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GLP-1 drugs such as Ozempic and Wegovy have completely changed not only how physicians manage weight loss but how healthcare views obesity.
Obesity has long come with the stigma of being weak. The way to lose weight, people have been told, is to “just eat less and move more,” said Dr. Craig Primack, obesity specialist and senior vice president of weight management at Hims and Hers, during “The Evolving Landscape of Innovations for More Equitable Obesity Care and Weight Loss Management,” webinar sponsored by HIMSS and the National Health IT Collaborative for the Underserved on Thursday. HIMSS is the parent company of Healthcare Finance News.
This doesn”t work for everyone, Primack said.
Obesity is a chronic condition, as recently classified by the Centers for Medicare and Medicaid Services. The American Medical Association classified obesity as a disease requiring medical attention in 2013.
An estimated 40% of the population in the United States is obese and that figure rises to 75% when accounting for the number who are overweight, Primack said. The World Health Organization and the Centers for Disease Control and Prevention define obesity as a body mass index (BMI) of 30 or higher.
“Obesity affects all of us,” said Primack, who practices in Arizona.
For people who have tried the “eat less, move more” approach without results, the GLP-1 drugs can literally be a lifesaver, panelists said.
But these injectable drugs should not be seen as a magic pill.
A not-so discussed factor is the psychological aspect of relatively fast weight loss, panelists said. The drugs must not only be prescribed, but managed, so that patients know what to expect both physically and mentally.
On the physical side, patients need resistance training to prevent the muscle loss that comes with a decrease in fat. Those on the drug should expect to eat differently as they feel fuller and have less of an appetite. This can cause issues with established relationships with food and with other people.
Mentally, someone who has been obese for much of their life may find it difficult to relate to people as they have in the past.
Health providers need to provide a layer of mental health for these drugs, said Gemma E. Lowery, CVH Technology Manager of Digital Solutions for ChristianaCare. If someone has been a foodie, weight loss drugs are changing that dynamic. This could affect marriages and friendships.
People are often assigned a value to their size, Lowery said.
There’s this feeling, she said, that “now that you’ve lost weight, you’re fixed,” she said. “That’s not dealing with eating disorders and other factors when weight was gained in the first place.”
“For a person with obesity, it is not an easy journey. There are short and long-term side effects,” said Barbara Eichorst, vice president for Health Care Programs at the American Diabetes Association.
Even when insurance covers the cost of the drug, physician visits may not be covered, Primack said. There’s also a shortage of specialists to treat this condition.
Insurance typically covers weight loss drugs if there is another medical issue, such as diabetes or heart disease. But the Centers for Medicare and Medicaid Services recently turned around that attitude when it announced coverage for obesity drugs in Medicare and Medicaid, starting in 2026. Current law had excluded obesity drugs from being covered. Some states offer coverage for Medicaid, but the majority do not.
The proposed rule revises the interpretation of the law and reclassifies obesity drugs as treatment for chronic disease.
The prevailing attitude is that, as CMS goes, so goes the commercial insurance industry.
Payers will pay, but employers have to find the right package to make it available, Eichorst said. But for people with diabetes, managing weight is as important as measuring glucose levels, she said.
At the end of the day, this is all tied to money, Lowery said. Health equity is a big issue for those who can’t pay out of pocket or who don’t have insurance that covers the cost.
For the healthcare industry, 10% weight loss in this population makes a big difference, said experts.
Obesity is related to hypertension and about 16 different types of cancers, said Jackie Ilacqua, global head of syndicated services and president of global oncology for Ipsos Healthcare.
Managing these would take away a burden from the healthcare system, Ilacqua said.
Weight loss is the tip of what could be a very big iceberg for treatment of other conditions using GLP-1 drugs.
Possible applications include reducing cardiovascular risk, sleep apnea, Alzheimer’s disease, knee pain and addiction.
Where once bariatric surgery ruled as a top solution to weight loss, glucagon-like peptide-1 receptor agonists (GLP-1s) now reign. A study published in JAMA this October found more than twofold increase in use of GLP-1 RAs as anti-obesity medications from 2022 to 2023, with a 25.6% decrease in the rate of metabolic bariatric surgery during the same period.
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