March 29, 2024 – It might be: If you'll be able to't beat them, join them. Commercial weight reduction corporations like WeightWatchers and Noom, which existed before some weight reduction medications became popular, at the moment are offering them to their members.
Providing glucagon-like peptide-1 (GLP-1) receptor agonists akin to Semaglutide (Wegovy) or Tirzepatide (Mounjaro) to the appropriate candidates offers its subscribers as many weight management options as possible, company officials said. They emphasized that their corporations fastidiously screen people and refer people to medical professionals who work with their organizations.
While an educational weight reduction physician praises the role these behavioral weight management programs play in a comprehensive approach, he believes the sequencing is backwards. Instead, individuals with obesity should see a family doctor or a health care provider who makes a speciality of obesity Firstthen get referred to those industrial programs, said Caroline M. Apovian, MD, co-director of the Center for Weight Management and Wellness at Brigham and Women's Hospital in Boston.
“Partnerships like this are important,” she said. “It needs to be a medical treatment program first because the primary event after which a behavioral program [a supplement] – not the opposite way around.”
Brigham and Women's Hospital, for example, refers patients to a behavioral weight management company, Restore Health, to provide the medication.
“I am by no means saying that the behavioral therapy that WeightWatchers and Noom offer is not important. This is extremely important,” said Apovian, who is also a spokesman for the Obesity Society, a professional organization dedicated to the treatment and prevention of obesity.
Bottleneck in primary care?
“In an ideal world, that would be wonderful. “But the truth is that less than 1% of providers are now actually trained to treat obesity,” said Amy Meister, DO, chief medical officer at WeightWatchers.
According to the American Board of Obesity Medicine, there are 8,263 certified doctors in obesity medicine in the USA and Canada. There are more than 1.1 Millions of active physicians in the US alone.
“Many people openly come to us and our competitors because they don’t have access to the traditional brick-and-mortar environment. Access is probably the most important thing we bring to the table – not just access to care, but access to providers who are specifically trained with that expertise,” Meister said.
Noom's chief medical officer echoed this view of the situation. “Family physicians are terribly limited in what they can do,” said Linda Anegawa, MD. Treating obesity requires time, sensitivity and experience. She estimated that most doctors only receive about 10 hours of obesity-specific instruction during medical school and training.
“As a family doctor myself due to my background and training, I cannot emphasize enough how important it is to have a family doctor. I know that many primary care physicians feel unable to address the needs of the patient undergoing obesity treatment. They don’t feel like they have the expertise or training to fully support these patients.”
Most at the same time current CDC estimates show that 42% of Americans are obese, including 9% who are severely obese.
“We finally have effective treatment options. But this is happening against a backdrop of enormous need, demand and costs,” Anegawa said.
The reaction so far
In May 2023, WeightWatchers purchased telemedicine company Sequence, a medical group that can prescribe medications in 50 states and Washington, DC. In December of that year, they founded the WeightWatchers Clinic. Last year, Noom also launched a medical weight management program, Noom Med. The weight-loss telemedicine company Calibrate, founded before these drugs became so popular, now also offers them.
“We actually had a better response than expected,” Meister said. By the end of 2023, 67,000 people had enrolled in the WeightWatchers Clinic program. An estimated 70% of this came from WW's 3.8 million active members or from lapsed members who returned because of the new offerings. “Unfortunately, the diet lifestyle solution just wasn’t enough for her. Now they are meeting with our doctors and nurses to try a medical solution.”
Due to what Kristin Baier, MD, Calibrate vice president of clinical development, calls their extensive screening process prior to enrolling in Calibrate, an estimated 90% of potential candidates who attend their medical appointments are considered eligible for GLP-1 drugs.
