and shows you how they correlate to your energy level. If you ate a bunch of junk food last week, how is your energy this week? Were you walking after eating a big meal? How did that make you feel?
What role does the medication play? Do you anticipate they will take GLP-1s long-term?
Our goal is to get people on medication, drive results, and then get them off medication. You have to use the time you’re on medication to make the behavior change and change the underlying physiology. Then, even when going off the drug, you can sustain long-term results.
GLP-1s are cardioprotective, anti-inflammatory, and increase your body’s insulin production. They have some effects that we don’t understand yet. We know that something happens when you’re on a GLP-1 that moves your body to defend a set point 10 to 15 percent lower than your baseline weight in the beginning.
Calibrate went live in June 2020. Now that you have real-world data, what have you found happens with users’ health?
Recently, we released our first-ever results report on the first cohort to go through the program. We were looking at how their metabolic markers improved and how they changed their eating, sleeping, exercise, and emotional health. We wanted to know how they felt as a result of the program. We saw that 75% of people who had prediabetes reversed it according to the HbA1C numbers. More than 70% saw fasting insulin decrease.
Perhaps most importantly, 100% of people said they plan to keep at least some of their new habits beyond the 1-year program, and 80% joined our Master’s Program for ongoing membership. We’re curious to see how these markers correlate over time and how they play into long-term success.
Can you speak to the role personalization plays in the program, given how individual our metabolic responses to food can be?
One of the most incredible things about running a business in the real world is that you get data points back all the time. We have people on different food tracks and understand how they respond to those. From the results of the first 15,000 members, we have a strong hypothesis that our core program works for the vast majority of people. For the remainder, we are still figuring out what works and why. We can say that there’s not one pathway for everyone, but there are escalation pathways, and there are off-ramps. If something’s not working for you, we’ll try something else.
And one of the benefits of tracking is that we can target which changes impact a given individual and which do not. To focus specifically on the food question, we have a series of what we call “focus classes,” where members can track what happens when they make specific dietary changes so we can nail what works for them and help them put those things into practice. In the big picture, we want to go back and spend time on understanding how we can identify those people upfront.