GLP-1 Weight Loss Drugs in the News, Again

The latest news about the GLP-1 weight-loss drugs looks at how the latest developments can potentially both positively and negatively affect consumers and businesses. Let’s take a look at several recent headlines to glimpse at what’s happening in the world of weight loss meds.

North Carolina won’t cover GLP-1 weight-loss drugs for its state employees

The North Carolina state employee health plan is discontinuing coverage for expensive GLP-1 weight-loss drugs like Wegovy and Zepbound due to their high cost. The decision, made by the plan’s board of trustees, comes as the drugs have become increasingly popular among members, costing the plan $102 million in 2023 alone.

This decision is expected to be the first major state health plan to cease coverage for these drugs. Despite concerns about the affordability of the drugs for members, especially considering the state’s economic ties to the manufacturer, Novo Nordisk, the board has decided to end coverage entirely, except for current users who will be grandfathered in.

This move is projected to save costs for the plan, but it also means losing a substantial rebate from the drug’s manufacturer. Other states, like Texas and Connecticut, have also grappled with the high costs of these weight-loss medications, with some implementing restrictions or prior authorization procedures to manage their use.

Unsurprisingly, the manufacturers are not amused. As Ars Technica reported a couple of days ago,

A spokesperson for Novo Nordisk called the vote to end coverage entirely “irresponsible,” according to a statement given to media. “We do not support insurers or bureaucrats inserting their judgment in these medically driven decisions,” the statement continued.”

Ars Technica’s Senior Health Reporter Dr. Beth Mole also quotes Sam Watts, director of the North Carolina State Health Plan, who told Bloomberg:

Every state has been wrestling with it, every professional association that my staff is a part of has had some discussion about it… But to our knowledge, we’re the first major state health plan to act on it.

Why is this important?

We’d say for three reasons. First, because people still want them, despite potentially serious side effects and sticker-shock prices. Second, this could be seen as a trend, for lack of a better description, that other states might follow.

The third reason is a downright dangerous one. As Reuters reported just two days ago, The World Health Organization (WHO) has issued a warning about global shortages of popular diabetes medications used for weight loss, such as Ozempic, leading to a rise in suspected counterfeit versions.

These fake drugs, primarily distributed through unregulated outlets including social media platforms, pose serious health risks due to potential lack of efficacy and contamination. Instances of dangerously low blood sugar and hypoglycemia have been reported in those who took suspected fake versions of these medications.

The high demand for these drugs, coupled with manufacturing constraints, has led to shortages in the U.S. market, exacerbating the issue of counterfeit drugs. The WHO emphasizes the importance of obtaining medicines from authorized and regulated suppliers to ensure patient safety. Not only all patients are at risk should they choose to (or unknowingly) buy counterfeit, “but the increased circulation of fake versions was likely to have a disproportionate effect on patients with type 2 diabetes.”

The rise in GLP-1 prescriptions can also influence commercial real estate

Say what? Bear with us. Last week, CoStar, a commercial real estate information outlet, reported that the increasing popularity of weight-loss drugs like Ozempic could have significant implications for commercial property demand, according to Anton Pil, an executive at J.P. Morgan Asset Management.

With potentially millions of users in the United States, the rise in GLP-1 prescriptions could influence consumer behavior and impact real estate decisions. Pil said:

While there’s no guarantee the popularity of the drug will grow or that any behavioral changes will be long-lasting or widespread, spending patterns already are changing for people who are taking GLP-1s, according to anonymous data from 95 million J.P. Morgan Chase Bank customers…

TheRealDeal.com broke down the four ways the drugs’ increased use and popularity could influence commercial real estate, and it makes sense. Here goes:

Decline in fast-food sales: Weight-loss-drug users may reduce spending on fast food by about 85 percent, prompting questions about how fast-food restaurants can adapt their offerings, which could impact real-estate footprints.

Drop in alcohol sales: Individuals on these drugs might make a 60-70 percent reduction in their alcohol consumption, impacting liquor retailers.

Shift in snack and soda preferences: Spending on snacks may decrease by 80 percent, and soda consumption may drop by 70 percent, potentially leading to increased spending at alternative venues like juice bars.

Increased demand for fitness and apparel space: A shift towards a healthier lifestyle post GLP-1 usage could result in higher demand for spaces such as gyms, spa and beauty retailers, and apparel stores as consumers seek to support their new lifestyle.

Your responses and feedback are welcome!

