Hello all,
I hope everyone is having a wonderful weekend. I am back home after an intense week on the road, capped by a terrific two days at the ASMBS Weekend conference in New Orleans (where twenty30 health is a Bronze-level Corporate Council Member). It was an outstanding opportunity to connect with old friends and colleagues while making new ones at the same time, comparing notes and learnings on emerging best practices in obesity medicine.
Speaking of learnings in obesity medicine, there are some good points to take away from this week’s news round-up: Employer health insurance plans are in a bit of a mad scramble to figure out how to deal with the ballooning costs of GLP-1 coverage while meeting demand for the meds, as they seek to help improve worker health; an excellent study explores access to publicly-funded weight management and bariatric surgery services in the UK; there is an interesting review of adverse GI events associated with GLP-1s; and, Novo Nordisk reckons with their expected ‘huge windfall from the runaway success’ of semaglutide.
Kind regards, Raj
AT A GLANCE
- Novo Nordisk ‘…was ready for a huge windfall from the runaway success of weight-loss drug Wegovy…’ as per Maggie Fick at Reuters.
- Employer health insurance plans ‘…are scrambling to find solutions to help improve worker health while simultaneously keeping a lid on rising health care spending…’ in reference to ‘Ozempic hype’.
- Access to publicly funded weight management [WM] and bariatric surgery services through primary care are reviewed for almost two million patients in the UK, from 2007 through to 2020.
- Researchers from Canada review the ‘…gastrointestinal adverse events associated with GLP-1 agonists used for weight loss in a clinical setting…’ in a recent article from JAMA.
NEWS
- Novo Nordisk ‘…was ready for a huge windfall from the runaway success of weight-loss drug Wegovy…’ as per Maggie Fick at Reuters. Estimated returns will generate ‘…more than $12 billion in coming years…’ with Novo Holdings CEO Kasim Kutay ebulliently stating ‘…If these forecasts are correct, that’s a hell of a lot of money coming our way over the next decade and hopefully more.’
- ‘Mike Mason, executive vice president and president of Lilly Diabetes & Obesity, is leaving after 34 years…’ with Eli Lilly, in reporting from Colin Kellaher at The Wall Street Journal. Mason has ‘…overseen the development and launch of the blockbuster diabetes drug Mounjaro…’ and ‘…and helped propel Eli Lilly’s market capitalization above $500 billion.’ I am curious to see where Mason will go next – am sure he will be a hot property in this super-hyped space.
- Dani Blum at The New York Times writes on the Wegovy ‘…shortage [that] has fueled widespread frustration among potential patients.’ Mark Basa, 37 who has been on Wegovy describes it as ‘…anxiety-inducing…’ and succumbs to a realization that ‘…I’m never going to lose this weight.’ Dr. Andrew Kraftson, at Michigan Medicine is more direct referring to it as a ‘…living hell.’
OPINION
- Employer health insurance plans ‘…are scrambling to find solutions to help improve worker health while simultaneously keeping a lid on rising health care spending…’ in reference to ‘Ozempic hype’. Many employers have been caught ‘flat footed’ on the ‘…quick rise in popularity of the drugs over the last two years…’ so much so that ‘…The University of Texas System and the health system Ascension found the cost unsustainable and ended coverage altogether.’ Indeed, the ‘…$10,000 annual price tag for this groundbreaking class of weight loss drugs have put employers in a tough spot.’ In way of a real world example, ‘…North Carolina, which covers 750,000 employees and their family members, spent $120 million on these new diabetes and weight loss drugs in just the first half of this year.’
- An Uber model for medicine, pill mills, asynchronous care, and clinical eligibility are discussed by Elizabeth Lopatto in The Verge. She focuses upon her experience with telehealth company Ro that ‘…can run subway ads with copy like <<A weekly shot to lose weight>> without mentioning any of the side effects of the GLP-1 class drugs, alongside images of models injecting themselves.’
