An overview of Ozempic, a drug used to treat diabetes, and whose use is prescribed for the semaglutide drug for weight loss

A drug used to treat diabetes has gained attention in the past few months as celebrities, a tech mogul and TikTok users have described using it to lose weight in less than a day.

The active ingredient in the medication, semaglutide, is currently in shortage according to an FDA database. Maintaining supplies is a priority for its manufacturer. Ozempic is a lower dose of the drug semaglutide that is used to treat diabetes.

The presentation concluded like no other at the conference, says Yanovski, co-director of the Office of Obesity Research at the US National Institute of Diabetes and Digestive and Kidney Diseases in Bethesda, Maryland. She says the room had sustained applause like a Broadway show.

After 16 months of treatment, people who received weekly injections of semaglutide lost 14.9% of their body weight, while those who received placebo lost 2.4%. In 2021, four years after approving it for diabetes, the FDA approved semaglutide for weight loss for adults with obesity.

The ability to melt weight away by tweaking biology gives credence to the idea that obesity is a disease. In the past, scientists and the public often thought that those with obesity simply lacked the willpower to lose weight. But evidence is growing that most people’s bodies have a natural size that can be hard to change. Richard DiMarchi is a chemist at Indiana University Bloomington.

However, some researchers worry that these drugs play into some societies’ obsession with being thin. Body size isn’t always a good predictor of health. Sarah Nutter, a psychologist at the University of Victoria in Canada who is specialized in weight stigma and body image, says she isn’t excited about something that she thinks could be harmful.

Research questions abound, including who will respond to treatment and whether people will have to take these drugs for life — a huge barrier to access, given that they also carry a hefty price tag: the injections often cost upwards of US$1,000 each month.

The Fat Fat Jacket: How Fat Was Jeffrey Friedman? The GoodRx Experience Reveals an Improved Treatment for Type 2 Diabetes

Jeffrey Friedman was racing to figure out why his mice were making them eat until they become obese when he got the seeds of today’s success. A faulty genes was discovered in 1994 by Friedman, the geneticist at Rockefeller University in New York City. mice that were fed leptin supplements decreased their hunger and body weight.

Many patients have this rebound weight gain and it can be really devastating, which is why I work at GoodRx, a company that helps people find the lowest prices for generic. There’s no generic version of semaglutide.

And evidence shows the new class of drugs are far more effective than prior obesity medications. The drug led to a 15% reduction in body weight in the trial, which was published in the New England Journal of Medicine.

There could now be an even more effective drug in town: tirzepatide. Tirzepatide doesn’t just target the GLP-1 receptor; it also mimics another hormone involved in insulin secretion, known as glucose-dependent insulinotropic polypeptide (GIP). Approved in 2022 for type 2 diabetes, this treatment — developed by Eli Lilly, based in Indianapolis, Indiana — led to a 21% drop in body weight, on average, at the highest dose, compared with 3% for placebo7.

Despite uncertainties, the levels of weight loss following treatment approach those that can only be achieved through surgery. This procedure reduces body weight by 30% or more after six months, and the weight loss continues for the next year or two.

“Ten years ago, if you had told me we have something that gets us pretty close [to bariatric surgery], I would have said that’s not possible,” says Ruth Gimeno, group vice-president of diabetes, obesity and cardiometabolic research and early clinical development at Eli Lilly. The company intends to apply for the drug to be approved before the second phase 3 trial is over.

Mller says they were the first to come up with the crazy idea. “And we were quite heavily criticized in the field.”

The cost of monoclonal antibodies, bimagrumab, and other drugs for weight loss: What do people think about bariatric surgery?

Other approaches include ‘triple agonists’ that mimic the actions of GLP-1, GIP and a third hormone, glucagon, which also stimulates insulin secretion9. The gut hormones involved in appetite, such as peptide YY, are being explored. Researchers are looking into the effect of the monoclonal antibody bimagrumab on fat and muscle mass.

Another unknown is who will respond to these drugs — and who won’t. It’s too early to tell now, but the drugs seem to be less effective for weight loss in people with type 2 diabetes than in those without. Conditions such as fatty liver disease and having fat around the organs, known as visceral body fat, might also affect how people respond to different drugs, Tschöp says.

Others worry about the idea that these drugs offer a quick fix. This is a common misconception about bariatric surgery, says Leslie Heinberg, a clinical psychologist at the Cleveland Clinic in Ohio who specializes in bariatric behavioural health and body image. She says some people will say, “Now people can just take this pill and that’s the easiest way out of weight gain.”

