Obesity is a common, serious, and costly disease.
If you’ve ever tried to lose weight and failed, you’re in good company. Nearly three-quarters of Americans are overweight (BMI >/= 25) or obese (BMI >/= 30), according to the Centers for Disease Control and Prevention, and it’s not from a lack of trying to shed pounds.
Note: Body Mass Index (BMI) is a person’s weight in kilograms (or pounds) divided by the square of height in meters (or feet).
BMI is screening tool, but it does not diagnose body fatness or health. A trained health care provider, like myself, should perform appropriate assessments to evaluate an individual’s health status and risks.
Given that obesity is a complex disease, you may ask, what are some of the most safe, effective and sustainable solutions?
I strongly believe that everyone should start with a diet based on their APOE gene status (refer to the LOLA Magazine December 2021 issue) and exercise. But for people who are overweight/obese, lifestyle changes may not be enough to move the needle on the scale.
Unfortunately, there aren’t many safe and effective drugs for chronic weight management, and those that do exist produce marginal benefits with troubling side effects. Some of these drugs are so dangerous, the Food and Drug Administration (FDA) pulled them off the market. But that tide changed on June 4, 2021, with the approval of semaglutide (Wegovy).
Wegovy is the latest in a line of medications, starting with phentermine in 1959, that have achieved FDA approval for the treatment of obesity.
The weekly, under-the-skin injection is the first weight loss drug the FDA has approved for chronic weight management since 2014 (liraglutide (Saxenda)). Wegovy produces twice the rate of weight loss compared to other approved medications with fewer side effects.
Here’s a little science…
Semaglutide is in a class of medications known as glucagon-like peptide-1 receptor agonists, or GLP-1 RAs. GLP-1 is a hormone naturally released in the gastrointestinal tract in response to food intake. It has multiple effects, including the following:
1. Increasing insulin release from the pancreas
2. Slowing down stomach emptying
3. Targeting receptors in the brain that cause appetite reduction
This results in a sensation of satiety, or fullness, lasting much longer than with the natural GLP-1 hormone levels.
Is Wegovy similar to the diabetes drugs Ozempic, Trulicity, and Victoza?
Wegovy, Ozempic, Trulicity, and Victoza all belong to the same group of drugs, called glucagon-like peptide-1 (GLP-1) receptor agonists.
Wegovy and Ozempic both contain semaglutide as their active drug. Trulicity contains dulaglutide, and Victoza contains liraglutide.
Ozempic, Trulicity, and Victoza work in similar ways, i.e., approved only to treat type 2 diabetes in adults, but not type 1 diabetes and not for weight loss. Wegovy is FDA approved for weight loss and weight management in certain adults, but it is not approved for diabetes treatment.
Waiting in the wings for FDA approval is another GLP-1 receptor agonist: tirzepatide (Mounjaro).
Results from the new trial suggest that tirzepatide at the highest dose may work as well as bariatric surgery.
Lacking was a direct comparison between tirzepatide (Mounjaro) and semaglutide (Wegovy).
Who can take Wegovy?
Wegovy, like all other prescription medications, designated for the treatment of obesity, is approved for use in those with a BMI >/= 30, or those with a BMI >/= 27 with a weight-related medical condition such as high blood pressure, type 2 diabetes, or high cholesterol.
What are the risks and benefits of Wegovy?
The widely reported Semaglutide Treatment Effect in People with Obesity (STEP) trial results, which were published in the New England Journal of Medicine, demonstrated an average of 14.9% body weight reduction* after 68 weeks of therapy in those assigned to the medication group, versus only 2.4% weight loss in those assigned to the placebo group. The average weight loss seen with existing anti-obesity medications is typically about 5% to 9%, while those engaged in lifestyle and behavioral therapy alone are expected to lose only 3% to 5% of their body weight.
*For example, in a person who weighs 200 pounds, losing 14.9% of their body weight would mean losing ~30 pounds (29.8 pounds to be exact).
Wegovy is one of six medications currently approved by the FDA for the long-term treatment of obesity. As such, it can be used for as long as it remains beneficial for weight loss and/or weight maintenance, and is not causing intolerable side effects.
The most common side effects of Wegovy are nausea, vomiting, diarrhea, and constipation. The medication also comes with a boxed warning for risk of a specific tumor of the thyroid, and thus it is not recommended for those with a personal or family history of medullary thyroid cancer or multiple endocrine neoplasia type 2 (a genetic condition associated with endocrine tumors).
