HJAR May/Jun 2024

30 MAY / JUN 2024 I  HEALTHCARE JOURNAL OF ARKANSAS POLICY COLUMN POLICY THEWEIGHT-LOSS DRUG BOOM is trans- forming the U.S. healthcare system. Analysts with investment bank Goldman Sachs have projected that by 2030, 15 million U.S. adults will be on anti-obesity medications. 1 Evi- dence has shown that new injectable drugs such as Ozempic and Wegovy can be ef- fective in helping patients lose weight, but their high costs keep them out of reach for many, and their long-term health effects are unknown. Demand for the drugs is particularly high inArkansas, where 37.4% of adults and 23.8% of school-age children are obese. 2,3 Last year, Arkansas was tied with Idaho for the eighth-highest prescribing rate in the nation for the class of drugs known as glucagon-like peptide-1 (GLP-1) agonists, according to an analysis by PurpleLab. 4 Originally developed and approved to treat Type 2 diabetes, GLP-1 agonists mimic hormones that are naturally produced in the gastrointestinal tract and help regulate blood sugar levels, decrease appetite, and slow digestion. Some drugs in this class, such asWegovy and Zepbound, are specifi- cally indicated for weight loss and have been approved by the U.S. Food and DrugAdmin- istration for that purpose. Others, such as Ozempic and Mounjaro, are approved to treat diabetes but can be prescribed off-label to help people lose weight. The drugs’ uses do not end at diabetes and weight loss. In March, Wegovy became the first GLP-1 agonist to be approved for use in reducing the risk of cardiovascular death, heart attack, and stroke. Research- ers have also begun to investigate whether the drugs could be beneficial to people with sleep problems or addiction. A study published in the New England Journal of Medicine in 2021 found that We- govy led to an average weight reduction of 15%. 5 A 68-week study conducted at Penn Medicine and funded in part by drugmaker Novo Nordisk found that participants taking semaglutide, the active ingredient in Novo Nordisk’s Ozempic andWegovy, lost an av- erage of 16% of their starting weight, with a third of the participants experiencing weight loss of 20% or more. 6 Those studies were confined to adults, but some research has examined the effective- ness of GLP-1 agonists in treating childhood obesity. A2022 study funded by Novo Nord- isk found that for adolescents with obesity, a once-weekly treatment with semaglutide in combination with lifestyle intervention — i.e., counseling on healthy nutrition and physi- cal activity — led to substantial weight loss compared to lifestyle intervention alone. 7 Opinions are mixed on whether weight-loss medications are appropriate for children. In January 2023, the Ameri- canAcademy of Pediatrics issued guidance recommending that children with obesity receive intensive treatment as early as pos- sible, including surgery and medication if warranted, along with intensive health be- havior and lifestyle treatment. The AAP did not recommend any specific medications. 8 The U.S. Preventive Services Task Force, however, stopped short of recommending surgical or medication interventions when it issued a draft recommendation in December 2023 calling for comprehensive, intensive behavioral interventions for children and adolescents with obesity. More research is needed on the long-term health outcomes of weight-loss drugs, the task force said. 9 Pregnant women should not take GLP-1 agonists. The prescribing information for Ozempic, Wegovy, and Zepbound note that animal studies suggest the drugs could pose health risks to a fetus. Significant weight loss during pregnancy can also increase the like- lihood of having a preterm birth or a baby who is small for gestational age. The drugs also should not be used if a patient has a personal or family history of thyroid cancer or the endocrine system condition known as multiple endocrine neoplasia type 2, also known as MEN 2. WEIGHT-LOSS DRUGS: What Is Known and Unknown About the New Class of Medication That Is Changing Healthcare