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Modern Solutions for Weight Management: Understanding Anti-Obesity Medications (AOMs)

Information Hub Introduction

Obesity is a complex health challenge that affects millions worldwide with more than one billion people worldwide identified as obese as of 2022 (UN, 2022). Traditional weight loss methods, led by diet and exercise routines, often fall short or have been difficult to maintain. This ineffectiveness has paved the way for modern solutions like Anti-Obesity Medications (AOMs) to spark a revolution in weight management as they offer new hope and effectiveness where diet and exercise alone may not suffice.

 

Why is there a large societal buzz about AOMs? Recent clinical studies and patient testimonials have shown the tremendous effectiveness of AOMs. These medications, as opposed to traditional approaches, target specific physiologic pathways to reduce appetite or increase feelings of fullness (Castro, 2022). The buzz accelerated as the GLP-1 approach demonstrated successful weight loss outcomes, including research showing the average patient losing about 15% of their body weight by taking an AOM weekly for 68 weeks (Wilding et al., 2021).

 

While AOMs offer exciting and potentially life-changing possibilities, it’s crucial to maintain a balanced perspective of both the benefits and limitations. With that in mind, this page provides a balanced, comprehensive perspective of AOMs across the following topics:

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The science and evolution of the AOM craze, including the molecules at the core and the history of AOM development and approval

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A comprehensive and unbiased description of the most popular AOMs, including profiles of each medication, the companies behind them, and their clinical research highlights

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Navigating the reality of access and affordability, including cost implications like insurance and discount programs

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What you need to know about patient safety, including common/rare side effects and an emphasis on consulting healthcare professionals for personal health decisions

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Discover concise insights! The TL;DR section offers a quick rundown of key findings from this packed AOM research page. In just one minute, grasp the answers to pivotal questions explored.

 

Disclaimer: this page is informational only. Consult a healthcare provider before making any decisions on Anti-Obesity Medications

Sources: the information on this page is based on published articles and research. Please see the "MW Sources" link at the end of the page for the full citation of sources used in creating this page.

Background: The Science and Evolution of AOMs

Our background section dives into the science underlying AOM effectiveness. We share the molecules that form the core of these medications and offer insights into how they work. Additionally, we outline the history of AOMs, highlighting key milestones in their development and approval.

 

Molecule History and Use Cases of GLP-1

The scientific breakthrough of Anti-Obesity Medications (AOMs) traces back to the 1980s discovery of a hormone called the glucagon-like peptide 1 (GLP-1) (Park, 2015). GLP-1 responds to food intake and plays a crucial role in regulating blood sugar (glucose) levels and reducing appetite (Surampudi, 2023). This hormone's discovery opened new avenues in medical treatments, particularly in Type 2 Diabetes and Weight Loss.

 

Type 2 Diabetes: GLP-1 quickly garnered attention for its potential in treating Type 2 diabetes. By causing the body to create more insulin, it helps lower blood sugar levels effectively (Knudsen & Lau, 2019). Over the years, GLP-1-based treatments have become a cornerstone in managing Type 2 diabetes, with several medications gaining prominence for their dual benefits on glycemic control and body weight regulation (Knudsen & Lau, 2019).

 

Weight Loss: Subsequent research has also shown that higher levels of GLP-1 can interact with brain receptors, leading to reduced appetite and increased feelings of fullness (Surampudi, 2023). This breakthrough led to the development of GLP-1 medications specifically targeting weight loss and weight management. Clinical trials prove that GLP-1s lead to significant weight loss results when used together with diet and exercise, marking a new era in obesity treatment.

 

Treating a Chronic Health Disease with Anti-Obesity Medications

Obesity, a complex health challenge, is when a person’s weight is higher than what is considered healthy for a given height (NIDDK, 2021) (Wilding et al., 2021). Body Mass Index (BMI) is categorized into ranges:

 

  • Underweight: <18.5 BMI

  • Healthy weight: 18.5 to <25 BMI

  • Overweight: 25.0 to <30 BMI

  • Obesity: 30.0 or higher BMI

  • Severe obesity: 40 or higher BMI

 

Recent data indicated that 42.4% of adults in the U.S. suffer from obesity, with 9.2% experiencing severe obesity (Overweight & Obesity Statistics - NIDDK 2021). Alarmingly, nearly 1 in 5 children and adolescents are obese, with 6.1% classified as severely obese. Obesity is not just about weight; it significantly increases the risk of various health issues like insulin resistance, high blood pressure, cardiovascular disease, Type 2 diabetes, and some cancers.

