BETHLEHEM, Pa. — Obesity affects 42% of all adults in this country, according to the U.S. Centers for Disease Control and Prevention, and newer medications such as Ozempic, Wagovy, ZepBound and Mounjaro have changed the way medical providers treat obesity.
Many physicians call them groundbreaking.
“They keep food in your stomach longer," said Dr. Angela Magdaleno from Lehigh Valley Health Network, who specializes in Bariatric Medicine and Endocrinology.
“They work in the brain to decrease hunger, to decrease sugar cravings — food noise as my patients put it. Appetite goes down, and then they treat insulin resistance.Dr. Angela Magdaleno from Lehigh Valley Health Network
"They're gut hormones, so they tell your body to hold on to the food in the stomach longer so you're physically more full.
“They work in the brain to decrease hunger, to decrease sugar cravings — food noise as my patients put it. Appetite goes down, and then they treat insulin resistance.
"They help with insulin sensitivity throughout the body and blood sugars, and the insulin resistance is a common cause why people are having trouble losing weight.”
The anti-obesity injections are in a class called GLP-1 receptor agonists or GLP-1s.
One in eight Americans have tried them, according to statistics.
Sixty-two percent of those who have used one of the drugs did so to treat diabetes, heart disease or some other chronic condition, while 38% used them for weight loss, as reported in a recent KFF Health Tracking Poll.
That survey also found that younger adults are more likely to report taking GLP-1 drugs just for weight loss.
Add other weight-loss tools
Since hitting the market in 2005, GLP-1s, like semaglutides, originally were approved for patients diagnosed with diabetes.
Since then, tirzepatides, which have an additional gut hormone called GIP, came out in 2023 for weight loss. Magdaleno said it's slightly stronger, with a little more benefit for weight loss.
“I think most importantly is, even taking a step back, the pillars of weight management, so nutrition, exercise, behavior change, water, sleep, stress management."Dr. Angela Magdaleno from Lehigh Valley Health Network
“I think most importantly is, even taking a step back, the pillars of weight management, so nutrition, exercise, behavior change, water, sleep, stress management," she said.
"The tools that we add to that won't work as well if you're not doing all of that. So on top of that, then we add tools as needed to help the individual patient.”
For weight management, the medicines are approved for patients with a BMI over 30 or with a BMI over 27 plus a weight-related morbidity, such as sleep apnea, high blood pressure, cholesterol or diabetes.
Once a physician prescribes one of the medications for weight loss, it’s not always easy to get them approved by insurance, Magdaleno said.
“We have to do the prior authorization paperwork to prove that you're doing all those things," she said. "And even then, some of them have complete plan exclusions, where they do not cover any weight loss medicines.
"So it's about a 50-50 whether the insurance covers it.”
Insurance can vary
Insurance coverage of the medications can vary from patient to patient and company to company.
“Primarily we have the coverage for diabetes today, but you may have seen recently the FDA approved Wegovy to treat patients with known cardiovascular disease, but also associated obesity," Capital Blue Cross Chief Medical Officer Dr. Jeremy Wigginton said.
"So now Wegovy is being added for coverage through Medicare to treat those patients that have obesity, but also known cardiovascular disease to prevent things like heart attack and stroke.
“There is certainly a trend for insurance companies to start looking at these additional indications."Dr. Jeremy Wigginton, Chief Medical Officer, Capital Blue Cross
“There is certainly a trend for insurance companies to start looking at these additional indications."
Wigginton said those who are unclear about coverage and options available to them should ask for assistance.
“If you have those questions about what is your coverage, what are those criteria, should you be looking or asking specific questions to your own health care provider," he said.
"Call that number on the back of your identification card, your insurance ID card, and ask those questions to that customer service rep, and they can certainly answer those questions for you no matter who your carrier is.”
Wigginton said insurance companies are following the research aroundGLP-1s to decide for which health conditions it should be covered.
“I do think in the next several years there will be continued additions of some of those other diagnoses that we've seen benefit in,” he said.
Nausea, constipation
Both Magdaleno and Wigginton said that currently, the recommendation is for those who start these medications to stay on them long-term.
Those who do not wish to do so should slowly lower their dose and frequency. Over time, medical providers say, the side effects that come with the weekly, sometimes daily, injections should subside.
“It's not about rapid weight loss, it's about healthy weight loss.”Dr. Angela Magdaleno, Lehigh Valley Health Network
“The most common side effects are definitely mild nausea," Magdeleno said. "Most of my patients tell me it's the day after the injection.
"Some women describe it as kind of a yucky morning sickness. Some people get worsening acid reflux and that makes sense. It's keeping food in your stomach longer so that acid reflux could occur.
"And then constipation or diarrhea are both very common and they make sense because it's a gut hormone and it's impacting your gut.”
She said loss of muscle mass also is a condition that can have a negative impact in the long term.
She said it's critical that people on the medicines try to exercise, add a strength training routine if they can and eat enough protein, so they won't lose their muscle while they're losing weight.
“It's not about rapid weight loss, it's about healthy weight loss.” Magdaleno said.
Who should not take the meds?
She said there also are those who should not take GLP-1s.
That includes anyone with a hypersensitivity to the GLP-1 agonist, anyone with a family history or personal history of medullary thyroid cancer, or those with a history of pancreatitis.
Also, anyone with inflammatory bowel disease should discuss with their gastroenterologist, and anyone with gallbladder issues or anyone pregnant also should check.
Again, according to PEW, nearly 2 million people in the United States were taking GLP-1 medications in 2021 — more than three times as many as in 2019.
And the numbers keep rising exponentially. Investment firm Goldman-Sachs has projected a “blockbuster” future in Pharma sales for the medications.
Magdaleno stressed the importance of taking care of a person’s overall health as patients look to take these weight loss medications.
