A new class of weight-loss drugs is giving some obese patients new hope that they can shed unwanted pounds and improve their health, without the dangerous side effects of old drugs.
But despite mounting evidence that the drugs are both safe and effective, doctors say relatively few of the millions of eligible patients take them.
“This drug is something that transforms the lives of some people,” said Thomas Wadden, director of the Weight and Eating Disorders Program at Penn Medicine in Philadelphia. But, he said, “I don’t think any of these weight-loss drugs are being prescribed as much as they should be.”
More than 70% of adults in the United States are overweight or obese, according to the Centers for Disease Control and Prevention. Obesity can lead to a variety of other medical conditions, including high blood pressure and cholesterol, type 2 diabetes, and stroke.
The drugs mimic a hormone produced in the gut called GLP-1, which tells the pancreas to secrete more insulin to control blood sugar. They are not new to medicine; they’ve been used for years to treat type 2 diabetes. But when doctors noticed that patients were also losing weight, drugmakers got on board, offering drugs in higher doses specifically to treat diabetes. ‘obesity.
It is still unclear exactly how the drugs help with weight loss. Wadden said they seem to slow stomach emptying, so people stop eating sooner and feel full longer.
The drugs are also thought to target certain receptors in the brain that affect appetite. “It can act on reward areas in the brain,” Wadden said. Thus, patients may eat less frequently for pure pleasure, which he calls “hedonic eating”.
So far, two of the new drugs, both from drugmaker Novo Nordisk, have been approved by the Food and Drug Administration. Saxenda was approved in 2020. The newest, Wegovy, was approved last year for patients with a body mass index of 30 or greater or those with a BMI of 27 or greater plus at least one weight-related condition . Studies have shown that the weekly self-injectable helped patients lose, on average, around 15% of their body weight over 16 months, making it twice as effective as older weight-loss drugs already on the market, such as Qsymia.
A new GLP-1 drug called tirzepatide, also a weekly injectable, appears to be even more effective. A study published last week in the New England Journal of Medicine found that it helped patients lose more than 20% of their weight in 72 weeks.
Medicines have side effects. Most often, patients complained of nausea, vomiting, diarrhea and stomach pain.
And experts stress that the drug is not a magic bullet.
“I don’t care how good the drug is, it won’t work for everyone,” said Dr. Zhaoping Li, director of the UCLA Center for Human Nutrition. “It’s a tool, but it’s not the tool.”
Yet doctors and obesity researchers say that compared to the old class of weight-loss drugs, the new drugs are impressive, especially for those whose obesity has caused other chronic diseases, such as heart disease and type 2 diabetes.
Denied by insurance
Given the benefits, why do Wadden and others think drugs are underutilized?
It’s all about the money, said Dr. W. Scott Butsch, director of obesity medicine at the Cleveland Clinic’s Bariatric and Metabolic Institute.
Wegovy costs around $1,300 per month and most insurance won’t cover it.
Insurance companies oppose coverage for weight-loss drugs, arguing that obesity is not a disease but a behavioral problem, Butsch said.
“Some people will lose a lot of weight” on these drugs, he said, but they can’t take them because they’re unaffordable. Some doctors, he added, are reluctant to prescribe them, knowing “there is already an initial hurdle”.
This barrier hampered Qamara Edwards, 40, of Philadelphia. Weighing over 300 pounds and a diabetic, she took Wegovy as part of a clinical trial at Penn Medicine in 2018.
“I like to eat bad food and drink a lot,” said Edwards, who says he faces these challenges on a daily basis while working in the restaurant industry.
But she said that although she had gastrointestinal side effects on Wegovy, she was eating healthier.
“The general feeling is that it doesn’t make you hungry,” she said. “It’s like having a gastric bypass without surgery.”
She lost 75 pounds during the 17-month study, which ended just before the coronavirus pandemic hit and the lockdown interrupted her routine. She regained almost all the weight.
So when Wegovy was approved last June, his doctor wrote him a prescription, but his insurance didn’t pay for it.
“The biggest tragedy is how expensive it is,” she said. “I had all these great results, and I may not be able to continue because insurance and the pharmaceutical industry think weight loss is not a medical issue.”
Butsch echoed the sentiment, blaming the lack of insurance coverage on the obesity stigma.
“The premise is that it’s behavioral, and then they’re stereotyped as binge eaters,” Butsch said. “Not all obese people eat fries, pizza and soft drinks.”
Indeed, growing evidence shows that for some people, obesity may not be caused by overeating, but by insulin resistance and hormonal issues – factors that are affected by the new class of weight-loss drugs.
Insurance company coverage decisions are worsening existing health disparities, Butsch said. Those who can afford to pay out of pocket can get the drugs. But study after study shows obesity rates are higher among those who live in poor communities, who typically have fewer histories of grocery shopping and lack access to health care.
That means “those who really need these drugs probably won’t get them,” he said.
A persistent shortage
Ongoing production issues are further compounding the access problem, forcing drugmaker Novo Nordisk to tell doctors not to prescribe Wegovy to new patients because it does not have the supply available to meet demand.
But Bonnie Drobnes, 42, of Lower Gwynedd, Pennsylvania, said her doctor never got the message. Drobnes, a mother of two, was prescribed Wegovy two months ago after a thyroid problem made her feel like she couldn’t lose weight.
It took her pharmacy three weeks to fill her prescription due to drug shortages. Once she started it, however, she felt an immediate change.
“One of the things I always faced was constant hunger in the back of your mind,” Drobnes said. “It’s still there. He left. It allows you to focus on being a human being.
“One of the things I always faced was constant hunger in the back of your mind,” she said. “It’s still there. He left. It allows you to focus on being a human being.
She lost 7 pounds in the first month, more than she lost after weeks of working with a nutritionist, wellness coach, and workout partner.
But when it came time to refill monthly, the pharmacy told her the drug was out of stock and it was unclear when it would be available again. She called dozens of pharmacies in the Philadelphia area, where she lives. None of them had the medicine.
Novo Nordisk says in a statement posted on its website that the company expects Wegovy’s supply to stabilize later this year.
This does not offer much comfort in Drobnes. “I feel like without the Wegovy, I’m losing my lifeline,” she said. “I finally allowed myself to start imagining a happier, healthier me, but now that image is slipping away.”
Indeed, weight gain after discontinuation of medication is of concern; studies have shown that two-thirds of patients regained weight after stopping Wegovy. But obesity experts disagree on how long a patient should take the drugs.
Li, of UCLA, said more research was needed before the drugs were prescribed long-term. Others, like Wadden and Butsch, argue that if obesity were treated as a chronic condition, like high blood pressure or diabetes, staying on medication for years wouldn’t be a problem.
Li prescribes the drugs to some of his patients, but only after other lifestyle changes and treatments have failed.
“It’s a cane that will help you walk,” she says. “But you’ll have to take the walk yourself.”
For Edwards, of Philadelphia, the “cane” changed his life. She is participating in another clinical trial for a pill form of Wegovy, which she hopes will be more affordable. Since starting the study in November, she has lost 45 pounds.
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