144. The Semaglutide Breakthrough: Why It's Time to Prioritize Coverage for Weight Loss and Heart Health

Check out this month's News Bite! We've got all the news you need to stay on top of nutrition, weight loss and health and wellness.

Speaking of health and wellness, are you a person living with, or caring for, obesity? Are you curious about the effects of prejudice and stigma on weight loss? Have you heard about the groundbreaking study revealing an astonishing reduction in cardiovascular risk due to Semaglutide? This is a conversation that's vital to anyone impacted by obesity, whether directly or indirectly. 

Semaglutide is a new medication that has been shown to significantly reduce cardiovascular risk and aid in weight loss. In this episode, Health Bite's Dr. Adrienne Youdim provides an in-depth analysis of the latest research on this drug, including its effects on physical and psychological health, its association with weight loss drugs, and its role in obesity stigma. This is an essential episode for anyone who is interested in the topic, lives with obesity, and is aware of the prevalence of obesity-related bias and stigma.

Here’s What You’ll Learn From this Episode:

• Oral Semaglutide on revolutionizing cardiovascular protection
• Weight loss data for oral semaglutide 
• Discover why obesity stigma goes beyond affecting mental and physical health, as it becomes inseparable from the conversation about weight loss drugs.
• Reasons why anti-obesity drugs are stigmatized. Find out the challenges of accessing anti-obesity medications due to insurance coverage issues and their wider implications.
• ...and more

“...for once have a medical treatment for obesity [semaglutide] that is effective and can result not only in weight loss, but also in reduction of cardiovascular events. That is striking.” 

-Dr. Adrienne Youdim

Recommended Podcast Episodes:

• 131. Food, Fun, and Freedom from Fear of Eating
• 136. Heart-Centered Healing for Health and Wellbeing with Cardiologist Jonathan Fisher
• 137. Mindful Aesthetics with Holistic Plastic Surgeon Emily Hartmann
• 138. Mind-Body Approach to Pain and Mobility/Revolutionize Your Recovery with Dr. Helen Porat

Ways that Dr. Adrienne Youdim Can Support You

1. Join the Monthly Free Mind-Body Workshops: Participate in engaging mind-body practices designed to help manage your stress response. Register here.
2. Sign Up for the Newsletter: Stay updated with valuable insights and resources by subscribing to the newsletter. Sign up here.
3. Freebie alert. Register for our monthly free MindBody Workshop and receive a downloadable guide on emotional labeling to help you manage your emotions effectively.

Connect with Dr. Adrienne Youdim

• Website :https://www.dradriennespeaks.com/
• Instagram: https://www.instagram.com/dradrienneyoudim/

Transcript

Welcome to this month's News Bite, where I talk to you about the latest headlines in nutrition, weight loss, health and wellness in the news. And this month, there was big, big news for Semaglutide, including a study that showed huge cardiovascular risk reduction. 

Also, we saw data on weight loss results for an oral formulation of Semaglutide. And we're going to talk about why obesity stigma not only impacts physical and mental health, but also is inseparable from this conversation of weight loss drugs as well. 

So if you're living with obesity or know someone who has obesity, if you're on Semaglutide or are interested in Semaglutide, or if you're interested in learning the deep rippling effects of obesity bias and stigma, then this episode is a must listen. 

Welcome back to Health Byte, the podcast for small actionable bites towards healthy living. If you're new to this podcast, head over to the show notes and grab your actionable bite towards healthy living. I'm going to send you five bites to fast track you into the practices that will help you achieve greater mental, physical and emotional health and wellbeing. The ones that I often discuss with you on this podcast and with my patients in my medical practice every day. I'm your host, Dr. Adrienne Youdim, and I'm excited to share with you this week's bite.

 So first up, big, big, big news about Semaglutide, the drug known as Ozempic and Wegovi and the heart. 

As you've heard me say many times before, obesity is not a cosmetic issue.

