Isabelle Kenyon, CEO & Founder of Calibrate, on setting a new standard of care for managing metabolic health

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Isabelle Kenyon, Founder & CEO, of Calibrate

In this episode, I sat down with Isabelle Kenyon, CEO and Founder of Calibrate. Founded in 2020, Calibrate is a metabolic health company on a mission to change the way the world treats weight. In August of 2021, Calibrate raised a $100M Series B round led by Founders Fund and Tiger Global. Since then, the company has hired hundreds of new employees and onboarded thousands of new patients, released its first Results Report, and geared up to launch its first enterprise clients.

Isabelle and I discuss:

• Isabelle’s own interactions with the healthcare system and why these experiences led her to commit to spending her career building a better, more consumer-centric system
• Why Calibrate’s emphasis on metabolic health represents a paradigm shift in how we treat weight loss and obesity
• Calibrate’s clinical model that combines medication, a holistic curriculum guided by synchronous 1:1 video coaching, and community
• The company’s plans to expand access to treatment through enterprise partnerships
• Isabelle’s focus on developing both her own and her company’s self-awareness as Calibrate’s leader

Beginning to 7:09: Isabelle’s path to Calibrate

• Career transitions: Isabelle’s love of learning has been the primary force behind her career moves over time. She studied Chinese as an undergrad, which led her to pursue a full-time job in China after school. She worked in investment banking there for a few years, which gave her an up-close view of the region’s tremendous development and growth. A recruiter urged Isabelle to consider startups, and she ended up taking a job at an ecommerce startup in London. She had always had a passion for understanding the consumer, beginning when she and her mom opened a store together years prior. Isabelle eventually returned to New York to work for an ecommerce incubator. These experiences taught Isabelle that she loved trying to understand the consumer and figure out what was next for them.
• Getting into healthcare: Soon after Isabelle returned to New York, she broke her back and pelvis skiing. This accident was her first real interaction with the healthcare system. To her, it seemed like one big retail business that should be an ecommerce one. The things that consumers value in retail — price and product transparency, for example — weren’t coming to light in healthcare. After this experience, Isabelle vowed to spend her career fixing this fundamentally broken system. She jumped in and joined the early team at Capsule, a pharmacy startup, where she got to learn the ins and outs of how the healthcare system works, how various incentives influence how money flows through it, and what’s next for the healthcare consumer.
• Her mom’s journey: Isabelle got a call from her mom one day saying that she needed Isabelle to find a doctor to help her lose weight. She shared with Isabelle that she had “tried everything and it doesn’t work anymore.” Isabelle found her a doctor at a fancy academic medical center (AMC) in New York, a process that taught her that every AMC in the country has a board-certified obesity doctor who treats a couple thousand patients each year. Isabelle saw this as indicative of a fundamental mismatch: there are 200M people who experience overweight or obesity in the US and only 5,000 doctors who specialize in treating these patients. Furthermore, thanks to the work of Dr. Thomas Wadden, these doctors have known for almost three decades what works for treating obesity, but these treatments haven’t become widely available or mainstream.

“For me, that was just this massive aha moment…we’ve known how to treat obesity for decades, and it’s been sitting in fancy academic research hospitals instead of getting to people… and I just started peeling back the layers and became completely obsessed with following the money, figuring out what the business could be there, and how you could really get access to more people in more places, ultimately, way more affordably.”

• An Aha Moment: This discovery — that we’ve known how to treat obesity for decades, but that this knowledge has been tied up in fancy AMCs instead of getting out to the people who need it — was a massive aha moment for Isabelle. She became obsessed with peeling back the layers on this problem, following the flow of money in the system and figuring out if there could be a viable business here. She sought to answer the following question: how could you give more people in more places more access and make it affordable? That’s where the idea for Calibrate came from.