 

Acknowledging these risks, obesity is a chronic disease and a global health challenge (Wilding et al., 2021). It requires ongoing management and can often lead to other chronic conditions, underscoring the need for effective treatment strategies (Castro, 2022).

 

In this context, Anti-Obesity Medications (AOMs) have emerged as a vital component in combating obesity. These medications work by targeting various mechanisms like appetite suppression and metabolism enhancement, aiding in weight loss and its maintenance (Surampudi, 2023). While AOMs have shown promise, it's important to note that they are most effective when used as a piece of treatment strategy, which includes lifestyle modifications like diet and exercise, and sometimes psychological support (Surampudi, 2023).

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Popular FDA-Approved Medications and Method of Use

The most common and FDA-approved GLP-1 agonist drugs for weight loss, including their brand name, dose, and FDA approval years, are as follows:

  • Semaglutide (Wegovy) (Castro, 2022)

    • Dosage: 2.4 mg injection once weekly.

    • FDA Approval: 2021

  • Tirzepatide (Zepbound) (FDA, 2023)

    • Dosage: injection once weekly. Starts with 5 mg weekly for the first week, then gradually to 10 mg or 15 mg one time per week after four to twenty weeks.

    • FDA Approval: 2023

  • Liraglutide (Saxenda) (Castro, 2022)

    • Dosage: injection once daily. Begins with 0.6 mg daily during the first week, then gradually increasing to 3.0 mg daily starting from week 5

    • FDA Approval: originally approved in 2014 with a supplemental approval in 2020

 

As of January 2024, the FDA has not approved generic versions of GLP-1 drugs (FDA, 2024).

 

For detailed information about these approved medications, including their effectiveness, safety profile, and company information, refer to the “Brands” section below.

 

Trends in Taking GLP-1s

Given the popularity and effectiveness of GLP-1s, coupled with both the high costs and the supply chain struggling to keep up with demand, several new companies have entered the market and accelerated the following trends related to how to take the medications:

  1. Low dose: instead of taking the full dose recommended by the brands, some patients are taking the medication in smaller doses consistently over time in an attempt to lose weight. A few reasons underlying this trend could be the original FDA approval for Type 2 diabetes treatments, the typical starting point for weight loss medication treatments, and dosing strategies as a result of supply chain challenges (Han et al., 2023). For Type 2 diabetes treatment, providers initially prescribed Semaglutide (“Ozempic'' brand name) in conjunction with diet and exercise programs at doses of up to 1 mg weekly. At this dosage, the clinical trials indicated weight loss for Type 2 diabetes patients. For semaglutide prescribed for weight loss in patients who have obesity, the studied and approved dosage is 2.4mg per week after increasing to this amount gradually over 16 to 20 weeks to reduce the gastrointestinal side effects (FDA, 2021). The results of the largest clinical trial for Wegovy included 16 weeks of dose increases, and after 68 weeks of taking Wegovy the average body weight loss was 12.4%. These results indicate the effectiveness of the higher dosage, and we cannot find a clinical trial on the effectiveness of sustained lower-dose GLP-1s. As always, this trend may be due to the consultation and prescriptions from licensed healthcare providers for specific treatment plans.

  2. Compounded GLP-1s: according to the FDA, when a drug is in shortage, manufacturers can make a compounded version meeting certain FDA requirements (FDA, 2023). A compounded drug is made with a combination of mixed or altered ingredients. Compounded drugs are not fully FDA-approved or vetted for safety or effectiveness. Due to the shortage of GLP-1 drugs, both Ozempic (approved for treating Type 2 Diabetes) and Wegovy (approved for treating obesity) are on the FDA’s shortage list as of May 2023, making compound GLP-1s available (FDA, 2024). The FDA recommends using approved drugs when available instead of a compounded drug. Finally, it is important to be aware of the difference between the compounded GLP-1s and potential counterfeit GLP-1s that are fraudulent, illegally marketed, or blatantly unapproved. Check out the FDA’s site for additional topics on compounded GLP-1s and, as always, consult a licensed healthcare provider for consultation.

