We are at the very beginning of a new era of weight loss drugs that promise extraordinary results. But ultimately, their effectiveness depends on several factors: how effective they are, how much they cost, and whether doctors prescribe them.
So far, these remedies seem to be working very well. On average, patients with Ozempic and Wegovy lose about 12% of their body weight, and more effective drugs are coming through the pipeline. However, medical insurance companies are reluctant to pay for these drugs, and even if they cover the premiums, they impose stringent prescription requirements, so the costs can be high.
So doctors are caught in a dilemma. Many of them are excited about the potential of these new treatments, while also trying to address patient expectations and convince health care systems that it is worth investing in.
The ubiquitous ads on Ozempic and Wegovy, like all prescription drug ads, tell patients to talk to their doctor if they are interested in the drug. So how’s the conversation going so far?
“At this point, if you’re a primary care provider, it’s probably outrageous to think about doing what it takes to prescribe these drugs,” said co-director of the Weight Center. Caroline Apobian said. Administration and Health Care at Brigham and Women’s Hospital in Boston.
The drug also comes amid a long-anticipated social and cultural paradigm shift around obesity in medicine. Physicians are increasingly treating obesity as a physiological disease in its own right, rather than as a character or willpower defect. Some doctors are still learning how to think about obesity that way, rather than focusing on symptoms that are likely to result from obesity, such as high blood pressure and heart disease.
It’s a tough moment. The public health opportunity these drugs pose is significant, but the U.S. healthcare system was ill-equipped to seize it. Too few family doctors are familiar with obesity medicine. Medical insurers have no incentive to cover expensive medications that can take years to pay off properly, even if that payment proves to be realistic. Patients are at risk of being taken advantage of by shady vendors looking to capitalize on the hype and confusion about the new era of obesity treatments.
But the demand is real. A recent STAT-Harris poll found that half of Americans would spend up to $100 a month out of pocket for travel.
I asked three leading experts in obesity medicine to share some of the most common misconceptions patients ask, what they need to know during discussions, and what to expect when considering whether to try obesity medicine. about questions to ask your doctor.
1) These Weight Loss Pills Are Not A Short-Term Solution
Different patients have different considerations before choosing one of these new treatments. Bariatric surgery is an option for extremely obese people. Some may want to go all out on diet and exercise. But obesity doctors say it’s important for patients to understand what’s going on biologically with their bodies if they decide to try weight-loss drugs.
Marcio Grieberer, director of the Obesity Center at the Cleveland Clinic Institute of Endocrinology and Metabolism, said despite the media coverage, patients were more likely to understand the physiological causes of obesity, how these drugs would treat obesity, and how it might affect obesity. He said he starts the conversation by making the patient understand why he means it. As for celebrities who use Wegovy as a crash diet of sorts, they can only take Wegovy or something else for a few months to lose weight and then stop.
Simply, and generally speaking (although it varies from person to person), the more obese a person is, the harder it is to lose weight. They undergo so-called metabolic adaptations. Their bodies begin to change and they begin to see a decrease in hormones that signal that they are full and should stop eating.
These new drugs stimulate those hormones. Ozempic and Wegovy target a single hormone called GLP-1. So-called “triple G” drugs are coming soon that are supposedly more effective, targeting multiple hormones. As a result, people feel full faster and it is easier to eat less.
“Patients can continue to make good decisions because they have better control over their hunger,” Grieber said.
But when you remove these hormones, your body starts working the opposite way.
Grieber said “95%” of patients ask if they can stop taking the drug for a few months. The answer is no, he tells them. Patients must come to terms with the reality that they will need to be on some kind of medication for the rest of their lives if they want to keep the weight off.
This is a particularly big hurdle for parents. “This is a tough drug to swallow,” said Claudia Fox, co-director of the Center for Pediatric Obesity Medicine at the University of Minnesota School of Medicine. “Probably not the same drugs that we start today, but they’re probably going to need some kind of treatment for the rest of their lives. We’re not curing it. We’re curing it.” We are in control of it.”
