How a 'miracle' weight loss drug exacerbated health disparities

American Heart Association calls them “Game changer.”

Oprah Winfrey says 'they are' “gift.”

Scientific journals tell them “2023 Breakthrough of the Year”

The brand names most familiar to Americans are Ozempic, Wegovy, Mounjaro, and Zepbound. These are the drugs that have revolutionized weight loss and raised the possibility of reversing this country's obesity crisis.

Obesity, like many diseases, disproportionately affects people from racial and ethnic groups who are marginalized by the U.S. health care system. Certain drugs that have succeeded where many others have failed appear to offer a powerful means of closing the gap.

In fact, doctors who treat obesity and the serious health risks associated with it are concerned that drugs are exacerbating these health disparities.

“These patients have a higher burden of disease and are less likely to have access to life-saving medicines.” Dr. Lauren Eberly, a cardiologist and health services researcher at the University of Pennsylvania. “If there's a disproportionate burden on a patient group, I think they should do that. increased Access to these medicines. ”

Why not? Experts say there are many reasons, but the main one is cost.

The injectable drug Ozempic has revolutionized obesity care.

(David J. Phillip/Associated Press)

Ozempicis approved by the Food and Drug Administration to help people with type 2 diabetes control their blood sugar and reduce the risk of serious cardiovascular diseases such as heart attacks and strokes, and the list price is $968.52 for 28 days. WegsHigher doses of the same FDA-approved drugs are suitable for weight loss in people who are obese or who are overweight and have weight-related conditions such as high blood pressure or high cholesterol. $1,349.02 every 4 weeks.

Munjaro This is a similar drug approved by the FDA to improve blood sugar levels in people with type 2 diabetes, with a list price of $1,069.08 for 28 days of medication. zep bounda version of the same drug approved for weight loss, with a slightly lower price. $1,059.87 per 28 days. At least for now, all new drugs are meant to be taken indefinitely.

Few health insurance programs cover prescribed medications to help you reach and maintain a healthy weight.Federal law requires the use of weight loss drugs excluded From basic coverage in Medicare Part D plans, as of early 2023; only 10 states Included anti-obesity drugs in Medicaid program prescriptions.

“This will help if everyone has equal access,” he said. Dr. Rocio Pereira, chief of endocrinology at Denver Health. “But without the equal access that we have now, we're probably going to see even more inequality.”

The obesity rate in the United States is has been on the rise for decades, is consistently higher for blacks and Latinos. Among adults age 20 and older, 49.9% of Black Americans and 45.6% of Hispanic Americans body mass index According to , 41.1% of white American adults and 16.1% of Asian American adults are 30 years of age or older. Age-adjusted data From the Centers for Disease Control and Prevention.

Obesity rates are also related to income. In 2022, the age-adjusted rate was 38.4% for adults with household incomes of $15,000 to $24,999, but 34.1% for adults with household incomes of $75,000 or more.

Pereira, who studies health disparities in obesity-related diseases, said the two are linked. Blacks and Latinos are more likely to live in low-income neighborhoods; fast food is usually cheap And it's more convenient than the grocery store.

“If you look at a map of the United States and plot out areas that don't have a grocery store within a mile and have a high percentage of people who don't own a car, those are the areas that have the highest obesity rates,” she says. .

There's also a time factor, she said. “Can you afford to cook for yourself? Or will you have to work two jobs?”

Ann unusual experiment Pereira said a study by the Department of Housing and Urban Development demonstrated how much the physical environment can influence obesity risk. In the 1990s, hundreds of mothers living in public housing were offered housing vouchers that could only be used in wealthy areas. After 10 to 15 years, women randomly assigned to receive the windfall had significantly lower rates of severe obesity (14.4%) than women in the control group who were not offered a voucher (17.7%). . They were also less likely to have a BMI of 35 or higher (31.1% vs. 35.5%).

Two women talking in New York.

(Mark Lenihan/Associated Press)

american medical association Obesity is recognized as a disease People with chronic illnesses are at increased risk of: cardiovascular disease, type 2 diabetes13 types cancerosteoarthritis, asthma and other health problems. Researchers calculated the annual medical costs associated with obesity as follows: $174 billion in the US alone.

