Obesity meds and affordability; Ozempic covered by NHS in the UK and becomes a frenzy in China; GLP-1s, addiction and desire; and pets with obesity!

OPINION

• In the United Kingdom, the National Health Service announced ‘…a £40 million two-year pilot…’ to ‘…explore how approved drugs can be made safely available to more people by expanding specialist weight management services outside of hospital settings.’ Prime Minister Rishi Sunak, son of a general practitioner and pharmacist, was quoted ‘…Obesity puts huge pressure on the NHS…’ and ‘…the latest drugs… will be a game-changer by helping to tackle dangerous obesity-related health conditions such as high blood pressure, diabetes and cancer.’ I am concerned of Mr.Sunak’s silver-bullet like approach to the new drugs, and lack of mention of the associated approach to impact lifestyle factors, through multimodal, whole-person care.
• The Lancet, a well-respected medical journal, publishes a comment on ‘Semaglutide and the future of obesity care in the UK’ with a timely and appropriate reference to the ‘…major challenges for the effective, equitable, safe, and sustainable use of these newer obesity medications in the UK.’ Medical services are wholly under prepared, and even when apparent, ‘…only half of primary care clinician respondents in a mock consultation would identify obesity, with under a quarter then offering referral for a weight management programme.’ The article continues on current evidence from trials of GLP-1 medications to be ‘…limited by a preponderance of female, white participants assessed over a short timeframe of 2 years…’ and ‘…the absence of long-term safety data for semaglutide requires vigilance in relation to these adverse effects and all-cause mortality.’ I agree wholeheartedly on ‘…arrival of these new medications must not distract us from the whole systems response…’ and the focus on ‘…Person-centred weight management…’ to achieved outcomes as desired at patient, clinician, population and policy levels. 
• From Reuters, Ludwig Burger and Maggie Fick refer to the £40 million pilot in the UK NHS, with reference to Prime Minister Rishi Sunak to support ‘…people to live healthier and longer lives, and helping to deliver on my priority to cut NHS waiting lists.’ The interesting quandary here is that the launch of Wegovy in the UK has been delayed by Novo Nordisk due to supply chain and manufacturing issues, in the UK and rest of Europe.
• CNN informs on the Ozempic ‘…frenzy is sweeping through China, where being “wafer thin” is a prevailing beauty standard…’ with social media ‘…posts from users bragging about how they’ve easily lost 10 or more pounds within a month.’ More worrying is the quote that ‘…No diet, no exercise, you can reduce weight even when you are lying still.’ In China, ‘…more than 50% of adults in China were overweight, which is defined as having a body mass index (BMI) of more than 24.0…’ though is lesser than the 70% or so rate in the U.S. Of interest too is ‘…Chinese firms have accelerated their development of generic versions of semaglutide…’ which will be off patent in China from Novo Nordisk by 2026.
• Weight loss drug coverage is on the agenda at the FDA, in Bloomberg’s reference to Commissioner Robert Califf’s comment at a biotechnology convention in Boston, that US drug regulators are in talks with the Medicare agency for ‘…what to do about obesity drugs.’ A key data point is that ‘…Medicare will pay for certain surgeries aimed at weight loss, but not for weight loss drugs or supplements…’ though there is intentionality to modify the current state through ‘…changes of Medicare’s prescription drug benefit under the Inflation Reduction Act.’ The reference to financial toxicity in the cancer community is relevant here, not to have patients ‘…suffer health consequences, because they don’t take their drugs, because they’re trying to save money.’
• This week, the Health Equity Coalition for Chronic Disease (HECCD) published a paper on ‘…the impact and prevalence of the disease of obesity across America, including among Black and Hispanics, people living in rural communities, and those living in poverty.’ The call to action is ‘…a comprehensive approach to combating and preventing obesity…’ and the ‘…clock is ticking…’ with ‘…now is the time to change policies that are preventing access to comprehensive care and revolutionary treatments for individuals suffering from the disease of obesity.’ Obesity is discussed in terms of its associated co-morbidities and early mortality, individual financial strain from out-of-pocket costs, the greatest impact on Black and Hispanic Americans, higher rates in rural America, an unmistakable correlation between obesity and poverty, and the alarming increase of obesity rates in children. Equitable coverage will save lives and conserve resources is the approach here, from improved obesity care, with ‘…access to evidence-informed interventions, including intensive behavioral counseling, pharmacotherapy, and surgery.’

DATA

• Yours truly, together with colleagues Dr. Duncan, Dr. Kerr and Dr. Huynh, published an article in the peer-reviewed medical journal, Population Health Management. We analyzed ‘…the 2019 costs of US Commercially insured patients at different levels of obesity (body mass index [BMI]) in the Merative data set…’ based upon ‘… total cost of care per patient per month for patients with different categories of obesity and other chronic conditions.’ From the data, the ‘…increase in cost per unit of BMI between BMI values of 30 and 60 kg/m² were 2.5%, 2.8%, and 2.9% for no conditions, diabetes, and behavioral conditions, respectively…’ and further that health care costs ‘…only began to escalate significantly at BMI >40 kg/m².’ To add some context, ‘…for an individual with diabetes and a BMI of 45, the costs averaged $10,800 per year…’ such that a reduction in weight of 15-20% [as per the current data on GLP-1 medications] ‘…would lower costs to $8200–$8700 per year…’ to derive savings of about $2,000 per year. Those with higher costs, such as from renal disease could see a reduction in up to $10,000 per year. The take home message on GLP-1 medication use that that ‘…there is insufficient reduction in their health care costs for individuals with a baseline BMI between 30 and 40 kg/m²…’ based upon the $12,000 to $14,000 annual cost of medication.

Kind regards, Raj