Bloomberg Businessweek January 10, 2022 pp48-51 “The Drugs Are Working” by Emma Court “The first step toward fulfilling a New Year’s resolution just might be a class of prescription weight loss pills and shots. The next steps: Getting patients and doctors to trust them and insurers to cover them.”
Read Bloomberg Businessweek for all the details.
Summary by 2244
Images above are from FDA.GOV
Talking about being overweight or frankly obese is a minefield discussion with the skinny and many healthcare providers still believing that "putting down the fork" is all one really needs to do to lose weight. Meanwhile researchers nibble away at the science but a key dogma is really unproven-that being that we each have a setpoint for weight which our body strives to maintain. It’s easy to imagine that, for example, coming from a hunter and gathering life that we would have adapted to make do with less in times of paucity and then store, in the form of fat, when we have excess. Jumping ahead to living next to a McDonald’s or having highly caloric meals effortlessly delivered-hot to our homes eliminates the scarcity part of the equation-the epigenetic or environmental piece, while our genetics remain the same.
Why lose weight?
Medically, it is now well-established that being overweight or obese is a comorbidity for type 2 diabetes, heart disease, cancer, “Covid-19, and straight up death from any cause.” Those struggling with being overweight too will recite being discriminated against socially and professionally.
How to lose and keep off unwanted weight?
Those wanting a leaner self will tell tales of having been through all the weight-loss programs that target the epigenetic piece of maintaining a desired weight. Veronika Miller-Eagleson, a patient in point, “has struggled with obesity since high school…she’s tried WW,...Jenny Craig, low-carb diets, [and] Noom…” all to no avail-for a wide range of cost these programs often offer some help but there’s a tendency over time to regain the weight-the idea being that your body readjusts your setpoint. She stopped short of having “bariatric surgery”, one method known to achieve as much as a 30% loss in weight, “but decided against it. (Her insurance wouldn’t cover the $20,000 price tag).” She reports now that “she got rid of 10 pounds, and she has consistently felt fuller while eating less.” Enter GLP-1.
What is the science behind the apparent success of GLP-1?
GLP-1, short for Glucagon-Like-Peptide-1, within the body is mostly produced in the small intestine after a meal. GLP-1 acts at two levels, it stimulates the pancreas and acts on areas of the brain. The pancreas responds by making blood-sugar lowering insulin and the brain releases chemicals that make you feel full sooner.
Is GLP-1 widely available?
Novo Nordisk A/S has the lead with "Wegovy" a “weekly obesity shot recently approved by “ the FDA”...after clinical trials “showed patients losing an average of about 15% of their body weight.” (See the press release by the FDA above for their messaging) Other makers are in the race for a GLP-1 drug, and many can be presumed to be working on modifications that will provide weight loss approaching bariatric surgery and versions that can be dispensed in pill form.
What are the barriers to greater adoption of GLP-1?
Cost and lack of insurance coverage are factors slowing adoption. “Brand-name GLP-1s run about $1,400 for a month’s supply of weekly injections.” These medications like drugs for ED are considered lifestyle medicines and are not covered by Medicare and generally not by private insurance. Experts claim that overcoming worries about past failures of diet medications that had significant side effects, the failure of prior diet programs and the recalcitrant belief that weight is a choice are also key barriers to quicker adoption.