Source: “Blockbuster weight-loss drugs slashed from NC state plan over ballooning costs,” Ars Technica.com, 1/29/24
Source: “Rise in reports of fake weight-loss drugs linked to shortage of real thing, WHO says,” Reuters.com, 1/29/24
Source: “Four Ways the Rise of Ozempic Could Shift Real Estate Investments,” CoStar, 1/22/24
Source: “Weight-loss drugs could reshape commercial real estate,” TheRealDeal.com, 1/27/24
Image by Anna Pelzer on Unsplash

Selling Crap to Kids, Part 7

In 2015 celebrities, especially if they worked for Disney, were catching flack for moonlighting in Coca-Cola ads. Journalist Jon Yaneff wrote,

Take for example a recent study published in the June edition of the journal Pediatrics. The study looked at 590 endorsements from 163 different celebrities. Researchers found that 65 celebrities were associated with 57 different food and beverage brands, including low-nutrient and sugar-sweetened drinks.

The American Academy of Pediatrics (AAP) wanted to ban both straightforward and covert advertising during children’s television shows. They established that pretty close to 100% of the food ads shown amongst highly-rated children’s programming featured junk food, and it wasn’t uncommon for any given child to see 20 such ads in a single day. That’s a lot of propaganda, particularly when poured into an immature mind.

The AAP wanted Congress, the FTC (Federal Trade Commission) and FCC (Federal Communications Commission) to forbid ads aimed at kids from being shown on TV, cell phones, and the like. In the same way that cigarettes and smoking had been excluded from entertainment movies, they also wanted to ditch the depiction of junk food. Julia Greenberg wrote of the FCC,

By the agency’s rationale, children haven’t developed the cognitive skills to distinguish between ads and content (or even read!). As a result, the FCC has set time limits on the number of ads allowed per hour during children’s programming. It’s also banned TV characters from selling products and prohibits product placement on kid channels and shows.

In another article written at the time, Drucilla Dyess said, “It is estimated that the ban could reduce the rates of overweight children and childhood obesity by as much as 15 to 20 percent.” But then, the Council of Better Businesses looked at the studies used by the AAP to reach its conclusions about the harmfulness of such advertising, and of course found them inadequate to the purpose.

The business groups claimed that the data used to condemn junk food advertising was either outdated, seriously inaccurate to begin with, or both. They claimed that research used flawed methodologies, and that there had been recent product improvements which the industry had not been given credit for. Some TV advertising was curbed, but obesity rates did not decrease, so the industry’s advocates claimed that forbidding ads obviously didn’t do any good. Of course, the other side argued that the children being observed had already been subjected to a ton of junk food ads, and were still responding to years of earlier brainwashing, so a dramatic change could not be expected to show up right away.

Back and forth

But industry representatives maintained that the situation had improved, because the products being advertised to kids were innocuous foods like “yogurt, soup, canned pasta, cereals, and meals with vegetables or fruit, milk or juice.” The child protectors responded by finding authorities who decried every one of those items. But the industry had another argument up its sleeve: leaving ads aside, there were also studies showing that just watching TV alone, without any food ads, also contributed to weight gain.

Furthermore, with or without advertising, just watching screens too close to bedtime had been shown to interfere with children’s sleep patterns, and it had been shown that bad effects on the quality and duration of sleep affected children’s tendency to put on pounds.

Some critics even proposed an extreme position: How about just not advertising to minors, period? After all, it’s not as if every child in America has a paycheck burning a hole in her or his pocket. Of course, that proposition was destined to go nowhere.

Your responses and feedback are welcome!

Source: “Selena Gomez, Madison Pettis Share Birthdays and Endorse Coca-Cola,” FoodsForBetterHealth.com, 08/27/15
Source: “Exposing the Murky World of Online Ads Aimed at Kids,” WIRED.com, 04/07/15
Source: “UPDATED: Will a Ban on Junk Food Ads Curb Childhood Obesity?,” HealthNews.com, 01/27/15
Images by Daniel M Vierdo, Pearl, Quinn Dombrowski/CC BY-SA 2.0

Selling Crap to Kids, Part 6

Early in 2014, Hank Cardello in a Forbes.com article noted how a drugstore chain had sacrificed $2 billion in annual profits by removing cigarettes from its shelves. Apple expunged 6,000 “sexually suggestive apps” from iTunes, and Costco banned firearms from its premises. Some companies discovered that what they lost in immediate income they could make back by the circuitous route of adopting “more socially acceptable products and practices.”

Before anyone could start feeling too warm and fuzzy about all this, the writer added,

[C]ompanies like CVS don’t give up a profitable line of business unless it is in their best long-term financial interest to do so. What CVS did is what I call having a moment of profitable morality.

Over a period of years, Disney theme parks shifted their children’s menus toward the healthier end of the spectrum. French fries were out; carrots were in. Even more surprising…

In 2012 Disney announced that it would no longer run junk food ads on its TV and radio stations, sacrificing a share of this $2 billion market in advertising to children… Disney’s stock price has doubled in the past two years.