7:09 to 15:29: On structural issues with the US healthcare system

• Why research stays in academia: I shared a recurring observation with Isabelle that I’ve noticed during my Pulse interviews to date — that evidence-based treatment models seem to keep getting stuck within academia. In response, Isabelle shared that there are structural reasons that explain why this happens even though these treatments can have major implications on how communities experience widespread diseases, like obesity. One reason is the high bar for publishing research that exists in clinical medicine — research has to undergo peer review, the publication process, and then findings are eventually shared at conferences, a fairly analog and slow process. After all of this happens, the research can be integrated into the standard of care and eventually be taught in medical schools. Because of how this process is structured, unless med school curriculums are constantly shifting and adapting to the latest research, we’re not constantly updating the standard of care. Isabelle recognized this isn’t an easy problem to solve. She also acknowledged that other issues, like who the healthcare experience is designed for, which she believes is never the consumer but rather the payer, also play a role in this phenomenon.
• Barriers to long-term health investments: Isabelle sees the UK healthcare system as one that more effectively incentivizes preventative care. The population looks fairly similar to the US’, but there’s a single payer that’s on the hook for cost and outcomes over time. The UK also has longitudinal data, so they know what happens over time if you do or do not effectively treat conditions like obesity. In the US, if you work for an employer for 1.9 years, which was the average time before the Great Resignation, the data from that time is siloed in one place, and there’s no incentive for your employer to invest in your long-term health.
• Patients as consumers: Isabelle strongly believes that consumers pay for their healthcare. When she shares this opinion, investors often assume she means payment through deductibles, but she means this more broadly. Due to employer-sponsored healthcare, employers face two choices: paying their employees more or paying for their healthcare. The total cost of employing people is the two categories combined, meaning that consumers have always been paying for their healthcare; they either get paid more but then need to pay for their healthcare or get paid less and have employer-sponsored insurance. That said, Isabelle is optimistic because she has started seeing consumers push hard for innovation in healthcare and demand things that have never been demanded before.

“And so ultimately, consumers have always been paying for their health care in the US because they’re either going to get paid more, or they’re going to get paid less and have health insurance. And so it’s kind of a myth to me that the deductible is the shift there. I think the shift there is consumer expectations”

• Building a consumer-focused system: Isabelle described some other changes she’s observed in the healthcare system over the years. The D2C healthcare movement largely flopped because consumers “didn’t want to pay for their healthcare” (she put this statement in air quotes). Because of this, companies needed to go the payer route, often B2B2C. They engaged in 18–24 month sales cycles with payers, raised a lot of money, got a payer contract, and then hired a team to build the product. Isabelle sees this order of events as “fundamentally messed up” because selling to payers means building the product for the payer rather than the consumer. Calibrate hasn’t been immune from this process. Isabelle has had payers, employers, and PBMs try to change Calibrate’s product to fit their own preferences. Her response to this: Calibrate’s solution has been clinically validated for the consumer, which is who the product is for, so why change it based on what you think the consumer wants.

15:29 to 20:03: On changing the way the world treats weight

• Metabolic health: Calibrate focuses on resetting metabolic health rather than weight or willpower management — an important distinction. The idea behind metabolic health is that we have a metabolic system, which is the combination of organs and hormones that determine our body’s consumption of energy. The CDC defines metabolic health according to five factors: waist circumference, blood sugar, blood pressure, cholesterol, and triglyceride levels. Being in the normal range for those five factors without medication indicates good metabolic health. However, seven out of eight Americans are not in good metabolic health. When a person isn’t in good metabolic health, their body is doing everything it can to defend a higher weight, which is why terms like weight loss and weight management have dominated this space despite them not being evidence-based.

“This idea that to be at a healthy weight or a normal weight, you have to be using your willpower is just fundamentally broken because your willpower cannot supersede your biology, which is going to push that weight higher and higher and then make your body defend that weight.”

