Weight Loss Drugs Could Have Behavioral Ramifications

Several drugs now help people lose weight - a lot of it, pulling them out of obesity, and saving their life….but there is a growing debate over the access, cost and appropriateness of these medicines, as well as the longer term effects including behavioral health disorders. What influences patient choice depends to a large degree on their prior experience, family history, mental health and finances.

A growing number of people we polled on the issue say they would contemplate a diabetes drug that also helps with weight loss and would rather take the medicine every month than go to a gym - nearly 5 to 1 in the poll of 812 adults who acknowledge being either obese or being significantly overweight.

Pharmaceutical company Eli Lilly, which produces medicines for cancer and pain, has a a Type 2 diabetes drug tirzepatide that can also lead to significant weight loss. A spokesman said some patients lost as much as 30 pounds in some cases. In a trial, the drug helped people lose 20% of their weight over a few months.

The FDA may approve this drug specifically for weight loss as early as 2024. Other drugs exist to help people lose weight. One, an injection called Saxenda from NovoNordisk, is targeting adults who have a body mass index of at least 27 and teens who weigh at least 132 pounds. The drugs can be costly, as much as $15,000 or more a year for Saxenda for instance.

Some of the insurers who cover people who earn less including those on Medicaid say there is a disparity in access for treatments like this. “We don’t cover these drugs and if our beneficiaries want them it’s too costly for them,” says a pharmacy director for a Midwest Medicaid health plan.

In contrast, commercial insurers tend to cover these medicines but understandably have rules on what they will pay for to ensure safety, effectiveness and evidence that the patient needs it. A lot of these insurers want to know what’s been tried first to address the weight issues. Insurers and policymakers are facing a challenge given they are now pressed to allow better coverage for therapy for people with eating disorders including those with a high BMI or obesity.

“I think the medications can work in select situations - what we would all want to avoid is someone losing all the weight then either reverting back and needing therapy, or developing an eating disorder,” says Ben Slate, a pediatrian who focuses on diabetes and advises insurers.

In a poll of consumers, 35% of adults over age 25 vs. 8% of those under age 25 would be open to trying these drugs. Many - as much as 50% with a higher BMI and long-time weight issues - say they are “interested” but also deal with either anxiety or depression at times and “worry about the impact” of the drug, the complications or the “cost.” One mom had her 23 year old take one of the drugs and although she reports that the drug worked well after a year leading to 35 pounds in weight loss it led to an eating disorder. “She begin to lose more and more weight and eventually developed anorexia,” the mom said. “People just need to be careful about the decision.”