Once the “halo effect” had been discovered, some corporations wasted no time “devoting their sharpest minds to figuring which of their products can thrive as the market changes, and de-emphasizing or eliminating the ones that no longer make sense.” But sadly, not enough corporations threw their sharpest minds into the job, and over the ensuing years, the world has seen plenty of examples that have no connection with morality, profitable or otherwise.

At the same time, though, other organizations became more conscious and more conscientious. In Australia, where almost two-thirds of school-age children participate in organized sports, a study published by a sports medicine journal shined a spotlight on the practice of advertising junk food at sports fields and even on the uniforms of young athletes.

By 2014, it was estimated that corporations spent a combined 1.6 billion every year on advertising specifically tailored to children, which achieved spectacular results, especially when imaginary characters were telling the kids what to eat. An interesting detail: The technique worked equally well in persuading them toward either junk food or healthy fare like vegetables.

Around the same time, Cornell University researchers studied the success of various in-store advertising ploys, such as positioning children’s cereal lower on the shelves, where actual children who happened to be shopping with a parent (and were too big to ride in the grocery cart) could more readily see them. It was also discovered that the friendly characters depicted on children’s cereal boxes were designed to make eye contact with their prospective customers, whereas on adult cereal boxes, characters like sports figures did not make eye contact with the viewer, but looked straight ahead.

Apparently, that is the sort of project into which most of the cereal industry’s sharpest minds invested their creative energies.

Your responses and feedback are welcome!

Source: “CVS and the Rise of Corporate Profitable Morality,” Forbes.com 02/27/14
Source: “Junk food ads taking over kids sport – study,” WordPress.com/,10/06/14
Source: “Me eat vegetable: Cookie Monster wants kids to snack healthier,” TheGuardian.com, 10/04/14
Source: “Warning: Cereal Box Characters Are Stalking The Children,” CBSNews.com, 04/07/14
Images by dancingbarefoot3, Karen, Matthew Sheales/CC BY 2.0

GLP-1: More Competition, Soaring Prices, and What Medicare Won’t Cover

Despite soaring prices, reported side effects (some serious), and the fact that many gain their weight back after stopping taking their weight loss medications, overweight adults are still very much interested in taking them. A recent poll from the University of Michigan found that more than 60% of overweight adults ages 50 to 80 are interested in taking one.

And many doctors are on board. “These are game-changing medications,” Shauna Levy, M.D., an obesity medicine physician at the Tulane University Medical Center and medical director of Tulane’s Bariatric and Weight Loss Center, was quoted as saying in a recent AAPR article detailing possible side effects of the new weight loss medications.

Let’s take a quick peek at last week’s headline to glimpse at what’s happening in the world of weight loss meds.

The competition heats up, and more pharma companies want in

Last week, CNBC Digital Reporter Annika Kim Constantino wrote about how the weight loss drug market is witnessing increased competition as drugmakers aim to tap into its potential worth of tens of billions in the next decade. Dominated by Novo Nordisk and Eli Lilly, the market is attracting both large and lesser-known players.

Some companies entering the race include Boehringer Ingelheim, in collaboration with Zealand Pharma, developing the drug survodutide targeting GLP-1 and glucagon, Constantino reported. The list of interested entities entering the game is growing. Consider this: Terns Pharmaceuticals is conducting early-stage trials for an oral weight-loss drug focusing on GLP-1. Viking Therapeutics and Structure Therapeutics are developing drugs targeting GLP-1 and other hormones. And Altimmune’s pemvidutide has shown promising results with a 15.6% weight loss.

Additionally, Sanofi and Bayer are considering entering the market with potential next-generation weight loss drugs. The demand is expected to rise, with Goldman Sachs projecting 15 million U.S. adults on obesity medications by 2030.

At the same time, the prices are soaring in 2024

Pharmaceutical companies have raised prices for over 700 medications, including popular drugs like Ozempic and Mounjaro, with an average increase of about 4.5% at the start of the year, slightly slower than in previous years. Notable increases include Ozempic (3.5% to $984.29) and Mounjaro (4.5% to $1,000), both GLP-1 agonists used for weight loss. CBS News reported that the analysis from 46 Brooklyn Research, a nonprofit that processes drug pricing data, found that the average price increase at year start was about 4.5%.

Why Ozempic and Mounjaro? These GLP-1 agonists, while designed to help diabetics regulate their blood sugar, also had been found to be effective weight loss drugs, prompting non-diabetics to seek out the drugs in order to slim down. Greater demand led to shortages.

Why this is bad news for employers

Increased prices mean potentially higher healthcare costs for employers. A recent article on Inc.com notes that the impact on employers may be more significant this year due to the already high costs and widespread use of Ozempic and Mounjaro. Associate Editor Brit Morse writes that market demand, coupled with inflationary pressures, is cited as the reason for the price hikes.

