When people with obesity can’t lose weight, suffering a host of health consequences as a result, a new generation of drugs can help, obesity experts say.
Wegovy is a treatment for chronic weight management that patients inject under their skin once a week. In studies, those who took the drug for 16 months lost an average of 12% of their body weight compared to those who received a placebo.
It’s in a class of drugs called GLP-1 receptor agonists and works by mimicking a natural hormone the body releases when a person eats food.
This hormone, called glucagon-like peptide-1, targets areas of the brain that regulate appetite and food intake. Researchers believe its action in the brain helps people feel satiated earlier, so they eat less than they usually would.
But one year after the U.S. Food and Drug Administration approved Wegovy, there have been a couple of snags.
“Unprecedented” demand for the anti-obesity therapy and issues at the manufacturing site have led to a shortage of the drug, said Novo Nordisk, the pharmaceutical giant that makes Wegovy. The company has asked doctors not to start new patients on the treatment for now.
But even when that issue clears up, many patients who want to take Wegovy will find it out of reach financially because health insurance often doesn’t cover anti-obesity drugs.
Wegovy has a list price of $1,349 per package, which contains four injector pens. Each pen contains a single dose of the drug, which should be injected once a week, according to the prescribing information, so the package lasts a month.
‘Obesity is not a choice’
Adriana Kelly, a 25-year-old social worker, knows all about the dilemma. She considered Wegovy her last option before resorting to bariatric surgery. Standing 5 feet, 2 inches tall, her weight reached 280 pounds last year. Kelly loves to dance, but her heavy frame put a painful strain on her knees and back, leading to injuries.
“I just kept gaining weight. I couldn’t lose it no matter what I did. I could eat salads for months, still couldn’t lose it,” Kelly, who lives in Branford, Connecticut, told TODAY. “It was a constant struggle.”
So her physician, Dr. Ania Jastreboff, prescribed Wegovy. But Kelly said her health insurance refused to cover it — a scenario that Jastreboff sees over and over again, to her frustration.
“Unfortunately, many insurance companies do not cover anti-obesity medications and that is extremely difficult for our patients. It’s extremely difficult for us. It’s a barrier that we really have to work to overcome,” said Jastreboff, director of weight management and obesity prevention at the Yale Stress Center in New Haven, Connecticut. She serves on the scientific advisory board for Novo Nordisk.
“Obesity is not a choice. It is a disease. There’s clear physiology that that leads to obesity, (but) there’s a bias that it’s not treated as a disease.”
TODAY contacted five of the country’s biggest health insurance companies and America’s Health Insurance Plans, the industry’s trade association, about coverage of Wegovy and other anti-obesity medications. Only one commented: Health Care Service Corporation said the medication is eligible for coverage under its pharmacy benefits, depending on a member’s plan.
Dr. Beverly Tchang, an endocrinologist and obesity medicine physician at NewYork-Presbyterian/Weill Cornell Medicine, said she has seen “a tremendous amount of interest” in the drug from patients and “pretty good” insurance coverage of it.
Insurance companies that refuse to cover the drug usually still believe obesity is a cosmetic problem, she noted.
“Some are still kind of in the Dark Ages in thinking that everyone should just do lifestyle, diet and exercise and think that’s going to work. We know from many, many long term studies that does not work and it’s not sustainable,” Tchang said.
“Most of the world recognizes now that (obesity) truly is a health issue — a medical problem.”
Obesity, which affects 42% of U.S. adults, results from the dysregulation of how much fat our body wants to carry — a setpoint determined by our brain, Jastreboff noted. The goal of anti-obesity medications is to reset that setpoint so that the body wants to carry less weight, specifically less fat.
When doctors can treat obesity, they can also treat or prevent many other weight-related conditions, including high blood pressure, diabetes and heart disease, she said. There are 13 types of cancer shown to be related to obesity, she added: “Our patients have suffered enough.”
Doctors turn to off-label use
Still, doctors like Jastreboff have used a unique workaround when it comes to Wegovy, the brand name for semaglutide. It’s the same molecule as Ozempic — a type 2 diabetes treatment also made by Novo Nordisk. The injector pens are slightly different and come in different doses, but the medication inside is identical.
If semaglutide in the form of Wegovy is not covered by a patient’s health insurance, Jastreboff tries to prescribe semaglutide in the form of Ozempic, which is more likely to be covered if the patient has type 2 diabetes.
“If an insurance company covers it for our patients who don’t have type 2 diabetes, then great. If they choose not to, then we move on to the next medicine,” Jastreboff said.
In a statement to TODAY, Novo Nordisk said it “cannot and will not promote, suggest or encourage off-label use of our medicines.” Although Wegovy and Ozempic both contain semaglutide, they are not interchangeable, the company noted.
Kelly, who is prediabetic, found out her health insurance does cover Ozempic. With that assistance, she currently pays $75 a month out of pocket for the drug.
She began treatment in August 2021 and has lost 50 pounds since — 40 of which she attributes to the drug. She injects herself once a week in her stomach and describes the medicine’s effect as making her feel fuller faster.
“My complete diet has changed. I used to be able to eat a whole pizza and be completely fine and get it down. Now, if I try to get down like two slices, I feel completely sick. It’s too much grease. Greasy food in general is really hard for me,” Kelly said.