For a start, they are pricey — semaglutide for weight loss, branded as Wegovy, costs about $1,300 a month — and many insurance companies in the United States refuse to cover the expense, primarily owing to a misunderstanding of what causes obesity and viewing the treatments as ‘vanity drugs’.

Organizations such as the OAC are pushing pharmaceutical companies to offer affordability programmes. Eli Lilly, for example, has a ‘bridging programme’ for Mounjaro — tirzepatide for type 2 diabetes — under which the medication can cost as little as $25 for the first three months. A similar programme exists for Wegovy.

The upfront costs of addressing the disease are not as important as the impact on health-care systems by changing conditions linked to the disease.

Her Aetna insurance plan covered the cost of the medication, but when she changed jobs last fall, her new insurance plan through Blue Cross and Blue Shield of Illinois denied coverage. She has to sit most of the day when she works in the hospital ER. She gained back 20 pounds after a few months not taking the drug.

That’s what is happening to Yolanda Hamilton from South Holland, Ill. Hamilton’s doctor prescribed Wegovy because she had an elevated BMI, high blood pressure and elevated blood sugar. She started to feel better after losing 60 pounds.

She says that it allowed her to exercise and do house chores. Her cravings for sugar subsided, and she felt satisfied from smaller meals. Hamilton says he was surprised by how well he felt. The drug is administered by a once a week injection at home, which Hamilton says is easy to do.

Blue Cross and Blue Shield: Insurance Coverage Choices for Wegovy Weight-Loss Drugs: The Ozempic Perspective

Blue Cross and Blue Shield of Illinois told NPR the benefits offered by employer plans can vary. “Weight-loss drugs like Wegovy may be covered, depending on the member’s benefit plan,” a spokesperson for the company said. Insurance carriers determine coverage depending on the employers willingness to cover.

Dr. Robert Kushner explains that the hormone tells the brain that I’m full and I don’t need to eat anymore. He also serves on the medical advisory board of the company.

He explained that pharmaceutical companies take a hormone that is naturally occurring and make it into a drug. He says that it’s not a surprise that people feel hungrier once they stop taking the medicine.

“I like sweets,” Hamilton says. Her appetite has gone up. She no longer feels satisfied with small meals. “I’m losing my energy” as the weight comes back, she says.

Hamilton is concerned that stopping her medication will affect her blood pressure and blood sugars, so she has enlisted the assistance of Kushner’s office to appeal the insurance denial. She is at risk of having these conditions worsened if she regains weight.

“If I gain more weight, I will be on more medications,” says Hamilton. Given her long struggle with weight loss, she’d finally found something that was working.

Source: https://www.npr.org/sections/health-shots/2023/01/30/1152039799/ozempic-wegovy-weight-loss-drugs

The importance of lifestyle and exercise to tackling obesity: An expert analysis of new medications that can help fight patients with pre-diabetes and hypertension

The lowest price among all retailers for people paying out of pocket is only $1,306 per month, which is not affordable for most people.

“Some of the people who need it the most are unable to access it,” Robinson says, pointing out that people with low incomes experience obesity at disproportionately higher rates.

Weight loss drugs can be provided to adolescents 12 and older with overweight or obese kids under the American Academy of pediatrics’ new guidance.

He says starting with a low dose and increasing it over time can help people tolerate the drug better. The positive effect of the drug on the cardiovascular system is currently being evaluated.

But the drug does carry a black box warning because in rodent studies it caused thyroid tumors. If doctors find out if a patient has a family history of a specific type of thyroid carcinoma or another rare condition called multiple endocrine neoplasia syndrome type 2, they’ll be better prepared to treat them. The conversation would be between the person and the patient. Generally, if you don’t have a history of these conditions, “this medication is thought to be safe,” he says.

It’s reminders of how important it is to combat obese people. The theoretical risk of thyroid tumors may be unnerving. In the U.S., heart disease is the leading cause of death and it’s related to obesity and weight-related conditions.

Of course, exercise and diet modification are still the first strategies to try. More interventions are needed to help people with hypertension and pre-diabetes since 70% of Americans are overweight or obese.

“We, as a society, are spending $173 billion in obesity-related health care costs,” says Dr. Marcus Schabacker, CEO of ECRI, an independent, nonprofit group that has reviewed the evidence of new weight loss drugs.

He argues that the drugs can be part of destigmatizing obesity by treating it like any other disease that you treat with medicine. “We would not ask someone who has hypertension to just do exercises and change your diet and then you will be fine. No, we give them beta blockers. It is the same here. Exercise and diet are key components of tackling obesity, but so are medications which have proven to be effective,” he says.