Morse quotes Nelly Rose, a pharmacist at NFP, a benefits consulting company, who said that covering said drugs through a workplace benefits program could be beneficial not only to employees but also to the companies who decide to offer them long-term. Employees who struggle with their weight are more likely to be on more expensive medication, or need more frequent hospital visits, Rose told Inc.com.

What Medicare won’t cover and why

If you have Medicare and want to lose weight, Ozempic won’t be covered. But if you need to take it for your type 2 diabetes, you are in luck. In an article for VeryWellHealth.com, Tanya Feke, M.D., a board-certified family physician, patient advocate and best-selling author, discussed the conditions for which Medicare covers Ozempic and when it does not.

In a nutshell, it’s super simple. Dr. Feke writes:

Medicare covers medications that it considers to be medically necessary. This includes most drugs approved by the Food and Drug Administration (FDA) for certain indications, which include a diagnosis, illness, injury, syndrome, or condition.

Ozempic is an injectable medication in the class of drugs known as glucagon-like peptide agonists (GLP-1 medications). It has an FDA-approved indication for type 2 diabetes and for cardiovascular-event reduction in people who have both type 2 diabetes (the body cannot properly regulate and use blood sugar as fuel) and known cardiovascular disease (conditions affecting the heart and blood vessels). Many Medicare Part D plans will cover Ozempic for beneficiaries who have these conditions.

Off-label use for weight loss may not be covered by Medicare due to regulations from the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, restricting coverage for cosmetic or weight loss purposes. Ozempic can be expensive, and if not covered by insurance, patients may need to go through prior authorization or step therapy processes.

Still, Dr. Feke notes, “That could change as professional organizations lobby for coverage of weight-loss medications by Medicare in the future.

Your responses and feedback are welcome!

Source: “What Are the Side Effects of New Weight Loss Medications?,” AARP.com, 1/17/24
Source: “Views on Medications for Weight Management,” HealthyAgingPoll.com, 12/13/23
Source: “The weight loss drug market may soon get more crowded. Here are the companies trying to enter the booming space,” CNBC.com
Source: “Drugmakers hiking prices for more than 700 medications, including Ozempic and Mounjaro,” CBSNews.com, undated
Source: “Prices for Weight-Loss Drugs Like Ozempic Are Skyrocketing. That’s Bad News for Employers,” Inc.com, undated
Source: “Medicare Coverage for Off-Label Ozempic to Lose Weight,” VeryWellHealth.com, 1/16/24
Image Copyright mahmud7.

Selling Crap to Kids, Part 5

This sequence of posts is a historical overview of the food industry’s ambitious project of brainwashing children to nag their parents to buy them the worst possible excuses for food. In Part 1, we looked at the good guys’ decades-long effort to ban the advertising of such products on television, while manufacturers continued to ramp up the proportions of sugar and salt in their breakfast offerings.

Meanwhile, the cereal moguls commissioned studies designed to convince everyone that kids simply will not eat cereal unless it is heavily sweetened. And gosh darn it, as much as they wished that they could help reduce the amount of sugar eaten by kids, there was simply nothing they could do. Their hands were tied. Because in commerce, markets are propelled by demand. So it was implied and presumed that if children were denied sugar-laden breakfast food, millions of them would go on hunger strike and starve themselves to death.

Part 2 discussed the efficacy of creating advertisements where the products were endorsed by celebrities or cartoon characters, or celebrity cartoon characters.

For AlterNet, reporter Martha Rosenberg reviewed a study that had been published in the journal Pediatrics, in which children sampled graham crackers with popular cartoon characters on their packages and found that they tasted better than other crackers (identical down to the molecular level) that came in plain wrappers.

The same type of comparison test was run with identical gummy fruit snacks, some packaged in bland anonymity, and others presented in packaging bedecked with — you guessed it — popular cartoon characters. By now, the astute reader will have also guessed that the cartoon-packaged treats actually tasted better! What is more, the degree of preference was not just noticeable but academically defined as significant.

Part 3 of the sequence looked at the technique of promoting basically valueless junk as being somehow healthful. And strangely, although kids don’t care about that sort of thing, it seems that, nevertheless, they are likely to form a positive impression of a product based on ads that claim health benefits.

About a decade ago, matters had advanced to the point where the average American child encountered around 16,000 TV commercials per year, a large proportion of them touting foodstuffs. At the same time, a growing number of adults were philosophically opposed to the tactic of direct-to-child advertising. Some critics asked, “Should they be allowed to show so many of these ads to kids?” while others were like, “Should they be permitted to do this at all, even a little bit?” It was an uphill battle of course.

