Obesity drugs deemed inefficient as consumers pay higher prices for short-term solutions

17 Jul 2023 --- Two-thirds of obesity medication GLP-1a (glucagon-like peptide-1 agonist) consumers stop taking the medication within a year, according to a new report by Prime Therapeutics.

The report details that the average annual cost of such drugs is US$19,657 for consumers, compared to the US$12,379 overall care cost for obese patients before taking the medication, an increase of 59%.

Nutrition Insight speaks with Dr. Neal Barnard, the Physicians Committee for Responsible Medicine president, about the results.

“Wegovy and other drugs in this class are marketed for permanent use because the lost weight tends to return when users stop. And that is why they are such a problem because no one wants to be saddled with costs above US$15,000 per year,” says Barnard.

Overpriced two-folds?
Recently, we sat down with Alex Miras, a professor of endocrinology at Ulster University, Northern Ireland, who shared the same opinion of semaglutide being cost-ineffective.

“When the patients are put on medication, it has shown to be beneficial for their health. The problem is that the treatment is stopped after two years because it is no longer cost-effective beyond two years. This makes sense regarding cost, but it doesn’t make clinical sense, as we wouldn’t do the same for any other chronic conditions we are treating,” Miras argued.

Barnard argues that although exercise helps with weight loss, it has a limited effect.“While the industry is poised to see broader approval of GLP-1a drugs for weight loss by the Food and Drug Administration in the near term, our analysis shows that a large, upfront financial investment is required when treating weight loss with these drugs,” says Joseph Leach, senior vice president and chief medical officer at Prime Therapeutics.

Leach continues, “We will need results of ongoing, multi-year studies to see if this treatment has downstream impacts on other health conditions, including cardiovascular events and diabetes development prevention, which are key benefits to weight loss management. Long-term impact on total cost of care also remains to be seen.”

Prime Therapeutics refers to an analysis by the Institute for Clinical Economic Review published in October, which identified “that GLP-1a weight loss therapies are overpriced two-fold to their expected value in weight loss associated reduction in cardiovascular events and diabetes development avoidance over a lifetime,” notes the company.

Exercise, diet and medication
Barnard argues that although exercise helps with weight loss, it has a limited effect.

“Running, for example, burns about 100 calories per mile, so you would have to exercise a lot and try to resist compensatory eating for exercise to do much for your weight. But diet changes are dramatic,” he says.

“The best is a low-fat and entirely plant-based diet. In the Adventist Health Study-2, vegans averaged 35 pounds lighter than omnivores. We now use that sort of diet in our clinic. People love having unlimited calories, unlimited carbohydrates and ‘good’ side effects, including lower cholesterol and blood sugar,” he adds.

In April this year, an eight-week intervention program conducted in the US found that five out of six women decreased their biological age by an average of 4.6 years when following a diet, sleep, exercise and relaxation guidance program.

Pediatricians in the US have suggested using weight loss medication for obese and overweight children in addition to nutritional diets and physical exercise.The average annual cost of such drugs is US$19,657 for consumers.

A recent study underscored that overweight and obese teenagers in Europe and America are underestimating their body weight, threatening to “undermine ongoing efforts to tackle increasing levels of obesity in this age group.”

Side effects outweigh benefits?
Barnard adds that side effects, such as nausea, vomiting and diarrhea, vanish over time for some consumers, while for others, they persist, which may lead to ending medication. 

Additional side effects are an increased risk of pancreatitis, gallbladder disease and thyroid cancer. Barnard also points out “the hassle of injecting.”

“There are other medications, but they have only modest benefits and carry their own risks. So, the best answer is to get on a good and healthy diet,” he notes.

Barnard argues that obesity can be treated without medication, with proper nutrition and physical activity.

“To make a diet change work, firstly, use an effective diet, particularly a low-fat and fully plant-based diet. Secondly, to get some support such as a class or a series of meetings with a vegan registered dietitian to answer questions along the way.”

“GLP-1a drugs and their use for weight loss have taken the healthcare industry by storm, but several issues must be resolved, including how to ensure that those who may benefit most have access while maintaining overall pharmacy benefit affordability,” said David Lassen, chief clinical officer at Prime Therapeutics.

“While we hope to see additional data to refine our guidance, health plans should consider programs to help adherence to avoid medication waste and comprehensive therapy plans – which include diet and exercise – to help people on their weight loss journey,” adds Lassen.

By Beatrice Wihlander