The latest generation of weight management medications has sparked new questions about chronic obesity treatment. It is easy to get distracted by sensationalized headlines (read our breakdown of these headlines here) or feel overwhelmed by the growing pipeline of weight management medications waiting in the wings. Understanding how to effectively harness these medications is important if we are going to reduce the prevalence of chronic obesity and other obesity-related chronic conditions.

In our conversations with leaders across the healthcare ecosystem, we’ve heard some common questions. We walk through five of these questions, along with our response, below.

Question: Why should I pay attention to these medications? Isn’t our current approach enough?

Answer: The latest generation of medications are powerful agents that cause weight loss and improve other health factors (e.g., reducing glycemia) for patients who need it.

Comprehensive lifestyle management (i.e., diet and exercise) is always the first line of treatment for weight management. Even if the number on the scale doesn’t move, people can still experience health benefits from eating a balanced diet and engaging in regular physical activity.

Nonetheless, history has demonstrated that lifestyle modifications alone haven’t always yielded clinically meaningful weight loss. Weight loss is often difficult to achieve for the average person because the body has a natural desire to defend a previous body weight. This is where the latest generation of weight loss medications can help. Currently, the FDA has approved Novo Nordisk’s Wegovy® for weight loss management. Medications like this are useful when lifestyle modifications alone don’t work but weight loss remains a health goal. Given the benefits of both lifestyle modification and weight management medications, healthcare leaders should integrate both approaches from a care delivery standpoint.

Question: Will everyone eligible for these medications take them?

Answer: No. While the potential population of patients eligible for these medications is vast (approximately 70% of adult Americans are living with obesity or considered overweight), not everyone who falls into the eligible population of patients will ultimately take the medications.

In 2019, before Wegovy® hit the market, only 1.3% of eligible patients were prescribed an anti-obesity medication. While the hype is certainly high for these new medications, it’s unlikely we’ll see an exponential increase in utilization rates. Factors that may limit utilization include health plan coverage, the cost of the medication, supply chain issues, side effects, and weight bias.

Importantly, not everyone who qualifies to take these medications wants to lose weight. Many patients seeking treatment for chronic obesity just want to “be healthier” so they can do the things they love to do. Those things may include playing with their kids, walking around the block without getting tired, or generally having more energy and feeling better within one’s body. For these patients, taking a medication may not be their preference or the recommended approach. Providers should operate with a lens of acceptance and help patients accomplish their own set of unique health goals. Together, the patient and provider should develop a treatment plan that addresses the patient’s long-term health goals.

Question: Will people stay on these medications for the rest of their lives?

Answer: Not necessarily. Duration of treatment with these medications is highly individualized. Every person’s approach to weight loss will look different because of their individual genetics, metabolism, resources, and environment (such as access to healthy foods and safe places to exercise).

Current adherence rates further confirm that not everyone will remain on these medications for the rest of their lives. Prime Therapeutics, a pharmacy benefits manager, reported that 32% of members taking GLP-1s for weight loss were adherent at one year, and only 27% were adherent to the therapy thereafter. Upon discontinuing these medications, most individuals experience some degree of weight regain, along with the return of some other metabolic conditions.

Healthcare leaders need to prepare for this discontinuation by having an intentional approach to weight maintenance support for patients. Supporting weight maintenance is critical for preserving health benefits gained from treatment. Approaches may include moving patients to lower doses, shifting to lower cost weight management medications, or partnering with virtual health vendors that support weight maintenance. Investing in weight maintenance also values the time and effort of patients who put in the work to lose weight, providers who prescribed and administered these medications, and payers who provided coverage for these medications.

Question: Will these medications solve the obesity epidemic?

Answer: These medications are not the silver bullet nor a definitive solution to the obesity epidemic, but they are poised to make a big impact. They are one additional tool in the toolbox for providers looking to help patients achieve clinically meaningful weight loss, and potentially treat the downstream health issues that may be exacerbated by obesity. Importantly, treating chronic obesity and achieving better health outcomes doesn’t require patients to lose half their body weight. Even smaller amounts of weight loss (5-10%) can yield substantial overall health benefits. The perception that all people need to be thin to be healthy, or that all patients on these medications are trying to achieve thinness, is exaggerated by the media and should be examined with a critical lens towards underlying weight bias. The goal of weight management medications is not to eliminate obesity through weight loss alone but rather to treat a chronic disease and reduce obesity-related comorbidities.

How we define obesity is critically important to answering this question. Many medical societies define obesity based on body mass index (BMI). BMI is also the main indication for the Food and Drug Administration (FDA) label for approved weight management medications. While BMI can be an appropriate screening tool and easily accessible health metric, this metric isn’t always the best indicator of health status.

Recently, the American Medical Association has voted and recommended that BMI be considered holistically with other health-related factors when treating chronic obesity. Accordingly, despite the broad label, other risk factors (such as percentage body fat, elevated liver enzymes, and other metabolic markers) should be considered when prescribing the medication.

Question: What’s next? What should I be doing in response to these medications?

Answer: Healthcare leaders should consider several action steps when deciding how to approach these new chronic weight management medications at their organizations.

• Determine your organization’s goals and how weight management medications can support those goals. Are you looking to provide better options for patients who want to lose weight or lower their glucose levels? Are you trying to improve patient outcomes or lower long-term costs as part of value-based care efforts? Are you trying to offer a more comprehensive or competitive benefit package?
• Invest in training on weight management medications, including the risks and benefits as well as how to best monitor for adverse events. Providers have been prescribing weight loss medications for years; however, newer medications likely require a training refresher. Providers will need clear clinical guidance to determine which patients are the best candidates for weight management medications. Providers would likely benefit from education on proper titration, negative side effect management, and drug-to-drug interactions. Health plans and pharmaceutical manufacturers should consider how they can best partner with providers to help provide these supports.
• Address weight bias in healthcare to reduce its impact at the point of care. Weight bias is common, particularly in healthcare. Providers and payers alike may not acknowledge chronic obesity as a complex disease, or falsely assume their patients just want to be thin in order to achieve their health goals. Different strategies to address weight bias can include professional development workshops to promote education and evoke empathy.
• Develop a plan for medication discontinuation and sustained weight maintenance. The reality is that most, if not all, patients will at some point discontinue their medications. Providers, health plans, and pharmaceutical manufacturers can help support those patients by ensuring that weight management supports are in place before patients stop treatment. Perhaps it means utilizing behavioral and nutritional support services or leveraging telehealth and virtual-first care. This plan will likely require some experimentation and partnerships. The evolving weight management landscape means healthcare leaders need to gather and analyze data to continually assess, monitor, and weigh these programs against their earlier goals.