Part 4 touched on the cultural weirdness of designating children’s food, as separate and distinct from adults’ food. Sure, in the olden days of the human race, there was breast milk; and no doubt a certain amount of maternal pre-chewing of edible plants and flesh for the benefit of kids who didn’t have teeth yet. But children’s food? No such thing. And yet somehow, thousands of generations of young humans survived.

Your responses and feedback are welcome!

Source: “Americans Are Huge: 5 Surprising Reasons Why We May Be Getting Fatter,” AlterNet.org, 03/12/14
Images by Jose Melendez, mliu92, Miguel Pimentel/CC BY-SA 2.0

Anti-Obesity Medications and Functional Impairment, Continued

This is the continuation of an exploration of the possible negative effects of the new wave of weight-loss drugs, which began with a recent post.

Physical function limitations affect the activities of daily living (ADLs) such as bathing, dressing, eating, transferring, and toileting. Then there are instrumental ADLs, which include such survival skills as meal preparation, shopping for groceries, taking medications properly, making telephone calls, and managing finances. The activity categories are further sorted into more specific tasks, like raising the arms above shoulder level, climbing one flight of stairs without resting, and picking up a dime from a flat surface.

The viewpoint of another bureaucracy, the Social Security Administration, is somewhat slanted because its main concern is an individual’s capacity for gainful employment. The SSA is not very concerned about limitations that only affect one’s personal life, but in millions of cases it makes judgment calls about the ability to work, so its definitions carry a lot of weight.

The main work-related disabilities have to do with: “climbing and balancing; fine manual dexterity; hearing; kneeling and crawling, using an upper extremity, alternately sitting and standing; reaching and handling; stooping and crouching; seeing.”

Mental limitations encompass the ability to understand, remember, and carry out simple instructions. A person also needs to make work-related decisions, including appropriate responses to people and situations, and to be capable of dealing with change. Another category of limitations has to do with environmental conditions. For various reasons, it might be very dangerous for someone to work around moving machinery or certain chemicals, in an excessively dusty or noisy environment, or extreme cold or heat.

Impairment claims and refutations

We have listed the broad categories of possible functional limitations upon the activities of daily existence, which may be physical, mental, or environmental. Other problems can affect a person’s ability to earn a living, depending on the field in which one has been trained and has successfully supported oneself. There are subtleties, less obvious skills — like the ability to hold onto and manipulate a small object, and to feel sizes, shapes, and textures — that might not affect a farm laborer but that would ruin the prospects of a surgeon.

All these many skills and abilities, it now appears, could potentially be affected by the new weight-loss drugs, in ways that will become increasingly apparent as time passes. A person’s RFC, or residual functional capacity, could be negatively impacted by these pharmaceuticals in ways that researchers are now only beginning to imagine.

When claims are made, one very problematic area is pain. Is it disabling, or merely unpleasant and inconvenient? Should people be permitted to collect Social Security just because they say they are in pain?

What if their pain, or any other physical function limitation, can be proven to result from using liraglutide, naltrexone-bupropion, orlistat, phentermine-topiramate, semaglutide, or setmelanotide electively, in a voluntary manner that is not medically necessary, but for cosmetic purposes — for instance, because they want to lose a non-life-threatening amount of weight? Such a development could provide numerous job opportunities for attorneys, and a whole new realm of problems for doctors and patients.

Your responses and feedback are welcome!

Source: “What Are Functional Limitations & How Do They Affect Disability Benefits?,” DSSMD, undated
Source: “How Do Physical Limitations in Disability Claims Affect Disability Benefits?,” CarmichaelLawGroup.com, undated
Image by Stephen Cherniske/Public Domain

A New Anti-Obesity Medications Study Reveals Interesting Insights

A recent study published in the medical journal Obesity revealed that approximately 80% of individuals prescribed anti-obesity medications discontinue usage within one year. Other insights were both unsurprising and yet others, unexpected. Here’s the gist.

Three main findings

The key takeaways are these three main finds, illuminated by health and lifestyle journalist Laura Hensley reporting for Very Well Health,  an online health and medical resource:

The majority of people who are prescribed anti-obesity medication discontinue the drugs at the one-year mark, according to new research

Wegovy (semaglutide), a newer medication, had the highest rate of patient adherence at one year compared to other, older drugs

Researchers suggest that the more effective an anti-obesity drug is, the longer a patient will likely stay on it

The weight-loss medication with the best adherence is…

The research, conducted by the Cleveland Clinic, indicated that at three months, 44% of patients filled their prescriptions, dropping to 33% at six months, and further decreasing to 19% at the 12-month mark. Notably, among the various anti-obesity drugs examined, semaglutide (marketed as Wegovy for weight management or Ozempic for type 2 diabetes) demonstrated the highest patient adherence, with 40% still taking the medication one year after the initial prescription. The study suggests a correlation between the effectiveness of anti-obesity medications and long-term patient adherence.

