Reasons Why Rx Weight Loss Drugs Aren’t Still in Demand
It should not come as much of a surprise to learn that the costs that obesity imposes on the health care system in the United States amount to close to $150 billion yearly when you consider that more than a third of adult Americans are overweight.
The Centers for Disease Control and Prevention (CDC) has not released any new data since 2009. According to some other estimates, the total price will be significantly higher, and it is projected that this trend will continue (1).
However, less than one percent of those $150 billion is spent on prescription pharmaceuticals that are licensed to treat obesity. These prescription weight loss drugs are only available through doctors’ orders. In spite of the fact that the long-awaited approval of two more recent anti-obesity therapies, Belviq and Qsymia, has resulted in an increase in sales, neither of these medications is even remotely close to being a blockbuster (2).
IMS Health, a worldwide information, services, and technology organization, estimates that the overall sales of anti-obesity pharmaceuticals in the United States in 2013 amounted to around $114 million. This figure was derived from the total sales of all anti-obesity medications in 2013. To put it into perspective, the total revenue earned by the sale of diabetic drugs in the United States was around $22 billion. There is a connection between having excessive body fat and type 1 diabetes (3).
Experts in the field of obesity point the finger at a variety of problems that contribute to the poor sales of the therapies, including the lack of training for doctors on how to manage obesity, concerns about the safety of the medications, and a lack of insurance coverage for the treatments (4).
When it comes to obesity prevention and treatment, we’re still relying on the same strategies, says Dr. Steven Smith, MD (the head of Obesity Society, a scientific organization).
It’s bad that we’ve been taught that willpower can be used to solve difficulties like this. Diet and exercise alone are often ineffectual in the treatment of obesity, according to Smith. The great majority of fat people, according to Smith, need anti-obesity medication, but only a small number of people are actually prescribed it. Contrary to popular belief, there has been little change in the number of persons who are actually obtaining prescriptions (5).
When it comes to dealing with obesity, he says, doctors are far more likely to suggest lifestyle changes such as eating less but getting more exercise or recommending weight-loss surgery than they are to prescribe medication. The Translational Research Institute for Metabolism and Diabetes, housed at Florida Hospital in Orlando, was founded thanks to Smith’s initiative. The institute’s first scientific director, Smith also holds this position (5).
For the most recent anti-obesity drug on the market in the United States, Smith was involved in all phases of clinical testing for Belviq. In the United States, Belviq is the most recent anti-obesity drug to hit the market. There is a clear chasm between the two sides. It came up during a meeting with the FDA’s advisory committee while he was representing Arena Pharmaceuticals, the company responsible for its production. We are not currently educating the medical profession on how to deal with obesity in a high-volume clinical practice setting at this time (6).
According to IMS Health, sales of pharmaceuticals designed to combat obesity came extremely close to doubling between the years 2011 and 2013. This is despite the fact that sales of these treatments aren’t exceptionally high. In September of that year (2012), a brand-new drug for weight loss known as Qsymia was made available on the market for the very first time in the preceding 13 years. Belviq became available in June 2013 (6).
The Food and Drug Administration (FDA) has given its approval for the use of these medications to treat people who are obese, which is defined as having a body mass index (BMI) of 30 or higher, as well as people who are overweight but have at least one weight-related condition, such as type 2 diabetes or high blood pressure, and whose BMI is at least 27. In addition, the FDA has given its approval for the use of these medications to treat people who are obese, which is defined as having a body mass. In the month of June, it was anticipated that the Food and Medicine Administration (FDA) would approve another weight-loss drug known as Contrave; however, the government delayed a decision by three months. It would like to continue discussing how to monitor the effects of the treatment on the heart once it is available on the market (6).
In the two clinical trials that led to the Food and Drug Administration’s approval of Qsymia, participants who were given the recommended starting dose of the drug lost 6.7% more weight over the course of a year than those who were given a placebo tablet. This difference was statistically significant. People who were given the highest dose of the medicine were able to lose 8.9 percent more body weight in one year than those who were given a placebo. This difference in weight loss was observed across all doses of the medication (6).
In the three clinical trials that led to the approval of Belviq by the FDA, participants who took the medicine for up to one year on average lost 3 percent to 3.7 percent more body weight than those who got a placebo. These results were consistent throughout all three studies. Both of these medications are prescribed to be used by a doctor in conjunction with making changes to one’s lifestyle, including decreasing the amount of food one eats and increasing the amount of exercise one does (7).
Phentermine was not taken off the market where it could be purchased. It is also one of the two components that make up Qsymia, the other component being topiramate, which is a medication that is also used to control seizures and prevent migraines. Together, these two components work to prevent migraines and manage seizures (6).
Phentermine is an amphetamine-like stimulant that has similar effects. Apovian says it’s more likely than Qsymia or Belviq to cause anxiety, palpitations, and sleeplessness. On the other hand, phentermine costs only eleven dollars for a month’s supply. When she heard the news, she made the following statement about how it clarifies everything (7).
After receiving their prescriptions for free for a period of two weeks from the pharmaceutical companies that distribute Qsymia and Belviq, patients are eligible for a reduction of $75 off the list price of each 30-day prescription that is filled. However, people still wind up paying anywhere from $100 to $200 out of pocket for their healthcare each month, as stated by Apovian. Believe what I say when I claim that they have shared with me the expense that it entails for them (7).
