Ozempic, an FDA-approved injectable drug for Type 2 diabetes, continues to make headlines for its off-label use in weight reduction. And when more than 73% of adults age 20 or older struggle with being overweight or obese, it’s no surprise a drug touted for quick, dramatic weight loss results would spark interest.
“GLP-1 RAs [glucagon-like peptide-1 receptor agonists] have been around more than 15 years for diabetes,” says Brian Johnson, MD and Regional Vice President of Clinical Leadership at Marathon Health. “They’ve been amazingly safe and effective at reducing appetite and helping manage diabetes. Newer forms are seeing more dramatic weight loss results, and they’ve become highly sought after.”
But should doctors prescribe these medications for weight management? It comes down to the patient and what has or hasn’t worked for them thus far.
What Are GLP-1 Medications?
GLP1s RAs are a class of medications used to help treat type 2 diabetes and obesity. According to the Mayo Clinic, the drugs mimic the naturally occurring GLP-1 hormone and stimulate the body to produce more insulin after someone eats to help lower blood sugar levels. The drugs curb hunger by signaling a feeling of satiety (fullness).
In a randomized control trial of two groups over 68 weeks—one taking weekly semaglutide injections and the other receiving a placebo—the group that received the drug lost 33.73 pounds on average, compared to 5.73 pounds in the placebo group.
Viewpoint: Helping Employees Manage Obesity and GLP-1 Medications
Weight Loss Treatment Benefits from Holistic Approach
It’s important to note both groups in the trial mentioned above also participated in lifestyle interventions throughout the 68 weeks.
“I don’t think anybody wants to rely on a pill or a medication long-term if they really step back and think about it,” Johnson says. “And certainly if they’re paying out of pocket, there’s a cost-effectiveness and return-on-investment ratio.”
GLP-1 medications come with a hefty price tag, whether the user or employer is footing the bill. GoodRx shows a one-month supply of Ozempic costs around $1,000. And many pharmacy benefit managers deny coverage. “Some of the PBMs are offering utilization management, prior approval processes and programming to make sure these medications are only being used for patients with diabetes, or under strict parameters,” Johnson adds.
Marathon Health’s obesity guidelines recommend thorough evaluation of the patient and treatment from a lifestyle-first approach. This includes screening for depression, assessing comorbidities and evaluating side effects of any medications the member currently takes. Recommended lifestyle changes could be improving sleep hygiene or reducing sedentary time.
“The focus is on working with our health coaches, behavioral health specialists, and the patients themselves to find out what they want to achieve, then encouraging them in those first steps,” Johnson says. “If they aren’t achieving results, then we may use FDA-approved medically assisted weight loss treatments.”
While the brand name Ozempic or oral semaglutide Rybelsus aren’t FDA-approved for weight loss, an injectable semaglutide is approved under the name Wegovy. Bariatric surgery is another option.
Advanced Care Models Support Lifestyle Modification
“GLP-1 therapies carry a high lifetime expense to employees while not really addressing the root causes of obesity,” says Eric Neuville, Marathon Health VP of Market Development. “Volume-based, fee-for-service primary health care systems seem to have very little clinical approach other than prescribing GLP-1s at a patient’s request.”
An advanced primary care model, which focuses on quality of care over quantity of services, uses a holistic approach as a best practice. “Obesity is recognized as an illness, not a moral failing,” Johnson says. “It has multiple input factors, from genetics to social and cultural influences, even related to other prescription medications a patient may be taking.”
Marathon Health employs health coaching, behavioral health services, support programs and chronic condition programming to assist members in their weight-loss journeys. This approach is supported by providers being able to spend time with their patients and personalize treatment plans.
“Today, I have what I call the luxury of adequate time in that exam room with a patient to dive more deeply into the root causes, develop a strong relationship of trust and deliver a great patient experience that can help us discover the patient’s underlying motivators,” Johnson says. “Then, I can help them take actionable steps through behavioral or lifestyle changes to improve their wellness.”