AT A GLANCE…
- The Oscar ceremony mocks Ozempic takers in Hollywood; Brendan Fraser wins best actor for his portrayal of a 600-lb gay man in The Whale.
- The Guardian, a British daily newspaper, reports on Novo Nordisk and its ‘orchestrated PR campaign’ to achieve regulatory approval
- Researchers calculate Medicare Part D would be on the hook for $27B, or 20% of its total budget, to serve adults 60 years and older with semaglutide, at 10% uptake on an obesity prevalence of 41.5%
- WalletHub, a personal finance website, this week ran an article on ‘2023’s Most Overweight and Obese Cities in the U.S.’
EVENTS
- Last Sunday, Jimmy Kimmel took the stage at the 95th annual Academy Awards ceremony in Los Angeles with an opening monologue ‘…Everybody looks so great. When I look around this room, I can’t help but wonder “Is Ozempic right for me?” in relation to the ‘…rumoured widespread use of diabetes drug Ozempic among Hollywood A-listers.’
- And on the evening before the ceremony, Saturday Night Live had as its spoof opening line ‘You’re about to watch the 95th annual Academy Awards, sponsored by Ozempic’, with the addition of ‘…Ozempic, I guess everyone in Hollywood has diabetes!’
- In less slapdash happenings at the Oscars ceremony, Brendan Fraser, a middle-aged Canadian actor who made it big in 1990s Hollywood, was named best actor for his role as Charlie in The Whale, ‘…as a 600-lb. man who reconciles himself to the limits of his reclusive life.’
- To play Charlie, ‘…Fraser consulted with the Obesity Action Coalition and donned a prosthetic suit so heavy that it had to be filled with tubes of cold water to regulate his body temperature.’ During an interview published two weeks ago in the New York Times, Mr. Fraser recounts ‘…I talked to maybe eight or 10 people — some bedridden, some perfectly mobile — and asked them, “Walk me through your diet for a day.” And they would describe it to me in [the] way a person drinks, a person uses substances, sex, gambling addiction. Self-medicating by eating is all in the same wheelhouse of that behavior, a cycle of risk, reward, risk, reward, pleasure me, pleasure me.’ On the final day of filming, the actor noted ‘The last time I took this makeup off, I became really emotional… it wasn’t lost on me that I could remove the costuming and the people who live in that body can’t.’ That’s powerful.
- Whilst method acting was popularized by Marlon Brando in the 1951 film A Streetcar Named Desire, the empathy, stark realism, and deep respect shown by Mr. Fraser goes far beyond; his portrayal of Charlie is compelling and uncomfortable all at the same time. The movie confronts us with our own biases, exemplified during a roundtable discussion with lead actor Brendan Fraser, playwright Sam Hunter and three volunteer advocates for people with obesity, Liz, Ian and Shelley.
- The 12-minute video session is led by Joe Nadglowski, CEO of the Obesity Action Coalition; in it, Liz describes the film as ‘a powerful portrayal, of life with obesity that was honest and real, with it being so hard to put into words life for someone who looks like me.’ Mr. Fraser speaks of the film as being ‘authentic, truthful, and having meaning, that can continue even when the film is over.’ Sam Hunter openly describes his depression growing up as a gay kid, and self-medicating with food; and when he lost a substantial of weight, the world related to him differently; cashiers and other gay men were friendlier to him. During the roundtable, participants talk of the blank zoom scene as part of the film, with Charlie not turning on his camera, to avoid being judged by his size, and how this relates to the literal and physical invisibility of living with obesity.
- Are we at a tipping point, where mass society is to become aware, engaged, and empathetic, with a drive to action, in the widespread discrimination toward people living with obesity? My memory goes back to the first time I watched the movie Philadelphia almost thirty years ago, with Tom Hanks and Denzel Washington in leading roles of a ‘…gay man Andrew Beckett (Hanks) who asks lawyer Joe Miller (Washington) to help him sue his employers, who fired him after discovering he has AIDS.’ And in a surreal coincidence, Mr. Hanks won the Academy Award for Best Actor at the 66th Oscars ceremony, while Bruce Springsteen won Best Original Song for ‘Streets of Philadelphia’ – in my mind, one of the most powerful, purposeful, and chilling songs of all time.