• The world is flat model: I liked an analogy Isabelle used to explain our culture’s dominant story around weight loss. She explained the “calories in, calories out” model for how to lose weight is similar to the concept that the world is flat — it looks flat and kind of feels flat, so that’s a good working hypothesis. Similarly, it makes sense that eating less would result in losing weight. However, with both ideas, it’s more complicated. With weight, we know that it’s determined by a complex interaction between genetics, hormones, biology, and environment. Isabelle clarified that environment is different from lifestyle. For example, if Isabelle had gotten asthma from living in Hong Kong, where the air pollution is 100 times worse than in New York, no one would have blamed her for making a poor lifestyle choice or blaming her for a lack of willpower. It would have been considered an environmental outcome. In the US, lack of time, money, access to childcare, healthy food, and time to exercise are environmental but we treat them as lifestyle choices. She also emphasized that additional factors including our sedentary lifestyle and poisoned and highly addictive food supply have made the idea that you can live in the US and not have overweight or obesity insane.

20:03 to 31:42: The Calibrate Model

• The Calibrate experience: Isabelle walked through a patient’s experience participating in the Calibrate model in detail, which I’ve summarized here. The first step is making sure the patient is eligible for a GLP medication, which are clinically-proven and FDA-approved weight loss medications. Then, a patient is enrolled in the program. The patient pays, fills out a 150 question intake form on their health, family health, and weight history. The doctor reviews this information along with lab work in advance of a 45 minute video visit with the patient. This is often the first time ever that a patient has a 45 minute encounter with a doctor as well as the first time a doctor has reviewed the patient’s information in advance of the visit. The patient and doctor discuss 1) a full picture of the patient’s metabolic health, 2) how Calibrate has created a purpose-built lifestyle intervention around medication, and 3) how these components work together to lead to sustained metabolic health. The doctor then prepares the patient for the coaching experience, which happens every other week for 26 weeks. It’s built around four pillars: eating, sleeping, exercising, and emotional health. The purpose of the coach is to help the patient navigate the program, celebrate their wins, and reach their goals. It’s not to force them to make behavior changes — that is ultimately up to the patient.

“For most people, this will be the first and only time that they’ve spent 45 minutes face-to-face with a doctor. And the only time that they spent time with a doctor who’s seen their lab results before their appointment and read their intake before their appointment. Think about how totally broken that is.”

• The Calibrate community: In addition to interacting with a coach, members also interact with the Calibrate community (other members). Isabelle sees this element of the experience as one of the most important parts of the business. As she put it, the community aspect is so powerful in terms of putting people together who are going through the same program and giving them opportunities to connect. More specifically, members build relationships with other members through cooking together, going on hikes, communicating on social media, and more. This ultimately builds a community of people there for each other during the Calibrate experience, which Isabelle described as “the most magic part of the entire thing.”
• Program adherence: When I asked Isabelle how Calibrate maintains high engagement, she shared this remains a secret even to her. Calibrate has spent time driving general engagement, and now the company is focused on figuring out which types of engagement drive better outcomes than others. Isabelle’s hypothesis is that face-to-face interactions — getting on Zoom every two weeks with your coach and sharing how it’s going and creating a strategy for improvement — hold members accountable. Out of 13 sessions that happen in a Calibrate member’s first 26 weeks, they attend 11 of them on average. Scaling this engagement that comes through human interaction, the community, and coaching is absolutely essential.
• Virtual v. in-person care: Following up on Isabelle’s point about getting on Zoom with a coach every two weeks, I asked her if she expects that Calibrate will continue to provide care exclusively through virtual modalities or if she plans to add an in-person component. Calibrate opened a physical clinic early on, which they closed at the start of the pandemic. This forced the team to realize they could deliver the program virtually at a lower cost and offer greater access. However, due to the central role that community has played in the member experience, Isabelle believes there is a real case to be made for brick and mortar clinics. That said, a final decision on this hasn’t been made. For now, the Calibrate team remains focused on driving access and making sure it’s affordable.
• Taking on risk: I shared with Isabelle that I really like Calibrate’s money-back guarantee model — if a member doesn’t reach a 10% reduction in weight, they get their money back. It’s essentially taking on risk, but the concept is much simpler than how we usually talk about risk in healthcare — upside risk, downside risk, shared savings, etc. Isabelle shared that from the outset, Calibrate wanted to stand behind its outcomes. In Isabelle’s words, “the business should work because the product works.” However, this model wasn’t easy to implement. The team spent 18 months working with lawyers to figure out how to do this legally. Isabelle was committed to making it work due to what she learned from her mom’s experience: if her mom goes back to the doctor every three months for the rest of her life and stays on medication that her insurance company won’t pay for, that isn’t solving obesity. It’s simply medicating symptoms. Isabelle described Calibrate’s service as an outcomes-based model in what remains a largely fee-for-service world.

