Katherine Streeter at NPR
From TikTok influencers talking to celebrities worried about “Ozempic face,” drugs like Wegovy and Ozempic are touted as weight-loss miracles in a weight-obsessed country.
However, the drugs are not designed for weight loss. Ozempic is approved for diabetes, and Wegovy is for obesity for people who also have conditions such as high blood pressure or high cholesterol that put them at risk for heart disease. That’s millions of Americans.
And the evidence shows that a new type of drug is far more effective than the previous drug. The term clinical trial is published The New England Journal of Medicine in 2021 he found that the drug led to a 15% reduction in body weight on average.
Such has been the growing demand that the FDA’s drug database lists the active ingredient, semaglutide, as “only in short supply.” Its manufacturer, Novo Nordisk, says keeping the firm’s supplies is a priority. The company also markets Ozempic to treat diabetes, which is a lower dose of semaglutide.
But at a cost of about $1,400 a month — out of pocket when insurance doesn’t cover it — many can’t afford to stay on the drug long term. When people stop taking it, they often experience weight gain that is difficult to control. In fact, the study found that most people regain more weight within a year of stopping the drug.
That’s what happened to Yolanda Hamilton from South Holland, Ill. Hamilton’s doctor prescribed Wegovy because he had an elevated BMI, high blood pressure and elevated blood sugar. He lost 60 pounds and started feeling much better.
“It gave me more energy,” she says, “to allow her to practice and do the dances at home.” His cravings for sugar subsided and he felt full from smaller meals. “I was very surprised at how well I felt,” Hamilton says. The drug is administered as a once-a-week injection at home, which Hamilton says is easy to do.
Her Aetna insurance plan covered the cost of the medication, but when she changed jobs last fall, her new insurance plan through Blue Cross and Blue Shield of Illinois denied coverage. She now works in a hospital ER registering patients, which requires her to sit most of the day. And after several months of not taking the drug, he gained 20 pounds.
“I’m very disappointed about the weight coming back in such a short amount of time,” Hamilton says.
Blue Shield and NPR’s Blue Shield of Illinois reported that benefits may vary by employer plan. “Weight-loss phases like Wegovy can be covered, depending on the member’s benefit plan,” said a spokesperson for the company. Many other insurance carriers also determine coverage based on what they want to cover renters.
Blocks for a life-changing drug
The weight gain rebound is not surprising given how the drug works. Wegovy’s active ingredient – semaglutide is GLP-1, or glucagon-like peptide-I, which mimics the satiety hormone GLP-I in our bodies. When we eat, GLP-I is released by our intestines and sends signals to our brain centers that control appetite.
“This hormone tells your brain, I’m full, I don’t need to eat anymore,” explains Dr. Robert Kushner of Northwestern University, who is treating Yolanda Hamilton. Kushner also serves on the advisory board of Novo Nordisk Pharmaceuticals, for which he receives honoraria.
“What pharmaceutical companies have done is take this naturally occurring hormone and restore it into a drug,” he explains. So it’s no wonder that when people stop taking medicine, they start to get hungry, he says.
“I want sweets,” said Hamilton. And his appetite grew. She no longer feels content with small meals. “I conquer my strength,” he says, instead of gaining weight.
Kushner’s office is helping Hamilton appeal the denial of insurance, but while he waits, he’s worried that his medication will interfere with his blood pressure and blood sugar. “The danger is that these conditions are more serious when the weight is recovered,” Kushner says.
“If I’m stronger, I’ll be on more drugs,” Hamilton said. After a long struggle with severe damage, he finally found something that worked.
“We’ve seen a lot of patients have this weight gain rebound and it can be really devastating,” says Dr. Karla Robinson, a family physician in Charlotte, NC, and medical editor at GoodRx, a company that helps people. find the lowest prices for generic and brand name drugs. There is no generic version of semaglutide.
“Unfortunately, the new drug is one of the things that underlies the price of the device,” says Robinson.
A representative from Novo Nordisk notes that the company is offering a $500 code for Wegovy to reduce the cost for patients paying in cash.
However, this card from GoodRX has the highest price among all retailers at $1,304 per month for out-of-pocket payments, which is out of the question for most people — even with a coupon.
“I feel like Wegovy is new,” Hamilton said. But he certainly denies that he cannot afford it.
“Some of the people who need it most can’t access it,” Robinson says, pointing out that low-income people experience obesity at disproportionately higher rates.
“We’re talking about a major health equity issue,” he said. Black and Hispanic adults have higher rates of obesity, according to the CDC.
When Wegovy was approved by the FDA in 2021, some insurance plans began to cover the drug for people meeting medical prescriptions. According to the FDA, people are eligible if they have a BMI of 27 or higher and also have at least one “weight-related medical condition” such as hypertension, diabetes, or high cholesterol. Or have a BMI of 30 or higher, regardless of weight-related illnesses.
But the insurance itself should be pure. Medicare does not cover Wegovy or other medical weight loss, and many insurers follow Medicare’s lead. There is more pressure to change this. As STAT reported last week, the Moffitt Cancer Center in Florida is lobbying for legislation that would allow Medicare to pay for pain medications, citing the link between obesity and cancer risk. The NAACP has also been reported to lobby on this issue.
In addition, the American Academy of Pediatrics has a new guideline recommending that pediatricians provide severe obesity medications to youth 12 and older with severe obesity as an adjunct to behavior change and lifestyle interventions.
But the fact that people need to stay on Wegovy to maintain weight loss indefinitely has raised concerns about long-term use. The most common side effects of the drug are GI symptoms. “Nausea, diarrhea, constipation, vomiting in some cases, or upset stomach,” says Kushner.
He says starting with a small weight and increasing it over time can help the drug get better. Research has continued to evaluate the effect of drugs on the cardiovascular system, which is only positive.
But the drug carries a black box warning because it caused thyroid tumors in rodent studies. Therefore, Kushner says doctors need to screen patients to find out if they have a family history of a certain type of thyroid cancer, or another rare condition called multiple endocrine neoplasia syndrome type 2 (MEN 2). “This interview would be unique to the patient,” Kushner says. Generally, if you don’t have a history of these conditions, “this medication is supposed to be safe,” he says.
If this sounds tumultuous, it’s a reminder of how high the stakes are with great pain. A theoretical risk of thyroid tumors may be nerves. But doctors point to the dangers of leaving obesity untreated: Heart disease is the leading cause of death in the US, and obesity and weight-related conditions are among the highest risk factors.
Of course, exercise and diet are still the first strategies to try. But since about 70% of Americans are overweight or obese, nearly half of adults in the US have hypertension and more than 1 in 3 have diabetes, groups of doctors are realizing the urgent need for more interventions to help.
“We, as a society, spend 173 billion in obesity-related health care costs,” Dr. Marcus Schabacker, CEO of ECRI, an independent, non-profit group, reviewed the evidence for new weight loss medicine.
And he argues that drugs can be related to obesity. “We don’t want to ask someone who has hypertension to just do exercises and change your diet and then you’ll be fine. Yes, we give them beta blockers. It’s no different here. Exercise and diet are the key tactics, but so are drugs that have been shown to be effective. ‘ he says.
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