Expanded access to weight-loss drugs could save thousands of lives

By Dr. Liji Thomas, MDReviewed by Benedette Cuffari, M.Sc.Oct 28 2024

A recent study published in PNAS explores the potential benefits of expanding access to novel weight loss drugs to enhance survival rates in overweight and obese individuals.

Study: Estimating the lives that could be saved by expanded access to weight-loss drugs. Image Credit: Shutterstock AI / Shutterstock.com

The threat of obesity

Obesity affects 42% of adults in the United States, with those between 40 and 59 years of age most likely to be affected by this condition.

Obesity increases the risk of several chronic diseases, including cancer, type 2 diabetes mellitus (T2DM), and cardiovascular disease (CVD). This disease also exacerbates infectious conditions, including influenza and coronavirus disease 2019 (COVID-19), and increases the risk of post-surgical and hospital-acquired infections.

Obesity prevalence and related healthcare costs are higher among those with lower socioeconomic status and inadequate insurance coverage. In fact, obese adults may spend $1,800 more for medical costs each year as compared to non-obese individuals, with total yearly medical costs exceeding $170 million USD.

Several drugs originally developed to treat T2DM have been shown to induce significant weight loss. These include glucagon-like peptide-1 (GLP-1) receptor agonists like semaglutide and liraglutide, as well as dual gastric inhibitory polypeptide and GLP-1 receptor agonists like tirzepatide.

Semaglutide (Wegovy) and tirzapetide (Mounjaro, Zepbound) have been approved for weight management in obese patients with one or more comorbidities linked to excessive weight. Notable limitations associated with these treatments include rebound weight gain after discontinuation of the drug, high costs that can exceed $1,000 each month, limited supplies, and restricted access.

Since these drugs are poorly covered by health insurance, including Medicare and Medicaid, their accessibility to vulnerable patients, especially as these are ongoing costs, is limited.

In the current study, researchers quantify the costs associated with restricted access to these drugs in terms of human lives lost in the U.S. These calculations considered the current prevalence of obesity, access to healthcare, personal readiness to be on weight-reduction drugs, as well as adherence rates to and observed efficacy of these drugs.

Saving thousands of lives

About 49.6% of total annual deaths in the U.S. occur among obese individuals with body mass index (BMI) values exceeding 30 kg/m². Over 45% of these individuals are eligible for weight loss drugs, including 54% of those on Medicare and 40% of uninsured. The prevalence of obese and diabetes patients varied by each state within the range of 34% to 56%.

Moderate estimates

Currently, about 27% and 49% of people on obesity and diabetes drugs exhibit satisfactory adherence to these medications, respectively. These estimates were used to compare mortality rates under the current availability status of newer weight-loss drugs to predicted rates under expanded access.

At the current low uptake of these medications, only 1.8% of obese people lose enough weight to shift their BMI into non-obese categories. With wider access, about 10.6% of obese patients would have BMI values below 30 kg/m², whereas 16.6% of severely obese individuals with BMIs of 40 kg/m² or greater would lose enough weight to have their BMIs decline to 40 kg/m² or less.

Current drug adherence levels would result in 8,592 fewer deaths each year in the U.S., mostly among those with private insurance, which reflects 17% of the total deaths that could be averted with expanded access. Expanded access at current willingness and adherence rates would prevent over 42,000 deaths each year, including over 11,000 deaths among patients with T2DM.

Over 25 million Americans are uninsured, with over 80 million inadequately insured.  With expanded access, 9,977 and 2,804 lives would be saved among Medicare recipients and uninsured, respectively.

Adults 65 years and younger on Medicaid are 27% more likely to be obese as compared to those on private insurance. However, Medicare does not always provide reliable or easy access to these drugs unless prescribed for non-obesity conditions.

Expanded access would reduce mortality by 9.6-15.7 deaths for every 100,000 individuals, with a reduction of at least 9.6 deaths for every 100,000 in all states. The highest per capita reduction would likely occur in West Virginia, Mississippi, and Oklahoma.

If only obese individuals without T2DM were given access to these drugs, the reduction in mortality rates would still occur across 40% of the U.S. With universal access for all eligible patients, the prevalence of obesity in the U.S. would decline to 38% and prevent over 50,000 deaths.

An optimistic model assuming 89% willingness to take these drugs with 100% adherence estimates that 41.3% of the obese would reduce their BMI to less than 30 kg/m² while also preventing 165,574 deaths.

Conclusions

These findings underscore the urgent need to address barriers to access and highlight the transformative public health impact that could be achieved by expanding access to these novel treatments.”

Despite their risks, new-generation weight-loss drugs can significantly reduce mortality and morbidity risks associated with obesity. Thus, the study findings support expanding access to these drugs by removing insurance constraints, increasing manufacturing capacity, and revising their high costs, all of which would reduce the healthcare costs and economic burden related to obesity.