Paying for anti-obesity medications, particularly Wegovy
The challenges arise with the exorbitant cost of some of the newer therapeutics, as well as refusal of many private insurers and public insurers (Medicare or Medicaid) to cover anti-obesity medications.
The costs can vary depending on many factors. These factors include what your insurance plan covers and which pharmacy you use.
Wegovy is not available as a generic drug. Generics usually cost less than brand-name drugs.
If you have any questions about how to cover Wegovy medication costs, talk with your insurance company, your healthcare provider or pharmacist. And, the Wegovy manufacturer’s website has some support options in the form of savings/discount cards.
By treating the weight, we not only prevent disease, but we also reduce the social stigma and reduced quality of life that often accompanies overweight and obesity. Healthcare providers are working on generating data to show that even though anti-obesity medications sound expensive up front, it’s cheaper to take meds like Wegovy each week than face the medical complications of obesity.
Again, no medication is a sure thing, but if you’re interested in weight loss, Wegovy may be a helpful tool along with diet (APOE diet) and exercise. So, if you are curious as to whether you are an acceptable weight management candidate, contact your healthcare provider or me, Dr. Karen Pendleton (drkarenpendleton.com).
You can ask questions that help you feel comfortable about the risks and benefits of Wegovy treatment. Some examples to help you get started are:
Does my medical history put me at a higher risk of side effects if I use Wegovy?
Will I have withdrawal symptoms if I stop treatment with Wegovy?
What should I know about other treatments for weight management besides Wegovy?
What type of diet (APOE diet) and exercise changes do you recommend for me before, during and after Wegovy treatment?
If I can be of any further service either in Shreveport (pairO’docs Bio-Rejuvenis) or the Greater New Orleans Area (Bopp Dermatology & Facial Plastic Surgery), please reach out to me by completing the Healthspan Quiz at www.drkarenpendleton.com
Here are some eye-opening statistics:
The U.S. obesity prevalence was 41.9% in 2017 – March 2020.
From 1999 – 2000 through 2017 – March 2020, U.S. obesity prevalence increased from 30.5% to 41.9%. During the same time, the prevalence of severe obesity increased from 4.7% to 9.2%.
All states and territories had more than 20% of adults with obesity.
And, our dear state of Louisiana ranked 4th at 38.1% of adults with obesity as of 2020.
Being overweight is a gateway disease that leads to more than 60 illnesses, including the nation’s top killers, such as heart disease (heart attack and stroke), cancer, diabetes, mental illness and complications from COVID-19. These diseases are among the leading causes of preventable, premature death.
The estimated annual medical cost of obesity in the United States was nearly $173 billion in 2019. Medical costs for adults who had obesity were $1,861 higher than medical costs for people with healthy weight.
Childhood obesity is also a serious problem in the United States, putting children and adolescents at risk for poor health. Childhood obesity is defined as a body mass index (BMI) at or above the 95th percentile of the CDC sex-specific BMI-for-age growth charts.
For children and adolescents aged 2-19 years in 2017-2021:
The overall prevalence of obesity was 19.7% and affected about 14.7 million children and adolescents.
Categorically, obesity prevalence was 12.7% among 2- to 5-year-olds, 20.7% among 6- to 11-year-olds, and 22.2% among 12- to 19-year-olds.
Obesity in children and adults increases the risk for the following health conditions:
High blood pressure
High cholesterol
Type 2 diabetes
Breathing problems, such as asthma and sleep apnea
Joint problems such as osteoarthritis and musculoskeletal discomfort
Gallbladder disease and gallstones
Psychological problems such as anxiety and depression
Low self-esteem and lower self-reported quality of life
Social problems such as bullying and stigma
Obesity as adults
And, when it comes to military readiness, nationwide, 71% of people between the ages of 17 and 24 do not qualify for military service. Obesity disqualifies 1 in 3 of them from serving, if they so choose.
DISCLAIMER:
All of the information found in this article is based on the opinion of the author Karen M. Pendleton, M.D. The information is meant to motivate readers to make their own health decisions after consulting with their own health care providers. All readers should consult a doctor before making a health change, especially those that are related to a specific diagnosis or health condition. No information in this article should be relied on in determining a diet, making a medical diagnosis or determining a treatment for a medical condition. The information in this article is not intended to replace a relationship with a qualified healthcare practitioner and is not intended as medical advice. No information in this article should be used to diagnose, treat, prevent or cure any disease or condition.