Obesity the disease
For many years, obesity was viewed as a lifestyle problem. More recently, it is considered a complex and chronic disease that requires a comprehensive medical approach and personalized treatment. “There is a dysfunction in the energy regulation pathway that leads from the gut to the brain,” explained Apovian. The drugs are analogues of intestinal hormones that our body normally releases when we eat. The hormones “tell the brain that you have eaten enough, that you are full.” So these medications correct the dysfunction of a serious illness.”
Anti-obesity medications therefore have an important role to play, agreed Katherine H. Saunders, MD, an obesity expert at Weill Cornell Medicine in New York and co-founder of Intellihealth, a company that offers virtual medical treatments for obesity. “Most people with obesity are unable to lose significant weight and maintain their weight loss long-term through lifestyle interventions alone.”
Although the GLP-1s are in the spotlight, they are not the whole story, said Saunders, who also serves as a spokesman for the Obesity Society. “It is important to reiterate that treating obesity is not just about one class of medication. There is so much we can do to treat obesity without help [GLP-1s].”
“Because obesity is a complex, chronic disease, treating obesity requires more than just medication to achieve long-term, sustainable results,” Baier said.
That could be good news for people who don't have access to or can't afford these medications.
What about the costs?
GLP-1 drugs are expensive and only covered by a minority of insurance companies for weight control. We asked these companies how they approach the estimated $1,000 to $1,500 per month with their members.
“The cost of medications is a huge problem, but it is just one barrier that prevents people with obesity from receiving life-saving medical treatment,” Saunders said. Other issues include the need to train more clinicians in comprehensive, long-term treatment of obesity, the need for more payers and employers to cover care, and an increase in drug supply to meet demand, she said.
Apovian agreed that the cost can be prohibitive.
“Nobody wants to pay for these medications out of their own pocket, not even people with a lot of money. They cost $1,500 a month and you have to be there forever,” she said.
She predicted that people who want to lose 10 pounds before an event will pay for a few months and expect to gain the weight back after quitting. But she said, “That’s not what these medications are intended for.”
Noom also offers medications “that are less expensive for the patient but can also be effective,” Anegawa said. “This may help maximize the effectiveness of GLP-1 while containing costs.”
Pursuit of insurance coverage
WeightWatchers, Noom and Calibrate each emphasized that they have staff dedicated to providing obesity drug coverage for their members. For example, the companies handle paperwork for prior authorizations and resubmitting denied claims. “That’s part of our secret recipe,” said Meister.
Still, only about 20% to 30% of private insurers cover obesity medications, Apovian said.
“Doctors don’t have the time to deal with prior authorizations,” Anegawa said. Most doctors don't have the trained and equipped staff “to truly follow through on these appeals and denials and take care of the mountains of paperwork. This gives us a singular advantage in prescribing.”
“For most people, it is not possible to pay for GLP-1 out of pocket,” Baier said. “The red tape involved in getting insurance to access these life-changing medications is daunting.”
She said Calibrate makes it easier for its members to access medications by navigating their formularies to find out which GLP-1 medications are covered based on their specific medical history and insurance coverage.
“We must demand better access to our life-saving medicines,” Apovian said. For example, in a clinical trial, semaglutide reduced serious problems in the heart and blood vessels by 20%. “Now…70% of insurance companies do not cover these agents and are denying life-saving medications to patients with significant obesity. That’s a problem, isn’t it?”
Meister said WeightWatchers also helps patients find medications during shortages by calling up to nine area pharmacies or contacting mail-order pharmacies when possible. “If you miss the dosage because you'll be able to't get the medication, sometimes you've to begin over,” she said. “This can be very frustrating for both the doctor and the patient as it impacts their care and outcome.”
“Obesity is a complex chronic disease. It is a treatable disease, but a holistic approach is required,” said Anegawa. “While GLP-1s have been absolutely groundbreaking in therapy for those of us in obesity medicine, they are not a cure. So you really need that anchor in behavior change to, along with medication, help rewire the brain's craving pathways, improve insulin resistance and drive those long-term improvements and health outcomes that we're all looking for.”