Bariatric Surgery Numbers increase in 2022; Wegovy for Depression; Doctors have Fatphobia; Disparities in Obesity Meds; Increased GLP-1 Availability from Novo Nordisk
The New York Times reports 750,000 state employees in North Carolina will no longer have insurance coverage for GLP-1 medications, as of April 1 2024.
Novo Nordisk ‘…had started to increase the availability of its blockbuster obesity drug Wegovy for new patients in the United States…’ from Andrew Joseph at STAT.
‘Many fat people recall going to the doctor with symptoms unrelated to their size yet being summarily told to lose weight…’ recounts Kate Manne in The Washington Post.
Dr. Hamlet Gasoyan at the Cleveland Clinic reviews 50,000 adults with obesity, and notes ‘…Significant disparities exist in access to AOM [anti-obesity medications]…’
University of Toronto psychiatrist Rodrigo Mansur has been running a trial on GLP-1 drug semaglutide to ‘…improve memory and attention in people who are overweight and have severe depression with impaired cognition.’
In addition, GLP-1 drugs may help by counteracting weight gain that often comes from taking treatments for mental health disorders such as schizophrenia, as per Dr. Mahavir Agarwal, a psychiatrist at the Centre for Addiction at Mental Health.
Indeed, Novo Nordisk is in process with a clinical trial over three years across almost 400 locations, to review whether semaglutide has a positive effect on early Alzheimer’s disease.
Novo Nordisk ‘…had started to increase the availability of its blockbuster obesity drug Wegovy for new patients in the United States…’ from Andrew Joseph at STAT.
Novo CEO Lars Fruergaard Jorgensen is quoted ‘…I am pleased to state that we are now enabling more new U.S. patients to initiate treatment by more than doubling the amount of lower-dose strength Wegovy compared to previous months.’
In 2023, Novo saw 154% growth in obesity care sales, with sales up by 36% and operating profit up 44%.
The National Consumers League and National Council on Aging today introduced the nation’s first Obesity Bill of Rights and launched a grassroots movement – Right2ObesityCare – to advance changes in federal, state, and employer policies that will ensure these rights are incorporated into medical practice.
From The New York Times, of the 750,000 state employees in North Carolina, those with obesity will no longer have insurance coverage for GLP-1 medications, as of April 1 2024.
The state paid for almost 25,000 employees to take weight-loss drugs, at a cost of $100 million, or about 10% of its entire drug spend. Dale Folwell, the state treasurer said ‘…This is something we never anticipated.’
The vote ‘…on Thursday to end all coverage of medications for weight loss…’ was close at 4 to 3 to end coverage, though ‘…will continue covering versions of the drugs for people with diabetes.’
Mr. Folwell, the chair of the health plan’s governing board, notes ‘…had the plan covered the medications without limits this year, the cost would be enough to pay for a 0.5 percent pay raise for all state employees.’
On the counter, Novo Nordisk spokeswoman Allison Schneider, said the company employs more than 2,500 North Carolinians and has poured more than $5 billion in capital spending into the state.
OPINION
Thanks to my friend and twenty30 health colleague Tzvi Doron, DO for co-authoring this article in HR Daily Advisor with me, on ‘Why Obesity’s Stigma Stands in the Way of Treatment and Care.’
Framing obesity as a moral issue leads to more stigma.
While some physicians may think of medication or bariatric surgery as taking the easy way out, arguing that patients should be able to lose the weight on their own, the eat less, exercise more approach does not work for most in this population.
Fewer than 1% of obese people will obtain a normal body weight long-term.
Continuing to stigmatize obesity is not only misguided, it’s futile.
Understanding obesity as a treatable medical condition and chronic disease is the first step to reducing stigma.
Obesity is not a personal failing.
While lifestyle interventions may contribute to weight loss, these are not the only options and promoting them exclusively further reinforces the stigma.
‘Many fat people recall going to the doctor with symptoms unrelated to their size yet being summarily told to lose weight…’ recounts Kate Manne in The Washington Post.
Ms. Manne is associate professor of philosophy at Cornell University and author of ‘Unshrinking: How to Face Fatphobia’, and notes ‘…fat patients were rated more negatively by doctors on 12 out of 13 indexes, including this patient would feel like a waste of my time and this patient would annoy me.
These views are not only false, they contravene the moral principle that everybody deserves humane, compassionate medical care, regardless of their weight or health status.
The whole truth is that ‘…fat people aren’t failing. It’s the system that is failing fat patients.’
MedCity News features Dr. Shantanu Gaur, CEO of gastric balloon company Allurion, on three key questions we can no longer ignore on obesity.
The sustainability of lifelong care at an affordable price, the role of virtual coaching and support at scale to improve outcomes, and the role for alternatives to GLP-1s.
All good, though Dr. Gaur is shortsighted to note Ozempic and other medications ‘…will address a very, very small piece of a very, very big pie.’
The number of people who will receive is absolutely going to get much much bigger, with bariatricsurgery, GLP-1s and lifestyle therapies all being a massive part of the forward approach.
In my mind, let’s not pit one treatment against another.
Let’s pursue personalized, whole-person care for people with obesity, leveraging the right treatment for the right person at the right time – just as we treat cancer, with an armamentarium of surgery, chemotherapy, radiotherapy, and additional interventions.
Ozempic and its counterparts ‘…cause a proportion of muscle loss higher than diet and exercise alone, though roughly on par with bariatric surgery…’ write Sarah Zhang at The Atlantic.
This is driving pharmaceutical companies to search for new drug combinations that could build muscle while burning fat.
Current wisdom promotes a high-protein diet, and resistance training.
Another approach works through blocking myostatin antibodies, such as in bimagrumab, a drug developed by Versanis Bio, the company acquired by Eli Lilly last year for up to $1.9 billion.
Regeneron and Scholar Rock are two additional companies working on myostatin antibody medications to pair with GLP-1s too.
DATA
Dr. Hamlet Gasoyan and colleagues at the Cleveland Clinic studied records from over 50,000 adults with obesity, and note that ‘…Significant disparities exist in access to AOM [anti-obesity medications] both at the prescribing stage and getting the prescription filled based on patient characteristics and insurance type.’
Namely, being a man, Black or Hispanic versus White, on Medicaid, Medicare, Medicare Advantage, versus private insurance, and a higher degree of social deprivation index was associated with lower odds of a new prescription for obesity medication, and lower fill rates.
From the overall population, only 8.0% had prescriptions and 4.4% had filled prescriptions; relaying a large, significant and well known underutilization of effective treatments for people with obesity, further exacerbated by racial, ethnic and socio-economic disparities.
This is ‘…a 6.5% increase in MBS volume from 2021 to 2022 and a 41% increase from 2020 which demonstrates a recovery from the COVID-19 pandemic.’
Despite being the most effective durable treatment for obesity, bariatric surgery remains underused as approximately 1% of all patients who qualify, undergo surgery.
The sleeve gastrectomy continues to be the most dominant bariatric procedure, encompassing just shy of 60% of all procedures, and gastric bypass at 22%.
To my surprise, almost 30% of cases are reported to be performed with robotic assistance, from barely 5% in 2015.
I am pleased with the small overall increase, which is dwarfed by the tens of millions of Americans who need, want and would garner value from bariatric surgery; to lead healthier and happier lives.