  3. Oral GLP-1s: there are currently no oral GLP-1s FDA-approved for obesity, however, Rybelsus is an oral GLP-1 approved for type 2 diabetes (Tucker, 2023). This may change in the coming years however as a recent study by Eli Lilly found daily oral use of a nonpeptide GLP-1 receptor agonist called orforglipron associated with weight reduction of at least -10% by week 36 in 46 - 75% of participants (Dunleavy, 2023). These initial results are encouraging and additional clinical trials of pill-form GLP-1 are underway by Novo Nordisk, and Pfizer is also in clinical trials for an oral GLP-1 medication (Pfizer, 2023). Pending trial success, an FDA-approved oral GLP-1 will become available.

 

Benefits and Effectiveness of GLP-1 Anti-Obesity Medications

GLP-1 Anti-Obesity Medications work because they mimic/spark the reaction of the naturally occurring GLP-1 hormone. The wide range of benefits of GLP-1 includes lowering blood sugar and reducing weight, as well as other benefits such as improving lipid disorders and fatty liver disease, reducing heart disease risk, and delaying diabetes-related nephropathy progression (Cleveland Clinic, 2023). The recently approved medications are focusing on weight loss, however, companies are exploring the range of benefits that the GLP-1 hormone provides for the next evolution of these medications (Cleveland Clinic, 2023).

 

GLP-1 medication benefits and effectiveness for weight loss vary based on several factors including starting weight, the specific GLP-1 drug used, and the dosage (Castro, 2022).

 

Strong Results of an Early Study on Semaglutide (Wilding et al., 2021)

  • One study on once-weekly semaglutide (2.4 mg) involving 2,000 obese adults showed an average body weight loss of about 15% after 68 weeks.

  • The study compared participants on semaglutide in addition to a diet and exercise program to those who only followed the diet and exercise regimen.

  • The key findings were as follows:

    • Nearly a third of the participants using semaglutide lost 20% of their body weight.

    • In contrast, adults only incorporating diet and exercise lost about 2.4% of their body weight.

 

FDA Study References:

  • Wegovy: According to the FDA, people using Wegovy lost 12.4% of their initial body weight on average as compared to people using the placebo (FDA, 2021)

  • Zepbound: In a trial for Zepbound, participants on the highest approved dose (15 mg once per week) lost 18% of their body weight on average compared to participants receiving a placebo (Thompson, 2023)

 

These studies highlight the potential high effectiveness of GLP-1 medications in weight management. However, it's important to note that studies show weight regain recurrence after stopping the medication (Surampudi, 2023). This underscores the importance of lifestyle changes for sustainable weight management, including diet and exercise. Dr. Surampudi emphasizes that while anti-obesity medications are a valuable tool, the fundamentals of weight management remain diet and exercise.

 

We recommend consulting with a healthcare provider to determine the most appropriate treatment plan, as these medications may not be suitable for everyone and individual results can vary.

Brands

In this section, we provide an unbiased summary of the FDA-approved GLP-1 anti-obesity medications. This section includes profiles of each medication as outlined on the websites of the companies behind them. Our goal is to present a balanced view, with content mainly pulled directly from that website to aid informed decision-making.

