Introduction: Overweight and obesity impact >200 million Americans, driving rates of diabetes and cardiometabolic disease. To address this, we established a digital metabolic health company to provide medically-supervised obesity treatment at scale. Methods: Treatment: GLP-1 receptor agonist medications combined with a proprietary intensive lifestyle intervention. Data analysis: Individuals who reached 12 months in the core program and a subset who continued to 18 months were analyzed for weight change, metabolic labs (baseline and 12mo) and patient-completed questionnaires (baseline, 6, and 12mo). Results: The cohort included 2,643 patients. At baseline, 3.9% had type 2 diabetes, and 22.8% had prediabetes. Average weight loss at 12, 15 and 18 months was 15.58% (n=2,397), 15.97% (n=1,319) and 15.82% (n=569). Average weight loss for patients with diabetes or prediabetes at 12, 15 and 18 mo was 16.22% (n=299), 16.60% (n=233), and 15.57% (n=133). Patients with diabetes saw average improvements of -1.42 percentage points for HbA1c and -14.05 units for insulin; for patients with prediabetes, these were -0.45 reduction to HbA1c and -7.05 for insulin. 72.9% of patients with abnormal HbA1c levels at baseline were normal at 12 months. Positive changes were also seen for other metabolic markers and for patient-reported outcomes. Discussion: Results from 2,643 enrollees in a new digital metabolic health program demonstrate robust and sustained weight loss through 18 months. For those with diabetes or prediabetes, there was significant weight loss, reduction in HbA1c and insulin with categorical improvement to diabetes status in 80.5%, improvements to other metabolic markers, and positive changes to health behaviors. These results offer great promise in addressing the obesity epidemic and reversing diabetes. Disclosure K.Boyd: Employee; Calibrate Health, Inc. K.L.Medeiros: Employee; Calibrate Inc. D.Kramer: Employee; Calibrate Health, Inc. C.Celio: None. D.H.Ryan: Advisory Panel; Altimmune, Wondr Health, YSOPIA, Zealand Pharma A/S, Consultant; Amgen Inc., Boehringer Ingelheim Inc., Carmot Therapeutics, Inc., Epitomee, Lilly, Other Relationship; Calibrate, Gila, IFA Celtic, Scientific Intake,, real appeal, Scientific Intake, Xeno Bioscience, Novo Nordisk. I.Kenyon: None.