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When patients start taking the latest obesity medications, they find that their appetite decreases and they lose weight. But when they stop taking the medication, the gears switch in reverse: food cravings slowly return and weight drops again. Within a year of stopping semaglutide (better known by the brand names Wegovy or Ozempic), people on average regain the following: two-thirds of the weight They lost. Tirzepatide, also known as Zepbound or Mounjaro, Similar patternsSo conventional medical wisdom holds that these obesity medications are meant to be taken indefinitely, perhaps for life.
That may be a pretty good proposition for the drug companies selling the blockbuster drugs collectively known as GLP-1 drugs because they mimic the natural hormone. Not so much for patients paying more than $1,000 a month out of pocket, a cost that most Americans simply cannot afford, month after month.
This has forced some doctors to get creative and come up with cheaper, if lesser-known, alternative treatments. While GLP-1 drugs are certainly very effective and produce weight loss more quickly than other obesity drugs on the market, some doctors are now saying that patients should not take GLP-1 drugs especially permanently. I’m wondering if I need to take it. “What if we made a short-term investment and used it for six months to a year and saved him 50 pounds?” said Sarah, an obesity medicine physician and director of the University of North Carolina Physician Network Weight Management Program. Mr Law asks: Patients could then move on to cheaper, older alternatives for long-term weight maintenance, as she and other doctors are currently considering.
In fact, Mr. Lo has already helped hundreds of patients transition out of financial need. Few of her patients in rural North Carolina have insurance that covers new obesity drugs, and few can afford to pay out-of-pocket on an ongoing basis. In April, North Carolina’s health insurance for state employees was also discontinued, leaving many without coverage. Sudden discontinuation of GLP-1 drugs Obesity treatment drug. Lo switched patients onto older medications such as topiramate, phentermine, metformin, and bupropion/naltrexone, and also provided lifestyle counseling. These drugs are not an ideal solution because they are generally considered less effective (only about half as effective at reducing weight as GLP-1 drugs), but they are much cheaper. When prescribed generically, a month’s worth of these drugs can cost as little as $10, Lo said.
Jamie Ard, an obesity specialist at Wake Forest University School of Medicine, also switched treatments for patients who lost coverage for GLP-1 drugs after they retired and enrolled in Medicare. Medicare currently does not pay for obesity drugs. (Like many researchers in this field, Ard receives grants and consulting fees from companies developing obesity drugs.) Although he was not aware of any research on the switch, Ard says the research is correct. It’s a practical necessity in the United States. As GLP-1 drugs have exploded in popularity, patients who take them are increasingly suddenly losing coverage once they reach retirement age and enroll in Medicare. “Now we have to figure out how to treat them,” he told me.
In fact, long-term data on older drugs themselves are quite sparse, even though these drugs have been available for many years. Before Ozempic, obesity drugs weren’t a lucrative market, so companies weren’t interested in funding long, very expensive clinical trials that followed patients for several years. “Such studies are extremely expensive,” Louis Aronne, a bariatric physician at Weill Cornell Medicine, told me. Some of the long-term follow-up data on these drugs came from patients at his Manhattan clinic, which he acknowledged is not a representative population, which he published in the paper. . Five years of study Funded by the National Institutes of Health. (Aronne also receives grants and consulting fees from manufacturers of obesity drugs.)
The condition of patients after switching from GLP-1 to conventional drugs is completely anecdotal, but so far the results seem to be quite different. A small percentage of patients who stop taking GLP-1 injections are able to maintain their weight through diet and exercise without taking additional medications. Other patients may find that traditional medications simply don’t work. In Ro’s experience, about 50 to 60 percent of her patients maintain their weight using one or more conventional medications in addition to lifestyle changes such as cutting back on fast food and sugary sodas. has been successful.
The best drug to switch to depends on the patient. Older drugs work differently and act on different biological pathways. For example, the combination of naltrexone and bupropion makes food less enjoyable and appears to be particularly effective for people who tend to eat emotionally, Ard said. On the other hand, topiramate makes carbonated drinks unpleasant, so it may be beneficial for patients who drink large amounts of carbonated drinks. Older drugs also have various side effects. Aronne told me a list of health risks that could rule out the use of certain drugs for certain patients. In the case of bupropion, it is seizures, and in the case of topiramate, it is glaucoma. Finding the most effective and best-tolerated drug for a patient may require trial and error.
Doctors are now finding that some patients are able to maintain their weight loss by lowering the dose or reducing the frequency of GLP-1 drugs. “For the first time in my career, I’m reducing the dosage of my medication,” Arone says. However, reducing the dose alone does not save money. Because low-dose injection pens cost the same as high-dose injection pens. But doctors have told me that by extending the dosing interval from the standard 7 days to 10 days, some patients have been able to make their drugs last longer. .
However, completely reducing obesity drugs, GLP-1 or not, is probably not possible for most patients. Weight loss tends to trigger a series of powerful compensatory mechanisms in the body. This compensatory mechanism evolved long ago to protect us from starvation. The more weight you lose, the more your body fights back. This battle will never completely go away, and most patients will likely need some type of ongoing intervention to lose weight. Long-term weight maintenance has always been the “holy grail” of obesity treatment, Susan Yanofsky, co-director of the Obesity Lab at the National Institutes of Health, told me. The optimal maintenance strategy, including whether to use GLP-1 drugs and their dosage, can ultimately be quite individual. Research is still needed to determine what works best and for whom. “These are really good research questions,” Yanofsky said. But these are not necessarily the questions that pharmaceutical companies focused on developing new drugs are most eager to answer.
In time, current GLP-1 drugs may also be available as generic drugs, and patients may no longer be tempted to look for cheaper alternatives due to cost. But for now, cost is the culprit.