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Saxenda

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Key Sources

Pharmaceutical Company

  • Novo Nordisk

Year Approved

  • 2014 (adults only)

  • 2020 (pediatric patients 12 and older)

GLP-1 Molecule

  • Liraglutide

Indications and Usage: Saxenda® (liraglutide) injection 3 mg is indicated as an adjunct to a reduced-calorie diet and increased physical activity for chronic weight management in:

  • Adult patients with an initial body mass index (BMI) of 30 kg/m2 or greater (obese) or 27 kg/m2 or greater (overweight) in the presence of at least one weight-related comorbid condition (eg, hypertension, type 2 diabetes mellitus, or dyslipidemia)

  • Pediatric patients aged 12 years and older with body weight above 60 kg (132 lbs) and initial BMI corresponding to 30 kg/m2 or greater for adults (obese) by international cut-offs

Weight Loss Clinical Results

  • In a 1-year study in adults, 85% of patients treated with Saxenda® lost some weight

  • In a 56-week study of 3,731 patients without type 2 diabetes and with a BMI ≥30 kg/m2, or ≥27% with at least 1 weight-related comorbidity, patients were randomized to either Saxenda® (n=2,487) or placebo (n=1,244), with all patients receiving a reduced-calorie diet (~500 kcal/day deficit) and physical activity counseling

  • The majority of patients achieved clinically meaningful weight loss of ≥5% with Saxenda

    • 62.3% lost >= 5%

    • 33.9% lost >= 10%

    • ~6% lost >=20%

Limitations of Use

  • Saxenda® contains liraglutide and should not be coadministered with other liraglutide-containing products or with any other GLP-1 receptor agonist 

  • The safety and effectiveness of Saxenda® in pediatric patients with type 2 diabetes have not been established

  • The safety and effectiveness of Saxenda® in combination with other products intended for weight loss, including prescription drugs, over-the-counter drugs, and herbal preparations, have not been established

Side Effects (Most Common)

  • Nausea, diarrhea, constipation, vomiting, injection site reaction, low blood sugar (hypoglycemia), headache, tiredness (fatigue), dizziness, stomach pain, and change in enzyme (lipase) levels in your blood

  • Additional common side effects in children are fever and gastroenteritis

Side Effects (Serious)

  • Pancreatitis, gallbladder problems, hypoglycemia in adults with type 2 diabetes who also take medications to treat type 2 diabetes, hypoglycemia in children 12 years or older without type 2 diabetes, increased heart rate, kidney problems/kidney failure, serious allergic reactions, and depression of thoughts of suicide

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Wegovy

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Key Sources

Pharmaceutical Company

  • Novo Nordisk

Year Approved

  • 2021

GLP-1 Molecule

  • Semaglutide

Indications and Usage: Wegovy® (semaglutide) injection 2.4 mg is indicated as an adjunct to a reduced calorie diet and increased physical activity for chronic weight management in the following:

  • Adults with an initial body mass index (BMI) of ≥30 kg/m2 (obesity) or ≥27 kg/m2 (overweight) in the presence of at least one weight-related comorbid condition (e.g., hypertension, type 2 diabetes mellitus, or dyslipidemia) 

  • Pediatric patients aged 12 years and older with an initial BMI at the 95th percentile or greater standardized for age and sex (obesity)

Weight Loss Clinical Results

  • A 68-week trial of 1,961 adults with obesity (BMI ≥30 kg/m2) or with overweight (BMI 27 kg/m2-29.9 kg/m2) and at least 1 weight-related comorbid condition, such as treated or untreated dyslipidemia or hypertension; patients with type 2 diabetes mellitus were excluded

  • Patients were randomized in a 2:1 ratio to either Wegovy® 2.4 mg or placebo (with a 16-week dose-escalation period), both in conjunction with a reduced-calorie diet (~500 kcal/day deficit) and increased physical activity (recommended to a minimum of 150 min/week)

  • Patients taking Wegovy achieved average ~15% weight loss at 68-weeks

  • The majority of patients taking Wegovy achieved clinically meaningful weight loss

    • 83.5%  lost >= 5%

    • 66.1% lost >= 10%

    • 47.9% lost >=15%

    • 30.2% lost >=20%

Limitations of Use

  • Wegovy contains semaglutide and should not be coadministered with other semaglutide-containing products or with any GLP-1 receptor agonist

  • The safety and effectiveness of Wegovy in combination with other products intended for weight loss, including prescription drugs, over-the-counter drugs, and herbal preparations, have not been established

  • Wegovy has not been studied in patients with a history of pancreatitis

Side Effects (Most Common)

