The myths and questions doctors are hearing from patients about Ozempic.
医生从病人那里听到的关于 Ozempic 的神话和问题。
Obesity doctors say patients need to know Ozempic and Wegovy are not short-term fixes and they may not be covered by health insurance.
肥胖症医生表示，患者需要知道，Ozempic 和 Wegovy 并非短期解决方案，它们可能不在医疗保险的覆盖范围之内。
We’re at the very beginning of a new era in weight loss drugs that promise extraordinary results. But ultimately, their impact depends on a few things: how well they work, how much they cost, and whether doctors are willing to prescribe them.
我们正处于减肥药新时代的开端，这些减肥药有着非凡的效果。但最终，它们的影响取决于几个因素: 它们的效果如何，它们的成本有多高，以及医生是否愿意开这些处方。
So far, these treatments seem to work extraordinarily well. Patients on Ozempic and Wegovy lose on average about 12 percent of their body mass and even more effective drugs are coming through the pipeline. But the cost can be high because health insurers are reluctant to pay for these drugs, putting strict conditions on prescriptions if they are willing to cover them at all.
到目前为止，这些治疗似乎非常有效。服用奥扎匹克(Ozempic)和 Wegovy 的患者体重平均下降约12% ，更有效的药物正在研发中。但成本可能会很高，因为医疗保险公司不愿意为这些药物付费，如果他们愿意支付这些费用，就会对处方设置严格的条件。
That has left doctors caught in the middle. Many of them are hopeful about the potential these new treatments hold while also trying to manage expectations with patients and convince health plans that the investment is worth it.
这让医生们左右为难。他们中的许多人对这些新疗法的潜力抱有希望，同时也试图管理患者的期望，并说服健康计划，这项投资是值得的。
The ubiquitous ads for Ozempic and Wegovy, like all prescription drug ads, tell patients to talk to their doctor if they’re interested in the medication. So, how are those conversations going so far?
无处不在的 Ozempic 和 Wegovy 的广告，就像所有的处方药广告一样，告诉病人如果他们对药物感兴趣，就去找他们的医生谈谈。谈得怎么样了？
“Right now, I can tell you, if you’re a primary care provider, it’s probably overwhelming to think about starting to do what they need to do to prescribe these agents,” said Caroline Apovian, co-director at the Center for Weight Management and Wellness at the Brigham and Women’s Hospital in Boston.
波士顿布里格姆妇女医院(Brigham and Women’s Hospital)体重管理与健康中心(Center for Weight Management and Wellness)联席主任卡罗琳 · 阿波维安(Caroline Apovian)说，“现在，我可以告诉你，如果你是一名初级保健提供者，想到要开始做他们需要做的事情来开这些药物，你可能会觉得压力很大。”。
这些药物的问世，正值医学界围绕肥胖问题进行了一场期待已久的社会和文化范式转变。越来越多的医生认为肥胖不是性格或意志力的失败，而是一种生理疾病。
Some doctors are still themselves in the process of learning how to think about obesity that way, rather than focusing on the conditions that are often its consequences, such as hypertension or heart disease.
一些医生自己仍然在学习如何以这种方式思考肥胖问题，而不是关注肥胖的后果，如高血压或心脏病。
It is a fraught moment. The public health opportunity these drugs present is significant, but the US health system was not prepared to seize it. Too few primary care doctors are well-versed in obesity medicine.
这是一个令人担忧的时刻。这些药物带来的公共卫生机会是巨大的，但美国卫生系统并没有准备好抓住这个机会。很少有初级保健医生精通肥胖症药物。
Health insurers are not incentivized to cover a costly medication that may take years to properly pay off — even if that payoff proves real. Patients risk being exploited by shady operators trying to take advantage of the hype and confusion around the new era of obesity treatment.
医疗保险公司没有动力承保一种可能需要数年才能获得适当偿付的昂贵药物ーー即使这种偿付被证明是真实的。患者面临被可疑操作者利用的风险，这些操作者试图利用围绕肥胖治疗新时代的大肆宣传和混乱。
But the demand is real: A new STAT-Harris poll found half of Americans said they would spend up to $100 per month out of pocket in order to take them.
但需求是真实的: 一项新的 STAT-Harris 民意调查发现，一半的美国人表示，他们愿意每月自掏腰包花费100美元来购买这些产品。
I spoke with three leading obesity medicine experts about the misconceptions they are often hearing from patients, the information they want patients to know when having these discussions, and what questions people should be asking their doctors when considering whether or not to try them.
我采访了三位著名的肥胖症医学专家，谈到了他们经常从病人那里听到的错误观念、他们希望病人在进行这些讨论时知道的信息，以及人们在考虑是否尝试时应该向医生询问的问题。
1) These weight-loss drugs are not a short-term fix
1)这些减肥药不是短期的
Different patients will have different considerations before deciding to take one of these new treatments. For people with extreme obesity, bariatric surgery is an option. Others may want to exhaust attempts at diet and exercise.
