Image by Novo Nordisk/Futurism Treatments
It all started with a news story for Zoe. Novo Nordisk had developed Wegovy, a new weight-loss drug. The FDA approved it. Intriguing, she joined a Facebook group to support people who were trying the drug.
She said that I was desperate to get it at that time, especially since I was seeing so many results from other people and was feeling major FOMO.
The new trade name for semaglutide is Wegovy. It has been approved since 2017 to treat Type II Diabetes. However, it also received FDA approval in June as a weight-loss medication. One in three participants who received it in a clinical trial combined with changes to diet and physical activity saw a dramatic drop in body weight. They also improved biomarkers for heart disease.
Startups are already looking to order it, despite its recent approval.
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Calibrate is a telehealth startup. It describes the drug as safe and effective in bringing about weight loss and health benefits when used with a change in diet and exercise.
Fella is another startup that focuses on stress eating in men. It combines lifestyle coaching with pharmaceutical weight management.
However, both were cautious about discussing the drug. Calibrate refused to comment and Fella answered general questions regarding its approach to weight management, but declined to answer specific questions about Wegovy or its overall view on the landscape.
Others once-promising weight-loss drugs have failed miserably, such as Fen-Phen which was linked with severe cardiovascular events and Belviq which was recalled due to potential cancer risks in 2020. People who follow a diet won't lose weight long-term. They often experience a rebound. Despite this, weight loss is still a lucrative industry worth billions of dollars.
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Zoe stated that even though all my blood tests were negative, I believe I would still choose to start Wegovy. Although I am primarily motivated by my desire to be healthy, I don't want to become obese forever.
Obesity is not a problem that can be treated alone. It is a systemic problem that must be addressed. It is unlikely that effective weight management drugs will solve obesity. Our bodies evolved in an environment that was less food-scarce. This makes it difficult to solve the problem of obesity, particularly when it affects low socioeconomic status and racialized minorities.
Timothy Gill, University of Sydney professor of public nutrition, expressed concern about semaglutide. He believes the drug is promising but that obesity and weight management must be addressed at an overall society level. He believes that while diet and exercise alone are not enough to lose weight, it is possible to address the problem at a local level.
He said that he was concerned that when these breakthroughs are made, it can be interpreted as if we have the answer to an obesity-related physiological problem. It is not a defect, it's just that some people are more successful at survival with the physiology evolution gave them.
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For example, increasing wages could lower obesity rates. This is because healthy food is more affordable and there are fewer financial stressors on a family. Also, working fewer hours means more time to prepare healthy meals fresh.
Gill stated, "Stop wasting your time, we're not going to bother." This reaction has allowed governments all over the world to ignore this issue as a serious health concern.
Gill was able to recognize the benefits of semaglutide. It works in a different way than the disastrous weight loss medications of the past. Researchers believe it mimics GLP-1, which is a satiety hormone that helps people feel fuller sooner. Even though there are side effects such as nausea and diarrhea, all those we spoke to agreed that it was worthwhile for their health.
One participant in the clinical trial said that they initially experienced acid reflux after eating. However, it disappeared after they reduced their food intake. We also heard from many people who took the drug and changed their lifestyles that they felt more full.
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Rich was another representative user. He was about to start his fifth month on Wegovy. Rich said he had lost five-pounds so far and that side effects were very minimal or nonexistent.
In complex ways, the approval of semaglutide for weight loss coincides with the rise in telemedicine. It is concerning to consider a doctor prescribing new medication without ever meeting with a patient. Fella and Calibrate go the extra mile to include blood testing for metabolic markers, rather than prescribing based solely on BMI, which can be problematic.
Many people oppose BMI. But it is like measuring blood pressure and cholesterol. Gill stated. None of these factors can predict your health.
Gill said that BMI alone should not be the determining factor in what treatment you receive.
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While Wegovy appears to be effective in helping people lose weight, it does not address the socioeconomic factors that lead to obesity. Many people don't have the means to shop at supermarkets that sell healthy, affordable food, or they may not have the time or money to make them.
Gill stated that it is not physiology that is wrong. It's the environment that's wrong.
He pointed out that although the drug was effective in clinical trials it is not guaranteed to have wider appeal.
He explained that entering a pharmaceutical trial is a controlled environment where you have a lot support.
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The fact that Wegovy, a brand new drug, has not been used for more than a few months is what causes much of the tension. It might prove to be a long-term treatment that is associated with positive health outcomes. It might be a great way to lose weight, but its health benefits will be minimal. It might lose its effectiveness over time, or be associated with serious health risks.
There is no way to know without long-term research. Even if the drug is a success, the biggest challenge could be the health insurance system.
The drug was almost $1600 per monthly without insurance. However, Zoe was able to obtain a savings card that allowed her to receive a discount. It wasn't easy to get insurance to cover the cost, she said. It is unclear if insurance will cover many of the people who may require the drug. Saxenda is a similar drug that is not covered by private insurance. Only 40% of private insurers cover it.
I spoke with Walgreens and NovoCare for hours, and felt hopeless at times.
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The high cost of the medication makes it unaffordable for many people who might benefit from it. Zoe currently uses a savings card to pay for her prescription but she is not confident that her insurance will cover the cost in six months.
Novo Nordisk stated that the savings offer was meant for healthcare providers to extend to patients with anti-obesity medication insurance who were waiting for Wegovy to be added to their prescription plans.
Access and affordability are very important in this area, and Jason Brett, director for obesity medical affairs at Novo Nordisk, stated that access and affordability are crucial.
Many Wegovy patients are experiencing delays in getting the medication, Zoe stated. This is also causing shortages of certain doses.
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She said that a lot of doctors encourage patients to skip their dosages. Doctors simply prescribed 0.5 mg instead of 0.25 mg because the 0.25mg dose was out of stock. It was then more difficult for those who had been on 0.25 mg to find the 0.5 mg dose.
It is also not clear how many people who obtain the drug via telehealth startups will be covered by insurance. Fella will help its subscribers to navigate the world of health insurance. Fella and Calibrate both offer a complete refund to customers who are not able to obtain adequate insurance compensation. Fellas charges $149 per Month for coaching and support. Calibrate costs $135 per Month.
Even if Wegovy does work as it was intended, it won't fix racial or socioeconomic disparities in nutrition. It will not prevent weight stigmatization or medical biases. It won't guarantee that insurance covers important medications. Wegovy might help some people, at least on an individual level. That would be a great accomplishment.
Zoe and many others on Wegovy intend to continue the journey long-term.
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She said that the main concern was not having insurance to cover it, stopping treatment and then [gaining] all the weight back.
Simon Spichak has a Master's degree in Neuroscience and is now a freelance journalist in Toronto. Resolvve is a telehealth mental healthcare startup that aims to provide students in Canada more access to psychotherapy.
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