By CECI CONNOLY and SAMI INKINEN
Unless you have been living under a rock, you likely have heard the names Ozempic, Wegovy or Mounjaro. Or perhaps been humming the jingle. Rarely has a class of drugs (in this case, GLP-1s) achieved such widespread attention in popular culture and the media, which has people clamoring for them in every doctor’s office in the nation.
And for good reason. What we know is that the efficacy and safety profile of these medications is substantially better than any weight loss drug in the past, while our obesity epidemic has only ballooned. As organizations committed to sound science and holistic patient care, we are encouraged by the benefits of these new therapies for diabetes. The clinical evidence shows that GLP-1s are highly effective for controlling blood glucose levels among patients living with Type 2 diabetes and certain co-morbidities. GLP-1s may even improve heart health for high-risk patients.
To date, the biggest worry with these weight loss therapeutics has been the hefty price tag, ranging from $800 to $1700 per person, per month. Conservatively, these weekly injections could cost the nation more than $100 billion dollars annually. Already, state Medicaid budgets are sagging under the financial burden. In North Carolina, for example, officials dropped coverage of GLP-1s for obesity, noting that two drugs alone would cost about $1 billion over 6 years, and that’s with a nice discount.
As troubling as the cost is, what we don’t know is what should really worry us. Amidst the excitement over patients rapidly shedding up to 15% of their body mass, fundamental questions remain about who should be taking GLP-1s, at what dosages and what the long-term health and economic consequences will be for patients and society. Ultimately, the price paid to people’s long-term health may be more concerning than the price paid out-of-pocket.
With the recent release of the SELECT trial data highlighting limitations of existing published studies of GLP-1s, it is now even clearer that the public isn’t getting the full picture.
Calls for widespread adoption are clearly premature. The stories touting GLP-1s clinical weight loss benefits often leave out that the studies are limited and based on a homogenous population, likely to further exacerbate existing inequities. For example, only 27.7% of the patients in the SELECT trial were women, compared with other trials in which they represented 74.1%. This smaller patient population rightfully leads to questions about the effectiveness in women and others not included in the trial. By only seeing part of the puzzle, we’re left to worry about the missing pieces such as what the GLP-1 cardiovascular benefit for people who are obese but without a prior heart condition could be.
Even more troubling are the unknown long-term effects. In people with diabetes, studies have found an increased risk of pancreatitis for some patients. For individuals taking GLP-1s for weight loss, usually at much higher dosages than for treating diabetes, we simply don’t know what the long-term implications, both positive and negative, will be because few longitudinal studies exist. Too many patients are prescribed GLP-1s for a lifetime without thought as to what comes next.
Pharmaceutical manufacturers will argue that anyone concerned about their weight would benefit from GLP-1s. However, based on the published evidence on weight re-gain, GLP-1s likely require a lifetime commitment to maintain weight loss and associated benefits. Many patients must contend with well-documented side effects such as nausea, diarrhea or the significant loss of lean body mass (ie. muscle) and bone density. Again, those are lifetime side effects. and some patients simply tire of giving themselves a weekly injection.
In a July 2023 study of real-world claims data from 16 million commercially insured members, Prime Therapeutics and MagellanRx researchers found that almost 70% of patients stopped GLP-1 treatment less than one year after starting. When you combine that data with the findings from a recent Journal of the American Medical Association study (in which patients regained two-thirds of the lost weight after switching to a placebo) you have the makings of a dangerous rollercoaster ride. We must consider whether the rider is prepared for the physical and mental implications of a weight-loss rollercoaster. The short-term benefit isn’t worth the long-term costs.
What we do know is that GLP-1s work best in combination with lifestyle modification and that clinicians need flexibility to determine the right combination for each individual. We can scale evidence-based nutrition treatments with proper support to deliver long-lasting results. Health plans, clinical teams, patients and – more broadly – society must deploy a full range of comprehensive population health tools to get the nation back to a healthy weight.
With so many unknowns about GLP-1s, a cautious approach is needed with continued focus on the evidence-based strategies that tackle root causes of obesity, including nutrition and socioeconomic factors. The work of population health is not as sexy as the slender models posting videos on Tik Tok, but it is the proven approach for many struggling with weight issues.
Clinicians and policy makers must resist the seeming quick fix of GLP-1s. Greater attention and resources must be devoted to treating the whole person and patiently evaluating the right and wrong candidates for GLP-1s.
A healthy lifestyle is likely the only sustainable, affordable and safe way to address our obesity epidemic and to deliver long-lasting results. By focusing on the drivers of obesity, we’re focusing on what we do know rather than being surprised by the unknowns.
Even if GLP-1s were free, they are not the magic pill to solve our obesity epidemic.
Ceci Connolly is the president and chief executive officer of the Alliance of Community Health Plans. Sami Inkinen is co-founder & CEO of Virta Health, a telemedicine and behavior treatment company focused on solving our T2 diabetes and obesity epidemic.
Leave a comment
