Newer medications to treat diabetes and obesity are saving lives, but a recent study from the Yale School of Public Health and the University of Florida found that those who need the injectable drugs the most, were the least likely to get them.
The drug semaglutide, sold as Ozempic and Wegovy, is marketed as a treatment for diabetes, but can also be used to treat obesity.
Semaglutide, and the drug tirzepatide, which is in the weight-loss medication Zepbound and the diabetes drug Mounjaro, are what’s known as glucagon-like peptide-1 (GLP-1) receptor agonists.
These drugs help lower blood sugar levels to control type 2 diabetes. They can also lead to weight loss. While Ozempic is approved for diabetes, it is also prescribed off-label for weight loss. Zepbound was approved solely for obesity.
But high prices, exceeding $1,000 per month without insurance, can restrict access to these drugs, said Alison Galvani, a professor at the Yale School of Public Health.
Medicare — one of the largest insurance programs for older adults — does not cover these drugs for weight loss. Medicaid in Connecticut also does not cover the drugs for weight loss. Writing in “Proceedings of the National Academy of Sciences,” Galvani and her co-authors say private insurance also often imposes high deductibles and copays, further restricting access to the drugs.
“Currently, about 8,000 deaths are being averted [because of the GLP-1 medications],” Galvani said. “However, if access were expanded to all who are eligible, more than 42,000 lives could be saved each year.”
But for people of some races and in rural areas, access can be further restricted.
“And this gap is especially alarming, given the disproportionate burden of diabetes and obesity among economically disadvantaged populations,” she said.
CDC data sounds alarm over obesity
Data for 2023 from the Centers for Disease Control and Prevention, released this September, found that in 23 states, more than 1 in 3 adults had obesity. Currently, at least 1 in 5 adults in each U.S. state is living with obesity.
"This new data highlight the need for obesity prevention and treatment options, which start with building healthier communities where people of all ages have safe places for physical activity, and where health care and healthy food options are accessible and affordable for all," said Dr. Karen Hacker, with the Centers for Disease Control and Prevention, in a statement.
Obesity treatment can also include obesity medications, such as GLP-1s recently approved by the U.S. Food and Drug Administration, combined with health behavior and lifestyle interventions, according to the CDC.
Weight-loss injectables could combat ‘a silent killer’
Obesity is a public health problem, Galvani said.
“It acts as a silent killer, increasing inflammation in the body and exacerbating mortality from a multitude of causes, including cardiovascular disease, cancer and type two diabetes,” she said. “It's even a risk factor for heightened severity of flu and COVID.”
The GLP class of drugs “are a blessing in the field, showing a marked improvement in weight loss and control of A1C [blood-glucose levels],” said Dr. Varalakshmi Venkatachalam, associate professor of medicine at UConn, and a primary care physician who specializes in obesity management.
“I want to prevent diabetes, but even [many] private insurers do not cover weight loss specifically and patients without diabetes are not getting these drugs,” she said.
Venkatachalam is relocating to California to start an obesity and lifestyle medicine program in the primary care division at Stanford University School of Medicine.
“These medications should be widely available regardless of insurance status,” she said. “There are now studies looking at CKD [chronic kidney disease] improvement as well as [better] cardiac outcomes.”
