Kathryn Streeter for NPR
From TikTok influencers talking to celebs worried about the “ozemic face,” drugs like Wegovy and Ozempic are being touted as miracle weight loss in a country obsessed with thinness.
But the drugs are not intended for cosmetic weight loss. Ozempic is approved for diabetes, and Wegovy is for people with obesity who also have weight-related conditions like high blood pressure or high cholesterol that put them at risk for heart disease. This is millions of Americans.
Evidence suggests that the new class of drugs is much more effective than previous obesity drugs. A landmark clinical trial has been published in the New England Journal of Medicine In 2021 it was found that the drug led to an average of 15% reduction in body weight.
There has been such an increase in demand that the Food and Drug Administration’s database lists the drug’s active ingredient, semaglutide, as “currently in short supply.” Its manufacturer, Novo Nordisk, says keeping supplies stable is a priority. The company also markets Ozempic for the treatment of diabetes, which is a lower dose of semaglutide.
But at a cost of about $1,400 a month—out of pocket when not covered by insurance—many people can’t afford long-term treatment. And when people stop taking it, there is often a rebound in weight that is difficult to control. In fact, a study found that most people regain most of the weight within a year of stopping the drug.
That’s what happens to Yolanda Hamilton of South Holland, Illinois. Hamilton’s doctor prescribed Wigoffee because of her high BMI, high blood pressure, and high blood sugar. I lost 60 lbs and started to feel so much better.
“It gave me more energy,” she says, allowing her to exercise and do housework. Her sugar cravings were supported, and she felt satisfied with small meals. “I was very surprised at how good it felt,” says Hamilton. The drug is given by injection once a week at home, which Hamilton says is easy to do.
Her insurance plan from Aetna covered the cost of the drug, but when she last changed jobs, her new insurance plan through Blue Cross and Blue Shield of Illinois refused to cover it. She now works in the hospital’s emergency room and registers patients, which requires her to sit most of the day. And after a few months of not taking the drug, she gained back 20 lbs.
“I’m very frustrated with the weight coming back in so soon,” says Hamilton.
Blue Cross and Blue Shield of Illinois told NPR that the benefits offered by employer plans can vary. “Weight-loss drugs such as Wegovy may be covered, depending on the member’s benefits plan,” a company spokesperson said. Many other insurance companies also determine coverage based on what employers wish to cover.
Barriers to life-changing medicine
The rebound weight gain is not surprising given how the drug works. The active ingredient in Wegovy — semaglutide — is GLP-1, or glucagon-like peptide-1, which mimics the satiety hormone GLP-1 in our bodies. When we eat, GLP-1 is released from the intestines and sends signals to the brain centers that control appetite.
“This hormone tells your brain that I’m full, and I don’t need to eat anymore,” explains Dr. Robert Kushner of Northwestern University, who treats Yolanda Hamilton. Kushner also serves on the medical advisory board for Novo Nordisk, for which he is an honoree.
“What the pharmaceutical companies have done is take this naturally occurring hormone and restructure it into a drug,” he explains. So, it’s no surprise that when people stop taking the drug, they start to feel hungrier, he says.
“I crave sweets,” says Hamilton. And her appetite increased. You no longer feel satisfied with small meals. “I lose my energy,” she says, as the weight returns.
Kushner-Hamilton’s office is helping her appeal the insurance denial, but while she waits, she worries that stopping the medication will also affect her blood pressure and blood sugar. “She’s at risk of worsening these conditions as she regains weight,” says Kushner.
“If I gained weight, I would take more medication,” says Hamilton. Given her long struggle with losing weight, she’s finally found something that works.
says Dr. Carla Robinson, MD, 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, because it’s a newer drug, it’s one that’s subject to manufacturer pricing,” says Robinson.
A representative from Novo Nordisk notes that the company is offering a $500 coupon for Wegovy to reduce the cost to cash patients.
But, this chart from GoodRX shows that the lowest price among all retailers is $1,304 a month for people paying out of pocket, which is out of reach for most people — even with a coupon.
“I feel like Wiggo is revolutionary,” says Hamilton. But she says she certainly can’t afford to pay for it.
“Some of the people who need it most are not able to access it,” Robinson says, noting that people on lower incomes experience obesity at disproportionately higher rates.
“We’re talking about a huge health equity issue,” she says. According to the Centers for Disease Control and Prevention, black and Latino adults have higher rates of obesity.
Since Wegovy was approved by the FDA in 2021, some insurance plans have begun covering the drug for people who meet clinical prescribing guidelines. According to the Food and Drug Administration, people are eligible if their BMI is 27 or higher and they also have at least one “weight-related aide” such as high blood pressure, diabetes, or high cholesterol. or have a body mass index of 30 or higher, regardless of weight-related means.
But insurance coverage is very spotty. Medicare does not cover Wegovy or other weight-loss medications, and many insurance companies follow Medicare’s guidelines. Increasingly, there is pressure to change this. As STAT reported last week, the Moffitt Cancer Center in Florida is pushing for legislation that would allow Medicare to pay for obesity medications, citing the link between obesity and cancer risk. The NAACP has also been registered to lobby on the issue.
In addition, the American Academy of Pediatrics has new guidelines that recommend that pediatricians offer weight-loss medications to adolescents 12 years of age and older with obesity as an adjunct to behavior change and lifestyle interventions.
unknown in the long run
But the fact that people may need to stay on Wegovy indefinitely in order to maintain weight loss has raised concerns about long-term use. The most common side effects of the drug are gastrointestinal symptoms. “Nausea, diarrhea, constipation, vomiting in some people, or heartburn,” says Kushner.
He says starting with a low dose and increasing it over time can help people better tolerate the medication. There is ongoing research evaluating the drug’s effect on the cardiovascular system, which is positive so far.
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 see if they have a family history of a certain type of thyroid cancer, or another rare condition called multiple endocrine neoplasia type 2 (MEN 2) syndrome. “This will be a one-on-one conversation with the patient,” says Kushner. In general, if you don’t have a history of these conditions, “this drug is thought to be safe,” he says.
If this sounds alarming, it’s a reminder of just how serious the fight against obesity can be. The theoretical risk of thyroid tumors may be of concern. But doctors point to the dangers of leaving obesity untreated: Heart disease is the leading cause of death in the United States, and obesity and weight-related conditions are major risk factors.
Of course, exercise and diet modification are still the first strategies to try. But given that nearly 70% of Americans are overweight or obese, nearly half of US adults have high blood pressure and more than 1 in 3 have prediabetes, physician groups point to an urgent need to scale up interventions. can be useful.
“We as a society spend $173 billion in health care costs related to obesity,” says Dr. Marcus Schabacker, CEO of ECRI, an independent nonprofit group that has reviewed evidence for new drugs for weight loss.
He argues that medications can be a part of obesity destigmatizing by treating it like any other disease you treat with medication. “We wouldn’t ask someone with high blood pressure to just do exercises and change your diet and then you’ll be fine. No, we give them beta-blockers. It’s no different here. Exercise and diet are key components in tackling obesity, but so are the medications that proven effective.”
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