July 24, 2023
Anti-Obesity Medications: A Story of Hope and Resilience
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Over the last few years, research and development of Anti-Obesity Medications (AOMs) has blossomed. For the first time ever, many patients are able to lose more than 10% of their body weight and successfully maintain weight loss. However, getting AOMs to the patients that need them has proven to be quite a feat. Insurance coverage has been a major barrier to using these medicines. A frequent complete lack of AOM coverage or unreasonable prior authorization requirements raises questions about equity and accessibility to morality and even appropriate medication rationing. Despite this, no other barrier has been quite as disruptive as AOM shortages.
As a practicing obesity medicine physician, the word “shortage” sends chills down my spine. Yes- it is even worse than another dreaded phrase “Prior authorization required”. Our patients are some of the most hardworking and motivated people and when they finally find a plan that leads to successful weight loss- it is truly heartbreaking to see their course derailed by AOM shortages.
With the FDA approval of Wegovy, we were thrilled to offer a once-weekly injectable medicine that on average offers 15% weight loss. Shortly after the rollout of Wegovy, the medicine became impossible to find at starting doses. This access crisis led to an Ozempic shortage as many people successfully treated with Wegovy tried to continue their medication uninterrupted. This spurred an incredible debate about patients with obesity “stealing” medication from patients with Type 2 Diabetes. In my opinion, this further reinforced how strong weight bias remains in our society and opened a debate about rationing medication to some patients above others. As if somehow patients with one disease are more deserving of this medication than patients with the other disease. This situation spurred debates in the medical and lay communities about issues with the market and pharmaceutical manufacturing and branding. Many patients frantically reached for Semaglutide from compounding pharmacies- a preparation of Semaglutide that is not reviewed by the FDA for safety, quality, or efficacy. Adverse events have been reported in patients using these compounded Semaglutide salts.
A few years later, Mounjaro became available for our patients with Type 2 Diabetes and Obesity promising on average about 20% weight loss. We were promised by the manufacturer that they learned from the mistakes of the Wegovy rollout, only to our horror to hear a few months later their supply was also running short. Once again, many patients with obesity were offered a highly effective treatment only to lose this medicine a few months later. Obesity medicine practitioners had to lean on each other to learn how to safely transition patients between these medications to avoid interruptions of care. Interruptions were simply inevitable, however.
The story continues with the awaited return of Wegovy to the market with promises not to run into supply issues again. What do you know- we are currently in the midst of yet another Wegovy shortage. The patience and resilience that our patients exhibit is inspiring, to say the least! I hear myself say the phrase “I got you, we will find a backup plan” on repeat in the clinic. The current shortage of Wegovy has prompted us to rely on the older daily injectable GLP1-receptor agonist Saxenda, but word on the street is that Saxenda supply is becoming questionable as well. Our plan B has been to offer patients the older and less effective AOMs such as Qsymia and Contrave. This begs the question- are we looking at supply shortages with these medications as well?
On a daily basis, I am both grateful and surprised that my patients stick it out with me for all the highs and lows of their obesity care. I reassure them (and truly believe) that in the next 5 years, we will be past many of the current barriers to AOM use. I can see that slowly insurers are seeing the benefits of treating obesity first. Our society is finally recognizing that obesity management is the ultimate prevention- helping maintain patient health and avoid paying for costly and deadly diseases that result from untreated obesity. I am encouraged by the incredible data coming out about several new AOMs in development- specifically an oral GLP1-receptor agonist (Orforglipron) and triple glucagon, GIP, and GLP1-receptor agonist (Retatrutide). My hope is that as more efficacious medications come to market, our choice of medication will truly be evidence-based and patient-centered and we no longer have either cost or shortage as barriers. In the meantime, obesity medicine practitioners will continue fighting the good fight as our patients need our support and expertise now more than ever.
Article written by:
Alina Elperin, MD, DABOM
Alina Elperin, MD, DABOM, is an Internist and Obesity Medicine specialist in Evanston, Illinois. She is a Clinical Assistant Professor at the University of Chicago Pritzker School of Medicine and frequently teaches residents and students. She strives to improve access for patients with obesity to get the compassionate and comprehensive care they need. Dr. Elperin's philosophy of patient care aims to empower patients to take control of their physical and mental health. She loves the longitudinal relationships she builds with her patients. She partners with her patients to change their mindset and improve their lifestyles gradually and sustainably to reach their health goals. She lives by the motto, "An ounce of prevention is worth a pound of cure". When not helping patients meet their health goals or teaching residents, Dr. Elperin is enjoying time with her husband and three children and maybe even planning her next travel destination.