Monetizing Obesity Medicine

• Reveals why patient dropout, and not medication effectiveness, is the greatest obstacle to successful obesity treatment
• Examines the structural collapse of traditional obesity care and the resulting rise of digital health platforms
• Analyzes how leading companies such as Apple, Peloton, Fitbit, Ticketmaster, and Zara solved customer retention challenges and what healthcare companies can learn from them
• Introduces the Canopy Framework, a practical architecture for building scalable, long-term obesity management programs
• Provides unique, key insights and tools from a physician who has worked across clinical practice, public health, healthcare policy, and digital health innovation
• Explores the powerful alignment between patient outcomes, healthcare economics, and sustainable business growth, showing why improving lives and building successful organizations do not have to be competing goals

Dr. Ashley White is a Canadian physician with dual certifications: family and emergency medicine through the College of Family Physicians of Canada and a U.S. board certification in obesity medicine through the American Board of Obesity Medicine. She holds an MD from McMaster University, a Master of Public Health in global health from Simon Fraser University, and an Honours Bachelor of Arts and Science with a Minor in economics from McMaster. Her career began outside clinical medicine, first as a senior policy analyst at the Public Health Agency of Canada, then in health program implementation with the Aga Khan Foundation in Afghanistan, and later in inner-city health research. She has practiced family and emergency medicine in rural and urban Ontario since 2017. Since 2021, her clinical focus has been on obesity and metabolic health, which includes the patient population whose patterns inform every scene in this book. For the last several years, she has also worked inside the digital health companies that this book examines—as Medical Lead in Canada for HeliosX and, before that, Director of Women’s Health and Obesity at PocketPills. In November 2023, she founded The Shift Clinic, a Canadian primary care practice for people with obesity and complex metabolic disease. Her practice is a living laboratory for innovation in ethical obesity care. The Shift is also where the Canopy was developed before becoming the framework that organizes this book. She lives in Hamilton, Ontario, with her family.

Disclaimer Acknowledgements Introduction About the Author Index of Key Performance Indicators PART I: THE GAP IN OBESITY MEDICINE Chapter 1: Miracles and Misconceptions Why Diets Fail A New Class of Medicine Lifelong Treatment The System Failure Endnotes Chapter 2: The Monetization of Obesity Medicine The Market Gap A Warning from Another Drug Class What These Medications Actually Cost Why 15 Percent Is Conservative, Not Aspirational Why Manufacturers May Accept Lower Revenue The Compounded GLP-1 Market Endnotes Chapter 3: Why You Are Reading, and I Am Writing This Book Where You Are Sitting What This Book Is For Why This Market Is Counterintuitive What Clinical Trials Actually Provide The Retention Problem Two Categories of Solvable Problems How Value Gets Captured What This Book Offers The Invitation Endnotes PART II: KEEPING YOUR CUSTOMERS: LESSONS FROM THE OUTSIDE Chapter 4: The Apple Pricing Lesson Where Apple Actually Makes Money The Actual Cost of Making These Medications The Availability of Medications in Oral Form Global Pricing on the Horizon The Best Buy Alternative The Customer Acquisition Cost Crisis Wayne’s Calculation Two Types of Gaps What about the App Store and the Geek Squad? Endnotes Chapter 5: The Ticketmaster Trap The Regulatory Squeeze The Prescription Economics Problem The Primary Care Myth The Cash-Pay Bypass Sarah’s Brand-Trust Problem The Canadian Crystal Ball Bridge Behavior: Direct-to-Consumer Pricing The Escape Route Endnotes Chapter 6: Peloton Was Not Selling Bikes High Retention, Wrong Metric The $50 Billion Manufacturing Bet How Peloton Saved Itself What Made the Peloton Subscription Stick WeightWatchers Was Watching What Drives Discontinuation? What Belonging Looks Like in Practice Endnotes Chapter 7: Fitbit: Data Without Interpretation Data Without a Story The Fitbit Bet The Hardware Choice What Interpretation Looks Like What the Livongo Outcome Shows Endnotes Chapter 8: Zara Is Built to Listen How Information Moves Responding to Patient Needs The Zara Culture Zara’s Listen-Respond Loop Endnotes PART III: THE CANOPY: BUILDING THE INFRASTRUCTURE FOR PATIENT SUCCESS Chapter 9: The Two Last Miles The Monocrop The Canopy Framework Retention Does Not Matter The Canopy Framework Key Performance Indicators Why Empowerment Lives in the Whole Canopy Two Example KPIs What Follows Endnotes Chapter 10: Cost in the Canopy Product-Price Fit The Four Cost Component KPIs The Flywheel of Success KPI Games Complexity and the Canopy Endnotes Chapter 11: Coverage in the Canopy How Coverage Works Coverage Is Access Creative Coverage The Long Game for Coverage From Coverage to Care Endnotes Chapter 12: Care in the Canopy The Monocroppers Good Care Handles Complexity Care Plans Live Care Transforms Care Requires Learning Endnotes Chapter 13: Curriculum in the Canopy How We Learn The Status Quo Problem The Curriculum Lives On The Restriction Era is Over Endnotes Chapter 14: Coach in the Canopy Bridging the Know-Do Gap The Patient’s Choice The Patient Who Goes Quiet Wayne’s Coach Profile: nymble.health—Closing the Know-Do Gap Endnotes Chapter 15: Community in the Canopy Bias Busting Helping Helps Helpers, Too More Than a Bulletin Board The Peer Ownership Pivot Livy’s Peloton Sarah in the Community Endnotes Chapter 16: Connection in the Canopy Listening between Visits What Would the Monocrop Do? Listening, Interpretation, and Sense-Making Connection KPIs Big Learning Comes from Big Listening Sarah, Connected RxFood—Patient-Centered Nutrition Support Endnotes Chapter 17: Transformation in the Canopy The Canopy, Revisited Whole Canopy Patient Behavior KPIs Whole Canopy Program Stewardship KPIs What about Weight? An Invitation to the Canopy Endnotes Index