Will Anti-Obesity Drugs Bankrupt Health Systems?
With the recent introduction of the new class of highly-effective incretin-based anti-obesity medications, we have seen a lot of hand-wringing about the prohibitive costs that would incur, if even a fraction of those who may stand to benefit, were treated. These assessments are of course based on current costs, which for Semaglutide 2.4 mg (Wegovy) in the US, can run up to $16,000 per year (albeit it is likely to be far less expensive in other countries). Current costs, however, are not the final word in pricing – rather, I can foresee several factors that will eventually drive prices down (despite apparently limitless demand). For one, we can expect that competition will have its effect (although this may not be immediately apparent). Over time, patents will expire and less expensive generic versions will appear – for e.g. liraglutide goes off patent this year. Oral forms of these medications will further reduce the logistical cost and hassles of cool-chains and devices. Small-molecules, that are easier to mass-produce than biologics, will further decrease cost. Given their potency, not everyone is going to need to be on the highest dose of these meds. Negotiations with payers (rebates) will likely land on more reasonable prices. Finally, as with all chronic diseases, only a fraction of eligible individuals will ever be on these medications for very long (even if they probably should be). Thus it is probably only a matter of time (probably a few years), before the cost of medically treating obesity falls to that of managing other chronic diseases like diabetes or hypertension. If we also factor in the potential healthcare savings from effectively treating obesity and reducing related complications (including heart disease and cancer), the economic picture certainly appears a lot less bleak than presented in most current projections. DrSharmaBerlin, D Disclaimer: I have received honoraria as an independent medical, research and/or educational consultant from various companies including Aidhere, Allurion, Boehringer Ingelheim, Currax, Eli-Lilly, Johnson & Johnson, Medscape, MDBriefcase, Novo Nordisk, Oviva and Xenobiosciences.
Is It Time To Change The Ask?
Most readers will be quite familiar with my 5As of Obesity Management (Ask, Assess, Advise, Agree, and Assist). Until now, we have emphasized that any conversation about weight with someone in your practice should begin with a polite and non-judgmental request for permission to bring up the topic. However, given the recent surge in popular interest in new medications for obesity, we now suddenly have patients lining up to request weight-loss prescriptions from their doctors. So, while previously, both doctors and patients have been hesitant to bring up the topic of weight, this is now often the exact reason why people are making appointments to see their doctors. This, of course, changes the nature of the Ask. No longer, is it about the doctor initiating the conversation by asking for permission to discuss weight. Rather it is now the patient who brings up the topic outright by asking for a prescription for an anti-obesity medication. This obviously changes the Ask – a more appropriate response would now be, “Why do you think you need this?” and “Where did you hear and what do you know about it?” This opens a whole new conversation. So, yes, we still start with an Ask, but it’s a different Ask. Obviously, we still need to then proceed with the other steps of Assessment, Advising, and Agreeing, before (if appropriate) we then Assist our patients in their treatment journey. An interesting twist to the story is now, that we are left with figuring out how to deal with individuals seeking prescriptions, for whom anti-obesity medication may neither be indicated nor suitable. @DrSharmaBerlin, D
Bing Chatbot Writes My Acceptance Speech
Last week at the 8th Canadian Obesity Summit in Whistler, BC, I was honoured to receive the innaugural Obesity Canada Founder Award for my services to the organisation. In preparation for this event, just for kicks, I asked Bing’s Chatbot to write me an acceptance speech. The following is verbatim what Bing came up with (in under 20 seconds!) – scary! @DrSharma,,Berlin, D p.s. I did not use any of it, but I probably could have without anyone noticing. Prompt: write an acceptance speech for Dr. Arya Sharma as recipient of the Obesity Canada Founders Award Bing Chatbot: Here is a possible thank you address for Dr. Arya Sharma: Ladies and gentlemen, it is my great honor and pleasure to receive the inaugural founder award from Obesity Canada, the leading obesity charity in this country. I would like to thank the board of directors, the staff, the members, and the supporters of Obesity Canada for this recognition and for their dedication to advancing obesity research, education, and advocacy. When I founded Obesity Canada in 2006, I had a vision of creating a network of obesity stakeholders who would work together to improve the lives of Canadians living with obesity. I wanted to challenge the stigma and discrimination that people with obesity face every day. I wanted to promote obesity as a chronic disease that requires evidence-based prevention and management. I wanted to foster collaboration and innovation among researchers, health professionals, policy makers, and people with lived experience. Fifteen years later, I am proud to say that Obesity Canada has achieved many of these goals and more. Obesity Canada has grown to become a network of over 10,000 members across Canada and beyond¹. Obesity Canada has produced the first Canadian clinical practice guidelines for obesity in adults² and children³ [sic], which have been widely adopted and endorsed by various organizations. Obesity Canada has organized six [sic] biennial Canadian Obesity Summits, which have brought together hundreds of experts and stakeholders to share knowledge and best practices. Obesity Canada has advocated for policy changes that support obesity prevention and care, such as the inclusion of obesity in the Canadian Disability Tax Credit and the recognition of obesity as a chronic disease by several provinces. Obesity Canada has also empowered people living with obesity to share their stories and voices through initiatives such as the Public Engagement Committee, the Weight of Living project, and… Read More »
Medications Only Work When You Take Them!
Now that we have medications for managing obesity that are safer and more effective than ever before, the issue of how to get patients to actually take them deserves more attention. Generally speaking, most people do not like taking medications, which is why the issue of adherence is not unique to patients with obesity. In fact, most people don’t take medications exactly how or for how long their doctor has prescribed them (I certainly used to belong to that club). Thus in many ways, adherence to anti-obesity medications (AOMs) is not far worse than to medications in general, which may come as a bit of a surprise, given that the long-term use of AOMs may face more hurdles than other medications. Thus, one of the most common reasons suggested for why people don’t stick with their AOMs is cost. While this may sound obvious, we should remember that many patients don’t stick with their prescription meds even when these are fully covered by their health plans (e.g. statins or anti-hypertensives). Another argument often brought up in this regard, is that patients don’t look at obesity as a chronic disease requiring long-term treatment. Again, while this is certainly true, as noted above, adherence to medications for other (well-established) chronic diseases is not much better (often no more than three to six months). It is also suggested that patients discontinue their AOMs because they are not meeting their (often unrealistic) weight loss goals. However, given that these medications take months before patients achieve their maximum weight-loss (never mind the time it takes to up-titrate to the recommended dose), this does not explain why most patients stop their meds only a couple of weeks into the treatment, i.e. long before they can expect to see the maximum effect or reach their weight-loss plateau. In fact, most patients never seek or fill a second prescription. I also often hear the notion that patients come off their AOMs because weight is easily monitored and patients can directly see the effect (or lack of it), which is certainly different for statins or ASS. Again, we don’t see much better adherence in patients with other conditions where patients can directly experience the effect of their medications (e.g. medications for chronic pain). The fact is that non-adherence is not unique to AOMs but of course as relevant to their use as for any other medications for chronic conditions. … Read More »
Obesity Trends To Watch For in 2023
There is no doubt that we are currently experiencing the dawn of a revolution in our ability to better treat and manage obesity. Under these circumstances, predicting the future of obesity medicine is perhaps even more difficult than when things were plodding along at a steady pace. Nevertheless, here are some of the trends we should watch for in 2023: With my best wishes for a Happy New Year!@DrSharmaBerlin, D
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