A new class of diet pills has given some obese patients new hope to lose weight and improve their health without the dangerous side effects of old drugs.
But despite evidence that the drugs are safe and effective, doctors say there are relatively few in the millions of people in the country. Eligible patients are taking them.
“This drug is something that has changed the lives of some people,” said Thomas Wadden, director of the Penn Medical Weight and Nutrition Disorders Program in Philadelphia. But he said, “I think it should have been one of the medications for weight loss.”
According to the Centers for Disease Control and Prevention, more than 70 percent of adults in the United States are overweight or obese. Obesity can lead to a variety of other medical conditions, including high blood pressure and cholesterol, type 2 diabetes, and stroke.
The drugs are similar to the GLP-1 hormone produced in the gut, which requires the pancreas to secrete more insulin to control blood sugar. They are not new to medicine; They have been used for many years to treat type 2 diabetes. However, when doctors noticed that patients were losing weight, pharmacists recommended high-dose drugs to treat obesity.
It is unknown how drugs can help you lose weight. According to Wadden, they slow down gastric emptying, so people stop eating earlier and feel fuller for longer.
Drugs are also thought to target certain receptors in the brain that affect appetite. “It can affect reward areas in the brain,” Wadden said. Thus, patients can eat less to get pure pleasure, which he calls “hedonic eating”.
So far, two new drugs from the drug manufacturer Novo Nordisk have been approved by the Food and Drug Administration. Saxenda was approved in 2020. The most recent Wegovy was approved last year for patients with a body mass index of 30 or higher or a BMI of 27 or higher and at least one weight. Studies found the weekly self-injectable helps lose, on average, about 15% of body weight in 16 months, making it twice as effective as old weight loss medications already on the market like Qsymia.
A new drug called GLP-1, called tirzepatide, also seems to be more effective when injected weekly. A study published last week in the New England Journal of Medicine found that it helped patients lose more than 20 percent of their weight in 72 weeks.
Medications are associated with side effects. Patients often complain of dizziness, vomiting, diarrhea and stomach upset.
But experts note that the drug is not a magic bullet.
“I don’t care how good the medicine is, it doesn’t work for everyone,” he said. Zhaoping Li, director of the Center for Human Nutrition at UCLA. “It’s a weapon, but it’s not a weapon.”
However, obesity doctors and researchers say that compared to the old class of drugs for weight loss, the new drugs are effective, especially for those who suffer from obesity, heart disease and other chronic diseases such as type 2 diabetes.
Rejected by insurance
Given the benefits, why do Wadden and others believe that drugs are being used less?
It’s all about money, says the doctor. В. Scott Butch, director of obesity medicine at the Institute of Bariatrics and Metabolism at the Cleveland Clinic.
Wegovy costs about $ 1,300 a month and most of the insurance doesn’t cover it.
Insurance companies argue that obesity is a behavioral problem, not a disease, and oppose the closure of medications to lose weight, Butch said.
“There are people who can lose a lot of weight from these drugs,” he said, but they can’t take them because they aren’t available. He added that some doctors are reluctant to prescribe them without knowing that “there is a front barrier.”
The obstacle blocked 40-year-old Camara Edwards from Philadelphia. Weighing more than 300 pounds and suffering from diabetes, he took Wegovy in 2018 as part of a clinical trial at Penn Medicine.
“I love eating bad food and drinking a lot,” Edwards said, adding that he faces those challenges every day in the restaurant industry.
However, he said that despite Wegovy’s negative effects on the gut, he was eating healthily.
“The general feeling is that it doesn’t make you hungry,” he said. “It’s like a stomach rotation without surgery.”
He lost 75 pounds in a 17-month study, which ended before the onset of the coronavirus pandemic, and the lock was removed from his daily life. He regained almost all his weight.
So when Wegovy was approved last June, his doctor gave him a prescription, but his insurance didn’t pay for it.
“The biggest tragedy is how expensive it is,” he said. “I’ve had these amazing results and the insurance and pharmaceutical industry doesn’t seem to have a medical problem because I can’t continue.”
Butch reiterated this, accusing the lack of insurance in stigmatizing obesity.
“Basically it’s behavior, and then they’re being stereotyped as overeaters,” Butch said. “Not all obese people eat chips, pizza and drink pop.”
In fact, for some people, there is growing evidence that obesity may be due to factors influencing a new class of weight loss medications – not nutrition, but insulin resistance and hormonal problems.
Insurance companies ’coverage decisions are exacerbating health imbalances, Butch said. Medicines are available to those who can afford to pay for them. However, post-mortem research has shown that obesity rates are higher among people living in poor communities, who usually have fewer food incidents and less access to health care.
This means that “those who really need these drugs cannot get them.”
Manufacturing problems, further complicating accessibility issues, are forcing pharmaceutical manufacturer Novo Nordisk not to prescribe Wegovy to new patients because it is not available to meet demand.
But Bonnie Drobnes, 42, of Lower Guinea, Pennsylvania, said her doctor never heard from her. Drobnes, a mother of two, was diagnosed by thyroid two months ago and was diagnosed by Wegovy after losing weight.
Due to a lack of medication, her pharmacy took three weeks to complete her prescription. But once he started it, he immediately felt a change.
“One of the things I always decide is to be constantly hungry in the back of your mind,” Drobnes said. “He’s always there. He went. It allows you to focus on being human. ”
“One of the things I’ve always decided on is a constant hunger strike in your mind,” he said. “He’s always there. He went. It allows you to focus on being human. ”
She lost 7 pounds in the first month after working for several weeks with a nutritionist, fitness trainer and exercise partner.
But when it came time to refill it every month, the pharmacy told him that the medicine had been ordered again and that it was unknown when he would bring it back. He called dozens of pharmacies in his Philadelphia area. None of them took medicine.
Novo Nordisk said in a statement on its website that the company expects Wegovy’s supply to stabilize by the end of this year.
This does not give much comfort to Drobnes. “I feel like I’m missing Wegovy and I’m losing my life,” he said. “I finally allowed myself to start imagining myself happier and healthier, but now that picture is gone.”
Indeed, weight gain after discontinuation of medication is a concern; Studies found that two-thirds of patients regained weight after stopping using Wegovy. However, obesity experts do not agree on how long a patient should take medication.
Lee, according to UCLA, needs more research before long-term prescription of drugs. Others, such as Wadden and Butch, argue that the use of drugs for many years would not be a problem if obesity was considered a chronic disease such as high blood pressure or diabetes.
I read that he prescribed medication to some of his patients, but only after other lifestyle changes and treatments were ineffective.
“It’s a stick that will help you walk,” he said. “But you have to walk yourself.”
For Edwards in Philadelphia, the “stick” changed his life. He is undergoing another clinical trial for the Wegovy pill form and hopes it will be cheaper. She has lost 45 kilograms since she started school in November.
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