Research: The Pre-Chronic Market: Preventing Chronic Disease Before Prediabetes

This report covers the following elements of the Pre-Chronic market

1. Demographic Boundaries – Who the Pre-Chronic consumers are, their risk factors, behavioral patterns, and why they are underserved by traditional healthcare.

2. Market Size – A detailed analysis of the total addressable market (TAM) and serviceable obtainable market (SOM) for direct-to-consumer solutions.

3. Appealing & Novel Services – Identifying unique, early-adopter-friendly offerings that reduce friction to longevity (telehealth, personalized nutrition, lifestyle coaching, MRTE meals, digital lifestyle medicine ACOs, etc.), with an emphasis on non-traditional healthcare delivery.

4. Customer Lifetime Value & Market Evolution – Mapping the adoption curve from early adopters to the late majority, along with a strategic roadmap for product sequencing (laying the groundwork like Amazon did with books before AWS).

5. Go-to-Market Strategy & Brand Positioning – Defining psychographics, sub-segmentation, and direct-to-consumer brand-building without relying on traditional healthcare networks.

6. Business Models – Exploring sustainable revenue models such as memberships, cash-pay bundles at retailers like Costco, and subscription-driven preventative care.

7. Historical Disruptions – Analyzing past cases where deep industry incumbents were disrupted by D2C, tech-driven solutions (e.g., Uber vs. taxis, Amazon vs. bookstores, GoodRx vs. pharmacies).

1. Demographic Boundaries of the “Pre-Chronic” Segment

Defining Pre-Pre-Diabetics: “Pre-Chronic” consumers are those at high risk for chronic metabolic diseases (like type 2 diabetes) but who have not yet been diagnosed as prediabetic. In other words, their blood sugar is still in the normal range, but they carry significant risk factors for developing prediabetes and diabetes. This group often includes individuals who are overweight or obese, have a family history of diabetes, or exhibit elements of metabolic syndrome (e.g. abdominal obesity, high blood pressure, or mild lipid abnormalities) – yet their fasting glucose or A1C hasn’t crossed clinical prediabetic thresholds. They are essentially metabolically unhealthy but not yet labeled with a chronic condition. Notably, this is a huge cohort: research shows only about 12% of American adults are metabolically healthy, meaning 88% have at least one metabolic risk factor (elevated blood sugar, blood pressure, cholesterol, or obesity). Most “Pre-Chronic” individuals fall into that 88% – for example, many of the ~72% of U.S. adults who are overweight or obese but do not yet have diabetes or diagnosed prediabetes. They are on the cusp of chronic illness, even if they feel “normal” today.

Lifestyle & Risk Profile: Pre-Chronic consumers typically share lifestyle patterns that elevate their health risks:

• Poor Diet: Many consume the standard American diet (high in refined carbs, sugar, and processed foods). Only about 1 in 10 U.S. adults eat the recommended servings of fruits or vegetables (Only 1 in 10 Adults Get Enough Fruits or Vegetables | DNPAO | CDC), indicating pervasive nutritional gaps. High calorie, low-nutrient eating leads to weight gain and insulin resistance long before blood sugar tests flag a problem.

• Physical Inactivity: A large portion are sedentary. Only ~24% of adults meet federal physical activity guidelines for both aerobic and strength exercise (Physical Activity Among Adults Aged 18 and Over: United States, 2020) – meaning roughly three-quarters are not getting enough exercise. Sedentary behavior contributes to weight gain and poor insulin sensitivity.

• Excess Weight: Being overweight or obese is one of the strongest risk factors. About two-thirds of U.S. adults have BMI ≥25 (Obesity in the United States - Wikipedia), which greatly increases odds of developing prediabetes. Abdominal obesity (high waist circumference) in particular correlates with insulin resistance.

• Other Factors: Many Pre-Chronic individuals have high stress levels and poor sleep habits (which can disrupt metabolism), and some may have had indicators like gestational diabetes or polycystic ovary syndrome (PCOS) that put them on a higher-risk trajectory. They might also have borderline-high blood pressure or cholesterol as early warning signs. Psychologically, they may not identify as sick at all – they often feel “okay” day-to-day – but their cumulative risk is building.

Behavior Patterns & Barriers to Healthcare Engagement: Ironically, those in this at-risk group often do not engage regularly with the healthcare system. There are several psychological and practical barriers that keep them from traditional care:

• Lack of Awareness or Denial: Because they haven’t been told they have a condition, many are simply unaware of their risk level. It’s estimated that only 19% of people with prediabetes know they have it – meaning 4 out of 5 are unaware. For pre-pre-diabetics, awareness is even lower. They may attribute weight gain or low energy to aging or stress, not realizing they are on a diabetic path. This false sense of “I’m fine” reduces motivation to seek medical advice.

