Weight-loss drugs: Who, and what, are they good for?
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[January 02, 2024]
By Michele Gershberg
(Reuters) - Powerful weight-loss medicines like Novo Nordisk's Wegovy
leapt into public view in 2023, from social media to doctors' offices
and cocktail parties, offering a new way to address record obesity
rates.
But extraordinary demand, and high prices, for these drugs will keep
them out of reach in the coming year for many patients who are likely to
benefit.
The new drugs are known as GLP-1 agonists, which mimic the activity of a
hormone that slows digestion and helps people feel full for longer. In
clinical trials, people lost 15% to 20% of their body weight, depending
on the drug. Nearly 120 million American adults could be eligible for
treatment, while Novo says its target market is more than 760 million
people with obesity worldwide.
Researchers have also found the treatments can protect against heart and
kidney disease, and are testing them for conditions such as Parkinson's
and alcohol addiction.
Yet Novo Nordisk can't make enough Wegovy to meet demand, and only sells
it in a few of the world's wealthiest countries. Many people have turned
instead to Novo's diabetes medicine Ozempic, which contains the same
active ingredient, to shed pounds. That has created shortages of Ozempic
and new insurance hurdles for the diabetes patients who need it.
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Eli Lilly and Co just launched Zepbound, another GLP-1, for weight loss.
Pharma industry rivals, including Pfizer Inc and AstraZeneca Plc, are
also seeking to enter the market, which is forecast to reach $100
billion within a decade. They are testing versions that may be more
convenient, with fewer side effects.
WHY IT MATTERS
When drugs like Wegovy work, they can be life-changing for people whose
weight increases their health risks, from diabetes to heart disease and
kidney disease. Many patients have struggled for years with obesity, and
found that changes to diet and exercise aren't sustainable on their own.
Still, the potential costs are extraordinary, with U.S. prices for
Wegovy and Zepbound set above $1,000 per month. Current data suggest
patients need to keep using them long-term to maintain their weight
loss.
Private health insurers are finding ways to delay or deny use of the
medicines. Some physicians say they find it harder to get coverage for
Black and Hispanic patients with obesity who rely on government health
plans and face a greater risk of diabetes and other complications.
"Are we going to have coverage for the majority of us, or is this just
going to be a medication for the elites who can pay out of pocket?" said
Dr Andres Acosta, an obesity expert at the Mayo Clinic.
Regulators are looking into reports of rare side effects, including a
potential link to suicidal thoughts, while any long-term risks will take
years to determine.
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An injection pen of Zepbound, Eli Lilly?s weight loss drug, is
displayed in New York City, U.S., December 11, 2023. REUTERS/Brendan
McDermid/File Photo
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WHAT IT MEANS FOR 2024
These trends raise profound questions for doctors trying to figure
out which of their patients need the drugs the most, and how to get
them access.
Dr Lauren Eberly, an assistant professor of cardiovascular medicine
at the University of Pennsylvania's Perelman School of Medicine,
found that use of GLP-1 drugs for diabetes was lower in Black, Asian
and Hispanic patients using private health insurance than their
white counterparts. She is working on a new study of coverage trends
for weight loss.
"We're really worried about the inequities that this will perpetuate
as a direct result of inaccessibility of these medicines, especially
for more marginalized groups," Eberly said.
Dr Lauren Oshman, an associate professor in the University of
Michigan Department of Family Medicine, expects many patients will
find themselves unable to afford the new weight-loss drugs in 2024.
Doctors should understand all of the tools to treat obesity, from
counseling to older, cheaper medications that lead to a smaller
percentage of weight loss, but still provide a health benefit, said
Oshman.
"In some ways we can do a better job across the board in treating
obesity," she said.
Obesity experts say they must also consider who does not need the
medications. By some estimates, up to 40% of people with obesity may
not have other serious health risks.
"These should not be put in the water, or taken by people who don't
really need them," said Dr Susan Yanovski, co-director of obesity
research at the National Institute of Diabetes and Digestive and
Kidney Diseases. For those who do, research is needed on how to
maintain the weight-loss long-term and whether they can reduce, or
stop, use of the drugs.
"We don't only want to impact their weight," Yanovski said. "Our
ultimate goal is to impact how they feel and, potentially, how long
they live."
(Reporting by Michele Gershberg, Editing by Rosalba O'Brien)
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