Treatment for people with obesity — including groundbreaking medications that are nearly as effective as bariatric surgery — aren’t often prescribed.Jackie Benz is a tiny woman. But most of her life, she has been heavy.”I was tired all the time. I was barely existing,” Benz said.About two years ago, frustrated with failed diets, Benz underwent bariatric surgery.”I’ve lost over 100 pounds. I’ve run my first 5K,” Benz said. “I think a half-marathon is probably my ultimate goal.”Bariatric surgery has been the gold standard for treatment, but most people with obesity aren’t heavy enough to qualify for it.”Surgery has been traditionally the best way of losing weight and keeping it off, ” said Dr. Kuldeep Singh, director of the Maryland Bariatric Center.But now there are pharmaceutical treatments that are showing tremendous promise.”It’s a very exciting time,” Singh said.Last year, the Food and Drug Administration approved Wegovy, or semaglutide, for weight loss. The FDA is in the process of approving Mounjaro, or tirzepatide, for weight loss. Both drugs were initially used to treat diabetes, but they have also been found to suppress appetite.”The weight loss with these medications is about 20% to 25% — pretty close to the surgery — and they are very safe. So, I think it’s revolutionary,” Singh said.Significantly more patients qualify for this treatment than they do for surgery.”(Someone with a body mass index of) 28 or above, or somebody who has diabetes (can qualify). That’s more than 98% of people with obesity. So, it’s not a small fraction,” Singh said.It all sounds very promising. But according to the STOP Obesity Alliance, fewer than 1% of providers are prescribing the drugs to their patients with obesity. One of the reasons is the medications are not covered by most insurance policies or Medicare.”Most of the states that we’ve studied, state employee programs provide for nutritional counseling. Most states provide for bariatric surgery. But fewer states — only 20% — provide for pharmacological interventions for drug therapy,” said Dr. Bill Dietz, director of the STOP Obesity Alliance.Wegovy can cost more than $1,500 a month and Mounjaro can cost $1,000 a month. Patients need to take the drugs indefinitely or they will gain the weight back.”The challenge is, it has to be continuous, and at the current prices, many plans are averse to allowing the use of those drugs,” Dietz said.Singh believes the perspective is short-sighted.”Imagine you lose weight, come off diabetes and all the health care savings that come (with that), but somebody has to look at the bigger picture,” he said.Dietz laid much of the blame on primary care providers.”I think the failure to prescribe these drugs, or to explore drug therapy, reflects the kind of bias and stigma associated with obesity, that people — including providers — blame people for their obesity and see it as a behavioral problem. ‘If they only change their behavior, then the problem would go away.’ We know that’s not the case. We know it’s a medical problem, we know it’s a disease and a disease requiring therapy,” Dietz said.Benz said she’s glad she took the step to get treated. She said the recovery wasn’t easy, but it’s worthwhile.”Words can’t express. It’s been life-changing in all areas,” she said.
Treatment for people with obesity — including groundbreaking medications that are nearly as effective as bariatric surgery — aren’t often prescribed.
Jackie Benz is a tiny woman. But most of her life, she has been heavy.
“I was tired all the time. I was barely existing,” Benz said.
About two years ago, frustrated with failed diets, Benz underwent bariatric surgery.
“I’ve lost over 100 pounds. I’ve run my first 5K,” Benz said. “I think a half-marathon is probably my ultimate goal.”
Bariatric surgery has been the gold standard for treatment, but most people with obesity aren’t heavy enough to qualify for it.
“Surgery has been traditionally the best way of losing weight and keeping it off, ” said Dr. Kuldeep Singh, director of the Maryland Bariatric Center.
But now there are pharmaceutical treatments that are showing tremendous promise.
“It’s a very exciting time,” Singh said.
Last year, the Food and Drug Administration approved Wegovy, or semaglutide, for weight loss. The FDA is in the process of approving Mounjaro, or tirzepatide, for weight loss. Both drugs were initially used to treat diabetes, but they have also been found to suppress appetite.
“The weight loss with these medications is about 20% to 25% — pretty close to the surgery — and they are very safe. So, I think it’s revolutionary,” Singh said.
Significantly more patients qualify for this treatment than they do for surgery.
“(Someone with a body mass index of) 28 or above, or somebody who has diabetes (can qualify). That’s more than 98% of people with obesity. So, it’s not a small fraction,” Singh said.
It all sounds very promising. But according to the STOP Obesity Alliance, fewer than 1% of providers are prescribing the drugs to their patients with obesity. One of the reasons is the medications are not covered by most insurance policies or Medicare.
“Most of the states that we’ve studied, state employee programs provide for nutritional counseling. Most states provide for bariatric surgery. But fewer states — only 20% — provide for pharmacological interventions for drug therapy,” said Dr. Bill Dietz, director of the STOP Obesity Alliance.
Wegovy can cost more than $1,500 a month and Mounjaro can cost $1,000 a month. Patients need to take the drugs indefinitely or they will gain the weight back.
“The challenge is, it has to be continuous, and at the current prices, many plans are averse to allowing the use of those drugs,” Dietz said.
Singh believes the perspective is short-sighted.
“Imagine you lose weight, come off diabetes and all the health care savings that come (with that), but somebody has to look at the bigger picture,” he said.
Dietz laid much of the blame on primary care providers.
“I think the failure to prescribe these drugs, or to explore drug therapy, reflects the kind of bias and stigma associated with obesity, that people — including providers — blame people for their obesity and see it as a behavioral problem. ‘If they only change their behavior, then the problem would go away.’ We know that’s not the case. We know it’s a medical problem, we know it’s a disease and a disease requiring therapy,” Dietz said.
Benz said she’s glad she took the step to get treated. She said the recovery wasn’t easy, but it’s worthwhile.
“Words can’t express. It’s been life-changing in all areas,” she said.
