A “Magic Bullet” Cure for Weight Loss

August 21, 2023
  • Magic Bullet Cure for Weight Loss

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

Treatment Options for Adults (always include lifestyle modifications)

Generic Name
(Brand Name)		 Administration
Type		 % Weight
Loss4-7		 % Rebound Weight
Gained After Stopping Medication8,9		 Estimated Yearly
Price10-19
BMI ≥ 25 kg/m2 with weight related problems
Lifestyle
Modifications		 Guidance on
daily caloric intake
and physical activities		 Depends on eating
and lifestyle habits		 Depends on eating
and lifestyle habits		 $0 – varies
BMI ≥ 30kg/m2 or ≥ 27 kg/m2 with weight related problems
Dulaglutide
(Trulicity®)		 Injections ≥ 5% within
72 weeks		 66% > $13,200
Exenatide
(Bydureon®)
(Byetta®)		 Injections ≥ 5% within
72 weeks		 66% $12,000
Liraglutide
(Victoza®)
(Saxenda®)*		 Injections ≥ 5% within
72 weeks		 66% >$14,300
Lixisenatide
(Adlyxin®)		 Injections ≥ 5% within
72 weeks		 66% $9,600
Semaglutide
(Ozempic®)
(Wegovy®)*
(Rybelsus®)		 Injections
Oral		 ≥ 5% within
72 weeks		 66% >$10,800
Tirzepatide
(Mounjaro™)		 Injections ≥ 5% within
72 weeks		 66% >$13,200
Bupropion/Naltrexone
(Contrave®)		 Oral ≥ 5% within
56 weeks		 100%
unless lifestyle
changes are made		 $2,250
Orlistat
(Alli®)*
(Xenical®)*		 Oral ≥ 5% within
12 weeks		 100%
unless lifestyle
changes are made		 $212.40-$3,600
Phentermine/Topiramate
(Qsymia®)*		 Oral ≥ 5% within
12 weeks		 100%
unless lifestyle
changes are made		 $2,600-$2,900
Stimulants Oral Varies 100%
unless lifestyle
changes are made		 Varies
BMI ≥ 40 kg/m2 or ≥ 30 kg/m2 with weight related problems
Lap Band Surgery 70% of
excess weight		 ≥ 30 after
10 years		 $14,500
Sleeve
Gastrectomy		 Surgery 70% of
excess weight		 ≥ 30 after
10 years		 $14,900
Roux-en-Y
(Gastric Bypass)		 Surgery 70% of
excess weight		 ≥ 30 after
10 years		 $15,000-$30,000

*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
  • Pregnancy

Additional warnings that are reported include:

  • Monitor for the development of Thyroid Disease
  • Acute Pancreatitis
  • Acute Gallbladder Disease
  • Hypoglycemia
  • 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

Formulary Considerations

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.

Disclaimer:
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.

References:

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  2. Obesity. Accessed August 2, 2023. https://www.who.int/health-topics/obesity#tab=tab_1
  3. Adult Obesity Facts | Overweight & Obesity | CDC. Accessed August 2, 2023. https://www.cdc.gov/obesity/data/adult.html
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  10. Dulaglutide: Drug information – UpToDate. Accessed August 2, 2023. https://www.uptodate.com
  11. Exenatide: Drug information – UpToDate. Accessed August 2, 2023. https://www.uptodate.com
  12. Liraglutide: Drug information – UpToDate. Accessed August 2, 2023. https://www.uptodate.com
  13. Lixisenatide: Drug information – UpToDate. Accessed August 2, 2023. https://www.uptodate.com
  14. Semaglutide: Drug information – UpToDate. Accessed August 2, 2023. https://www.uptodate.com
  15. Tirzepatide: Drug information – UpToDate. Accessed August 2, 2023. https://www.uptodate.com
  16. Bupropion and naltrexone: Drug information – UpToDate. Accessed August 2, 2023. https://www.uptodate.com
  17. Orlistat: Drug information – UpToDate. Accessed August 2, 2023. https://www.uptodate.com
  18. Phentermine and topiramate: Drug information – UpToDate. Accessed August 2, 2023. https://www.uptodate.com
  19. Calculate Your Expected Weight Loss From Gastric Bypass. Accessed August 2, 2023.
    https://www.obesitycoverage.com/weight-loss-surgeries/gastric-bypass/how-much-can-i-expect-to-lose
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