I’ve seen some pretty impressive weight loss numbers for Ozempic, Wegovy, Zepbound, and other GLP-1 drugs. It is not uncommon for people to lose 10% to 20% of their starting weight in the first year using GLP-1 drugs. Unfortunately, most of the lost weight is found again when patients stop taking the drugs.

When I recently saw eye-popping numbers for a weight loss program that does not involve drugs, I had to investigate further. The study has been accepted by Frontiers in Psychiatry but has not been published yet. Researchers claim to have achieved the following results using the TOWARD intensive lifestyle intervention:

• 34.7% reduction in binge eating symptoms
• 40.7% reduction in food addiction symptoms

The TOWARD principles were developed by Dr. Tro Kalayjian, the founder and chief medical officer of TOWARD Health. Formerly obese, Dr. Kalayjian spent years getting board-certified in obesity medicine, losing 150 pounds, and developing an “intensive lifestyle intervention” for people suffering from obesity and type 2 diabetes. 

The intervention involves:

T = Text-based communications

O = Online interactions

W = Wellness coaching

A = Asynchronous education and community support

R = Real-time biofeedback and remote monitoring

D = Dietary modification (therapeutic carbohydrate reduction)

The TOWARD method was put to the test by researchers in a study published earlier this year in Frontiers in Nutrition. In that study, the TOWARD intervention was offered as part of an employee wellness plan. Fifty employees were enrolled in the trial, with a mean BMI of 43.2, a median age of 52, 46% male, two-thirds pre-diabetic, and two with diabetes. 

Forty-one employees completed the one-year trial. The results:

• Mean weight loss = 43 pounds
• 15.5% mean body weight loss
• Deprescription of 96 medications = 1.92 per employee
• Annual cost saving vs. GLP-1 is approximately $15,000 per employee

Those are some amazingly good numbers. A chart accompanying the study shows a timeline of the weight loss for all 50 participants. A beautiful, downward arc emerges, showing the most dramatic impacts in the first three months, stabilizing but still falling through the end of one year.

Here’s the kicker: The researchers were able to compare the impacts of TOWARD with and without GLP-1 drugs. “Total weight loss was comparable in patients with and without GLP-1RA,” the researchers note. Of the 50 initial employees, eight were using GLP-1 drugs at the onset of the intervention. During the trial, four employees discontinued the use of GLP-1 drugs; they experienced less than 5% weight gain.

What’s in this “intense lifestyle intervention” that leads to such dramatic and lasting results? Let’s take it from the “D” — dietary modifications — and work backward through TOWARD.

The dietary modification is therapeutic carbohydrate reduction (TCR). Patients were each given a customized “ketogenic diet” based on individual preferences and food allergies. “[A]ll patients were instructed to reduce total carbohydrates to fewer than 30 g to maintain nutritional ketosis.” Intermittent fasting was encouraged, but not tracked.

The “R” is real-time biofeedback and remote monitoring. All patients were prescribed one  month of continuous glucose monitor use and given a remote bodyweight scale, a glucose–ketone meter, and a blood pressure cuff. “The equipment also allowed for remote monitoring of real-time patient data, facilitating the safe clinical execution of deprescription.”

The “A” stands for “asynchronous education and community support,” but it might as well stand for “app.” It’s a smartphone application that includes a monitored community chat room for peer support:

All employees were given access to the clinic’s smartphone application that included a self-guided multi-media curriculum focusing on the science of hunger, appetite, food addiction, and cravings, as well as the role of stress and sleep hygiene on health and well-being.

The “O” stands for “online interactions” which means telemedicine between patients and the team. The team included “two physicians, one physician assistant, three medical assistants, four health coaches and one personal trainer.” That’s nine professionals servicing 50 patients. The process starts with an elaborate onboarding to learn about each patient’s diet, medications, physical health, mental health, and attitudes toward weight loss.

Patients are instructed in the scope of the program, the use of the equipment, and a tour of the app. A personal medical appointment reviews their initial lab results, medical history, and goals, and explains the dietary restrictions. Health coaches meet individually with patients, providing assignments involving educational resources, and requesting changes to their “behavior,” which I assume means requesting fasting or elimination of problem foods. After an “initial period,” virtual meetings with the team happen about once per week.

Finally, the “T” in TOWARD is perhaps the least exciting: Text-based communications. The ability to easily communicate with team members using text messaging, email, or the app is an important part of the whole program. It allows for mobile and real-time communication when food cravings strike or glucose levels drop.

I’m not so sure how helpful the anagram is. It sounds like a program of low carbs combined with tough love generates a significant weight reduction and dramatic lifestyle change. Employees are able to lose the weight — without the drugs — and keep it off, with a combination of real-time monitoring and just-in-time support. TOWARD is poised to take a big step forward in improving employee health.

Written by Steve O’Keefe. First published July 9, 2025.

Sources:

“TOWARD: A Metabolic Health Intervention that Improves Food Addiction and Binge Eating Symptoms,” Frontiers in Psychiatry, July 2, 2025.

“TOWARD, a metabolic health intervention, demonstrates robust 1-year weight loss and cost-savings through deprescription,” Frontiers in Nutrition, February 13, 2025.

“Making America Healthy: New Study Shows Weight Loss, Medication Deprescription, and Cost Savings Using the TOWARD Approach,” PR Web News Release, February 14, 2025.

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