NEWS
- The Guardian, a British daily newspaper, reports on an ‘orchestrated PR campaign’ based upon the premise that ‘…Novo Nordisk gave millions to obesity charities and healthcare professionals’ in order ‘…to boost its UK influence.’ The reporting relates to ‘An expert who praised the drug as a “game changer”, Nick Finer, a former honorary professor at University College London, was a senior clinical scientist at Novo until last July and owns shares’ and a ‘…prominent scientist, Prof John Wilding, who gave evidence to Nice, was president of an organisation paid more than £4.3m by Novo in three years. His declaration of interests to Nice show these donations were not disclosed.’ I think that Professor Allyson Pollock, from Newcastle University frames this well, in that ‘…Novo’s campaign was “not unusual” in the drugs industry and called for measures to improve trust.’
OPINION
- Dr. Fatima Cody Stanford, a well-known obesity medicine physician from Boston, a paid consultant to Novo Nordisk and recently featured on CBS’ 60 Minutes, appeared on Amanpour and Company to describe the mechanisms of action of GLP-1 receptor agonists on the brain, gastrointestinal tract, and adipose tissue. The changing conversation surrounding obesity as a chronic disease, the long-term usage of the medication, patient identification for successful therapy, costs of medication and impact on access and equity, were topics of discussion. There was though very little, if no, mention of a multi-pronged approach to care delivery incorporating all aspects of nutrition, exercise, behavioral, pharmacologic, and surgical therapy; and further, beyond weight loss as a metric of success, toward remission and resolution of chronic diseases with subsequent reductions in total costs of care.
DATA
- Researchers in health policy from Vanderbilt University and the University of Chicago published a Perspective article in the New England Journal of Medicine this week with reference to ‘…net prices can be more than 20 times as high for new anti-obesity medications as for older ones, and lifetime use might be required to prevent weight regain’ with ‘…concerns that payers may not cover new anti-obesity products and that patients won’t be able to afford them without coverage.’ Medicare Part D coverage, with more than 47 million beneficiaries, ‘…is prohibited by law from covering prescriptions for weight loss.’ The authors calculated that, at obesity prevalence of 41.5% for adults 60 years of age or older, and at a 10% uptake of semaglutide, the costs to Medicare would be just shy of $27B, representing almost 20% of the $145B in net total spend of the 2019 Part D Medicare program. A more likely scenario is 1% uptake, at an estimated annual total cost of $2.7B, or just shy of 2% of the Part D spend. From the article, ‘The burden of obesity and obesity-related conditions is unquestionably high, but the value of Medicare coverage of anti-obesity medications remains unclear’ pushes the ball right in front of the goal face for Congress and the Centers for Medicare and Medicaid Services to wrestle; may the games begin!
- Elaine Chen, in STAT News, inadequately states that ‘Covering new weight loss drugs could strain Medicare…’ for which I would aggressively modify the wording from ‘strain’ to ‘bankrupt’. These drugs do work, and much better within the confines of a multimodal program of care; my key tenet is, even if we decide to fund them, what of the huge issue concerning long-term medication adherence rates to manage chronic disease? (About 50% for those with diabetes and hypertension). In the words of former Surgeon General C. Everett Koop, ‘Drugs don’t work if patients don’t take them.’
- Researchers from Pennington Biomedical Research Center, part of Louisiana State University in Baton Rouge, published on physical activity and weight loss, in an underserved population of 402 individuals from Louisiana. The study delivered a multi-component, health literacy appropriate, weight loss program with health coaches embedded in primary care clinics, supported by an obesity science education program for the PCPs of participants too. The intervention resulted in up to 7% weight loss from baseline over a 24 month period, with higher levels of weight loss associated with greater increases in physical activity. Good for them, not only to focused on an underserved population, but also to have a pretty significant impact through intensive lifestyle modification.
- WalletHub, a personal finance website that also produces research reports, such as Happiest States in America and Best Places for Halloween, this week ran an article on ‘2023’s Most Overweight and Obese Cities in the U.S.’ The methodology was based upon 19 key-indicators of weight-related problems, from rates of obesity and overweight in adults, teenagers and children, the share of diabetic adults and those with high blood pressure, to city friendliness toward an active lifestyle. In the table on the website titled ‘Fattest Cities in the U.S.’, first is the issue of inappropriateness and stigma regarding the title; and second, a quick review of the data reveals the top ten are based in the U.S. states of TX, TN, AL, MS, AR, LA and SC – unlikely to be a surprise for many of the readers. Though I am perplexed as to the role, impact, and use of such a scoring table – interesting that there was an attempt to garner an ounce of credibility, by interviewing Dr. Colleen Tewksbury, and assistant professor in nutrition science at the University of Pennsylvania School of Nursing.
Kind regards, Raj
