While weight-loss drugs like Wegovy are being hailed as "weight loss miracles," many people cannot afford to stay on the medication long term—and they often experience "devastating" rebound weight gain when they stop taking it, Allison Aubrey writes for NPR's "Shots."

Barriers to 'weight loss miracles'

Weight-loss drugs like Wegovy and Ozempic have been regarded by many as "weight loss miracles," Aubrey writes. Currently, millions of Americans are eligible take these drugs.

While Ozempic is approved for diabetes, Wegovy is approved for individuals with obesity who have other weight-related conditions that increase their risk of heart disease.

According to FDA, people are eligible to take Wegovy if their BMI is 27 or higher and they have at least one "weight-related ailment," including hypertension, diabetes, or high cholesterol. Individuals are also eligible if they have a BMI of 30 or higher—even if they do not have other weight-related conditions.

However, the high cost of the drugs—which can be around $1,400 without insurance coverage—means many people cannot afford to stay on them long term.

"[I]nsurance coverage is very spotty," Aubrey writes. "Medicare does not cover Wegovy or other weight loss drugs, and many insurers follow Medicare's lead."

And while Novo Nordisk, the company that manufactures Wegovy, offters a $500 coupon to help lower the cost for individuals paying cash, data from GoodRx shows that the lowest out-of-pocket cost among all retailers is still $1,304 per month—a price few can afford.

What happens when you stop taking Wegovy?

When people can't afford to keep taking these weight loss drugs, they often experience rebound weight gain that is difficult to control. According to an April 2022 study published in Diabetes, Obesity, and Metabolism, most people gain back a majority of the weight within one year of stopping Wegovy.

For example, Yolanda Hamilton's doctor prescribed Wegovy because she had an elevated BMI, high blood pressure, and elevated blood sugar. After Hamilton started taking the medication, she lost 60 pounds and started to feel much better.

"It gave me more energy," she said, allowing her to be more active. In addition, she no longer felt sugar cravings, and she felt satisfied from smaller meals. "I was very surprised by how good I felt," Hamilton said.

Initially, her health plan covered the cost of Wegovy. Then, when she changed jobs last fall, her new insurance plan denied coverage. Unable to afford a monthly cost of $1,400, Hamilton stopped taking the drug. A few months later, Hamilton gained back 20 pounds.

"I'm very frustrated about the weight coming back on in so little time," Hamilton said.

According to Aubrey, the prevalence of rebound weight gain after stopping Wegovy is not surprising given how the drug works. Wegovy's active ingredient, semaglutide, is a glucagon-like peptide-1 (GLP-1), which imitates the GLP-1 satiety hormone in our bodies. "When we eat, GLP-1 is released from our intestines and sends signals to our brain centers that control appetite," Aubrey writes.

"This hormone is telling your brain, I'm full, I don't need to eat anymore," said Robert Kushner of Northwestern University, who treats Hamilton.

"What the pharmaceutical companies have done is taken this hormone that is naturally occurring and restructured it into a drug," he explained. So, Kushner noted that it is not surprising that people start to feel hungrier when they stop taking the drug.

"I crave sweets," Hamilton said. In addition, she said her appetite has increased, and she does not feel satisfied with small meals anymore. "I'm losing my energy" as the weight comes back, she said.

While Kushner's office is helping Hamilton appeal the insurance denial, she is worried that stopping the medication will have an impact on her blood pressure and blood sugar while she waits. "She is at risk of having these conditions worsen with regain of weight," Kushner said.

"If I gain more weight, I will be on more medications," said Hamilton.

"We're seeing a lot of patients have this rebound weight gain, and it can really be devastating," said Karla Robinson, a family physician and a medical editor at GoodRx. (Aubrey, "Shots," NPR, 1/30)