  • Nausea, diarrhea, vomiting, constipation, stomach (abdomen) pain, headache, tiredness (fatigue), upset stomach, dizziness, feeling bloated, belching, gas, stomach flu, heartburn, and runny nose or sore throat

Side Effects (Serious)

  • Pancreatitis, gallbladder problems, hypoglycemia in adults with type 2 diabetes - especially those who also take medicines for type 2 diabetes, kidney problems/kidney failure, serious allergic reactions, increased heart rate, and depression of thoughts of suicide

 

Zepbound

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Key Sources

Pharmaceutical Company

  • Eli Lilly

Year Approved

  • 2023

GLP-1 Molecule

  • Tirzepatide

Indications and Usage

  • Zepbound is an injectable prescription medicine that may help adults with obesity, or with excess weight (overweight) who also have weight-related medical problems, lose weight and keep it off. Zepbound should be used with a reduced-calorie diet and increased physical activity.

Weight Loss Clinical Results

  • Throughout a 17-month clinical trial, people who dieted, exercised (reduced-calorie diet and increased physical activity), and took Zepbound sustained weight loss—whether taking the 5-mg, 10-mg, or 15-mg dose

  • In a 72-week study of adults without diabetes, average weight loss was 15.0% (34 lbs) for 5 mg, 19.5% (44 lbs) for 10 mg, 20.9% (48 lbs) for 15 mg, and 3.1% (7 lbs) for placebo.

  • In a 72-week study of adults with diabetes, average weight loss was 12.8% (28 lbs) for 10 mg, 14.7% (33 lbs) for 15 mg, and 3.2% (7 lbs) for placebo.

Limitations of Use

  • Zepbound contains tirzepatide and should not be used with other tirzepatide-containing products or any GLP-1 receptor agonist medicines.

  • It is not known if Zepbound is safe and effective when taken with other prescription, over-the-counter, or herbal weight loss products.

  • It is not known if Zepbound can be used in people who have had pancreatitis.

  • It is not known if Zepbound is safe and effective for use in children under 18 years of age.

Side Effects (Most Common)

  • Nausea, diarrhea, vomiting, constipation, stomach (abdominal) pain, indigestion, injection site reactions, feeling tired, allergic reactions, belching, hair loss, and heartburn

Side Effects (Serious)

  • Severe stomach problems, kidney problems/kidney failure, gallbladder problems, pancreatitis, serious allergic reactions, hypoglycemia, changes in vision in patients with type 2 diabetes, and depression or thoughts of suicide

Access and Cost

We recognize that access to AOMs can vary. In this section, we discuss how to obtain these medications, considering factors like geographic location, insurance coverage, and income. We also address the cost implications, including insurance considerations, discount programs, and total expenses, to help you understand the financial aspect of AOM treatment.

 

Access: Prescriptions from Licensed Healthcare Providers

 

FDA-Approved GLP-1 Medications (Prescription / On Label)

The only way to access FDA-approved GLP-1 medications (i.e., Wegovy, Zepbound, Saxenda) is by obtaining a prescription from a licensed healthcare provider (Kubala, 2023). Patients obtain prescriptions via either online or in-person provider appointments. In-person consultations can be with primary care physicians, endocrinologists, and nurse practitioners, and these providers can work at general health practices or specific weight loss clinics. During the appointment, the licensed healthcare professional evaluates the individual, makes a decision on the need and health/safety of taking the medications, and determines a treatment plan that works best for the individual.

 

Individuals can also obtain prescriptions for approved GLP-1 medications through some approved telehealth service companies. With this route, individuals meet virtually with US-licensed medical providers for evaluation and treatment determination (Kubala, 2023). Examples of telehealth services that help with accessing these medications, as consolidated by Healthline, are as follows:

  • PlushCare | Weight loss guided by doctors and compatible with numerous insurance providers

  • Sesame | Telehealth platform giving virtual and in-person visits

  • Noom Med | Initially began as a subscription app for tracking eating and exercise habits. Offers an add-on to a psychology-based weight loss app

  • Ro Body | Personal coaching (1-on-1) and weight loss medications

  • Calibrate | Drives sustainable behavior and lifestyle changes through coaching and education

  • LifeMD Weight Care | Weight management via at-home metabolic testing and ongoing support from licensed health care professionals

  • Everlywell Weight Care+ | Weight loss membership program with at-home testing

 

Finally, as of 2023 Weight Watchers, the long-time weight management and fitness program company made popular with their points program, now offers access to GLP-1s via their WW clinic (weightwatchers.com).

