The Pizza Night Revolution: How One CEO is Personalizing Obesity Care

A conversation with Elina Ontiskansky on removing stigma, embracing personalization, and treating the whole human in obesity medicine

When Elina Ontiskansky asks whether someone at 60 BMI and someone at 30 BMI should receive the same treatment, she's challenging a fundamental assumption in obesity care. As the founder and CEO of Ilant Health, she's witnessed firsthand how the healthcare system applies one-size-fits-all solutions to a condition affecting 75% of Americans.

"Should we say that someone at 60 BMI, which by the way is the fastest growing segment in the US right now, and someone at 30 BMI are the same?" Elina asks. [00:00:08] The question cuts to the heart of everything wrong with current obesity treatment.

The Personal Journey That Sparked a Revolution

Elina's path to founding Ilant Health began with her own decades-long struggle with obesity. "If there is a solution that someone has proposed in the US, I've done it," she explains. From the grapefruit diet to ketogenic approaches called by different names, Atkins, South Beach, keto, she tried them all.

But what frustrated her most wasn't the failed attempts. It was the consistent message that failure was her fault. "There's just like this sales process that really says if it's not working, it's you," she reflects. "And a lot of those are not evidence based and they build on this sort of like deep sense of shame and stigma."

This personal experience, combined with her professional background in healthcare systems and services, led to a crucial realization: the problem wasn't individual willpower, it was systemic approach.

The Structural Problems in Obesity Care

According to Elina, obesity has only been considered a disease for about 10 years according to the American Medical Association. "We haven't paid doctors for treating obesity," she notes, highlighting how the healthcare system has systematically ignored a condition affecting the majority of Americans.

The data is stark: while about 50% of the population has obesity, it's only coded in medical records at the 5-10% level. "That's if we coded like everyone with a heart condition as heart condition," Elina explains. "So you'd literally have no differentiation between hypertension and a heart attack."

Even more concerning, over three-quarters of primary care physicians feel uncomfortable treating obesity and exhibit bias against individuals with obesity. "Obesity is one of the only areas where implicit bias culturally has gone up, not down," Elina reveals.

The Pizza Night Philosophy

What sets Ilant Health apart isn't just the technology, it's the philosophy. When Elina talks about accommodating "pizza night with the kids," she's addressing something deeper than dietary flexibility.

"If you are someone who really, your family is pizza night with the kids on Wednesday, right? How do we not disrupt pizza night?" she asks. This isn't about enabling poor choices, it's about recognizing that humans are complex beings with relationships, traditions, and values that matter more than any diet plan.

"Everything we do is deeply personalized," Elina emphasizes. "We really think about like person as a person and helping them get the right medical care and the right support."

The Human-First Technology Approach

While Ilant Health uses machine learning and behavioral science, Elina is clear that technology serves human connection, not the other way around. "We lead with a human is one of the ways I would say that," she explains. "But we use technology and information to help our humans know when to intervene."

The platform starts with a peer navigator, someone who has lived with obesity and received treatment. "We deeply believe in empathy and recognizing that for a lot of folks, this feels really scary. They've had bad experiences," Elina notes.

This peer support model builds trust quickly because "it immediately says, like the subtext of it is I don't understand exactly what you're going through, but I've been through my own journey so I can share that. I'm not gonna judge you because I get it."

Evidence-Based Personalization at Scale

Ilant's approach combines all evidence-based treatments, bariatric surgery, anti-obesity medications (both GLP-1s and non-GLP-1s), and intensive behavioral therapy, but personalizes the combination based on individual factors.

The company has developed what they call "Metabolism Matters," a clinical decision support protocol that takes extensive patient data and determines optimal treatment paths. "What's the weight loss that you need to achieve to meet some of the disease burden that you have? What do different treatment modalities mean? Not just for weight loss, but for some of your other disease states?"

Every treatment path includes meetings with obesity medicine physicians, registered dietitians, and mental health clinicians. "We really lead with clinical care," Elina emphasizes.

The Machine Learning Behind the Empathy

While the human connection is central, Elina is excited about using technology to enhance personalization. "How do we get better at understanding who's going to be a responder or non-responder to different medications, to different sort of behavioral therapy modalities and support to different motivators?"

The company uses machine learning to identify patterns in patient motivations, prior experiences, and engagement with the program. "We use a lot of machine learning around understanding are there different, not just phenotypes in terms of people's composition medically, but in terms of their motivations and their prior experiences."

Addressing the Innovation Challenge

The conversation reveals a deeper challenge in healthcare innovation: how to scale empathy and personalization while maintaining evidence-based care. Elina's approach suggests that technology's role isn't to replace human connection but to enable it at the right moments.

"How do I take that innovation and get it to the right human in the right way that's applicable to them?" she asks. This last-mile problem, connecting innovation to individual patients, is where many healthcare technologies fall short.

The Business Model That Enables Access

Ilant Health works exclusively with employers and health plans, a decision Elina frames as both ethical and practical. "We have a belief that the way you create access is to really partner with the institutions that support access," she explains.

This approach addresses a common problem in healthcare innovation: solutions that work well for wealthy, early adopters but fail to reach broader populations. "A lot of times when you design for that direct to consumer, you're designing for that type of individual and frankly not addressing broader needs."

Looking Forward: The Experimental Future

As Ilant collects more data, Elina sees opportunities to further personalize interventions. "The world's a natural experiment," she notes. "When you collect as many data points as we collect, you might say gosh, like I thought this type of intervention was gonna work really well, but it worked particularly well for these people and less well for these people."

This data-driven approach to personalization, combined with deep empathy for patient experiences, represents a new model for chronic disease management. It's neither purely technological nor purely human, it's both, integrated in service of individual patient needs.

The Broader Implications

Elina's work at Ilant Health offers lessons beyond obesity treatment. Her approach, combining personal experience, systems thinking, evidence-based medicine, and empathetic technology, provides a blueprint for addressing other chronic conditions where shame, stigma, and one-size-fits-all approaches have failed patients.

The conversation also highlights the importance of patient preference in healthcare innovation. As Elina notes, "Everyone who's ever struggled with weight has had ups and downs and imperfect moments. And so that's normal, right? And in some sense, like we wanna normalize, right? The idea that you don't have to be perfect 24/7 or 365 days of the year and you can be healthy and achieve goals."

This philosophy, that healthcare should accommodate human imperfection rather than demand mechanical adherence, may be the most revolutionary aspect of Elina's approach.

Elina Ontiskansky is the Founder and CEO of Ilant Health, a company applying machine learning and behavioral science to deliver precision care for obesity and cardiometabolic conditions. This blog post is based on her conversation with Shannon Lantzy on the Inside MedTech Innovation podcast.

Listen to the full episode: https://creators.spotify.com/pod/profile/shannon-lantzy

Connect with Elina Ontiskansky on LinkedIn: LinkedInConnect with Shannon Lantzy on LinkedIn: LinkedIn | Website

This content was repurposed from the original podcast discussion by a genAI prompt.