It’s time to have an honest discussion about weight-loss drugs

One in eight American adults has now tried the injection or a similar weight-loss drug. With the hashtag #ozempic pulling over 1.2 billion views on TikTok, there’s no sign that the hype is slowing. However, 58% of patients discontinue use before reaching a clinically meaningful level of weight loss.

Blue Cross Intelligence states,” When weight management interventions are used successfully, they can potentially lower the healthcare costs and health risks associated with obesity. Adults with obesity average $1,861 more in medical expenses annually than people who are a healthy weight, and severe adult obesity was linked to $3,097 in excess annual costs per person. Additional research is needed to understand if GLP-1 interventions lead to lower medical costs in the longer term.”

They also found:
1ne: More than 30% of patients dropped out of treatment after the first four weeks when the dose was increased to reach the target dose.

2wo: When looking at patients using GLP-1 drugs for weight management, our findings show that most individuals did not stay on their prescribed treatment for a minimum of 12 weeks, suggesting they were unlikely to achieve clinically meaningful weight loss.

3hree: Patients prescribed GLP-1s by providers with expertise in weight management and obesity, like
endocrinologists and obesity specialists were likelier to complete 12 weeks of treatment.

To achieve health benefits, it is critical that people prescribed GLP-1s continue to take them at least long enough to realize clinical success, and preferably longer to avoid possible weight rebound once they come off the medications. In the BCBSA study, patients with coexisting conditions such as peripheral vascular disease and diabetes were more likely to be persistent in taking their medications. However, the study shows that 58% of all individuals whose claims were analyzed stopped taking their medicines before reaching a clinically meaningful level of weight loss—moreover, 30% of patients discontinued use within the first month.

Medicare still prohibits coverage of all obesity drugs if prescribed as weight loss medications alone. Congress is unlikely to lift the prohibition shortly. A report issued in May by the Senate Health, Education, Labor and Pensions Committee claiming that high GLP-1 drug prices combined with rising uptake could “bankrupt our entire healthcare system” isn’t helping move legislation along that would authorize Medicare to cover obesity drugs.

Then there are the side effects. The manufacturers of the most popular weight loss drugs are being challenged in court. A federal court in Philadelphia will soon evaluate claims against the makers of Ozempic, Wegovy, and similar products. Dozens of patients who suffered gastrointestinal problems after taking these drugs brought lawsuits alleging that these companies failed to adequately warn patients about the risks.

Semaglutide has only been used for a bit more than two years now for people with obesity. We don’t know the long-term effects of taking them. There’s a concern that maybe they’ll have some impact that we don’t know in the long term.

Then there is the cost. The astronomical cost of Ozempic and similar drugs reflects an ongoing crisis in America. Despite the Biden administration’s efforts to curb prescription drug prices for consumers, they remain nearly three times as expensive in the United States as in peer countries. It might be time for the government to put Big Pharma on a less gluttonous financial diet.

Much of that value has been driven by the United States, where 66 percent of Ozempic sales came from in 2023. For Wegovy, another weight loss drug from the same company, that figure is over 90 percent. As it happens, Novo Nordisk charges type 2 diabetics over 15 times more for Ozempic in the United States than it does in Germany, where patients can get a monthly dose for just $59.

Part of the reason it can charge outrageous prices in America is because it has a patent monopoly on semaglutide—the active ingredient in Ozempic and Wegovy—preventing other companies from producing generic alternatives. The United States is unique among wealthy countries because it allows drug companies to charge whatever they see fit for life-saving medication. Perhaps that has something to do with Big Pharma outspending all other industries on lobbying: Washington, DC, is home to over 20 lobbyists for each member of Congress, and Big Pharma does more than its part by paying for three lobbyists per senator and representative.

 While Donald Trump brags about protecting American trade and putting America first, his administration allowed, and even abetted, pharmaceutical price gouging. If President Biden wants to drive up his electoral margins, cracking down on drug prices might be just what the doctor ordered.

But what about the benefits?

There is no doubt that these drugs can be beneficial to obese patients, but my pushback has been, what about patients who lose weight without these drugs? Are they seeing similar benefits? I talked to some thought leaders, who all said that losing weight is beneficial, whether with or without the new diet drugs.

Ultimately, big pharma is just giving the public what they want: a solution to reduce their weight. How many people understand the risks versus the costs? How will they keep the weight off? This needs to be addressed if we hope to reduce the obesity rate in this country.