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Prevalence of Off-Label GLP-1 Use and Compounded GLP-1s

Note: this section gives an unbiased view of how people access GLP-1s. Consult a licensed healthcare practitioner for access to and use of Anti-Obesity Medications.

 

Recently, Americans have started to access GLP-1 medications “off-label” - meaning they are using the medication for a non-approved purpose - for weight loss (Wehrwein, 2023). This off-label use is especially true of Ozempic (semaglutide), the FDA-approved Type 2 diabetes medication (T2DM), given its research-proven effectiveness in reducing weight. Social media platforms and celebrity influencers popularized off-label Ozempic use (Han et al., 2023). A recent study by the health system Baylor Scott & White Health showed that the proportion of patients prescribed GLP-1s (approved for diabetes) without diabetes increased from 6% in 2018 to 27% in 2022. Although these patients still require a prescription from a healthcare professional, it demonstrates the growing popularity of prescribing off-label GLP-1s for weight loss even for individuals. Although the media widely reports the popularity of off-label GLP-1 use, no full study of off-label medication use has been published to date.

 

Finally, as mentioned in the trends section, patients are getting access to compounded GLP-1 medications. Compounded GLP-1s are custom-made by specialty pharmacies, not the same and/or tested as the branded medications, and only prescribed because of the FDA declaring a shortage for the branded medications (GoodRx, 2023). The FDA does not regulate compounded medications and compounded medications may contain ingredients from unregistered manufacturers.

 

Access: Filing and Receiving the Prescription

Patients fill their GLP-1 prescriptions in a variety of ways, including via pharmacies or direct-to-consumer options.

  • Pharmacy: traditional pharmacies, such as Walgreens and CVS, fill the prescriptions in person and through the mail

  • Direct to Consumer: given the high demand in the evolving market for GLP-1s, companies in the industry are sending the prescriptions directly to consumers (Collins, 2023). A few examples of this are as follows:

    • LillyDirect | Eli Lilly, the maker of Mounjaro and Zepbound, has created their LillyDirect website to send prescriptions directly to patients. The website shares a few benefits to patients from using LillyDirect

      • Gives patients an option to obtain required pharmacy services with online and home delivery

      • Allows patients to skip going to the pharmacy by having their healthcare provider send the prescription to LillyDirect pharmacy solutions to fill

    • Ro | Ro offers weight loss Rx online, which prescribes and delivers to qualified patients. According to their website, they also provide on-demand provider coaching and support

    • Premier Weight Loss | According to their website, Premier Weight Loss is an Indianapolis-based weight loss clinic that consults and provides personalized patient treatment plans. Their weight loss program includes options for direct access to Ozempic, Mounjaro and other brand name medications, cutting out the pharmacy and saving patients money

 

Supply Chain Issues: Trouble Finding GLP-1 Medications and Strategies for Addressing

The increase in demand for GLP-1 medications has resulted in unexpected and wide-spread shortages (Collins, 2023). The demand grew faster than the production forecasts of the major pharmaceutical manufacturers, and supply challenges are leading to global shortages (McCarthy & Cretella, 2023). Supply challenges are predicted to last through 2024 according to the UK, and the FDA has kept GLP-1s such as Ozempic and Wegovy on their shortage list (Mahase, 2024).

 

Both new patients and existing patients are impacted by the lack of supply. While the manufacturers work to resolve their production issues to meet demand, providers have been leveraging a few strategies (Whitley et al., 2023):

 

Alternative Dosing Strategies: lowering the dose amount per injection or spreading out the time between injections

 

Interchanging GLP-1 Medications: using multiple GLP-1 medications in your treatment based on availability. There are several studies underway to test the effectiveness of this strategy

 

These strategies are not the recommended treatment and providers/patients may choose to restart their preferred GLP-1 medications following resolutions to the supply chain issues.