不同的病人在决定采用这些新疗法之前会有不同的考虑。对于极度肥胖的人来说，减肥手术是一种选择。其他人可能想在节食和锻炼方面耗尽精力。
But once they have decided to try a weight-loss drug, obesity doctors say it is critical that patients grasp what is happening biologically with their bodies.
但是肥胖症医生说，一旦他们决定尝试一种减肥药，患者就必须掌握他们身体的生物学变化。
Marcio Griebeler, director of the Obesity Center at the Cleveland Clinic’s Endocrinology & Metabolism Institute, told me he starts these conversations by making sure his patients understand the physiological roots of their obesity and how these drugs treat that — and why that means, despite media stories about celebrities using them as a kind of crash diet, they can’t just take Wegovy or whatever for a few months to slim down and then stop.
克利夫兰诊所(Cleveland Clinic)内分泌与新陈代谢研究所肥胖症中心(Obosis Center)主任马尔西奥 · 格里贝勒(Marcio Griebeler)告诉我，他通过确保患者了解肥胖症的生理根源以及这些药物如何治疗肥胖症来开启这些对话，以及为什么这意味着，尽管媒体报道有名人把它们当作一种快速减肥方法，但他们不能只是服用韦戈维(Wegovy)或其他药物几个月，然后就停止服用。
In brief and in general (each individual is unique), it becomes more difficult for a person to lose weight as they become more obese.
简而言之，总的来说(每个人都是独一无二的) ，当一个人变得越来越肥胖时，减肥就变得越来越困难。
They experience what is called metabolic adaptation; their body begins to change, and they start to see a decrease in the hormones that signal they are full and should stop eating.
他们经历了所谓的新陈代谢适应; 他们的身体开始发生变化，他们开始看到荷尔蒙的减少，这些荷尔蒙表明他们已经吃饱了，应该停止进食。
These new drugs stimulate those hormones. Ozempic and Wegovy target a single hormone, called GLP-1. The so-called “triple-G” drugs coming soon that appear more effective target multiple hormones. The effect is that people feel more full more quickly, which makes it easier for them to eat less.
这些新药会刺激那些荷尔蒙。Ozempic 和 Wegovy 针对一种叫做 GLP-1的激素。即将推出的所谓“三重 G”药物似乎更有效地靶向多种激素。其效果是人们更快地感到饱，这使得他们更容易吃得少。
“You have more control of the hunger, so patients can continue to make the right decision,” Grieleber said.
“你可以更好地控制饥饿，所以病人可以继续做出正确的决定,”格里勒伯说。
But take away those hormones and the body starts to work in reverse.
但是如果没有这些荷尔蒙，身体就会开始反向工作。
Grieleber said “95 percent” of his patients will ask if they could take the drugs for a few months and then stop. The answer, he tells them, is no.
格里勒伯说，“95%”的病人会问他们是否可以服用几个月的药物，然后停止服用。他告诉他们，答案是否定的。
Patients must be prepared for the reality that they would need to take some kind of medication for the rest of their life if they intend to keep the weight off.
患者必须准备好面对这样的现实: 如果他们想要减肥，他们就必须在余生中服用某种药物。
This is an especially big hurdle for parents. “That’s a big pill to swallow: My kid may potentially be on this medication for life,” said Claudia Fox, co-director of the Center for Pediatric Obesity Medicine at the University of Minnesota Medical School.
这对父母来说是一个特别大的障碍。明尼苏达大学医学院儿童肥胖医学中心的主任克劳迪娅 · 福克斯说: “这是一个难以下咽的大药丸: 我的孩子可能一辈子都在服用这种药物。”。
“Probably not the same medication that we start today, but they will likely need some sort of treatment for life. We’re not curing it. We’re treating it. We’re managing it.”
“可能不是我们今天开始使用的那种药物，但他们可能需要某种终身治疗。我们没有治愈它。我们正在治疗。我们正在处理这个问题。”
2) Your health insurer might not want to cover these treatments
2)你的健康保险公司可能不想承担这些治疗费用
Without health insurance, these are expensive drugs. Ozempic costs about $900 a month without insurance, and Wegovy costs about $1,350. But health insurers are reluctant to cover them — and that has led to cost coming up very early in these conversations between doctors and their patients.
没有医疗保险，这些药都很贵。没有保险的话，Ozempic 每月的费用约为900美元，而 Wegovy 的费用约为1,350美元。但医疗保险公司不愿意承保这些费用，这导致医生和病人之间的谈话很早就出现了成本问题。
All of the doctors I spoke to said they bring up insurance coverage almost immediately. “We have to make sure your insurer covers it,” Apovian said.
我问过的所有医生都说他们几乎立刻就提出了保险覆盖范围。“我们必须确保你们的保险公司负担得起,”阿波维安说。
For patients on Medicare and Medicaid, those government programs generally will not cover weight-loss drugs, a longstanding statutory prohibition that physicians believe must be revisited if the US is to take advantage of these treatments.
对于享受医疗保险(Medicare)和医疗补助(Medicaid)的患者来说，这些政府项目通常不会涵盖减肥药。医生们认为，如果美国想要利用这些治疗方法，就必须重新审视长期存在的法定禁令。
For private insurers, the picture is more mixed, but most commercial health plans also do not cover weight-loss drugs.