- It is clear there is a wealth of ‘…research showing that doctors are some of the worst offenders when it comes to weight stigma.’ Dr. Mara Gordon from Camden, NJ reflects on her approach to be a ‘…body-positive doctor…’ and how ‘…It’s getting harder in the age of Ozempic.’ On Ozempic per se, she continues ‘…when patients ask for it, I usually prescribe it…’ though the ‘…medication is a mixed bag, it turns out. Some of my patients can’t stand the side effects. They tell me the nausea and vomiting aren’t worth it, that they’d rather stay fat than feel sick all the time.’
- Dr. Daniel Knecht, Chief Clinical Innovation Officer at CVS Caremark writes on the ‘…advent of GLP-1 therapy is nothing short of transformative for countless individuals living with obesity…’ and perhaps can put an end to ‘…battling hunger pangs, calorie counting, and a seemingly futile efforts at the gym.’ The article reviews the ‘…significant concerns remain about cost, access, and the long-term health and societal implications…’ and to ‘…to separate fact from fiction.’
- Indeed, obesity is a serious clinical condition, ‘…associated with over 200 diseases, including hypertension, diabetes, mental health conditions, and roughly a dozen forms of cancer.’
- The separation of hype from reality is well taken Dr. Knecht, though we all know that obesity as a disease aggressively continues to cripple the costs of health care in most, if not all, developed countries… and as such, a solution is necessary, timely and urgent!
- It is startling that ‘…Nearly 7% of the population is projected to be on weight-loss drugs in 2035…’ in reporting from Jesse Newman at The Wall Street Journal. ‘…Wall Street has been trying to project the drugs’ impact on sales for food and beverage makers, restaurants and grocery stores.’
DATA
- Access to publicly funded weight management [WM] and bariatric surgery services through primary care are reviewed for almost two million patients in the UK, from 2007 through to 2020. Superstar bariatric surgeon Dr. Richard Welbourn and colleagues report ‘…Only 56,783 (3.13%) were referred to WM, and 3,701 (1.09%) of those with severe and complex obesity) underwent bariatric surgery.’
- Indeed, ‘…People with BMI ≥40 kg/m2 were more than 6 times as likely to be referred for WM (10.05% of individuals) than BMI 25.0 to 29.9 kg/m2…’ and ‘…were more than 5 times as likely to undergo bariatric surgery (3.98%) than BMI 35.0 to 40.0 kg/m2 with a comorbidity (0.53%).’
- In reference to patients with severe and complex obesity, longer duration of severe obesity, and increasing comorbidities, they ‘…were also strongly associated with bariatric surgery.’ In essence, a ‘…very small percentage of the primary care population eligible for WM referral or bariatric surgery according to national guidance received either…’ and ‘…improved access to WM interventions is needed to reduce obesity levels.’
- Researchers from Canada review the ‘…gastrointestinal adverse events associated with GLP-1 agonists used for weight loss in a clinical setting…’ in a recent article from JAMA. Sixteen million patients from a health claims database ‘…were observed from first prescription of a study drug to first mutually exclusive incidence (defined as first ICD-9 or ICD-10 code) of biliary disease (including cholecystitis, cholelithiasis, and choledocholithiasis), pancreatitis (including gallstone pancreatitis), bowel obstruction, or gastroparesis (defined as use of a code or a promotility agent).’ Of ‘…4144 liraglutide, 613 semaglutide, and 654 bupropion-naltrexone users…’ incidence rates were elevated for pancreatitis, bowel obstruction and gastroparesis.
- The European Association for the Study of Diabetes, or EASD, held its annual meeting in Hamburg, Germany this week. Among the presentations was a ‘…network meta-analysis to compare tirzepatide with SC semaglutide in terms of their efficacy and safety in people with type 2 diabetes.’ From twenty-two studies of over 18,000 subjects, ‘…Tirzepatide 15 mg was the most efficacious in reducing HbA1c versus placebo…’ though ‘…tirzepatide (15 mg) was associated with increased risk for vomiting versus low- and medium- dose of semaglutide.’ There is a definite trade-off between efficacy and tolerability, as with most things in life.
Kind regards, Raj