The medical history of the patient’s family, as well as any other medications the patient is currently taking, are taken into consideration by Apovian when prescribing a medication to a patient. Qsymia or Belviq, depending on the patient’s ability to pay. As previously said, there are times when you should use the first approach and times when you should use the second (5).
When it comes to treating people, it appears that the treatments she uses have the same positive impact on their health as they did in the research. She adds that it’s difficult to keep patients on the treatment for more than a year because of the exorbitant expense (6).
Reduced Hunger and Weight Loss
One of Apovian’s patients, Versey Bell, age 29, took Qsymia for one month before she was forced to stop taking it because the cost of the medication was not covered by her health insurance, and she was unable to pay for it herself. Apovian was unable to help her because she was one of the company’s patients. However, after a few more months had gone, Bell’s financial situation began to improve, and she started making use of the medication once more (4).
Bell, who is 5 feet and 5 inches tall, stated that she had dropped almost 20 pounds after being treated with Qsymia for three months. She had started off weighing 214 pounds when she began the medication. (It is probable that this does not represent the typical amount of weight loss that occurs as a result of taking the medication (6).
She claims that it prolongs the feeling of being full. According to the speaker, he or she does not currently have the desire to consume foods that he or she would ordinarily consume. Alternatively, she states that she will eat a far smaller portion than she had anticipated. When she relocated from California to Boston two years ago, she gave up jogging as a pastime, but she just resumed it. When she moved, she stopped doing it (7).
She decided to stop using Qsymia in June, despite the fact that she had found it to be a useful weight-loss tool at first. According to Bell, a nurse’s aide and a student in nursing school, it made her very angry and frustrated. As a result, she began to believe that she was unable to alter the course of events. Thus, she appeared to be powerless in the face of my emotions. It had a huge effect on my emotional state. One of the other issues that bothered her was that she wasn’t getting a good night’s sleep as she had in the past nothing worked, no matter how many times she attempted to sleep. After being awakened, she had trouble settling back to sleep (6).
For the first time, she is attempting to lose weight using phentermine. For more than one reason, it keeps me from overeating and provides an abundance of energy for my day. Aside from “cottonmouth,” she claims that drinking a lot of water helps alleviate the problem (7).
At the University of Pittsburgh Medical Center, where she works as an internist and obesity specialist, Dr. Vicki March says that she is “very cautious and mindful” about the patients she prescribes these medications to. When it comes to who I prescribe these medications to, I exercise a good deal of caution and awareness (6).
She notes that insurance is a factor and that some people are apprehensive that the prescriptions won’t be effective or that there will be adverse effects. She also mentions that insurance is a factor (6).
According to the Food and Drug Administration (FDA), the side effects of Qsymia that are experienced the most frequently by patients are tingling in the hands and feet, dizziness, a change in taste, inability to sleep, constipation, and dry mouth. The Food and Drug Administration (FDA) reports that individuals who do not have diabetes and who take Belviq are more likely to experience unpleasant effects such as headaches, dizziness, fatigue, nausea, dry mouth, and constipation as a result of taking the medication (6).
Do you have uncontrolled high blood pressure? People who already have heart failure should exercise extreme caution when taking this drug. Other potential side responses include problems with the valves in the heart and a disease known as serotonin syndrome, which is exceedingly hazardous but extremely infrequent. Both of these conditions are quite rare. A disorder known as serotonin syndrome is characterized by an unusually high quantity of the chemical serotonin that has accumulated in the body. Serotonin syndrome can cause symptoms such as fever and convulsions (6).
Persons who have diabetes are more prone than people who do not have diabetes to experience low blood sugar, headaches, back discomfort, coughing, and tiredness (6).
Women who are pregnant are strongly discouraged from using any of these prescription weight loss pills due to the possibility that they could cause birth defects. It is recommended that women have a pregnancy test before starting Qsymia and every month while they are taking it to verify that they are not carrying a child who has a cleft palate or cleft lip (6).
Cleft palate and cleft lip are both birth defects that affect the upper and lower jaws. Because of the possibility of having a child born with a cleft lip or palate, the manufacturer of Qsymia recommends that only women use the medication. The Food and Drug Administration has requested that the companies that make both of these drugs perform additional research to see whether or not their products raise the probability of major health issues such as heart attacks and strokes (7).
March asserts that she has had success in the treatment of patients with all three prescription medications. According to her, the potential negative effects are far exceeded by the benefits that they bring to the weight loss attempts of a large number of obese people. She believes this to be the case because of the nature of the benefits that they provide. On the other hand, she asserts that reducing one’s body weight cannot be achieved by only taking a drug as directed. According to a popular proverb, medication to treat obesity “is not going to work by itself.” To tell the truth, it is not the case (7).
There may be more edge cases, cautionary tales, and satisfied consumers as weight loss treatments and techniques for weight management continue to improve and become more potent, but access will remain the biggest test. To reach the other 97% to 99% of the potential market, doctors, insurers, and the rest of us will need to rethink how we think about obesity and weight loss (5).
There’s really no shortcut in losing weight. Even if these weight loss medications are good enough to help you through your journey, lifestyle change is still a big factor.