The study examined various anti-obesity medications, including Qsymia, Contrave, Xenical, Wegovy, and Saxenda, focusing on 1,911 adults with a BMI of 30 or higher who initiated FDA-approved weight management medication between 2015 and 2022. Researchers, using data from the Cleveland Clinic’s electronic health records, found that patients on newer, more effective drugs demonstrated better adherence compared to those on older, less effective medications.

Semaglutide (Wegovy) showed the highest adherence, having been FDA-approved for weight loss in 2021. A 68-week clinical trial revealed that Wegovy users lost an average of 12.4% of their initial body weight. In contrast, Naltrexone-bupropion (Contrave), approved in 2014, had lower adherence, with only about 10% of patients remaining on it at one year. Clinical data on phentermine-topiramate (Qsymia), approved in 2012, indicated varying percentages of patients achieving weight loss milestones over 56 weeks.

Reasons patients stop taking their anti-obesity meds

The Cleveland Clinic study did not directly look into the reasons behind patients discontinuing their anti-obesity medication, but it is suggested that some may have stopped within three months due to drug intolerance or dissatisfaction with early weight loss results. Possible side effects of these medications vary and may include nausea, vomiting, headache, dizziness, diarrhea, numbness or tingling, trouble sleeping, and dry mouth. (That is quite a list.)

Older anti-obesity medications, described as mild stimulants, might induce anxiety or elevate blood pressure. Hensley writes,

“Some of the older anti-obesity medications tend to be mild stimulants. They can create a little bit of anxiety or raise blood pressure,” Vijaya Surampudi, M.D., an assistant professor of medicine in the Division of Human Nutrition who works in the Center of Obesity and Metabolic Health at UCLA, told Verywell.

One of the oral anti-obesity medications does have an anti-addiction medicine in it called naltrexone, so you can’t be on any sort of narcotic painkiller [at the same time]. So if someone needs to have surgery, it’s very difficult to actually be on that anti-obesity medicine,” she said.

Another reason individuals may discontinue anti-obesity medication is the perception that weight management is temporary, as some believe they no longer need the medicine once they reach a comfortable weight. Despite expert opinions viewing obesity as a disease requiring chronic treatment, this mindset persists.

The study by Dr. Gasoyan and colleagues at the Cleveland Clinic did not specifically investigate why individuals stop medication, but they analyzed health insurance coverage’s impact on medication adherence. Reports suggest that some U.S. employers are considering restricting insurance coverage for anti-obesity pharmacotherapy due to perceived unsustainable costs and rapid weight gain after treatment discontinuation. Additionally, patients might stop taking weight management drugs simply because they can no longer afford them.

The study conducted by Dr. Gasoyan suggests that new data on the health benefits of newer anti-obesity medications could influence future coverage decisions by insurance providers. According to Hensley, Dr. Gasoyan said:

Our findings, along with future studies on determinants of non-persistence with anti-obesity medications, could offer opportunities for more nuanced insurance benefit design, incorporating evidence-based usage management tools, rather than limiting or eliminating anti-obesity medications coverage altogether.

The new promising weight-loss drug

The research did not include Zepbound (tirzepatide), a recently approved highly effective anti-obesity drug associated with significant weight loss. Gasoyan anticipates that the positive results seen in the study, where greater medium-term weight loss correlated with higher odds of persistence, could extend to newer drugs like tirzepatide, warranting further exploration in future research.

As parting advice, Dr. Surampudi emphasizes the importance of patient satisfaction with medications, stating that if a patient is unhappy with a specific drug, healthcare providers can work together to find alternative strategies for managing obesity.

Your responses and feedback are welcome!

Source: “Which Anti-Obesity Medication Do Patients Stay On the Longest?,” VeryWellHealth.com, 1/11/24
Source: “Early- and later-stage persistence with antiobesity medications: A retrospective cohort study,” Obesity, 12/6/23
Source: “FDA Approves New Drug Treatment for Chronic Weight Management, First Since 2014,” FDA/gov, 6/4/21
Image by Jennifer Burk on Unsplash

Anti-Obesity Medications and Functional Impairment

Over the past year or so, millions of words have been published about new products in the pharmaceutical industry. For a while, it seemed as if there might be no downside at all; that these awesome substances might be the first in the history of medicine to come unaccompanied by any ill effects. Then slowly, the miraculous illusion began to fade.

The honeymoon might be over, according to some signs, like for instance a University of North Carolina study that produced sentences like these:

Among individuals with obesity, participants using anti-obesity medications, compared with those not using said medications, were more likely to report physical function limitations… Older adults with obesity on [anti-obesity medications] had higher rates of self-reported limitations in function and were more likely to be treated.

