You may have heard of Ozempic, as it’s been in the news- what’s the deal?!
Ozempic is a glucagon-like peptide 1 (GLP 1) agonist, which is a medication that is used to help control the body’s average blood sugar level. It is a treatment for patients with diabetes to reduce insulin resistance and improve hemoglobin A1c. The medication, whose chemical name is Semaglutide, was approved by the FDA for use in diabetic patients in late 2017. (1) It was been an excellent addition to management of diabetes.
So why do we hear about this in the media? What is all the buzz?
Semaglutide is also highly effective as an adjunct to diet and exercise, for weight loss. In June 2021, Semaglutide – under a different trade name, Wegovy – was approved to help with weight loss. (2) This medication, as well as other anti-obesity medications, are indicated for patients with BMI >30 or BMI >27 with weight related conditions. Semaglutide is very effective, with nearly half of study participants having seen a 15% weight loss. Many of us in the obesity medicine field see this as a game changer.
The problem is that this life changing medication is only available in brand name. As a result, it is very expensive and it is in limited supply. With ~40% of the US population having obesity and ~70% having overweight, the issue of who should get this life changing medication is an important public health dialogue. In the U.S., health care availability is controlled by private insurance or state run insurance companies, which often make arbitrary decisions about such medications. To make matters worse, the media has been running stories about the medication, often judging the use of the medication or reporting that celebrities who do not meet use criteria, have been taking the medication. (3)
Per the Obesity Medicine Association and the American Board of Obesity Medicine, obesity is a chronic disease, specifically “obesity is a chronic, progressive, relapsing, and treatable multi-factorial, neurobehavioral disease.” and treatment of this disease is best provided based on a full evaluation and incorporation of 1)nutritional intervention, 2)physical activity, 3)behavior therapy, 4)pharmacotherapy, 5)bariatric procedures – the latter two options when indicated by severity of the disease and the associated complications. The disease of obesity disproportionately affects black (49.9%) and hispanic (45.6%) individuals. Racial and financial barriers do appear to be an important concern when it comes to patients who need the medication having access to it. (5)
So, what does all this mean? The good news is that there are some amazing new medications available to treat the disease of obesity. In addition to Semaglutide, there are other GLP-1 agonists that are also effective at supporting weight loss, although not FDA approved for this purpose. There are even newer medications that have combination hormone effects and are likely to be more effective at assisting in weight loss. An example of this would be Mounjaro (chemical name tirzepatide) which is a combined glucose-dependent insulinotropic polypeptide (GIP) – and GLP-1. This medication is currently undergoing the process of FDA approval for treatment of obesity. (6)
The bad news is that these medications are a limited resource and a large portion of our population could benefit from their use. Many patients run into a circle of prior authorizations, appeals, and ultimate denials – with responses from insurance companies including lack of coverage for weight-loss medications. One has to wonder whether this is a form of prejudice – most other chronic disease treatments are covered under insurance. Weight loss medications have criteria for use – based on the risk/benefit profile of treating obesity and overweight vs. the risks of medications. These denials are occurring despite the patients meeting criteria and facing significant longterm health benefits from the potential weight loss. This may be a hold out of bias against the people who are affected by this disease, as they are often told – ‘why not just diet and exercise?’ The medical truth is that some of the hormones that regulate weight, such as leptin and ghrelin, change with calorie deficit weight loss. This change causes the body to go into starvation mode. The longterm reality is that even people with strong “will power” will not be able to maintain longterm weight loss by diet and exercise alone if they are suffering from obesity. That hormonal regulation is the physiologic reason why patients need the adjunct of medication or surgery (depending on degree of obesity) in combination with healthy lifestyle changes, to maintain longterm weight loss.
References
- https://www.drugs.com/history/ozempic.html
- https://www.fda.gov/news-events/press-announcements/fda-approves-new-drug-treatment-chronic-weight-management-first-2014
- https://people.com/health/stars-whove-spoken-about-ozempic-use-and-what-they-said/ . Ultimately, this causes bias against use of the drug in the general public.
- Obesity Algorithm 2023, Obesity Medicine Association
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9673703/
- https://www.forbes.com/sites/ariannajohnson/2023/01/31/diabetes-drug-mounjaro-expected-to-be-approved-for-weight-loss-soon-what-to-know-and-how-it-compares-to-similar-drugs/?sh=7a01f4f4477a
