OW2024: Chronic Care for This Chronic Disease Is Compelling

This should not be so hard. New research at ObesityWeek 2024 tells us that chronic care for the chronic disease is truly compelling. Specifically, we are talking about the results of three years of treatment with tirzepatide presented yesterday from the SURMOUNT-1 study. In this study of more than a thousand adults with pre-diabetes, three years of tirzepatide therapy meant that 99% of those treated remained free of diabetes. In fact, 97% of them had a resolution of pre-diabetes. This is a 94% reduction in the risk of progressing to diabetes in comparison to people who received a placebo.

These results are indeed compelling. A full, peer-reviewed publication will appear in the New England Journal of Medicine nest week.

Yet Health Plans Undermine Health

And yet, as Sarah Le Brocq told us in the Presidential Plenary on Sunday, “We offer acute treatment for a chronic condition and that simply does not work.”

In fact, a study by Jenna Napoleone and colleagues at ObesityWeek tells us that access issues are the primary reason persons receiving GLP-1 medicines stop taking them. These issues include cost, loss of insurance coverage, and drug shortage.

This is simply backwards.

Health insurance is supposed to help people in the pursuit of better health. The pharmaceutical firms that developed these amazing drugs did it “to improve the lives of people with chronic diseases.”

So why are they making it harder, not easier, for people with the chronic disease of obesity to continue receiving chronic care for it? Is human greed, part of this picture?

The most dispassionate explanation we can offer is a gap between words and deeds. Everyone speaks of the virtues of chronic care, but they price it out of reach. They erect other barriers through pre-authorizations and the imposition of administrative burdens that frustrate delivery of chronic care. They tolerate years of an inadequate supply chain.

Access to chronic care for obesity at scale is the number one challenge that lies ahead of us. Those who meet it will prosper. Those who don’t will fade.

Click here and here for more on the SURMOUNT-1 study and look for the full manuscript next week in NEJM. For perspective on the equity issues this creates, click here.

Facade Clock in Budapest, photograph by Godot13, licensed under CC BY-SA 3.0

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November 5, 2024