31:42 to 35:18: Looking Ahead

• Calibrate’s future: Calibrate’s focus for 2022 is to prove that their model works at scale. After that, the primary focus will shift to rolling out its program in partnership with organizations that pay for the service. By early next year, Calibrate expects to be live with its first employer partners, and then some health plan and PBM partners soon after. These partnerships will really start to fundamentally change the access equation according to Isabelle. Calibrate also plans to continue publishing its results in order to set a new standard of care that other providers and companies can practice. Isabelle believes that the best way to increase access is not for one company to provide care to 200M people. Rather, it’s for one company to share its model with the world so that others can start to use that model too. Doing this is what will shift the standard of care.

“The fundamental way to increase access is not for one company to provide care for 200 million people. It’s for one company to share what they’re doing with the world and the world to start using that as a standard of care.”

• Equity: Isabelle emphasized that weight bias is pervasive, and people of color are disproportionately affected by obesity. Calibrate wants to determine what works, normalize obesity, standardize treatment according to a better standard of care, and then increase access for everyone. To improve equity, these activities have to happen in parallel. This work aligns with Calibrate’s core mission, which has always been to change how the world treats weight. This mission has two meanings: 1) change the way we think and talk about weight, and 2) to change the way we actually treat it. To do this, Calibrate is constantly focused on healthcare’s iron triangle: increasing access and quality while decreasing cost at the same time.

35:18 to End: Leading and Developing Culture

• Leadership through self awareness: Isabelle described that her leadership journey over the last couple of years at Calibrate has consisted of focusing on self-awareness as a journey rather than a destination. This means working hard on her own self-awareness and building her team and company’s self-awareness. Calibrate focuses on matching what employees love doing and excel at with business needs. Isabelle has found that working at this intersection is what creates real operating leverage in a business. Calibrate calls this “the unlock.” More specifically, before kicking off a big project, team members write down the project’s “unlock” — why they are doing this now versus later and why the people working on this initiative are the right ones. Another component of Calibrate’s culture “operating system” is user manuals, which team members continuously update.

“The way that you bring culture to life is to repeat it…[and] to constantly and totally obsessively make sure that people are living the values day in and day out.”

• Scaling culture: Isabelle sees repetition and simplicity as the key components of building and scaling culture. In other words, to bring culture to life, you have to repeat actions, celebrate them, and make sure that people are living out the values that correspond to these actions. Hiring — intentionally and thoughtfully hiring people whose values align with Calibrate’s values — and firing — separating from people when their values don’t align with the company’s — have huge implications on culture.
• Partnering with investors: When I asked Isabelle what she was looking for in investors for Calibrate’s latest funding round, she shared that she always looks for the same thing in investors: people who believe in her, the team, and the category. This is because the business model and exact care model will shift over time, but these three elements will remain constant. She seeks out investors who will push her to be a better leader and help her grow and develop in lockstep with the business.
• Hiring: Lastly, Calibrate is hiring and looking for results-driven people with an “in it together” attitude. Isabelle encourages folks interested in digital health to figure out what they enjoy doing and are best at and do these things in a place that’s working on a problem they’re excited to think about every day.

We are so appreciative to Isabelle for joining us on this episode of The Pulse Podcast! Subscribe for our new releases on Twitter, Spotify or Apple podcasts.