In a piece by Jessica Nye, Ph.D., several drugs are mentioned by their generic names (liraglutide, naltrexone-bupropion, orlistat, phentermine-topiramate, semaglutide, and setmelanotide); none by commercial brand; but they include all the biggies. Dr. Nye writes,

Participants older than 60 years of age were evaluated for self-reported functioning and basic and instrumental activities of daily living… Older adults with a body mass index (BMI) greater than 30 kg/m2 are eligible to receive anti-obesity medications. However, this cohort of patients are also at an elevated risk for functional limitations and disability.

The report under discussion utilized data from the National Health and Nutrition Examination Surveys of 1999 to 2018. Included were very nearly 20,000 subjects, 55% female and 45% male, with a mean age of 70.3 years.

Some definitions

According to various authorities, physical function limitation includes “basic activities of daily living limitations,” “instrumental activities of daily living limitations,” and even “any impairment.” Knowledge of what is meant by these terms will come in handy, to understand the implications of these findings.

A different study in the same genre gives examples. Mobility limitations may include the inability to walk several blocks and/or climb a flight of stairs, the inability to get up from a sitting position or to stoop, crouch, or kneel. Similar limitations can affect the upper extremities, rendering the person unable to push or pull heavy objects or to lift more than a few pounds. In their studies of pre-diabetic patients, researchers assessed six geriatric conditions.

One would be cognitive impairment, ranging from mild and all the way to dementia. For individuals over 65, frequent or serious falls count. There is urinary incontinence serious enough to require the use of absorbent pads. Decreased hearing and/or vision that cannot be helped by the use of corrective technology, count as limitations; as does chronic pain.

(To be continued…)

Your responses and feedback are welcome!

Source: “Anti-Obesity Medications Increase Risk for Functional Impairment,” EndocrinologyAdvisor.com, 10/19/23
Source: “Physical Function Limitations Among Middle-Aged and Older Adults With Prediabetes,” NIH.gov, 09/14/13
Image by Quinn Dombrowski/CC BY-SA 2.0 DEED

Start Making Sense

Lately there has been a revival of interest in a subject that many people, regardless of how well-intentioned, have trouble wrapping their heads around: the paradox of obesity and food insecurity. How can they both exist together?

According to government figures,

12.8 percent of American households (17.0 million households) were food insecure in 2022, meaning that they had difficulty at some time during the year providing enough food for all their household members because of a lack of resources.

Sadly, what a lot of it boils down to is a survival mode, “Get it while you can” philosophy. When it’s uncertain where the next meal will come from — let alone, next week’s groceries — a person tends to chow down on anything that happens to be available because it might be their last chance for a while.

The language has evolved. Instead of “poor neighborhoods,” we say “under-resourced communities.” Instead of “hunger” we say “food insecurity,” but it all boils down to the same thing, in the words of writer Ann Shovels:

[…] the state where there is limited, inadequate, or unreliable availability or access to obtain nutritionally sufficient and safe foods in socially acceptable ways.

Of course, that definition can be broken down even further. It is against the law, anywhere, to break into an establishment and steal food from the stockroom. But things are a little different in the tourist-friendly part of town, where restaurants feature outdoor seating adjacent to public sidewalks. After the customer has finished and left, it is socially acceptable for hungry people to swipe leftovers from the tables, as long as they aren’t too obnoxious about it.

There are people who depend on street scores for most of their calories, and there are even other people who will considerately leave a partly-eaten lunch on an accessible ledge, rather than stuff it into a trash can because they know this.

Challenges on every side

The CDC (Centers for Disease Control) speaks of obesity in terms of the social determinants of health, “the conditions in which people are born, grow, work, live and age, and the wider set of forces and systems shaping the conditions of daily life.” According to the CDC,

Examples of social determinants can be job opportunities and income, access to education, healthcare, transportation, housing, and a safe physical environment, as well as the experience of structural racism.

A lot of factors figure into the ability to obtain food that doesn’t promote obesity. A person with no kids and a car is going to have better access to healthful groceries than a person with five kids and no car, that is for certain.

Now, suppose that a family member is too sick to be left at home alone. If no one else is available to cover for a while, the primary caregiver can’t go shopping. For many Americans, especially since COVID, the answer springs readily to mind: Have the groceries delivered, of course! But delivery of any commodity generally involves an extra charge.

Prosperous people forget that little detail, or maybe never know it in the first place, because their underlings handle such matters. A famous queen of France, when informed that the peasants didn’t have any bread, supposedly retorted, “I don’t see the problem. Just tell them to eat cake.”