 

In addition to the above provider-based strategies, patients continue to seek their alternative strategies for access. In response, there are social media sites, telehealth clinics, and other clinics that claim to have either commercial GLP-1 medications or compounded medications available to purchase. As mentioned in the section on the “compounding” trend, patients need to realize that compounded GLP-1s are not approved medications and the production sources may be unknown (NCBI).

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Cost

The total patient costs of using GLP-1 medications can be broken down into a few key categories, including healthcare provider consultation costs, ongoing provider programs/visits, and medications. These costs can vary significantly depending on the service provider chosen, the medication prescribed, and the patient's ability to use insurance. For this section, we focus on data on the expected cost range for GLP-1 medications 100% out-of-pocket and with insurance coverage.

 

Out-of-pocket List Prices

Due to the high demand and brand protection of the GLP-1 anti-obesity medications, the average per-month price per patient is typically around $1,000 and can cost even more (Reuters). Example list prices are as follows:

  • Wegovy ($1,349 per month): research by Peterson-KFF showed the list price of one month of Wegovy (15mg) as $1,349 per month as of August 2023 (Krutika Amin & 2023, 2023)

  • Zepbound ($1,059.87): Eli Lilly announced the FDA approval of Zepound (Tirzepatide) for Obesity or Overweight treatment sharing the list price of $1,059.87 (Thompson, 2023)

 

Discount Coupons

List prices do not indicate the typical patient cost due to insurance coverage and discounts. The manufacturers provide discounts via savings programs (“savings cards”) or patient coupons. These discounts can lower the net price by a large percentage of the list price, and here are a few examples by medication:

 

Insurance

Private US insurers are still determining if they will cover the cost of weight loss drugs, and the coverage and cost-sharing details are varying across plans (Ortaliza et al., 2023). Insurers typically do not cover weight loss medications as they still consider them as cosmetic rather than medical treatments (Green & Taddei-Allen, 2023). Under current law, Medicare does not cover anti-obesity medications. The story for employers is very similar - although many cover GLP-1 medications for diabetes treatments, there is still uncertainty, and a range of answers to coverage for obesity treatment (Leo & Mandowara, 2023).

 

As indicated in the above sections, insurance coverage helps lower the list price of GLP-1 medications substantially. The total savings depend on the type of insurance coverage: a few examples of patient costs with insurance coverage, found on a blog on the Dignity Weight Center’s website, are as follows:

  • Patient on Wegovy with Blue Cross Blue Shield: $35 per month

  • Patient on Zepbound with United Health Care: $140 for a 90-day supply

 

Coverage and amount of coverage will vary patient-by-patient and plan by plan.

 

Additional Cost Considerations

Finally, the cost range estimates reflect patients in the US purchasing FDA-approved anti-obesity medications. Outside of the US, the per-patient list cost is between 5 and 10 times less than it is in the US, according to research by Peterson-KFF (Twitter et al., 2023). Further, online telehealth providers marketing compounded and/or commercially viable GLP-1s are claiming to offer lower prices. Given the high costs, supply shortages, pharmacy vs. direct-to-consumer channels, and compounded medications available, patients need to research their options and confirm what’s best for them with their healthcare provider.

Side Effects and Safety

Patient safety is paramount. This section includes the latest side effects and safety research, detailing both common AOM side effects and specific side effects associated with the approved brands. Further, we list the safety risks with AOMs, and as always above anything, emphasize the importance of consulting healthcare professionals for personalized advice and monitoring.

 

Common GLP-1 AOM Side Effects

Like any drug, there are potential side effects with taking AOMs. The common side effects improve over time as you take the drug. As mentioned in the use section, a few of the brands recommend increasing the dosage gradually when you first take the medications for your body to get used to it and to reduce the gastrointestinal side effects (Castro, 2022). With that said, three of the more common side effects according to the Mayo Clinic are as follows:

  • Nausea

  • Vomiting

  • Diarrhea

 

Other side effects to watch out for include dizziness, heart rate increases, infections, headaches, indigestion, and mild itchiness and redness at the injection location.

