Disruption, Discomfort, and Hazards in Obesity

Chaos #2In case you missed it, the framework for obesity care is in the midst of great change. The availability of medicines that actually work to an extent never seen before is causing everyone to question presumptions that researchers and specialists have known to be false for some time. But these great changes are giving rise to disruption, discomfort, and hazards in obesity care.

One of the hazards came into view this week – compounded semaglutide from sketchy sources at a price that seems too good to be true.

Stark Warnings

FDA issued stark warnings about preparations of semaglutide from compounding pharmacies. They noted that some of these contain forms of semaglutide that have never been adequately tested or approved for use in humans. Additionally, FDA noted that the agency has received adverse event reports arising from the use of these preparations.

Mixed Messages

But at least in part, both FDA and the maker of the approved form of semaglutide are responsible for the frenzy that is creating this hazard. First of all, Novo Nordisk has failed miserably to assure an adequate supply. Yes, it’s been hard to forecast, but as they say, that’s why they get the big bucks. The company signed up for doing something hard and now they have to deliver.

There’s nothing like a shortage to make people clamor for something all the more.

Furthermore, both FDA and the company are sending mixed messages about what this drug is for. Is it all about weight loss? Or is it about ongoing health gains from obesity treatment? Presented with something for obesity, consumers are much more cautious and hesitant about using it. An average person sees obesity as a more serious concern. More like diabetes.

But when they frame semaglutide as a weight loss drug, all bets are off. FDA approves these drugs for an indication of “weight management” rather than obesity treatment. The approved label for Wegovy (semaglutide) mentions weight 126 times. Obesity gets only 43 mentions.

It’s little wonder that the public is confused about whether this is a lifestyle drug for weight loss, or a serious medicine for obesity care. Hence all the sensational frenzy, with people clamoring for sketchy knock-offs.

Big Changes in Systems for Obesity Medicine

Beyond the present problem with mixed messaging, more change is coming. Because many millions of people living with obesity are getting the idea that real medical help for their condition is possible. And that brings us to the inevitable disruption and discomfort that is coming to the present systems for obesity care.

Those systems simply don’t work. Experts in medical centers delivering a very high level of care for obesity don’t have the capacity to provide care for all these people. Many of them already have thousands on waiting lists. And most primary care providers are not yet ready to provide good obesity care for these millions of patients. Telehealth models of care might be part of the adaptation that comes.

Another part of the system that doesn’t work is the pricing for these medicines. GLP-1 medicines like semaglutide are presently priced like specialty pharmaceuticals – a high price for very selective use in a very small population. But it’s becoming clear that many millions of people will need these medicines at a much lower price. Even at a lower price, with much higher utilization, this market will be quite profitable. These medicines will inevitably move from specialty pharmaceutical pricing to pricing for a mass market prescription product. Like statins.

Disruption and Discomfort

But getting from here to there will bring disruptions in the order of things for obesity care. That will mean discomfort and, yes, some hazards along the way. We’re already seeing this and there’s much more to come.

Click here for more from the FDA on the hazards of compounded semaglutide and here for more on the need for better access to care for obesity. For more on getting beyond weight and BMI toward understanding the many dimensions of obesity, we recommend this new publication by George Bray.

Chaos #2, painting by Hilma af Klint / WikiArt

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June 3, 2023

One Response to “Disruption, Discomfort, and Hazards in Obesity”

  1. June 03, 2023 at 8:13 am, Angie Golden said:

    This was an excellent review of the state of things! Thank you once again Ted for laying it all out so succinctly!