When it comes to healthcare, Habitual is playing a big game. In fact, this British MedTech start-up’s ability to roll out to millions of customers quickly and affordably is its defining characteristic – it has been created entirely for that purpose. The other noteworthy thing about this company is the size of the problem it’s trying to solve: Herculean, titanic, humongous, mammoth… pick your adjective. And then use the same word to describe Habitual’s potential.
Here’s why. Habitual is building a business that could, theoretically, improve the lives of more than 500 million people living with type 2 diabetes. According to WHO, that’s the total number of people living with the disease – a rise of over 300 million since 1980. Not only that, but Habitual could also help the one in three of the world’s population who have prediabetes – a high-blood-sugar condition that often leads to diabetes.
Beating the bottleneck
Its co-founders – British doctor Ian Braithwaite and California-born biochemist Napala Pratini – looked at these staggering, exponentially growing numbers and scratched their heads. They noted that many diabetes-fighting companies were already trying to tackle the problem – Omada and Livongo in the US, for example, worth around $1bn and $4bn respectively. But the mountain of patients was so massive that these organisations were barely scratching the surface. The pair concluded that a new approach was needed to bypass a bottleneck in the standard ‘health-coach’ model of treatment. That model, where patients pair up with coaches, could never seriously reduce the galloping numbers. Why? Simply because there could never be enough advisors.
The size of the problem
Solving this issue is where Habitual focuses its attention. Ian explains: “There are 4.2 million people with type 2 diabetes in the UK alone. To tackle such a big problem, the solution has to be limitless. So from day one, we have built our intervention to be delivered fully digitally. That has always been our goal because the health-coach model can never scratch the surface of such a big problem – there aren’t enough coaches out there.”
To find out how and why Habitual works, we need a little medical knowledge. First, let’s look at why Type 2 diabetes figures are climbing so sharply. There are a few reasons, says Napala: “One is that we are overeating because we live in an ‘obesogenic’ environment. But it’s not just the quantity of food we eat; it’s what we are eating, our physical habits, and our mental relationship with food. There are other factors, too, such as technology and our modern lifestyles.”
However, whatever reasons exist for this troubling trend, thanks to medical science all is not lost. “The big breakthrough came around five years ago,” says Ian. “Until then, doctors thought of type 2 diabetes as irreversible, believing that excess fat damages the cells in the pancreas, and that’s that. But research has since proven that if you decrease the pancreas’ fatty infiltration by losing weight, those cells can start to function normally again. It was an amazing breakthrough.”
The discovery led to trials run by the Universities of Glasgow and Newcastle. Ian and Napala – then work colleagues – worked closely with the researchers delivering these trials. Ian says: “The trials took 260 participants in a real-world environment, randomised them, and asked: If we can help them to lose 15kg and sustain it, can we reverse type 2 diabetes at scale? We saw the results first-hand. Ultimately, 60% of patients reversed their type 2 diabetes. It was astounding.”
But it was also frustrating for Ian and Napala because, having seen the results, they realised such programmes could never be rolled out to enough people. Millions of people with type 2 diabetes would therefore miss out on potentially life-saving interventions. Why? Because the programme’s delivery model inherently limited the numbers of people who could access it. “We saw that it was possible to help so many,” says Napala. “But the programmes were delivered in GP’s practices by nurses. And there could never be enough nurses. So we thought, why can’t these programmes be delivered completely digitally?”
And that burning question – now made all the hotter by Covid19 – led to the creation of Habitual in September 2019. The Habitual team, now six strong, have since designed a programme that does two main things. The first – ‘Total Diet Replacement’ (TDR) – is a nutritional treatment clinically proven to allow patients to “rapidly, safely and effectively lose 15kg”. The second is Habitual’s digital intervention – a range of digital tools that support patients to change their lifestyles so the weight stays off and type 2 diabetes is reversed.
“If you look at most diabetes-management companies – most diet companies even – they see an average weight loss of 5-6kg,” says Ian. “We see much closer to 15kg. That’s great, but it’s only the starting point. That person must go on to fundamentally change their relationship with health in the long term. That’s what our digital intervention aims to achieve.”
Napala says: “We’ve developed our digital programme with top psychologists from the Universities of Harvard, Stanford and Cambridge. It is delivered digitally, monitored digitally, and focuses on diet, exercise, mental habits and education. It’s bolstered by our Digital Companion App, which allows people to track their journeys and request support and content. We’re still in the early stages of developing these digital products, and we’ll only continue to make them better and better.”
It’s early days, but the results of Habitual’s initial 30-patient test are impressive. The group lost an average of 15.5kg each and are reporting a vast range of benefits. “It’s still too early to measure diabetes reversal,” says Napala, “that’s usually done at 12 months. But two patients have reversed their prediabetes and there’s been a huge improvement in exercise, sleep quality and general wellbeing.”
Aggressive acceleration plans
The scalability of Habitual’s non-human-led programme means, of course, that those 30 patients can quickly become 1,000, or 100,000, or 1m and more. That is both the beauty and the raison d’etre of this start-up. Ian says: “We’ll be taking on 150 patients in the next three months. From there, we’ll raise more funds, scale aggressively and accelerate as fast as possible.”
Looking to the future
With a total of £575,000 raised so far and much more to come, the journey of Habitual is one to follow. This British start-up has Silicon Valley-sized dreams. And when you consider that the company’s potential market grows even larger if it looks beyond the world of diabetes then the opportunity becomes even more interesting. We’ll certainly be watching to see what’s next…