Places with Wealth-Based Access to Diabetes and Obesity Care

Portrait of Adolphe BaslerWriting for the New York Times, Joseph Goldstein tells us that prescriptions for GLP-1 agonists are going to the wealthiest, whitest, and healthiest neighborhoods in New York City. Neighborhoods where the medical need is greatest? Not so much. Though we might hope that advanced medicines for obesity and diabetes would go to places with the most medical need, wealth seems to be a more potent driver of access.

Prescriptions by Zip Code

The Times commissioned Trilliant Health to conduct this analysis of prescription dispensing in New York, broken down by neighborhoods. The prescriptions they examined were for Ozempic, Wegovy, and Mounjaro. Only Wegovy is approved for obesity. The approved indication for Ozempic and Mounjaro is type 2 diabetes. But Ozempic gets plenty of use for obesity because it has the same active ingredient as Wegovy, albeit at lower doses. Mounjaro has shown remarkable effectiveness for obesity, but this indication is still under review at the FDA.

Overall, Goldstein found less than two percent of the city’s residents were using any of these medicines. Compare that to 14% of adults using a drug to lower their cholesterol. Utilization of these medicines seems especially low when we consider that obesity and overweight affects the health of well over half of adults.

Only in the wealthier, healthier, and whiter neighborhoods of New York did utilization exceed two percent. Analysts found stark disparities in utilization where the need is greatest:

“In some parts of Brooklyn, by contrast, where diabetes and obesity are far more prevalent, the usage rate of these medications was just over half of what it was in affluent parts of Manhattan, according to that analysis.”

Wealth and Health, Obesity and Diabetes

We have healthcare systems that make disparities in access to care for obesity and diabetes almost inevitable. Obesity medicine physician Beverly Tchang was not surprised by these findings:

“I think we all knew that these medications were going to worsen healthcare disparities in the short term just because of how they are priced and covered. This is a systemic problem, not human problem.

“We should take a step back and recognize that the two percent uptake of these medications is dismal, given the rate of obesity.”

So for anyone who needs and is receiving care with advanced medicines for obesity and diabetes, that’s great. But we agree with Priya Jaisinghani, an endocrinology and obesity specialist who told Goldstein:

“My hope is in the future, this is more accessible to those who really need it.”

Click here for the reporting in the New York Times, here and here for further perspective.

Portrait of Adolphe Basler, painting by Moise Kisling / WikiArt

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August 27, 2023

3 Responses to “Places with Wealth-Based Access to Diabetes and Obesity Care”

  1. August 27, 2023 at 9:54 am, Angie Golden said:

    I am unsure what is meant by “who really need it”. I agree that these medications should be available to all people that have obesity and diabetes if they need them, but this is implying that those who are getting it now are not “needing” the medication. Do they not have diabetes and obesity just because they are white and have higher incomes? I think what this should be telling us is that it should not be available ONLY to those zip codes but to all who need it and not implying that folks getting it now are not the ones who “really need it”, their disease could be severe – we don’t know one way or another. Let’s work to make this available to all our patients!

    • August 27, 2023 at 11:04 am, Ted said:

      You are asking a good question, Angie, because too often this is presented in terms of who has the greatest need. I see this as a plea to open up access to care for communities where the need is great but the access is poor. This should not and need not be a zero sum exercise where one person’s access to care comes at the cost of denying care to someone else.

  2. September 01, 2023 at 8:22 pm, Shaun Chavis said:

    I can confirm through personal experience this is true in the Atlanta metro as well. I live in an older Black middle class neighborhood, average household income $55K, and the national pharmacy chain closest to me has had Ozempic on back order for months. When I ask, they say they don’t know when they’re going to get it.

    It just didn’t make sense that no locations of this store had Ozempic in a city as large as Atlanta. So I decided to call the location in Buckhead, average household income $157K. Their response: “We have your dose in stock.”