knownwell is a U.S.-based hybrid healthcare company providing weight-inclusive primary care and metabolic health services through a combination of virtual appointments and in-person clinics. Founded in 2023, it offers longitudinal obesity, diabetes and metabolic care, integrating primary care with nutrition, behavioural health and medication support.
Your path to founding knownwell began long before the company itself. What convinced you to leave a career in technology and focus on obesity care?
Weight has been the defining feature of my experience with healthcare since childhood. When I was eight, my primary care doctor told me I should go to fat camp, and I even gave the Harvard Business School graduation speech about my weight. I never thought it would become the focus of my career, but in 2020, after moving to Chicago, I was re-establishing primary care. I ran late to my appointment because I wouldn't go without wearing a Harvard T-shirt, having learnt that if a clinician saw me as smart, they would take me more seriously despite my weight.
That night, I researched whether people with obesity avoid healthcare and was shocked by what I found. Fifty-five percent of women with obesity have cancelled a doctor's appointment because they're embarrassed about their weight, and patients who do seek care are less likely to receive a mammogram or colonoscopy, even though those are based simply on age. When I realised people didn't feel welcome in healthcare—and often received worse care when they did—I became determined to solve the problem. I met my co-founder, a long-time leader in obesity medicine and now our Chief Medical Officer, and together we founded knownwell.
knownwell describes itself as a healthcare home rather than a weight-loss clinic. What does that approach look like in practice, and what evidence shows it's working?
We're filling a gap. Primary care often doesn't treat obesity well and often doesn't welcome these patients, while programmes like WeightWatchers don't keep patients engaged long term. The real insight is that sustainable weight-loss outcomes depend on staying in treatment. We see obesity as going into remission rather than being cured because, for most people, it's a lifelong condition.
We believed patients needed comprehensive care while having their obesity treated by experts. That meant accepting insurance, hiring a welcoming multidisciplinary team, and designing both our app and clinics to signal that patients belong there—from the size of the chairs to blood pressure cuffs that always fit. We also use technology and dedicated staff to make sure we don't lose track of patients. We've seen 97% weight-loss sustainment at two years, about three times the benchmark; 81% medication persistence, comparable to Eli Lilly and Novo's clinical trials; patients lose lean muscle mass at about half the benchmark; and an NPS of 90 across more than 25,000 patients. Those outcomes tell us patients value the inclusive, welcoming environment we've created.
knownwell has expanded its work with pharmaceutical companies through clinical trials. What has that meant for the business?
We partner with several pharmaceutical companies on Phase II and Phase III pharmacotherapy trials, and being selected by so many sponsors speaks to both the complexity of our patient population and the quality of our clinical care. It shows they trust our clinicians and care model.
To me, that's one of the highest bars you can meet. Being selected by so many sponsors shows we've delivered on the promise we made to patients and partners.
AI and digital tools are giving clinicians and patients access to more information than ever before. How is that changing the clinician-patient relationship, and how does knownwell use AI to deliver more personalised care?
We use a proprietary, AI-driven clinical decision support system. It brings together a patient's medical records, behavioural and emotional information they've shared with us, their insurance coverage, the latest obesity research and what we call the "Knownwell Way." At a patient's first visit, it gives clinicians five or six recommended next steps based on everything we know about that individual. That might include starting a medication, meeting with a dietitian or making nutrition changes—it depends entirely on the patient.
It helps clinicians identify important details buried in years of records and make better-informed recommendations. That allows appointments to focus on patients' goals and agreeing on a care plan, rather than collecting medical history, creating more time to build the clinician-patient relationship. At the same time, patients arrive with far more information than they did 10 or 20 years ago, regardless of how good that information is. They often have stronger views about what they want, what's wrong and even which medications they should receive. That's positive, but clinicians now spend more time helping patients navigate information as part of the consultation.
GLP-1s have transformed the conversation around obesity. Has the focus on medication come at the expense of long-term behaviour change?
I actually think we've done too much of the opposite. For the last 50 years, the message has largely been, "Work harder." Whether it was exercise programmes, in-person meetings, or the latest diet, the focus was on trying harder and eating better. I remember going to a WeightWatchers meeting when I was 11. We never really appreciated the biology behind obesity.
The current focus on medication is a healthy overcorrection because the data is clear. We have 30 years of evidence showing that the vast majority of patients cannot lose weight with lifestyle changes alone, and most won't keep it off. The mental health aspects remain important, but recognising obesity as a biological disease rather than a lifestyle failing is a healthy shift.
Obesity care is changing rapidly. As that landscape evolves, where do you see knownwell’s role, and how do you expect obesity care to change over the next decade?
We proudly use pharmacotherapy. For the right patient, it's an important tool—but it's only one tool. That's why we have health coaches, registered dietitians and a multidisciplinary team. We don't think these drugs are going away. They'll continue to improve, and patients deserve access to them. We also advocate for Medicare coverage of GLP-1s because we believe healthcare is a human right. When health plans don't cover these medications, they're effectively telling patients they can simply work harder to overcome the disease. We don't say that about other chronic conditions.
We'll continue expanding across the US, both virtually and through more in-person locations. We think insurance coverage will improve, drug prices will come down, treatments will get better, and more patients will enter care. Today, we're serving only a small fraction of the people who need treatment. Around 70% of Americans are overweight or have obesity, and most aren't receiving treatment. My vision is to serve millions of Americans with obesity. In 10 years, if a patient who would benefit from pharmacotherapy isn't receiving it, there will be a real question about why—just as there would be if someone who should be on a statin wasn't. I also hope we'll see far less bias and stigma as obesity becomes better understood as a biological disease.
The success of obesity care depends on closer alignment between patients, providers and insurers. What's still preventing that today?
The biggest barrier is still the price of the drugs. As medication prices come down—and they already have—and newer therapies improve, it becomes much easier for insurers to justify covering them. We know that, at today's pricing, these medications are already ROI-positive for patients with obesity.
Insurers understand that intellectually, but it's still difficult when they're facing such a large annual spend. As prices fall and insurers see the long-term health outcomes, you'll see much stronger alignment between providers, insurers and patients.