2) Your health insurance company may not want to cover these treatments
Without health insurance, these drugs are expensive. Ozempic is about $900/month without insurance, Wegovy is about $1,350. However, health insurance companies are reluctant to cover them, leading to costs coming up very early in the conversation between doctors and patients.
Every doctor I spoke with said they would offer insurance coverage almost immediately. “We’ll have to see if the insurance company will cover it,” Apobian said.
For Medicare and Medicaid patients, these government programs typically don’t cover weight-loss drugs, but when the United States uses these treatments, doctors are repurposing drugs that have been legally banned for many years. I think it is necessary to consider. For private insurers, the situation is even more complicated, but most commercial health plans also don’t cover weight loss drugs.
Even if technically it is, securing coverage can still be administratively cumbersome. Apovian said the workload at her specialty practice, where her one employee manages pre-approval and other paperwork for her eight practitioners, is “overwhelming.” I was. For independent doctors who practice on their own, the burden will be even greater.
In Minnesota, the Medicaid program does cover weight-loss drugs, but the conditions imposed on prescriptions can still be complicated, Fox said. She recounted the story of a teenage patient who met eligibility criteria based on age and BMI. The state program also wanted to require patients to eat a low-calorie diet, have regular meetings with a nutritionist, and participate in an exercise program.
Fox wrote an appeal, admitting that the patient had gym classes at school and played basketball outside of school. The Medicaid program replied, “Not enough.” After several salvoes over the plan, Fox called for the intervention of an independent adjudicator overseeing the program.
“The challenge is how to implement these approvals. The provisions are often not based on scientific recommendations,” she said. “We face delay tactics like this even though this should be covered upfront.”
There are alternatives for patients who can’t have insurance to cover the drug and can’t afford the $1,300 copay. Saxenda and phentermine were among the options doctors considered. But there are pitfalls that are not as effective as these new treatments that are gaining attention.
3) Your own experience with these drugs can vary greatly
Another thing patients should be aware of, obesity doctors say, is that their personal experiences may not match the hype.
The 10 to 20 percent weight loss headline numbers patients may have seen are just averages. Some people can lose 35%. Some people may only lose 10%. A few may not lose at all. At this time, bariatric science does not fully understand how different patients will respond. Apovian said there is still a lot of trial and error.
“There will always be patients who don’t lose much weight with these drugs,” she says. “Patients should be aware that there is a small chance of non-response.”
Grieberer also said he warns patients that it is normal to experience a plateau in weight loss after six to 12 months when their metabolism begins to adjust.
This does not mean that the patient can stop taking the drug for the reasons we have addressed. But plateaus can still be frustrating for those looking for exceptional returns.
There are side effects: Most people experience some nausea, says Apobian. Some people experience very bad nausea and end up in the ER. She also said that a small number of patients experienced constipation so severe that they had to be treated in hospital.
From an individual’s and physician’s perspective, the discomfort of side effects and the risk of more serious complications from the drug may be worth the potential benefit. But it’s important that doctors and patients confront them and prepare for them.
4) You need a comprehensive plan for weight loss and management
All the doctors I spoke to finally stressed that their patients needed a comprehensive weight management plan, including a strict diet and exercise regimen.
It’s not because weight loss is as easy as eating right and training. All these doctors were trying to break down that misconception. But these drugs “will work best in patients who are also dieting and exercising,” Apobian said. “You can’t just prescribe these drugs.”
Exercise has well-documented health benefits, especially for obesity-related conditions such as high blood pressure and diabetes. Building muscle helps your body burn calories. And even if you’re light weight, sitting still poses some health risks. Some people may start noticing a change in taste after taking these medications, so finding a satisfying diet and finding something to help control appetite in conjunction with the medication can also be beneficial.
Strategies for achieving better sleep and managing stress can also help patients get the most out of these medications and manage other symptoms they may be facing. Physicians and patients need to think about how to treat the whole person, rather than hoping and hoping that a new treatment will work as a miracle drug.
“Obesity treatment is an ongoing treatment… once you prescribe it, you can’t go without follow-up,” Grieber said. “We have to use this drug as a tool.”