New weight loss drugs like Wegovy and Zepbound have been heralded as game-changers in tackling obesity, helping people lose significant amounts of weight and potentially prevent Type 2 diabetes.
But many doctors caution that these medications have limitations, especially around manufacturing shortages and high prices, and they are skeptical that drugs alone can turn the tide of soaring Type 2 diabetes cases in Georgia and across the country.
“Type 2 diabetes is an enormous problem,” said Dr. Loida Bonney, a regional medical director for primary care for Piedmont Physicians. “And I think it’s wonderful that we now have a medication that looks like it can solve this problem. But I don’t have hope the solution to diabetes is in this medication. I think just like diabetes is a multifactorial problem, this will require a multifactorial approach in our tool kit.”
Doctors rarely treat people who are obese immediately with prescription weight-loss drugs, usually starting instead with plans centered on changes in diet and exercise. But for those who continue to struggle to lose weight, these drugs — known as glucagon-like peptide 1 agonists — can help.
There now are multiple drugs on the market that are approved by the Food and Drug Administration for weight loss. Among them are Wegovy and Zepbound. Wegovy contains the same main ingredient, semaglutide, as Ozempic, which is approved to treat diabetes. Zepbound contains the same main ingredient, tirzepatide, as Mounjaro, also originally developed to treat diabetes.
GLP-1 drugs, typically taken once weekly as injections, are extremely effective for blood glucose control and weight loss. The drugs slow down digestion, curb hunger and help manage blood sugar levels. They can result in people losing as much as 20% or more of their body weight.
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Credit: cust
“I don’t have a negative feeling toward this (new class of) medicine. I am excited about them,” Bonney said. “I have loved what I have seen with patients who have lost weight on these medications. But what’s discouraging is the access.”
Not a long-term solution
Obesity has remained a major driver of diabetes for the past two decades, with people who are obese nearly three times as likely to develop Type 2 diabetes compared to those who are not obese. Prediabetes, the condition that leads to Type 2 diabetes, now affects 98 million American adults, says the Centers for Disease Control and Prevention. That’s roughly one in three adults in the U.S.
Type 2 diabetes is a serious and chronic condition that happens because the pancreas produces too little insulin or the body rejects the insulin being produced. Type 2 diabetes affects many organs, and if not well-managed, it can lead to chronic kidney disease, heart disease and stroke.
People can prevent or delay Type 2 diabetes by losing weight — even a modest amount — and with dietary changes, physical activity and stress reduction.
While the new weight-loss drugs might seem like an easy way to prevent new diabetes cases, that likely would require a long-term and expensive commitment.
“I can’t imagine anyone long term paying to continue to stay on these medications if they don’t have diabetes and it is not covered by insurance. If I am being frank, I can’t imagine 30% of our population on this medication for the rest of their lives,” Bonney said.
Bonney also said these medications would need “large-scale access” for them to play a major role on a population level. There are other challenges. They are not universally effective nor are they well-tolerated by everyone. Some patients may experience side effects, including gastrointestinal issues like nausea and vomiting, she said.
Credit: NYT
Credit: NYT
The stakes are huge. The number of people in Georgia diagnosed with Type 2 diabetes has risen sharply over the past decade, fueled by soaring obesity levels, poor diet and lack of physical activity.
Cost is a major barrier for some of those who could benefit from the drugs. Insurance companies rarely cover GLP-1 drugs for patients who don’t have diabetes, and the monthly cost can rise to $1,000.
And when people go off the medication, they often gain the weight back, Bonney said, meaning people likely need to make a lifelong commitment to the medication.
Credit: TNS
Credit: TNS
Rising diabetes cases
Charlene Wilson, a registered dietitian and specialist in diabetes care at Northside Hospital Gwinnett, said she is seeing more patients in their 20s already diagnosed with diabetes, as well as young patients who are obese and at a higher risk of developing diabetes who are eager to try to make changes to avoid the disease.
“I will say COVID probably didn’t do us any favors,” Wilson said. “I think we are seeing the results of being more homebound, people working more from home. So we are even more sedentary, which can lead to more access to food constantly and less exercise. So I do think that’s something that has shifted.”
Wilson helps leads a four-hour class for patients with diabetes or at risk of diabetes, covering a wide range of topics including side effects from medication and potential complications. She stressed that more than half the class is dedicated to diet and nutrition, which looks at what to eat as well as how to manage challenges with healthy eating, such as traveling for work.
“I do know weight loss is hard,” Wilson said. “These drugs do seem to be beneficial when it comes to weight loss. So any weight you lose — even if you can lose 5% to 10% of your total body weight if you are considered obese — that reduces your risk of developing diabetes. So if those drugs help you get there, I think that’s wonderful. I always try to view it as a tool; they are just one part of your care. ”
Those who are most successful at losing weight and keeping it off combine multiple strategies that include eating a well-balanced healthy diet and regular exercise, she said.
Bonney agrees, and added obesity is a complex condition influenced by many factors, which can include environmental and genetic factors. The treatment plan is not always clear-cut. For patients considering paying $500 a month for the GLP-1 drugs, she will ask if they might rather invest that money in a gym membership and for additional funds on a budget for healthy foods.
Weight loss is a key strategy to stave off diabetes, but it’s important to know that not everyone needs to lose a massive amount of weight, doctors say.
The CDC’s national Diabetes Prevention Program has shown that people with prediabetes who lose even a modest amount of weight, in the range of 5% to 7%, (10 to 14 pounds for a person weighing 200 pounds, for example) through this structured program focusing on healthy eating and increasing physical activity cut their risk of developing Type 2 diabetes by 58%.
Around the nation, Type 2 diabetes increased by almost 20% between 2012 and 2022, says a new study from the University of Georgia, which was based on data from the nationally representative Behavioral Risk Factor Surveillance System, an ongoing health survey of more than 400,000 people.
In Georgia, the proportion of the adults with Type 2 diabetes increased by 22% during the decade studied. In 2022, 12% of the population had Type 2 diabetes, up from 10% a decade earlier.
Black people are particularly hard hit by the disease, with just under 16% of Black study participants nationally reporting being diagnosed with Type 2 diabetes. In Georgia, about 14% of Black people reported being diagnosed with Type 2 diabetes in 2022.
What is prediabetes?
Prediabetes is a serious health condition that increases your risk of developing Type 2 diabetes, heart disease and stroke. With prediabetes, blood sugar levels are higher than normal but not high enough for a Type 2 diabetes diagnosis.
The good news? If you have prediabetes, lifestyle changes can help.
Take the CDC risk test to see if you might have prediabetes.
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