Some people with obesity can lose weight by changing their diet or burning more calories through exercise.But it doesn't work for developed people Resistance to leptina hormone that suppresses appetite.

“If you try to lose weight through diet and exercise, your body will fight back,” he said. Dr. Caroline Apovianco-director Weight management and health center at Brigham and Women's Hospital in Boston. “Leptin levels drop, and when leptin drops, it sends a signal to the brain that there isn't enough fat to survive.” This stimulates the release of ghrelin, another hormone that causes hunger.

Leptin resistance also reduces the value of exercise.

“Your body is fighting you by reducing your total energy expenditure,” Apovian says. “When your muscles work, they work more efficiently. If you want to lose 10 pounds, you have to be really hungry. And you can't fight it. Your body thinks it's going to starve to death.”

A “breakthrough” drug combats this by masquerading as a hormone called . Glucagon-like peptide 1, or GLP-1, is involved in regulating appetite. Inside the cells, the drug binds to the same receptor as her GLP-1, lowering blood sugar levels and slowing digestion. It also lasts longer than natural products.

Oprah Winfrey believes she can control her weight thanks to a new generation of drugs.

(Chris Pizzello/Associated Press)

The first so-called GLP-1 receptor agonists were Approved in 2005 Used to treat diabetes, early versions required injections once or twice a day. Ozempic improved on this by requiring only one injection per week.rear clinical trial The drug has been shown to help obese patients achieve substantial and sustained weight loss, the FDA announced. Approved Wegovy In 2021, as a weight management drug.

Mounjaro and Zepbound also mimic a related hormone called GLP-1. Glucose-dependent insulinotropic peptideor GIP.

Linda Morales credits Ozempic and Munjaro with helping her lose 100 pounds and drop from a size 22 to a size 14. The 25-year-old instructional assistant at Lankershim Elementary School in North Hollywood said she started gaining weight in middle school and weighed 293 pounds. When she was referred to the hospital, her weight was heavy on her 5 feet 5 inches body. Weight Management and Metabolic Health Center Two years ago at Cedars-Sinai.

She no longer gets out of breath when climbing stairs, goes bowling more easily, and fits comfortably in the chair seat. harry potter rides At Universal Studios. Thanks to her medication, she is no longer on the path to her type 2 diabetes.

Her job with the Los Angeles Unified School District has health insurance that covers expensive medications, and her co-pay for Munjaro prescriptions is $30 a month. She said she's OK with her monthly payments up to $50, but beyond that she'll have to stop taking the medication and make lifestyle changes to maintain the weight loss she's achieved. Ta.

“For sure, it's definitely going to be difficult for me,” Morales said.

Indeed, even if there were drugs, covered by insurance or patient Eligible for discount from Pharmaceutical companyresearchers have found that they are often just out of reach.

In one study, Eberly and her colleagues looked at the insurance claims of about 40,000 people who were prescribed GLP-1 counterfeit products. Patients who had to pay at least $50 a month to fill their prescriptions were 53% less likely to fill most of their prescriptions in a year compared to patients who paid less than $10 out of pocket. Even for patients whose out-of-pocket costs ranged from $10 to $50, they were 38% less likely to purchase their medications regularly over the course of a year. the team found.

in another study Among insured patients with type 2 diabetes, blacks were 19% less likely to receive treatment with these drugs compared to whites, and Latino patients were 9% less likely to receive these drugs, Eberly and colleagues reported. did.

In some parts of the country, black patients with diabetes are only half as likely to receive GLP-1 drugs as white patients. According to research by Dr. Selina Zhichuan Guo She received her PhD from the University of Florida, where she researched health disparities in drug access. The difference was largest in regions with the highest overall drug use, such as New York, Silicon Valley, and South Florida.

“In those areas, drugs actually widen the gap,” she says.

Researchers have spent years document racial disparities In the use of effective treatments for obesity, obesity surgery etc.. New drugs like Ozempic only bring the problem into sharper focus, he said. Dr. Hamlet Gasoyana researcher at the Cleveland Clinic Values-Based Care Research Center.

“We are excited every time a new and effective treatment becomes available,” Gasoyan said. “But we should be equally concerned that this new and effective treatment will narrow the gap between the haves and have-nots.”