Why Would Anyone Want Access to Prescription Medications For Obesity?Friday, May 5, 2017
Just imagine if the question in the title of this post was, “Why would anyone want access to prescription medications for diabetes?” (or heart disease? or lung disease? or arthritis? or, for that matter, cancer?)
Why would anyone even ask that question?
If there is one thing we know for sure about obesity, it is that it behaves just like every other chronic disease.
Once you have it (no matter how or why you got it) – it pretty much becomes a life-long problem. Our bodies are so efficient in defending our body fat, that no matter what diet or exercise program you go on, ultimately, the body wins out and puts the weight back on.
In those few instances where people claim to have “conquered” obesity, you can virtually bet on it, that they are still dealing with keeping the lost weight off every single day of their life – they are not cured, they are just treated! Their risk of putting the weight back on (recidivism) is virtually 100% – it’s usually just a matter of time.
Funnily enough, this is no different from people trying to control any other chronic disease with diet and exercise alone.
Take for e.g. diabetes. It is not that diet and exercise don’t work for diabetes, but the idea that most people can somehow control their diabetes with diet and exercise alone is simply not true. No matter what diet they go on or what exercise program they follow, sooner or later, their blood sugar levels go back up and the problems come back.
You could pretty much say the same for high blood pressure or cholesterol, or pretty much any other chronic health problem (that, in fact, is the very definition of “chronic”).
So why medications for obesity?
Because, like every other chronic disease, medications can help patients achieve long-term treatment goals (of course only as long as they stay on treatment).
Simply put, if the reason people virtually always regain their lost weight (no matter how hard they try to lose it) is simply because of their body’s ability to resist weight loss and promote weight regain, then medications that interfere with the body’s ability to resist weight loss and promote weight regain, will surely make it far more likely for them to not only lose the weight but also keep it off.
Now that we increasingly understand many of the body’s mechanisms to defend against weight loss and promote weight regain (and the body has a whole bag of tricks that you are up against), then pharmacologically blocking these mechanisms makes this a manageable (fair?) fight.
This is by no means easy. Interfering with human physiology always comes at a cost – which is why we need medications that are robustly tested for safety and efficacy (which is why we are here talking about prescription medications and not the nonsense you can buy over the counter in your local drug store or health supplement outlet).
There is of course no guarantee that any one medication will work for or be tolerated by everyone – again, no different from the medications for other chronic diseases (which is why we have so many of them for the same indication).
So who has access to prescription anti-obesity medications in Canada?
Short answer – almost no one.
Thus, in the 2017 Report Card on Access To Obesity Treatment For Adults, released last week at the 5th Canadian Obesity Summit, the less than 20% of Canadians living with obesity (and that is a very generous estimate) have access to the two prescriptions medications approved by Health Canada for long-term treatment of obesity.
Thus, as far a coverage for obesity medications in Canada is concerned,
Neither anti-obesity medication (Xenical® or saxenda®) are listed as a benefit on any provincial/territorial formulary and, therefore, they are not covered under any provincial public drug benefit (or pharmacare) programs.
There may be special-access programs in some provinces that adjudicate coverage for non-formulary medications based on individual case review; however, coverage for anti-obesity medications through these programs are not guaranteed and are, in fact, rare.
Anti-obesity medications are not covered in any federal public drug benefit programs.
Again one must ask, what will it take for governments, employers, and payers to stop discriminating against Canadians living with obesity in our healthcare system?
Disclaimer: I have received honoraria for speaking and consulting for companies that make anti-obesity medications
Friday, May 5, 2017
Obesity is just like any other chronic illness. It persists until the cause is addressed. Once the cause is addressed, it is cured. Just like a chronic infection – which cannot be cured by antibiotics, but must be cured by removing the chronic cause of infections. Just like chronic malnutrition (actually, obesity is chronic malnutrition in many cases), which can only be cured by healthy nutrition.
Every illness has a cause. Every chronic illness has a chronic cause. If an illness does not have a cause, it’s a disability, not an illness. If a chronic illness does not have a chronic cause, it’s a disability, not an illness.
Medicines for chronic illnesses are ‘chronic’. They are chronic causes of other illnesses. We call those ‘side effects’….
Treating an illness that has a chronic cause with a chronic medication only decreases the likelihood that the cause will found, increases the likelihood that the cause will persist. It’s abdication of responsibility to attempt a cure.
to your health, tracy
Saturday, May 6, 2017
If only things were really that easy – sigh!
Monday, May 8, 2017
Interesting article Dr Sharma. Personally, although medications are the mainstay of treatment for many chronic conditions, perhaps there needs to be a shift towards lifestyle interventions. Diet and exercise have been advocated for decades but I think there is a growing body of evidence that there is an art to it. What is healthy and what is not is changing (e.g. fat vs sugar debate at the moment) and there are some diets (e.g. intermittent fasting, low carb diets) that are showing potential avenues towards achieving LONG TERM weight loss in obese patients. For many, the weight loss is accompanied by improvements in lipids and blood sugar tolerance. I think medications may “work” but they are not ideal, have side effects and are a band aid solution. Would love to hear what you(Dr Sharma) or anyone else thinks about this?