Obesity affects 41.5% of Americans age 60 and older.1 This chronic, life-changing condition has been linked with heart disease, type 2 diabetes, and certain types of cancer—not to mention a lower quality of life.
Despite what the diet and fitness industries would like you to believe, losing weight is not always a matter of willpower. Rather, there are often physiological reasons that make it harder for some people to reach and maintain a healthy weight.
"It's a brain disease," said Dr. Fatima Cody Stanford, an obesity medicine physician at Mass General Hospital and associate professor at Harvard Medical School, on a recent episode of 60 Minutes. "And the brain tells us how much to eat and how much to store."
If you’re living with obesity and have tried diet and exercise with limited success, weight loss medications could give you an added boost. There are six drugs approved by the FDA to treat obesity; five of these are approved for long-term use. These drugs work in different ways to make weight loss more achievable.
Who qualifies for weight loss medication?
Weight loss medications should not be taken solely for the sake of appearance. They’re meant for people who struggle with health problems due to being overweight or having obesity. Your provider may prescribe medication if you have a body mass index (BMI) of 30 or greater, or if you’ve been diagnosed with a condition related to your weight—such as type 2 diabetes, high blood pressure, heart disease, or sleep apnea.
Not all people with a high BMI should take weight loss medications. Many adults are able to lose weight successfully by improving their diet and adding more physical activity to their routine.
What are the newest anti-obesity prescription drugs?
There is a new generation of safe, effective weight loss drugs shown to help people shed significantly more weight than previous medications.
Approved by the FDA in 2021, semaglutide (Wegovy) is a GLP-1 receptor agonist delivered via subcutaneous (just under the skin) injection. This class of drugs was originally created to treat type 2 diabetes. Semaglutide works on appetite centers in the brain, helping a person eat less food and still feel satisfied. This weight loss medication also reduces feelings of hunger. In a clinical trial, subjects who received a weekly injection of semaglutide lost an average of 15% of their total starting body weight.2
Another newer weight loss medication is liraglutide (Saxenda). While once indicated only for people with type 2 diabetes, liraglutide was approved for chronic weight management without diabetes in 2014 and expanded to adolescents in 2020. Like semaglutide, liraglutide works by decreasing appetite and helping you feel fuller for longer. A trial of liraglutide with more than 3,700 participants showed an average weight loss of 8%.3
The FDA is expected to approve an additional weight loss drug in 2023: tirzepatide. Tirzepatide is also an injectable GLP-1 agonist and has been shown to be highly effective for losing weight.
Is medication to treat obesity a good idea?
There is no "magic pill" or injection to cure obesity. Understanding the pros and cons of weight loss medications can help you make an informed decision about taking them.
Pros
Weight loss medications should not replace smart eating habits and exercise. However, when combined with healthy lifestyle changes, these drugs could help you treat your condition, improve your health, and lose more weight in the long run. One study showed that some people taking prescription weight loss medications were able to achieve and maintain a loss of 10% or more of their starting body weight.4
Why is this good news? Shedding even 5% of your weight can help lower blood pressure and blood sugar, reduce triglyceride levels, ease joint pain, and improve sleep. That means weight loss medications have real potential to provide relief and improve overall health for millions of older Americans.
Cons
All weight loss medications—both newer and older versions—come with the risk of unpleasant side effects. Side effects may include:
- Dry mouth
- Dizziness
- Insomnia
- Oily stools
- Abdominal pain
- Headache
- Nausea
- Vomiting
- Diarrhea
- Constipation
While side effects are usually mild and temporary, some people may experience more severe complications that impact their ability to function. That’s why it’s important to discuss the risks vs. benefits with your health care provider before starting any drug regimen.
How do I talk to my doctor about weight loss medication?
Learning to be your own advocate can help you get the high-quality obesity care you need. Start by asking questions at your next checkup:
- What is my ideal weight and/or BMI?
- Could a health problem or current medication be causing me to gain weight?
- How will weight loss improve my health?
- Do I qualify for weight loss medications?
- Are weight loss medications safe for me to take?
As a person with obesity, you should know and understand all the treatment options available to you. If you feel your doctor is not listening to your concerns, or that they don’t take obesity seriously as a chronic disease, it may be time to find a new provider. You deserve to feel seen and heard.
Are obesity drugs covered by insurance?
Some insurance plans cover anti-obesity drugs while others, such as Medicare, outright exclude them (see what Medicare covers for obesity treatment here). Lack of insurance coverage can prevent many people from accessing the full continuum of care for obesity. The newer injectable drugs have a high out-of-pocket cost. For example, the retail price of Wegovy (semaglutide) is around $1,626 per month according to GoodRx.
If you’re considering medication, it’s a good idea to contact your insurance carrier to see what your plan covers, if anything.
What if insurance won’t cover my weight loss medication?
Your doctor prescribed a weight loss medication, and you're feeling hopeful—until you get a denial from the insurance company. While this can be frustrating, here are some tips on how to move forward.
- Ask your provider to advocate for you to your insurance company. They can often make a more compelling case for coverage than you could on your own.
- Appeal the insurer’s decision. You generally have 180 days to file an appeal. Have your insurance card handy and call the customer service line to get the process started. Keep a log of all conversations.
- Explore other ways to manage the cost. If you are unable to get your insurer to cover the cost of weight loss medication, there may be alternative ways to ease your out-of-pocket expenses:
- Check with the drug manufacturer to see if they offer any savings coupons.
- Request a discount card from GoodRx or SingleCare, which both offer prescription drug savings of up to 80% at most U.S. pharmacies.
- Ask your provider if they offer low- or no-interest payment plans.
- Speak out. Contact your state Senators and House of Representatives member and urge them to pass the Treat and Reduce Obesity Act (TROA). This bipartisan bill includes expanded Medicare Part D coverage for obesity, including FDA-approved medications for chronic weight management. Learn more at ObesityAction.org.
Sources
1. Adult Obesity Facts, U.S. Centers for Disease Control and Prevention. Found on the internet at https://www.cdc.gov/obesity/data/adult.html
2. Once-Weekly Semaglutide in Adults with Overweight or Obesity, The New England Journal of Medicine. Found on the internet at https://www.nejm.org/doi/full/10.1056/NEJMoa2032183
3. A Randomized, Controlled Trial of 3.0 mg of Liraglutide in Weight Management, The New England Journal of Medicine. Found on the internet at https://www.nejm.org/doi/full/10.1056/nejmoa1411892
3. Anti-obesity drug discovery: advances and challenges, Nature. Found on the internet at https://www.nature.com/articles/s41573-021-00337-8
Your Right to Quality Obesity Care
Obesity is the most prevalent and costly chronic disease in the United States, remaining largely undiagnosed and untreated a decade after the American Medical Association classified it as a serious disease requiring comprehensive care.
