Kristina M. Thurber, Pharm D., R.PH., specializes in obesity pharmacotherapy management at Mayo Clinic. In this discussion, she highlights the alarming obesity epidemic in the U.S. and the role of GLP-1 agonists in weight loss and diabetes management. Kristina explains how these medications work, their potential impact on weight loss expectations, and economic challenges facing patients. She also advocates for a holistic approach to obesity management, combining medication with lifestyle changes and emphasizes the importance of communication in patient care.
GLP-1 agonists effectively support weight loss by enhancing insulin production and suppressing appetite, but should complement lifestyle changes.
The high monthly cost of GLP-1 medications significantly limits accessibility for many patients, highlighting the importance of comprehensive weight management strategies.
Deep dives
Role of GLP-1 Agonists in Obesity Management
GLP-1 agonists have emerged as a significant option in managing obesity by supporting weight loss alongside traditional methods like diet and exercise. These medications function through various mechanisms, including stimulating insulin production in the pancreas and suppressing appetite through effects on the brain's appetite regulatory center. They also slow down gastrointestinal motility, which helps individuals feel fuller for longer periods. While these medications can assist in weight loss, they are not a standalone solution and should be part of a comprehensive weight management strategy that includes lifestyle changes.
Efficacy and Expected Weight Loss
Patients using GLP-1 agonists can expect notable weight loss, with clinical trials indicating an average reduction of about 5% to 18% of baseline weight depending on the specific medication. For instance, liraglutide typically results in a 6% weight loss, while semaglutide has shown an average loss of 10-12%, and the newer agent, trisepitide, may lead to significant drops of 12-18%. This weight loss is often sustained over longer periods, as studies generally span from one year to one and a half years. Understanding the percentage of baseline weight loss rather than absolute pounds can help patients set realistic expectations.
Cost and Accessibility Challenges
The financial component of GLP-1 agonist treatments poses a significant barrier, with monthly costs reaching approximately $1,000 to $1,200 for those without insurance coverage. Insurance approval can vary widely, with many commercial providers requiring prior authorization or limiting coverage primarily to those with a BMI of 30 or more, or 27 with related health issues. Unfortunately, Medicare does not currently cover weight loss medications, which particularly affects patients seeking assistance for obesity. This high cost underscores the need for a multi-faceted approach to weight management that incorporates lifestyle changes along with medication, to ensure more sustainable results.
Obesity in the U.S. is reaching epidemic proportions. Managing our overweight patients has been challenging, with few being able to adopt and adhere to a healthy diet and exercise program. There is a class of medications that improves blood glucose in type 2 diabetics and in most cases also results in significant weight loss. These medications are known as glucagon-like peptide 1 or GLP-1 agonists. A substantial number of patients are taking these medications, some for management of diabetes but for many others, the weight loss they produce. How do these medications work to produce weight loss? How much weight loss can patients expect? How much do they cost and most importantly, are these medications the solution to obesity as a health problem? In this podcast, I’ll be discussing these questions with my guest, Kristina M. Thurber, Pharm D., R.P.H., a pharmacist at the Mayo Clinic as we review “Obesity Pharmacotherapy Management”.
Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.
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