 

More serious and not common side effects are as follows: (Cleveland Clinic, 2023):

  • Pancreatitis

  • Medullary thyroid cancer

  • Acute kidney jury

  • Worsening diabetes-related retinopathy

 

Safety Risks

Medical professions generally view GLP-1 medications as safe to use (Cleveland Clinic). That said, it is important to consider the risks and have routine check-ins with your healthcare provider when using GLP-1s as the provider can assess the success and any risks. Several risks to be aware of are

  • Allergic Reactions: redness/itching at the location of injections or a major allergic reaction (“anaphylaxis”) resulting in symptoms such as shortness of breath, hives, chest tightness, and more. Call 911 or immediately go to the closest emergency room if you are exhibiting signs of anaphylaxis

  • Pregnancy: GLP-1 medications are not safe to take during pregnancy. Visit or check in with your healthcare provider immediately if you get pregnant while taking a GLP-1 treatment

  • Hypoglycemia: having mild or low blood sugar level episodes is possible while taking the medications, but this risk is more serious for patients also taking a separate drug known to lower blood sugar (e.g., insulin). Symptoms include shaking/trembling, cold sweats, dizziness, weakness, increased heart rate, pale skin, and nausea. Quick treatments for low blood sugar levels include consuming sugar (e.g., apple juice) or carbs (e.g., banana). Without proper treatment, low blood sugar levels can be life-threatening, so patients should watch out for these symptoms carefully.

 

Finally, additional side effects and safety concerns may be relevant for each branded and compounded GLP-1 medication. It is important to check the label/prescription details and discuss side effects with a healthcare provider.

TLDR Topics / Frequently Asked Questions

What are the modern weight loss medications?

  • Categorized as anti-obesity medications or GLP-1 antagonists based on their effectiveness in causing weight loss by mimicking the GLP-1 hormone

What are the benefits?

  • The most popular benefit proven by clinical studies is weight loss (~15% of body weight) in obese and overweight individuals without Type 2 diabetes

  • Additional benefits include decreasing blood sugar, improving lipid disorders and fatty liver disease, reducing heart disease risk, and delaying the diabetes-related nephropathy progression

How do I access them?

  • To receive FDA-approved GLP-1 medications, patients must have a prescription from a licensed healthcare provider received via an in-clinic or online consultation

  • Patients are filling prescriptions via pharmacies or direct-to-consumer channels

  • Due to the high demand stemming from their effectiveness as well as a social media-influenced craze, the supply chain for GLP-1 manufacturing is behind and there is currently a shortage as declared by the FDA. Given this shortage, another popular option is accessing unregulated “compounded” medications from specialty pharmacies. Compounded medications do not have FDA approval

How much do they cost?

  • The FDA-approved medications cost around $1,000 a month for patients before insurance and coupons

  • Given this high cost, the manufacturers are offering savings discounts/coupons to lower the out-of-pocket costs for patients. Example discounts include the following:

    • Zepbound: offers savings cards to patients for 1 or 3-month supplies. Patients with insurance coverage might be eligible to pay as low as $25, and patients without insurance coverage may pay as low as $550

    • Wegovy: provides coupons for a 28-day supply with a maximum of $225 savings for patients without insurance coverage or a maximum of $500 for patients with insurance coverage

  • Many insurers are not covering GLP-1 medications prescribed for obesity treatment currently, and the few that are covering the medications do not cover the full cost of the medications. Check with your insurance provider for detailed information

  • Medicare does not cover GLP-1 medications for obesity treatment currently 

Are there any side effects?

  • Yes, documented side effects include nausea, vomiting, and diarrhea

  • Less common and likely side effects are pancreatitis, thyroid cancer, acute kidney injury, and worsening diabetes-related retinopathy

  • Other side effects include dizziness, mild increased heart rate, infections, headaches, indigestion, and mild itchiness and/or redness at the location of injections.

  • Patients having immediate reactions to the medications need to contact 911 or go to an emergency room immediately

  • Patients should routinely check in with their healthcare provider to asses their treatment and discuss risks and side effects

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