Dr. Zhaoping Li, professor of medicine and chief of the division of clinical nutrition at the University of California, Los Angeles, prescribes Wegovy as a second-line therapy for patients with obesity who can’t lose or maintain weight with diet, exercise and other lifestyle changes. Li also prescribes Ozempic if a patient’s insurance doesn’t cover Wegovy.
But she cautioned the drug is not necessarily effective for everyone.
“It is definitely a new tool in the toolbox, but I don’t believe it is the tool,” Li told TODAY.
There is no “magic bullet” that melts weight off for long-term weight loss, said Emily Rubin, director of clinical dietetics at Thomas Jefferson University Hospital in Philadelphia. Even patients who’ve undergone weight-loss surgery can still gain weight back if they don’t follow a healthy diet and lifestyle, she noted.
Rubin said she has seen patients taking Wegovy lose about 5% to 7% of their body weight — on the right track to a 10% drop, a change that offers “significant health benefits,” she noted.
“Some patients cannot achieve a 10% weight loss with diet alone — that is where weight loss medications such as Wegovy may help meet this weight loss reduction,” Rubin said.
She recommends it for people who see no weight loss after three months on a calorie-restricted balanced diet and a physical activity regimen, or if a patient’s weight plateaus.
All drugs have side effects, Li noted, adding she and her team monitor them very carefully.
In clinical trials, almost 7% of patients treated with Wegovy permanently stopped taking the drug because of adverse reactions, or more than twice the number of people who received a placebo, Novo Nordisk reported.
The most common side effects that led patients to stop treatment were nausea, vomiting and diarrhea.
Other side effects included constipation, abdominal pain, headache, fatigue, indigestion and dizziness.
Stacey Ferguson, a marketing professional who lives in Laurel, Maryland, said she started taking Wegovy at the beginning of this year but decided to stop in April after experiencing “a constant state of nausea.”
“It was terrible,” Ferguson, 44, told TODAY. “Nausea to the point where I couldn’t be upright, I would have to lie down… just overall feeling really crappy. That said, it did completely curb my appetite. I had no desire to eat. But I was also vomiting. This is not life.”
Still, most people are able to tolerate the treatment, said Tchang, who was a paid consultant to Novo Nordisk in 2020.
Doctors are careful to raise the dose slowly to give patients the best chance of getting used to the medication, she noted. Some doctors also give patients an anti-nausea medication to use on the first one or two days after the injection when the side effects tend to be felt the most, she added.
Patients, in turn, need to be mindful of hunger and fullness cues and avoid overeating, Tchang said.
The gastrointestinal side effect profile was similar for Ozempic, with Novo Nordisk listing the most common adverse reactions as nausea, vomiting, diarrhea, abdominal pain and constipation. In clinical trials, about 3% to 4% of patients stopped taking the drug due to GI adverse reactions, compared with 0.4% for those taking a placebo, the company reported.
Both Wegovy and Ozempic carry the warning that semaglutide causes thyroid C-cell tumors in rodents, though it’s unknown whether that can happen in humans. People who have a personal or family history of medullary thyroid carcinoma or those who have multiple endocrine neoplasia type 2 syndrome should not use either drug, the warning for each medication states.
You must stay on the medicine for it to keep working
Kelly has experienced side effects from the treatment including headaches (which stopped after the first month), nausea and an upset stomach. She called them “very tolerable” and “definitely worth it.”
She now craves healthier foods like fruits and vegetables because they make her feel better. Her lighter body means she has more energy for her job working in a shelter and no longer feels exhausted after walking up a flight of stairs, she said.
Now at 230 pounds, her goal is to drop down to 190, her college weight. She is also planning her wedding.
“I feel so much more excited about getting married because I feel healthier and better. Being able to know that I’m going to continue to lose weight and feel like myself on my wedding day, it makes me so happy,” Kelly said.
Obesity is a chronic disease that requires continued treatment, so patients have to stay on the medicine for it to keep working in the same way people who receive medication for high blood pressure must keep taking it, even when their hypertension improves, Jastreboff said.
Tchang agreed. Regulating weight is not like an infection that clears up after taking an antibiotic for five days, she said. It requires a patient “to keep your foot on the gas pedal” with diet, exercise and medications that should be taken for as long as they’re helping with weight loss or maintenance, she added.
But Li said more long-term data is needed about Wegovy.
“I understand there is an argument that obesity is a chronic disease like hypertension, diabetes, and once you need to be on it, you should be on it for lifetime. But I don’t think the data is there really for that kind of statement. There is a potential, but we’re not there,” Li noted.
“We need to be vigilant to monitor all our patients carefully.”
When patients are concerned about taking drugs like Wegovy long-term, Tchang confirms there are no lifelong prospective trials for this medication.
“We don’t know absolutely for sure that it won’t hurt you lifelong,” she said. “But I can say without the medication, if you continue to gain weight, we know what will happen with that,” such as a higher risk of developing fatty liver, cardiovascular disease, stroke, high cholesterol and other health problems.
Jastreboff and her colleagues have been lobbying for health insurance to cover the anti-obesity drugs.
“If insurance covers the same molecule, so semaglutide Ozempic for diabetes, why would they not cover semaglutide (Wegovy) for obesity treatment?” she noted.
“We don’t want our patients develop diabetes. We want to provide them treatment for their obesity and prevent the diabetes from occurring.”
This story was updated on July 8, 2022, with a statement from Novo Nordisk about off-label use of its medicines.
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