ctiveThan Ever


In clinical trials, less than 6% of people discontinued treatment due to side eff ects.


only been possible heretofore with bariatric surgery. And if further trials of retatrutide


continue to produce a 24% weight loss, it could be even more successful. However, because retatrutide is still in phase 3 trials it could be a year or more before it is considered for FDA approval. All the incretin drugs are given


by weekly injection under the skin (subcutaneous). All are given in gradually increasing doses to avoid side eff ects that can include nausea, vomiting, abdominal pain, constipation, and diarrhea. In clinical trials, less than 6% of


people discontinued treatment due to side eff ects.


WHO BENEFITS? The drugs available now are approved for people with a body mass index of 30 or higher. Wegovy is also approved for people with a BMI over 27, if they have hypertension, high cholesterol, or diabetes. The new incretin drugs have been


called the biggest breakthrough in recent medical history because they tackle both obesity and diabetes. Obesity is the most common disease in the world, and obesity


drives an epidemic in Type 2 diabetes. In fact, the combination has been called “diabesity.” However, there is a danger that


this breakthrough may benefi t only the wealthy. According to the FDA, we should expect a year of tirzepatide for weight loss to cost about $13,000. Wegovy is about the same.


WHY COVER DIABETES NOT OBESITY? Part of the reason for diff erent brand names for the diff erent doses is some insurance plans will only cover medication for diabetes, not for obesity. “The insurance company can


then approve the low dose only for diabetes and reject the obesity dose if the policy does not pay for obesity medication,” says Greenway. For many people, including


health insurers, there is still a stigma attached to obesity. They see it as a lifestyle choice, not as a disease. But that is not the view of obesity


researchers and experts. “Obesity is a disease. With lifestyle


changes alone, we see a 3% to 8% total body weight loss. More weight loss is needed to achieve health improvements, like cardiovascular


risk reduction and diabetes reversal,” says Warriner. “Diet and exercise are useful to


help people lose weight, but it is very hard to overcome physiology with behavior over the long term. Thus, medications or surgery that decrease the physiologic level at which the body wants to maintain weight are much more eff ective to maintain a weight loss than is lifelong dependence on diet and exercise alone,” says Greenway.


LOOKING AHEAD Experts believe that as the value of these drugs becomes more obvious and cost eff ective for treating the epidemics of obesity, diabetes, hypertension, and cardiovascular disease, the prices will come down and start to be covered by Medicare and Medicaid. Semaglutide recently became


available for diabetes as an oral drug, called Rybelsus. If oral forms of incretins are as eff ective as injection drugs for weight loss, that will help reduce the price. There are more incretins working


their way through the clinical trial pipeline that should off er more choice and competition and bring down cost. And eventually there should be generic incretins available at lower cost. These drugs will become some


of the most prescribed medications in coming years — and the fi rst real, potent, and safe treatment for obesity.


SEPTEMBER 2023 | NEWSMAX MAXLIFE 77


BACKGROUND/SCALE/ENISAKSOY©ISTOCK


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