Unfortunately, we continue to view it this way in our culture, which impacts our perceptions about medications, who and why we should prescribe, and which is why this study is so very important. But first as a backdrop, I want you to consider this. In the years 2017 to 2020, nearly 42% of the US population was considered to have obesity with a total of nearly 74% classified as being either overweight or having obesity. 

Now if you're curious about your BMI, you can Google BMI calculator, plug in your weight and height and figure it out for yourself. But I want you to keep this in mind. There are limitations. For example, BMI does not adjust for age, race, ethnicity, body composition, and so there are a lot of critics of this way of determining excess weight. That being said, it is a measure, and the number gives us a sense for a person's degree of excess weight. A BMI of 25 to 29.9 is considered diagnostic of overweight, and a BMI of 30 or greater is diagnostic for obesity. 

And it's projected that by the year 2030, every one in two US adults is expected to have obesity. And this is important because it isn't cosmetic, because we know that the likelihood for certain diseases, including cardiovascular disease, in particular cardiovascular disease, rises as individuals that have obesity. The corollary to that is that with effective weight loss interventions, we can reduce the risk. And that is why it is so important to have this conversation. 

It is so that we can acknowledge where we can limit our risk of having diseases so that we can live full, vibrant, and healthy lives. 

To date, no medical intervention has shown a reduction in cardiovascular events, in large part because non-surgical weight loss interventions like diet and exercise and the medications that we've had so far have been unable to provide true, durable weight loss. That is until now. And the weight loss that is seen with Semaglutide is really unprecedented. Studies show that an average weight loss of 15% can be achieved, and this results in a reduction in blood pressure, in blood sugar, in blood lipids, aka cholesterol, all known contributors of cardiovascular disease. 

So knowing this, researchers set out to see if, in fact, users of Semaglutide could take the additional step of not only reducing their weight and their cardiometabolic risk factors, but actually cardiovascular events themselves. So in a large study, they took adults age 18 years or older who had either a BMI of 30 or greater, so diagnostic of obesity, or a BMI of 27 or greater with one or more obesity-related comorbidity, like known heart disease, hypertension, dyslipidemia, or abnormal cholesterol, and obstructive sleep apnea. 

All diseases that we know increase in incidence in individuals who have or are diagnosed with obesity.

Of note, they excluded diabetics, and as you know, these drugs are also approved for diabetes. So they really wanted to tease out, do these medications help at-risk individuals who don't have diabetes? And that's important because, again, the spin out on the street is that only diabetics should be given this medication. So based on these criteria, they estimated that 93 million adults in the US would qualify based on the criteria above. They showed that, or determined, that nearly 42 million people could be expected to have the 15% or more weight reductions that we see with these drugs. And 51.8 million could be expected to see the greater than 10% weight reductions that we see with this drug. Again, this is already demonstrated. And it would result in a reduction of obesity in the population by over 46%. This is indicated into 43 million people who are no longer living with the condition of obesity if they were, in fact, prescribed Semaglutide. And those numbers, in of themselves, are pretty dramatic. Taking this information and applying it to cardiovascular risk models, they estimated that 8.4 million events would occur in individuals who weren't taking Semaglutide, so were not, compared to 6.9 million individuals who were on treatment, meaning that the use of Semaglutide would result in an estimated reduction of up to 1.5 million cardiovascular events in the US. 

That's a relative risk reduction of nearly 18% over a 10-year period. The public health implications of this data is huge. And this is also why we need to talk about expanding coverage of these drugs. By proving to insurance companies that the cost of treating obesity with a drug like this is significantly less than the cost of treating the heart attack or the stroke. Not to mention the human cost and toll of these diseases, is exactly what it's going to take to make these life-saving medications more accessible. That's not to say it's for everyone. That's not to say it's for anyone. 

But once again, we for once have a medical treatment for obesity that is effective and can result not only in weight loss, but also in reduction of cardiovascular events. That is striking. 