• Avoidance of Medical Settings: Some have a fear of what they might learn (e.g. “white coat anxiety” or fear of being lectured about weight). Others simply avoid doctors due to inconvenience or cost. Preventive care usage in the US is notoriously low – in one analysis, only ~8% of adults over 35 were up-to-date on all recommended preventive services (Increase the proportion of adults who get recommended evidence ...). Most Pre-Chronic folks aren’t going in for annual checkups or routine bloodwork that might catch rising glucose early.

• Busy Lifestyles and Complacency: Many are working adults (often 30s-50s) juggling jobs and families. If they feel generally okay, health maintenance falls behind other priorities. The effort to schedule doctor visits, get lab tests, and follow up can feel like too much friction when nothing “hurts” yet. They may intend to lose weight or exercise, but without immediate health scares, it’s easy to procrastinate.

• Distrust or Dissatisfaction: A subset are dissatisfied with traditional healthcare. They might have had appointments where they felt rushed or judged (“the doctor just told me to lose weight and come back in a year”). This leads to disengagement – they don’t see traditional clinics as helpful for prevention. Consumers frustrated by rising deductibles and impersonal care often skip the doctor and instead rely on online information or over-the-counter supplements. Indeed, many Americans are turning to alternatives like retail clinics or self-care; retail clinic usage has surged 200% since 2017, while primary care visits declined by 13% in that time ("Your Costco Provider is Ready to See You": When Mental Health Goes Retail - Integrated Care News). This suggests people (especially those without acute issues) are bypassing primary care in favor of more accessible options.

Underserved by Conventional Healthcare: Traditional healthcare models tend to under-serve Pre-Chronic individuals for several reasons:

• Reactive Focus: The medical system is largely reactive – geared toward diagnosing and treating defined illnesses. If a patient isn’t yet officially sick (no diabetes or even prediabetes diagnosis), providers have limited tools and incentives to intervene. A pre-pre-diabetic might be told “lose some weight, eat healthier” during a brief checkup, but there is rarely a structured program or follow-up through the clinic. Providers acknowledge this gap; over 80% of primary care doctors say they lack time during visits to do detailed lifestyle counseling (Incorporating Lifestyle Medicine Into Primary Care Practice). The result is that early-risk patients get superficial advice, at best, and then they’re on their own.

• Coverage Gaps: Insurance typically doesn’t pay for extensive prevention or coaching unless a condition is diagnosed. For example, a CDC-recognized Diabetes Prevention Program (DPP) (an intensive lifestyle program) is often only covered for those with prediabetes. Our Pre-Chronic segment doesn’t qualify, so they would have to pay out of pocket – something few realize or do. This means there’s little funded support for someone who is, say, 30 pounds overweight but not yet prediabetic. Conventional care might shrug until that person’s A1C rises above 5.7%. By then, the window for easy reversal may be narrower.

• One-Size-Fits-All Advice: Traditional healthcare hasn’t personalized prevention. Telling every at-risk patient to “eat better and exercise” isn’t very actionable and often fails to motivate changes. Without regular guidance, feedback, and tailoring to an individual’s life (services typically outside the scope of brief doctor visits), many Pre-Chronic people make no sustained changes. They then “graduate” into prediabetes over time – essentially becoming patients that the system will treat later, at greater cost.

• High Friction and Low Continuity: The effort required to engage with standard care (appointments, labs, insurance approvals) is a big deterrent for those not yet ill. Pre-Chronic consumers often face psychological barriers (feeling out of place seeking help when not sick, or embarrassment about weight) that our current clinic model doesn’t overcome. There’s also poor continuity – a yearly checkup isn’t enough to keep someone on track weekly or daily in their lifestyle. The result is an engagement gap: this segment is largely left to drift toward chronic illness without effective intervention. As one commentary on U.S. health prevention put it, “even for free services…only one in four middle-aged and older adults” utilizes them (Strategies for Improving the Utilization of Preventive Care Services). The conventional system simply isn’t designed to proactively chase down those almost at-risk and keep them healthy.

Bottom Line: The Pre-Chronic segment is huge and growing, comprised of individuals whose lifestyles put them on the brink of cardiometabolic diseases. They share patterns of poor diet, inactivity, and weight gain that go unaddressed. Culturally and structurally, this group is falling through the cracks – they don’t see themselves as patients, and traditional healthcare isn’t built to reach or serve them until it’s often too late. This creates an opportunity for new models to engage these “healthy today, sick tomorrow” individuals in a way that aligns with their daily lives and motivations.