To a sensible human, the logical flaw here seems obvious. If the lower class can’t afford plain old bread, they almost certainly can’t afford cake. But well-to-do people are often clueless about the challenges of the under-financed life. They just don’t get it.

All kinds of things can go wrong in families, and even if close friends and neighbors are willing to step up, they often can’t, because they are just as broke as the people they wish they could help.

Your responses and feedback are welcome!

Source: “Understanding the paradox of obesity and food insecurity,” CANR.MSU.edu, 12/22/23
Source: “Is Online Grocery Delivery Worth It?,” RamseySolutions.com, 1/24/23
Image by Michael Coghlan/CC BY-SA 2.0 DEED

Childhood Obesity Specialists Struggle to Get GLP-1 Agonists

This week’s Medscape report by journalist Alicia Ault discusses the latest challenges faced by pediatric obesity specialists in accessing glucagon-like peptide 1 (GLP-1) agonists, medications approved by the U.S. Food and Drug Administration (FDA) for weight loss in adolescents aged 12 years or older. She opens with:

While adults, many of whom don’t meet the clinical definition of obesity, scramble to procure glucagon-like peptide 1 (GLP-1) agonists for weight loss, pediatric obesity specialists said their young patients who could benefit more over the long term often are unable to access the potentially life-altering medications.

The FDA approved two GLP-1 agonists so far — both marketed by Novo Nordisk — for use in adolescents aged 12 years or older: Saxenda and Wegovy. Several pediatricians told Medscape that despite the potential benefits of these medications for young patients with obesity, the increasing demand for GLP-1 agonists has led to supply shortages, making it difficult for pediatricians to initiate new treatments or maintain existing ones.

Ault writes:

The crushing demand for semaglutide in the past year, driving a thriving market in compounded versions and online prescriptions, has made it increasingly difficult to find pharmacies that can fill prescriptions.

Two pediatric specialists, Brooke Sweeney, M.D., medical director of weight management services at Children’s Mercy in Kansas City, Missouri, and Sarah Raatz, M.D., a pediatrician at the University of Minnesota’s Center for Pediatric Obesity Medicine, both said because of the supply issues they can’t prescribe the medication for new patients because then the patients already taking it might not have enough, which may lead to weight loss reversal and other negative outcomes.

Potential benefits appeal to some pediatricians

Ault quotes Susma Shanti Vaidya, MPH, M.D., associate medical director of the IDEAL pediatric obesity clinic at Children’s National Hospital in Washington, D.C., who said that “patients taking GLP-1 agonists in her practice have reduced their body mass index and have seen resolution of prediabetes, diabetes, and fatty liver disease.”

Insurance denials are piling up

Insurance coverage for these medications, even for FDA-approved indications, is also becoming more difficult, with insurers setting weight trajectory thresholds that, if not met, could result in coverage withdrawal. Ault explains:

In January 2023, the American Academy of Pediatrics urged aggressive treatment of childhood obesity, including using FDA-approved medications such as GLP-1 agonists combined with lifestyle and dietary modifications.

The U.S Preventive Services Task Force, however, has issued a draft proposal that recommends a variety of lifestyle and behavior modification interventions for children and adolescents but says the evidence does not yet support recommending bariatric surgery or medications.

Concerns about more restrictions this year

Pediatricians express concerns about potential restrictions in 2024, creating uncertainties for patients who have benefited from these medications. Some of the patients, for example, were told that prior authorization would be required for new prescriptions for a GLP-1 agonist.

Some parents want GLP-1 agonists for their kids, too

Some parents, when they feel they have exhausted all other options for their children, are requesting GLP-1 agonists for their children, emphasizing the life-changing effects reported in some cases. The pediatric obesity specialists quoted in the article cited one such effect as stopping the “food noise” and thus curbing cravings.

In a recent poll by Morning Consult, 65% of parents of children with weight-related issues said they would be interested in GLP-1 agonists for their kids. And a third of parents said “they would be interested in having their children use the drugs if they were available.”

However, there is a need for more data on the long-term effectiveness and safety of these medications in pediatric patients, and clinicians are counseling families that obesity is a chronic disease, requiring lifelong treatment with GLP-1 agonists in some cases.

Your responses and feedback are welcome!

Source: “Pediatric Obesity Specialists Struggle to Get GLP-1 Agonists,” Medscape, 1/8/24
Source: “Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity,” American Academy of Pediatrics, 1/9/23
Source: “High Body Mass Index in Children and Adolescents: Interventions,” U.S. Preventive Services Task Force, 12/12/23
Source: “A Third of Parents Are Interested in Weight Loss Drugs Like Ozempic for Their Children,” Pro.MorningConsult.com, 12/4/23
Image by Elena Leya on Unsplash

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Profiles: Kids Struggling with Weight

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The Book

OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:

Presentations

Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

Food & Health Resources