Weight loss has been a hot topic for years causing people to search for an easy “cure.” Weight loss can be challenging despite making changes to diet and adding physical activity. Beyond just the overall immediate health, there are many long-term consequences or comorbidities of obesity such as type 2 diabetes, hypertension, heart disease, high cholesterol, major adverse cardiac events (MACE), kidney disease (may require dialysis and transplant), gallstones, cancer (colorectal, uterine, kidney, pancreatic, etc.), sleep apnea, chronic pain and mental wellness. Determining the best way to manage obesity may cause many to wonder when medications are part of solution.1
The World Health Organization (WHO) defines obesity as an abnormal or excessive fat accumulation. A body mass index (BMI) ≥ 25 kg/m2 is considered overweight, and ≥ 30 kg/m2 is considered obese.2 According to the Centers for Disease Control and Prevention (CDC) obesity prevalence is3:
- Children and adolescents (12 – 19): 19.7%
- Adults (20 – 59): 39.8 – 44.3%
- Older adults (60+): 41.5%
With the increase in weight and prevalence, society is looking feverishly for a “magic bullet” for safe and easy weight loss. Many resources are available to achieve a healthy weight including eating a healthy diet, exercising, medications, and procedures.
Overview of GLP-1 Receptor Agonists
Glucagon-like peptide-1 (GLP-1) Receptor Agonists are a class of medications used to treat type 2 diabetes with two of the medications approved for weight loss.
What we know about GLP-1 Receptor Agonists:
- Increase appetite suppression through brain biofeedback
- Increase insulin secretion/sensitivity
- Decrease glucagon secretion
- Decrease gastric emptying
- Increase glucose utilization
*FDA Approved for Weight Loss
GLP-1 RECEPTOR AGONISTS HAVE THE POTENTIAL FOR SERIOUS SIDE EFFECTS THAT COULD RESULT IN DEATH OR HOSPITALIZATION.20
This class of medications should never be used with:
- Personal or family history of Medullary Thyroid Cancer
- Personal history of Multiple Endocrine Neoplasia, type 2
Additional warnings that are reported include:
- Monitor for the development of Thyroid Disease
- Acute Pancreatitis
- Acute Gallbladder Disease
- Kidney Injury
- Increased Heart Rate
- Suicidal Behavior and Ideations
- Retinal Disorders may be worsened
- GI pain or slowness like nausea, vomiting and diarrhea
- Interactions with medications and surgeries
Goals for Long-term Weight Loss and Coverage Decisions
- Medications should only be approved in conjunction with lifestyle changes, including counseling
- When medications are stopped, 100% weight gain may result
- Long term effects from weight loss medications are either not fully understood or are harmful
Best to be used in conjunction with wellness programs and counseling.
Lack of coverage will lead to a risk in weight related diseases.
About the Authors
Makayla Hoke is attending the University of Pittsburgh School of Pharmacy expecting to graduate Spring of 2024. While shadowing here at Complete Captive Management Services, she reviews medical and drug information to apply to the covered lives within each captive to ensure Best Practices are followed at the bes tprice.
Jamie Holowka, BS, PharmD. is the Clinical Strategy & Underwriting Director at Complete Captive Management. She excels at proactively identifying high risk claims under both the specific and aggregate populations and maximizing cost containment solutions.
The content of this informational blog is for general informational purposes only and is not intended to provide medical, health plan or legal advice. No material on this blog is intended to be a substitute for professional medical advice, diagnosis, or treatment, or legal advice. This blog does not address ERISA or other related laws. Always consult a professional prior to making any professional, legal, medical, financial or tax-related decisions.
- Kushner RF. Clinical assessment and management of adult obesity. Circulation. 2012;126(24):2870-2877.doi:10.1161/CIRCULATIONAHA.111.075424
- Obesity. Accessed August 2, 2023. https://www.who.int/health-topics/obesity#tab=tab_1
- Adult Obesity Facts | Overweight & Obesity | CDC. Accessed August 2, 2023. https://www.cdc.gov/obesity/data/adult.html
- White GE, Shu I, Rometo D, Arnold J, Korytkowski M, Luo J. Real-world weight-loss effectiveness of glucagon-like peptide-1 agonists among patients with type 2 diabetes: A retrospective cohort study. Obesity (Silver Spring). 2023;31(2):537-544.doi:10.1002/OBY.23622
- Contrave vs. phentermine: Which is better for weight loss? | SingleCare. Accessed August 2, 2023.
- Drew BS, Dixon AF, Dixon JB. Obesity management: Update on orlistat. Vasc Health Risk Management. 2007;3(6):817. Accessed August 2, 2023. /pmc/articles/PMC2350121/
- Weight Loss Surgery – Does Insurance Cover It? How Much? Accessed August 2, 2023.
- Dulloo AG. Physiology of weight regain: Lessons from the classic Minnesota Starvation Experiment on human body composition regulation. Obesity Reviews. 2021;22(S2). doi:10.1111/OBR.13189
- RACGP – Weight regain after bariatric surgery: Nutritional considerations. Accessed August 2, 2023. https://www1.racgp.org.au/newsgp/clinical/weight-regain-after-bariatric-surgery-nutritional
- Dulaglutide: Drug information – UpToDate. Accessed August 2, 2023. https://www.uptodate.com
- Exenatide: Drug information – UpToDate. Accessed August 2, 2023. https://www.uptodate.com
- Liraglutide: Drug information – UpToDate. Accessed August 2, 2023. https://www.uptodate.com
- Lixisenatide: Drug information – UpToDate. Accessed August 2, 2023. https://www.uptodate.com
- Semaglutide: Drug information – UpToDate. Accessed August 2, 2023. https://www.uptodate.com
- Tirzepatide: Drug information – UpToDate. Accessed August 2, 2023. https://www.uptodate.com
- Bupropion and naltrexone: Drug information – UpToDate. Accessed August 2, 2023. https://www.uptodate.com
- Orlistat: Drug information – UpToDate. Accessed August 2, 2023. https://www.uptodate.com
- Phentermine and topiramate: Drug information – UpToDate. Accessed August 2, 2023. https://www.uptodate.com
- Calculate Your Expected Weight Loss From Gastric Bypass. Accessed August 2, 2023.
- Nachawi N, Rao PP, Makin V. The role of GLP-1 receptor agonists in managing type 2 diabetes. Cleve Clin J Med.2022;89(8):457-464. doi:10.3949/CCJM.89A.21110