Diabetes drugs that cause weight loss find plus-size online demand

dietdrug-150x150They’re expensive and often uncovered by health insurance. They’re unfamiliar for now to many doctors, especially those in primary care. But — as expected — patients are hearing a lot about the effectiveness of new prescription medications aimed at treating diabetes and how these drugs have another positive outcome:

They help users lose weight, potentially lots of it.

Now, add in the capacity of the internet to spread information rapidly and quickly. And figure in the growing trend for patients to consult with doctors online and to be prescribed drugs by them via telehealth appointments.

That is why concern is growing among specialists treating obesity and diabetes, as well as patient safety advocates, about the ‘wild West’ distribution and use of “GLP-1 receptor agonists — which, last year, became the first new [federal Food and Drug Administration]-approved chronic weight management drug since 2014,” Stat, a science and medical news site reported. Katie Palmer found this in her reporting about the online crush for drugs with names like Wegovy, Ozempic, Plenity, and Contrave:

“With enthusiasm for a new class of [diabetes / weight loss] drugs has come dozens of telehealth companies ready to prescribe them. Online searches surfaced an ad for Found, a virtual weight loss coaching program that can be paired with a drug prescription for $149 a month. Another pointed to Calibrate, a $1,650, year-long online program that guarantees 10% weight loss with coaching and the prescription of an oral or injectable GLP-1, including Novo Nordisk’s recently approved Wegovy. Other ads tease quick prescriptions: ‘Weight Loss Shots Online – Rx After 15 min Dr. Consult,’ one says. ‘$99 Weight Loss Pills Near You – No Diet or Exercise Required,’ reads another. Tens of thousands of people have gotten online scripts from telehealth companies. On the surface, that’s not a bad thing: Good weight loss support is hard to come by. But experts are growing deeply worried that the rise in direct-to-consumer platforms could harm patients. They see two causes for concern: First, that even well-intentioned companies that pair prescriptions with weight coaching aren’t designed to provide long-term support, leaving chronic disease patients in a lurch. And even more troubling, they say, are the platforms that have seemingly cropped up just to churn out prescriptions for a profit.”

The GLP-1 drugs were developed out of research finding a surprising role for hormones in suppressing appetite and leading to weight loss, which can be significant for patients taking the new medications. Dropping pounds, in turn, can be exceedingly helpful in treating diabetes and reducing other medications and treatments for the chronic disease.

Patients, of course, aren’t focused on medical science. They are hearing about pills they can take to help slim themselves — yeah, sure,  with diet, exercise, and monitoring of other weight-related problems.

And so patients ask: What’s the fast, easy way to get this stuff?

As Palmer reported, quoting Scott Kahan, director of a weight management clinic in Washington, D.C.:

“The world of obesity and weight loss treatments and products have forever been a wild West. While there’s a legitimate core of the field, far more that surrounds it is bogus and nonsense and predatory. And a lot of these telehealth companies, from what I’ve seen, are sort of toeing the line between them.”

Palmer also noted this:

“Virtual weight loss platforms, obesity physicians acknowledge, are the product of a broken system. There are more than 100 million people in the United States with obesity, and only 5,000 specialists. At one Boston-based weight center, the wait list is 4,000 people long. Another is booking appointments out until November. For patients who could benefit from anti-obesity medications, the path to a prescription can be truly odyssean. The shortage of specialists means most patients turn to their primary care office for help. But non-specialists can struggle to navigate a complex web of prescriptions, medication shortages, and insurance coverage for the many classes of weight management drugs.”

While patients may be enticed by taking the new diabetes drugs, off-label, and with the potential loss of 15% of their weight — pounds they have struggled in Herculean fashion before to shed — they also may not be as clued in to some tough reality: Research shows they may need to keep taking the costly drugs or see those problem pounds return, especially if they have not adopted a full, robust regimen of weight control. Bona fide specialists can help patients to not only lose weight with the drugs’ assistance, but also to transition off them, Stat reported. This is a major issue given the medications’ cost and current lack of insurance coverage.

Can telehealth services provide the sustained programs patients need, and not just scripts for pricey drugs? Palmer reported this:

“’ A lot of these [companies], unfortunately, hold the GLP-1s up and sort of dole them out like candy,’ said Kahan. Wegovy is only indicated for people with BMIs that fall in the obese category, or those with BMIs over 27 who have at least one other weight-related health issue, such as prediabetes or high cholesterol. Many virtual weight loss startups, including Calibrate, attempt due diligence before prescribing: asking patients a lengthy list of questions, conducting video intake visits, and ordering blood work to check for undiagnosed metabolic conditions before writing a prescription. And some companies emphasize that GLP-1s are a good fit for virtual prescribing because they have fewer side effects and contraindications than other weight management drugs. But some services provide prescriptions based on nothing more than a glorified Google form, and without careful screening, patients could easily be handed medications that harm them. ‘When you create these conveyor belt treatment programs, I think that’s where you risk more blanket inappropriate care, or really stretching the bounds of what’s medically appropriate,’ said Kahan. There are dangerous drug interactions with many weight-management drugs. And experts said rapid online prescribing could put them in the hands of patients with histories of disordered eating.”

In my practice, I see not only the harms that patients suffer while seeking medical services, but also the damages that can be inflicted on them by dangerous and bankrupting drugs, notably of the prescription variety.

There’s no question that excess weight imperils Americans’ health, contributing significantly to their problems with diabetes, as well as leading killers like heart disease, and cancer. It’s good news that medical science is advancing our knowledge about dealing with the rising problem of diabetes as well as biological processes that affect appetite, food consumption, and weight.

But the quest for pharmaceutical magic solutions always carries big risks. In the 1990s, real harms occurred with the fad prescribing of the weight-loss drug combination nicknamed Phen-fen. In recent years, heavily promoted diet and pound-shedding prescriptions have disappointed and embarrassed doctors and patients, with one notable med having flatulence and explosive diarrhea as unexpected side-effects. Some patients reported in clinical trials of the new diabetes drugs that they experienced nausea, vomiting, abdominal pain, diarrhea, and constipation, causing doctors to discontinue them on the meds.

We have much work to do to ensure the safety, access, affordability, and effectiveness of all prescription drugs, and we have more ways to go to find solutions to the nation’s struggles with excess weight and the medical conditions it fosters.

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