Now, speaking of what is coming up in the pipeline, let's talk about oral Semaglutide. As you know, the Semaglutide that we've been talking about so far that's approved for obesity as Wegovi and even the one that's approved for diabetes as Ozempic is an injectable.

But oral Semaglutide does exist. And in fact, it's been available for years as a treatment option for diabetes. But a recent study showed its efficacy as an anti-obesity agent. Now, one thing to keep in mind is that the currently available dosing for diabetics is small, 3, 7, and 14 milligrams, whereas the dose study for weight loss or in the weight loss trials was 50 milligrams. One of the reasons why it's very hard to use this oral agent off label for weight loss. However, those who took oral Semaglutide for over a year had a 17.4 percent weight reduction. That's an average of approximately 40 pounds in 16 months. Wowzers. Again, these numbers for weight loss medication are quite striking. This medication is yet to be approved for obesity, but again, something to watch for. 

And I think that right now, the landscape of anti-obesity medications is so bright and there's so much to be hopeful for in terms of agents that are safe and effective to treat obesity. 

So with all this talk about drugs, it's hard to ignore the elephant in the room. Access. As I already alluded in this podcast and in prior podcasts, insurance coverage of these medications is limited. It has been even more so in the past few months. In the past month, even as a provider myself, I have noticed so much pushback in terms of insurance companies paying for these medications on patients in mind who are justified to use these drugs on labels. So all kosher prescribing practices in appropriate candidates who were doing well and are now seeing the medication yanked out of their hands. 

And in fact, insurance companies have tightened their grip across the board. In fact, an article came out in Healthline earlier this month that shared that Essentia, one of the largest healthcare systems in the US, has stopped coverage on all anti-obesity drugs as of July 2023, as did University of Texas healthcare system. And they stated that in the month of May, coverage for these drugs cost them $5 million in just one month compared to the $1.5 million that it cost them a year and a half ago. 

So cost is definitely an issue here. But you know what? So is stigma. So is weight bias and weight stigma. 

Imagine if payers all of a sudden decided to stop paying for all drugs treating hypertension. Or if a payer decided to suddenly stop paying for all drugs treating cancer. It's just unheard of. It doesn't matter how expensive they are. You would never hear of an entire class of medications no longer being accessible to our population. 

And if you're thinking that bias does not exist, then there are studies to prove you wrong. 

Weight stigma and weight bias is prevalent in all spaces of our society, including education, employment, and also sadly in healthcare. 

In this area, stigma results not only in poor psychological outcomes such as depression, such as depression, anxiety, even suicidality, but also results in not abnormal, but in negative physical health outcomes. 

For example, adolescents who reported mistreatment on the basis of their physical appearance or on their bodies had elevated ambulatory blood pressure all throughout the day. Think about that. A child or an adolescent exposed to bias or mistreatment on the basis of their body had high blood pressure all day long. And as we've discussed, hypertension is a known risk factor for heart disease. And finally, obesity bias contributes to the prescribing of weight loss medications and to the receptability of the patients themselves. So doctors are not prescribing and patients are not receptive. 

These biases and stigmas must be named and must be acknowledged if we're going to be in a society where obesity is effectively treated like any other chronic medical condition. 

So I want you to take that in because even if you're not a provider and not necessarily responsible for the treatment of people who've been diagnosed with obesity, remember that implicit bias exists. And we do take our biases out there into the world in the way that we treat each other, in the way that we treat loved ones, in the way that we interact in our workplace, educational spaces, and all other domains. 

So if there's one thing that I can impart to you on this week's bite is to really, without judgment and without self-condemnation, be open to where and how your own biases exist, even if you have obesity yourself. And understand that that bias not only impacts the mental and emotional health of ourselves and our neighbors, but the physical health of them as well. 

And that's my take on this month's News Bite. As I said before, head over to the show notes and grab your actionable bite towards healthy living. And don't forget to like, share, and subscribe. I'm so happy to have had you here with me this week. Until next time, stay healthy, stay active, and stay mindful. I'll see you then.