Transforming Weight Management with Breakthrough Medications

By Dr. Kate Cabral, PharmD, BCCP, FACC

Over the past two years, weight management medicines have taken center stage in headlines and social media channels. From revolutionary injectables for weight loss to nationwide medication shortages, even celebrities endorsing these treatments, the coverage has been extensive. Recent headlines have brought attention to lawsuits involving 'stomach paralysis,' a term used to describe the slowing down of the gastrointestinal tract. Additionally, newer pill versions of the well-known drug Wegovy (or Ozempic) have been introduced, showcasing the rapid evolution in the field.

But what's all the hype about?

Enter Semaglutide, initially approved by the FDA as Ozempic for Type 2 diabetes back in 2017. Observing weight loss as a side effect led to further studies in non-diabetic patients. The results were remarkable – when combined with lifestyle changes including exercise and diet, patients on this medication lost an average of 15% of their body weight within a year. As a result, in 2021, the medication gained approval for weight loss under the name Wegovy. It's indicated for patients with a BMI ≥ 30 or those with a BMI ≥ 27 and at least one weight-related comorbidity.

This marks the first instance of a highly effective weight loss medication that also offers cardiovascular benefits. Notably, the SELECT trial recently reported a 20% reduction in major adverse cardiovascular events (cardiovascular death, nonfatal heart attack, and stroke) for non-diabetic patients on semaglutide for weight loss, up to 5 years out. This medication, along with others in its class, is reshaping the landscape of obesity treatment by mitigating cardiovascular risk factors and other associated risks.

While this class of medications is generally well-tolerated, their most common side effects are gastrointestinal (GI) related, as they slow down gut motility due to their mechanism of action. Consequently, they may not be suitable for everyone, and results and tolerability can vary from patient to patient. We recommend discussing with your healthcare provider to determine whether a weight loss medication could be a suitable option for you.

At Capital Cardiology Associates (CCA), our Healthy Life Initiative provides comprehensive integrated weight management services, including dietitians, health coaching, clinical pharmacists, the Capital Bariatric team, surgeons, and an obesity board-certified doctor. We endorse a personalized, multidisciplinary approach to weight management that may include medications, particularly when combined with diet and exercise, producing the best weight loss outcomes.

Are these medications accessible to you?

Due to their high effectiveness and general tolerability, demand for medications in this class has surged nationwide, leading to medication backorders and shortages over the past 1.5 years. These shortages persist locally, and there may be delays in obtaining the medications from your pharmacy. Furthermore, recent regulatory changes in insurance coverage have added another layer of complexity. Insurance plans may exclude 'weight loss' medications from their formularies (similar to Medicare and Medicaid), and typically do not cover medications indicated for diabetes (such as Ozempic, Mounjaro, and Victoza) without a documented lab-proven diabetes diagnosis. Some local insurance providers have recently discontinued coverage for Ozempic, Mounjaro, and Victoza unless the patient has a type 2 diabetes diagnosis. For those without insurance, these medications can cost around $1200 per month on average.

If you're intrigued to learn more or want to explore these medications, we encourage you to reach out to your cardiologist or healthcare provider. Additionally, contacting your insurance company can help determine whether your plan covers weight loss medications.

What's on the horizon?

While not currently available, this class of medications is expected to expand within the next five years. Several related medications within the same class are undergoing research and development. Tirzepatide, approved as Mounjaro for diabetes, has been studied in comparison to semaglutide for weight loss, demonstrating an impressive average weight loss of 22.5% of body weight over 72 weeks. This positions it as one of the most effective weight loss medications, with approval for weight loss indication anticipated within the next year. Furthermore, three other injectables are in the early stages of research, all showing promising results.

In terms of oral options, a recent study presented at the 2023 American Diabetes Association Sessions found that higher doses of oral semaglutide (currently available in low doses as Rybelsus) were as effective in weight loss as the injectable formulation. Tolerability was also comparable to the injectable version. Another oral pill, orforglipron, has also displayed early efficacy in weight loss.

Research indicates that even a 5-10% reduction in body weight can lead to improved blood pressure and cholesterol levels, subsequently decreasing the risk of cardiovascular disease. With new evidence pointing to a direct reduction in cardiovascular death, heart attack, and stroke with these medications, it is our hope that insurance companies will acknowledge their value in enhancing patients' overall well-being and amend their coverage policies accordingly.

For those interested in our weight management program, feel free to contact us at CCA to schedule an appointment or discuss with your cardiologist during your next visit. At CCA, our Healthy Life Initiative offers extensive information about our integrated weight management services, including dietitians, health coaching, clinical pharmacists, the Capital Bariatric team, surgeons, and an obesity board-certified doctor. We remain dedicated to providing comprehensive care that enhances your quality of life, even as we embrace these groundbreaking medications in our approach.

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