7 May 2022 | New Scientist | 49“ Once people
start taking
it, they will
probably
need to do
so forever”
Semaglutide is approved by the FDA for
people who are obese, with a BMI of 30 or
more, as well as individuals with a BMI of 27
and up – considered overweight – who also
have a weight-related health condition, such
as diabetes, high blood pressure, osteoarthritis
or sleep apnoea. When prescribed, it should
coincide with lifestyle changes like exercise
and calorie-restrictive diets, says Kushner.
“Obesity is a public health issue that requires
a widespread public health response,” he says.
Since semaglutide is relatively new and was
only approved for use in weight loss last June,
it is too soon to know its true effectiveness.
A trial looking at the change in body weight
of 304 people given the drug or a placebo over
two years is already under way. Some of those
who work on obesity have been prescribing the
drug regularly. So far, anecdotally, “the effects
from the trial are being reproduced in my
patients”, says Kushner.
Even so, not everyone responds in the
same way. “While some patients achieve
a 15 per cent or more weight loss, some
only achieve a 3 per cent reduction,” says
Stanford. “There’s high responders and low
responders and those low responders may be
better suited for some of the more traditional
anti-obesity medications.”Sara Novak is a science
journalist based in
South CarolinaLifestyle changes
are still important
for those taking
weight-loss drugsThen there is the cost. At around $1500 per
month, the drug is out of reach for most people
in the US. Although there are hints it may be
covered by the various parts of the National
Health Service in the UK, it hasn’t yet been
approved there.Heavy cost
Given the global cost of high BMI, estimated at
$990 billion per year, a drug that could prevent
obesity in high-risk people could be worth the
cost. But for insurers to get on board, we must
not only be sure of its safety and efficacy, says
O’Neil. We will also need to eradicate antiquated
stereotypes around obesity. Many still view
obesity as a condition caused by a lack of
willpower. Research has shown that people
of all ages and professions look at people with
obesity in a negative light. “We still, as a society,
make assumptions about people based on
their weight,” says O’Neil. “The world can be
very cruel to those with severe obesity.”
Perhaps the biggest reason why the US state-
funded healthcare programme Medicare and
most private insurers in the country aren’t yet
covering the cost of these drugs is due to the
sheer number of people who could benefit.
“The market for these medications is just
so big and if we cover them, it could cost a
fortune,” says Geoffrey Joyce at the University
of Southern California. Even so, it isn’t out of
the realm of possibility. Bariatric surgery is
now covered by Medicare at $25,000 per
procedure (see “Pills vs surgery”, left).
For Rhinehardt, the cost has been the biggest
challenge. “My [insurance] plan will pay for
[gastric] band or gastric bypass surgery twice,
but not Wegovy, even with the results I’m
experiencing,” she says. It remains to be seen
whether she can scrape together enough cash
to stay on the drug that she thinks may save
her life. “I want to live a long and healthy life,
and I have a better shot at both if I achieve a
healthy-range BMI.” ❚MI
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