A new class of weight loss drug is giving some patients with obesity new hope that they’ll be able to lose excess pounds and improve their health, without the dangerous side effects of older medications.
But despite mounting evidence that the drugs are both safe and effective, doctors say relatively few of the country’s millions of eligible patients are taking them.
“This drug is something that transforms lives for some people,” said Thomas Wadden, the director of Penn Medicine’s weight and eat disorders program in Philadelphia. But, he said, “I don’t think any of these weight loss medications are being prescribed as much as they should be.”
More than 70 percent of adults in the US are overweight or obese, according to the Centers for Disease Control and Prevention. Obesity can lead to a variety of other medical conditions, including high blood pressure and cholesterol, Type 2 diabetes and stroke.
The drugs mimic a hormone produced in the gut called GLP-1, which tells the pancreas to secrete more insulin to control blood sugar. They’re not new to medicine; they’ve been used to treat Type 2 diabetes for years. But when doctors noticed that patients also lost weight, drugmakers got on board, offering the medications in higher dosages specifically to treat obesity.
It’s still unclear exactly how the drugs help with weight loss. Wadden said they seem to slow down stomach-emptying so people stop eating sooner and feel full longer.
It’s also thought that the drugs target certain receptors in the brain that affect appetite. “It may be acting upon areas of reward in the brain,” Wadden said. So patients may eat less frequently for pure pleasure, which he calls “hedonic eating.”
So far, two of the new drugs, both from drugmaker 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 body mass indexes of 30 or greater or those with BMIs of 27 or greater plus at least one weight-related condition. Studies found the weekly self-injectable helped patients lose, on average, about 15 percent of their body weight over 16 months, making it twice as effective as older weight loss drugs already on the market, like Qsymia.
A newer GLP-1 medication called tirzepatide, also a weekly injectable, appears to be even more effective. A study published last week in the New England Journal of Medicine found it helped patients lose more than 20 percent of their weight over 72 weeks.
The medications do come with side effects. Most commonly, patients complained of nausea, vomiting, diarrhea and stomach pain.
And experts stress the drug is not a magic bullet.
“I don’t care how wonderful the drug is, it will not work for everyone,” Dr. Zhaoping Li, the director of the Center for Human Nutrition at UCLA. “This is a tool, but it’s not the tool.”
Still, obesity doctors and chronic researchers say that compared to the older class of weight loss drugs, the new medications are impressive, especially for those obesity whose obesity has caused other conditions, such as heart disease and Type 2 diabetes.
Denied by insurance
Given the benefits, why do Wadden and others believe the drugs are being underused?
It all comes down to money, said Dr. W. Scott Butsch, the director of obesity medicine at the Cleveland Clinic’s Bariatric and Metabolic Institute.
Wegovy costs about $1,300 a month, and most insurance doesn’t cover it.
Insurance companies push back against coverage for weight loss drugs, arguing that obesity is not a disease but a behavioral problem, Butsch said.
“There are individuals who will have a significant amount of weight loss” from these drugs, he said, but they can’t take them because they’re unaffordable. Some doctors, he added, are hesitant to prescribe them at all knowing “there’s already an up-front barrier.”
That barrier got in the way for Qamara Edwards, 40, of Philadelphia. Weighing more than 300 pounds and diabetic, she took Wegovy as part of a clinical trial at Penn Medicine in 2018.
“I like to eat bad food and drink a lot,” said Edwards, who says she faced those challenges daily working in the restaurant industry.
But she said that while she had some gastrointestinal side effects on Wegovy, she was eating more healthily.
“The overall feeling is that it makes you not hungry,” she said. “It’s like having a gastric bypass without having surgery.”
She lost 75 pounds in the 17-month study, which ended right before the coronavirus pandemic began and lockdown threw off her routine. She gained almost all of the weight back.
So when Wegovy was approved last June, her doctor wrote her a prescription — but her insurance wouldn’t pay for it.
“The biggest tragedy is just how expensive it is,” she said. “I had all these great results, and I may not be able to continue because insurance and the pharmaceutical industry feels like weight loss is not a medical issue.”
Butsch echoed the sentiment, blaming the lack of insurance coverage on the stigmatization of obesity.
“The premise is that it’s behavioral, and then they’re being stereotyped as overeaters,” Butsch said. “Not everybody who has obesity eats chips and pizza and drinks pop.”
Indeed, a growing body of evidence is finding that for some people, obesity may not be caused by overeating but by insulin resistance and hormonal issues — factors that are affected by the new class of weight loss drugs.
Insurance companies’ coverage decisions are expanding existing health disparities, Butsch said. Those who can afford to pay out of pocket can get the medications. But a study after study shows that obesity rates are higher among those who live in poor communities, which typically have fewer grocery stories and lack access to health care.
That means that “those who really need these drugs are likely not going to get them,” he said.
An ongoing shortage
Further compounding the problem of access are ongoing production issues, forcing drug manufacturer Novo Nordisk to tell doctors not to prescribe Wegovy to new patients because it doesn’t have the supply available to meet the demand.
But Bonnie Drobnes, 42, of Lower Gwynedd, Pennsylvania, said her doctor never got the message. Drobnes, a mother of two, was prescribed Wegovy two months ago after a thyroid problem made it feel like it was impossible for her to lose weight.
It took three weeks for her pharmacy to fill her prescription because of the drug shortages. Once she started it, however, she felt an immediate change.
“One of the things I’ve always dealt with was a constant hunger in the back of your mind,” Drobnes said. “It’s always there. It went away. It allows you to focus on being a human being.”
“One of the things I’ve always dealt with was a constant hunger in the back of your mind,” she said. “It’s always there. It went away. It allows you to focus on being a human being.”
She lost 7 pounds in the first month, more than she’d lost after weeks working with a nutritionist, a wellness coach and a workout partner.
But when it was time to get her monthly refill, the pharmacy told her the drug was on back order and that it was unclear when it would get it in again. She called dozens of pharmacies in the Philadelphia area, where she lives. None of them had the medication.
Novo Nordisk says in a statement on its website that the company expects the supply of Wegovy to stabilize later this year.
That doesn’t offer much comfort to Drobnes. “I feel as though without the Wegovy, I’m losing my lifeline,” she said. “I finally allowed myself to start picturing a happier and healthier me, but now that picture is slipping away.”
Indeed, weight gain after discontinuing the drugs is a concern; studies have found that two-thirds of patients gained the weight back after they stopped taking Wegovy. But obesity experts disagree about how long a patient should stay on the drugs.
Li, of UCLA, said more research is needed before the drugs are prescribed for the long term. Others, like Wadden and Butsch, argue that if obesity were treated like a chronic disease, like high blood pressure or diabetes, staying on the drugs for years wouldn’t be an issue.
Li does prescribe the drugs for some of her patients, but only after other lifestyle changes and treatments have failed.
“This is a cane that’s going to help you walk,” she said. “But you’re going to have to do the walk yourself.”
For Edwards, of Philadelphia, the “cane” changed her life. She’s in another clinical trial for a pill form of Wegovy, which she hopes will be more affordable. Since she started the study in November, she has lost 45 pounds.