Can medications slow rising obesity rates?

The U.S. Centers for Disease Control and Prevention now estimates that about 42% of American adults are obese — defined as having a body mass index of 30 or higher.

It is a serious condition that can lead to type 2 diabetes, heart disease, some cancers, and major medical bills. An obese adult pays, on average, $1,861 more a year in medical costs than an adult of a healthy weight, according to the CDC.

Diet and exercise remain the bedrock treatment for weight loss. But a number of new diabetes medications hold promise for those who continue to struggle even after lifestyle changes.

To learn more about these drugs, we spoke with Kunal Shah, an assistant professor of endocrinology at Rutgers University’s Robert Wood Johnson Medical School who has specialized in the treatment of obesity for more than a decade.

An effective obesity treatment would be one that provides at least — I would emphasize, at least — 5% total body weight loss.

I use that number because that’s the threshold at which we start seeing metabolic improvements in your health. Improvements in blood pressure. Improvements in blood sugar, if you’re diabetic. Improvements in cholesterol. The more weight you lose, the better. But that is what we look for as an initial target.

One type of medication basically acts as a stimulant, where it revs up your metabolism and stops cravings. The brand names are Qsymia and Contrave. Both are pills, and they typically reduce weight by about 7%-8%.

But there are some concerns with these medications. They are powerful medications, and powerful medications can have powerful side effects.

The stimulant medications have side effects that can include heart palpitations. They are not for use if you have high blood pressure or heart disease, because it can worsen these conditions. It can put undue stress on the heart. And sometimes, people just don’t feel good on these medications.

These newer medications were first prescribed for [people with diabetes] because they helped with blood sugar levels. Then, we found that patients on the drugs were losing a lot of weight. Now they are available [by prescription] to anyone.

One has been out since 2016, with the brand name Saxenda, in a once-a-day injection. Another that was approved in 2021 is Wegovy, a once-a-week injection. (Wegovy is basically the same as Ozempic, which is specifically for diabetes, but it comes in different doses.) Both work by making you feel full.

For now, these medications provide the most weight loss. In trials, Wegovy provided 15% total body weight loss. With Saxenda, we’ve seen weight loss of about 10%-12%.

What really sets these two medications apart is, whereas the other obesity medications have a lot of side effects and are really used to treat only obesity, these medications will help with diabetes. They also have been found to lower your risk of heart attack or stroke.

These medications work quite well. Sometimes they can cause a little bit of nausea and cramping. There is a rare risk of pancreatitis — it happens in one of every 1,000 people.

One more medication — brand name Mounjaro — got approval from the Food and Drug Administration in May.

It’s also closely related to Saxenda and Wegovy, but has been shown to be even a little more potent in terms of treating diabetes, and in early studies, it has shown up to 20%-25% total body weight loss. Before this medication, those are numbers we would see only with bariatric surgery. This has the potential to be a game-changer.

For now, it’s only approved as a treatment for diabetes. But it is likely that Eli Lily, the company that makes it, will pursue FDA approval for weight loss.

First of all, these drugs are not meant to be the main form of therapy for weight loss. That is always going to be proper diet, proper exercise. That has to be the foundation. These medications can help you get there. But if you don’t have the proper lifestyle changes, even if you lose weight initially, you’re just going to gain it back. There is no magic bullet.

That said, these medications should be used by a lot of people who are trying to follow the right diet and exercise regimen as a way of getting them to their weight-loss goal.

But it’s difficult to get insurance plans to pay for these drugs. It’s very difficult to get them approved through Medicare and Medicaid. It’s been a huge frustration for prescribers. That’s one reason a lot of patients are not on these medications.

Patients who don’t have insurance can expect to pay $1,200 to 1,400 a month for these medications. We spend a lot of time arguing with insurers.

Another reason more patients aren’t on these drugs is that a lot of physicians are not familiar with these medications, so they don’t prescribe them.

We need to make obesity an important diagnosis worthy of having medical coverage. A lot of companies will pay for heart medicines and blood pressure medicines and cholesterol medicines. But they don’t consider obesity to be enough of a genuine diagnosis to cover medications for it. They consider it elective when it really isn’t.

If these drugs were to become widely available and covered, you would see a lot more people on them. We’d have a potential reduction — although this hasn’t been studied — in new cardiovascular disease and diabetes diagnoses. We would potentially have a healthier population.