Julie Appleby: Fat America (excluding N.E.) —many Americans want those pricey anti-obesity drugs
William Howard Taft (1857-1930) U.S. president in 1909-13 and chief justice in 1921-1903. He was well known for his obesity as well as for his high intelligence and integrity.
From Kaiser Family Foundation Health News
“Unfortunately, a lot of insurers have not caught up to the idea of recognizing obesity as a disease”.
— Fatima Cody Stanford, M.D., an obesity medicine specialist at Massachusetts General Hospital and Harvard Medical School, both in Boston
In data comparing obesity rates by state, four of the six lowest obesity states were Connecticut, Massachusetts, Vermont, and Rhode Island. The District of Columbia, Hawaii and Colorado, in that order, were the lowest. New Hampshire and Maine had the 15th and 18th lowest obesity rates, making New England the least overweight part of the U.S.
Many Americans really want to lose weight — and a new poll shows nearly half of adults would be interested in taking a prescription drug to help them do so.
At the same time, enthusiasm dims sharply if the treatment comes as an injection, if it is not covered by insurance, or if the weight is likely to return after discontinuing treatment, a new nationwide KFF poll found.
Those findings display the enthusiasm for a new generation of pricey weight-loss drugs hitting the market and illustrate possible stumbling blocks, as users potentially must deal with weekly self-injections, lack of insurance coverage, and the need to continue the medications indefinitely.
For example, interest dropped to 14 percent when respondents were asked if they would still consider taking prescription medications if they knew they might regain weight after stopping the drugs.
One way to interpret that finding is “people want to lose a few pounds but don’t want to be on a drug for the rest of their life,” said Ashley Kirzinger, KFF’s director of survey methodology. The monthly poll reached out to 1,327 U.S. adults.
The U.S. represents a large market for drugmakers who want to sell weight- loss prescriptions: An estimated 42 percent of the population is classified as obese, according to a controversial metric known as BMI, or body mass index. In the KFF poll, 61 percent said they were currently trying to lose weight, although only 4 percent were taking a prescription medication to do so.
That gap between the 4 percent taking any kind of prescription weight-loss treatment and the number of Americans deemed overweight or obese is the sweet spot that drugmakers are targeting for the new drugs, which include several diabetes treatments repurposed as weight-loss drugs.
The drugs have attracted much attention, both in mainstream publications and broadcasts and on social media, where they are often touted by celebrities and other influencers. Demand jumped and supplies have become limited. About 7 in 10 adults had heard at least “a little” about the new drugs, according to the survey.
The newer treatments include Wegovy, a slightly higher dose of Novo Nordisk’s diabetes drug Ozempic, and Mounjaro, an Eli Lilly diabetes treatment for which the company is currently seeking FDA approval as a weight loss drug.
Weight loss with these injectable drugs surpasses those of earlier generations of weight loss medications. But they are also costlier than previous drugs. The monthly costs of the drugs set by the drugmakers can range from $900 to more than $1,300.
At, say, a wholesale price tag of $1,350, the tab per person could top $323,000 over 20 years.
The drugs appear to work by mimicking a hormone that helps decrease appetite.
Still, like all drugs, they come with side effects, which can include nausea, diarrhea, vomiting and constipation. More serious side effects include the risk of a type of thyroid cancer, inflammation of the pancreas, or low blood sugar. Health officials in Europe are investigating reports that the drugs may result in other side effects like suicidal thoughts.
The KFF survey found that 80 percent of adults thought that insurers should cover the new weight-loss drugs for those diagnosed as overweight or obese. Just over half wanted it covered for anyone who wanted to take it. Half would still support insurance coverage even if doing so could increase everyone’s monthly premiums. Still, 16 percent of those surveyed said they would be interested in a weight loss prescription even if their insurance did not cover it.
In practice, coverage for the new treatments varies, and private insurers often peg coverage to patients’ body mass index, a ratio of height to weight. Medicare specifically bars coverage for drugs for “anorexia, weight loss, or weight gain,” although it pays for bariatric surgery.
“Unfortunately, a lot of insurers have not caught up to the idea of recognizing obesity as a disease,” said Fatima Cody Stanford, an obesity medicine specialist at Massachusetts General Hospital and Harvard Medical School.
Employers and insurers must consider the potential costs of covering the drugs for enrollees — perhaps for them to use indefinitely — against the potential savings associated with losing weight, such as a lower chance of diabetes or joint problems.
Stanford said the drugs are not a miracle cure and do not work for everyone. But for those who benefit, “it can be significantly life-altering in a positive way,” she said.
It’s not surprising, she added, that the drugs may need to be taken long term, as “the idea that there is a quick fix” doesn’t reflect the complexity of obesity as a disease.
While the drugs currently on the market are injectables, some drugmakers are developing oral weight loss drugs, although it is unclear whether the prices will be the same or less than the injectable products.
Still, many experts predict that a lot of money will be spent on weight-loss products in the coming years. In a recent report, Morgan Stanley analysts called obesity “the new hypertension” and predicted that industry revenue from U.S. sales of obesity drugs could rise from a current $1.6 billion annually to $31.5 billion by 2030.
Julie Appleby is a Kaiser Family Foundation Health News reporter
But fat fieldmice are tasty
“More die in the United States of too much food than too little’’
— John Kenneth Galbraith (1908-2006) economist, author and Harvard professor in The Affluent Society (1958)
“Fieldmouse Pie
5 fat fieldmice
1 cup macaroni
1/2 onion, thinly sliced
1 medium-size can tomatoes
1 cup cracker crumbs
Boil the macaroni 10 minutes. While it is cooking, fry fieldmice long enough to try out excess fat. Grease casserole with some of the fat and put a layer of macaroni on it. Add onion and tomato, then salt and pepper it well. Add fieldmice and cover with the remaining macaroni. Sprinkle the top with cracker crumbs seasoned with salt, pepper, and butter. Bake at 325 for 20 minutes or until mice are well done. (Note: if insufficient mice are available, substitute sausages.)”
— From a 19th Century cookbook created by some Vermont women, who used a lot of unusual sources to keep the wolf from the door.