Katherine Streeter for NPR
From TikTok influencers talking about them to celebrities worrying about the “ozempic face”, drugs like Wegovy and Ozempic are being touted as weight loss miracles in a country obsessed with thinness.
But, drugs are not meant for cosmetic weight loss. Ozempic is approved for diabetes and Wegovy is for obese people who also have weight issues such as high blood pressure or high cholesterol that put them at risk for heart disease. That’s millions of Americans.
And evidence shows that the new class of drugs is much more effective than previous obesity drugs. A landmark clinical trial published in The New England Journal of Medicine in 2021 found that the drug caused a 15% reduction in body weight, on average.
There has been such a surge in demand that an FDA database lists the drug’s active ingredient, semaglutide, as “currently in short supply.” Its manufacturer, Novo Nordisk, says supply stability is a priority. The company also markets Ozempic to treat diabetes, which is a lower dose of semaglutide.
But at a cost of around $1,400 a month — out of pocket when insurance doesn’t cover it — many people can’t afford to keep taking their medications long-term. And when people stop taking it, there is often weight gain that is hard to control. In fact, one study found that most people regain most of their weight within a year of stopping the drug.
That’s what’s happening to Yolanda Hamilton of South Holland, Illinois. Hamilton’s doctor prescribed her Wegovy because she had a high BMI, high blood pressure, and high blood sugar. She lost 60 pounds and started feeling much better.
“It gave me more energy,” she says, allowing her to exercise and do household chores. Her sugar cravings subsided and she felt satisfied with small meals. “I was very surprised at how good I felt,” Hamilton said. The drug is given by injection once a week at home, which Hamilton says is easy to do.
Her Aetna insurance plan covered the cost of medication, but when she changed jobs last fall, her new insurance plan through Blue Cross and Blue Shield of Illinois declined coverage. She now works in the emergency room of a hospital where she registers patients, which forces her to sit most of the day. And, after a few months without taking the drug, she gained 20 pounds.
“I’m very frustrated with the weight coming back in such a short time,” Hamilton said.
Blue Cross and Blue Shield of Illinois told NPR that the benefits offered by employer plans may vary. “Wegovy weight-loss drugs may be covered, depending on the member’s benefit plan,” a company spokesperson said. Many other insurers also determine coverage based on what employers are willing to cover.
Barriers to a life-changing drug
The rebound weight gain is no surprise given how the drug works. The active ingredient in Wegovy – semaglutide – is a GLP-1, or glucagon-like peptide-1, which mimics the satiety hormone GLP-1 in our body. When we eat, GLP-1 is released from our intestines and sends signals to our brain centers that control appetite.
“This hormone tells your brain, I’m full, I don’t need to eat anymore,” says Dr. Robert Kushner of Northwestern University, who treats Yolanda Hamilton. Kushner also sits on Novo Nordisk’s medical advisory board, for which he receives an honorarium.
“What the pharmaceutical companies have done is take this natural hormone and restructure it into a drug,” he explains. So it’s no surprise that when people stop taking the drug, they start to feel hungrier, he says.
“I crave sweets,” Hamilton says. And his appetite increased. She is no longer satisfied with small meals. “I lose my energy” as the weight comes back, she says.
Kushner’s office is helping Hamilton appeal the insurance denial, but in the meantime, she worries stopping the drug could also affect her blood pressure and blood sugar levels. “She is at risk of seeing these conditions worsen with weight regain,” Kushner said.
“If I gain more weight, I’ll take more medication,” Hamilton says. Considering her long struggle with weight loss, she had finally found something that worked.
“We see a lot of patients having this rebound weight gain, and it can be really devastating,” says Dr. Karla Robinson, a Charlotte, North Carolina-based family physician and medical writer at GoodRx, a company that helps people find the lowest prices for generic and brand name drugs. There is no generic version of semaglutide.
“Unfortunately, being a new drug, it is one of those that is subject to manufacturer pricing,” says Robinson.
A Novo Nordisk representative notes that the company is offering a $500 coupon for Wegovy to reduce the cost for patients paying cash.
But, this graph from GoodRX shows that the lowest price among all retailers is $1,304 per month for people paying out of pocket, which is out of reach for most people even with a coupon.
“I feel like Wegovy is revolutionary,” Hamilton says. But she says she definitely can’t afford to pay for it.
“Some of the people who need it the most can’t access it,” Robinson said, pointing out that low-income people suffer from obesity at disproportionately higher rates.
“We’re talking about a huge health equity issue,” she says. Black and Hispanic adults have higher obesity rates, according to the CDC.
Since Wegovy was approved by the FDA in 2021, some insurance plans have begun to cover the drugs for people who meet clinical prescribing guidelines. According to the FDA, people are eligible if they have a BMI of 27 or higher and also have at least one “weight-related disease” such as hypertension, diabetes, or high cholesterol. Or they have a BMI of 30 or more, regardless of weight-related conditions.
But insurance coverage is very uneven. Medicare does not cover Wegovy or other weight-loss drugs, and many insurers are following Medicare’s lead. Increasingly, there is pressure to change that. As STAT reported last week, the Moffitt Cancer Center in Florida is pushing for legislation that would allow Medicare to pay for obesity drugs, citing the link between obesity and cancer risk. The NAACP is also registered to lobby on this issue.
Additionally, the American Academy of Pediatrics has new guidelines recommending that pediatricians offer weight-loss medication to adolescents 12 and older with obesity alongside behavior change and lifestyle interventions.
But the fact that people may need to stay on Wegovy indefinitely in order to maintain weight loss has raised concerns about long-term use. The most common side effects of the drug are gastrointestinal symptoms. “Nausea, diarrhea, constipation, vomiting in some people, or heartburn,” Kushner says.
He says starting with a low dose and increasing it over time can help people tolerate the drug better. Research is underway to assess the effect of the drug on the cardiovascular system, which is positive so far.
But the drug carries a black box warning because in rodent studies it caused thyroid tumors. So, Kushner says doctors should screen patients to find out if they have a family history of a specific type of thyroid carcinoma or another rare condition called multiple endocrine neoplasia syndrome type 2 (MEN 2). “It would be a one-on-one conversation with the patient,” Kushner says. Generally, if you don’t have a history of these conditions, “this drug is considered safe,” he says.
If that sounds troubling, it’s a reminder of just how high the stakes are in tackling obesity. The theoretical risk of thyroid tumors can be disconcerting. But doctors point to the risks of not treating obesity: heart disease is the leading cause of death in the United States, and obesity and weight-related conditions are the leading risk factors.
Of course, exercise and diet modification are always the first strategies to try. But given that about 70% of Americans are overweight or obese, nearly half of adults in the United States have high blood pressure, and more than 1 in 3 have pre-diabetes, physician groups cite an urgent need to layer more interventions that may be useful.
“As a society, we spend $173 billion in obesity-related health care costs,” says Dr. Marcus Schabacker, CEO of ECRI, an independent nonprofit group that has reviewed the evidence for new weight-loss drugs.
He argues that drugs can be part of destigmatizing obesity by treating it like any other disease you treat with drugs. “We wouldn’t ask someone with high blood pressure to just exercise and change their diet and they’ll be fine. No, we give them beta-blockers. It’s no different here. L exercise and diet are key elements in the fight against obesity, but so are they.” drugs that have been shown to be effective,” he says.