对于私营保险公司来说，情况更为复杂，但大多数商业健康计划也不包括减肥药。
Even if they technically do, securing coverage can still be an administrative hassle.
即使他们在技术上这样做，保障覆盖仍然是一个管理上的麻烦。
Apovian said her specialized practice has one employee managing prior authorizations and other paperwork for their eight practitioners and described the workload as “overwhelming.” That burden is going to be only greater for an independent physician practicing on their own.
阿波维安说，她的专业实践有一名员工负责为他们的八名从业人员管理事先授权和其他文书工作，她形容这项工作“非常繁重”这种负担只会对独立执业的医生造成更大的负担。
In Minnesota, the Medicaid program does actually cover weight-loss drugs, but the conditions placed on prescriptions can still be cumbersome, Fox said. She recounted the story of one patient, a teenager who meets the eligibility criteria based on age and BMI.
福克斯说，在明尼苏达州，医疗补助计划实际上涵盖了减肥药，但处方上的条件仍然很繁琐。她讲述了一个病人的故事，一个青少年符合资格标准的年龄和体重指数。
The state program also wanted to require the patient to eat a low-calorie diet, to meet regularly with a dietician, and to be enrolled in an exercise program.
国家计划还想要求患者吃低热量饮食，定期与营养师见面，并参加一个运动计划。
Fox wrote an appeal letter, affirming that the patient was in gym class in school and also playing basketball outside of school. The Medicaid program wrote back: Not good enough.
福克斯写了一封申诉信，确认病人在学校上体育课，也在校外打篮球。医疗补助计划回复说: 不够好。
After several volleys with the plan, Fox sought the intervention of an independent arbiter who oversees the program.
在对该计划进行了几次抨击之后，福克斯寻求监督该计划的独立仲裁人的干预。
“The challenge is how they implement those approvals. The stipulations are often not based on any scientific recommendation,” she said. “We face these delay tactics, even though this should be covered upfront.”
“挑战在于他们如何执行这些批准。这些规定往往没有任何科学依据。”。“我们面临这些拖延战术，尽管这些问题应该提前得到解决。”
There are alternatives for patients who can’t get insurance to cover the drugs and can’t afford the $1,300 out-of-pocket price. Saxenda and phentermine were some of the options these doctors consider.
对于那些无法获得医疗保险、无法承担1300美元现付费用的患者，还有其他选择。萨克森达和芬特明是这些医生考虑的一些选择。
But they come with the catch that they are not as effective as these new treatments attracting so much attention.
但是，这些新疗法吸引了如此多的注意力，因此它们并不像这些新疗法那样有效。
3) Your own experience with these drugs can vary significantly
3)你自己使用这些药物的经验可能会有很大的不同
Another thing patients should be aware of, obesity doctors say, is that their individual experience may not match the hype.
肥胖症医生说，患者应该意识到的另一件事是，他们的个人经历可能与宣传不符。
The headline numbers that patients may have seen showing people losing 10 to 20 percent of their body weight are only averages. Some people may lose 35 percent. Some people may lose only 10 percent. A small number of people may not lose any at all.
患者可能看到的显示人们体重减轻10% 到20% 的标题数字只是平均值。有些人可能会损失35% 。有些人可能只损失10% 。少数人可能根本不会失去任何东西。
At this point, obesity science does not fully understand how different patients are going to respond. There is still a lot of trial and error, Apovian told me.
在这一点上，肥胖科学并不完全理解不同的患者将如何反应。阿波维安告诉我，还有很多尝试和错误。
“There are always gonna be patients who don’t lose a lot of weight with these drugs,” she said. “Patients need to know there’s a small chance that you’re not going to respond.”
她说: “总会有病人用这些药物减不了多少体重。”。“病人需要知道你不会有反应的可能性很小。”
Griebeler said he is also warning patients that it is normal to experience a plateau in weight loss after six to 12 months, as your metabolism begins to adjust.
格里贝勒说，他还警告患者，随着新陈代谢开始调整，6至12个月后体重减轻出现平台期是正常的。
That doesn’t mean a patient can stop taking the medication, for the reasons we covered. But a plateau can still be frustrating for somebody expecting extraordinary returns.
这并不意味着病人可以停止服药，原因我们已经说过了。但对于期望获得非凡回报的人来说，停滞期仍可能令人沮丧。
Then there are the side effects. Most people will experience some nausea, Apovian said. Some people experience such significant nausea that they end up in the ER.
还有副作用。阿波维安说，大多数人会感到恶心。有些人感到非常恶心，最后进了急诊室。
She has also had a small number of patients experience very severe constipation that had to be treated in the hospital.
她还有一小部分病人经历了非常严重的便秘，必须在医院治疗。
The unpleasantness of side effects or the risks of more serious complications of the medications may be worth it for the potential benefits, in the view of an individual and the doctor. But it is important that physicians and patients confront them and prepare for them.
从个人和医生的角度来看，药物副作用的不愉快或者更严重并发症的风险可能是值得的，因为它有潜在的好处。但重要的是，医生和病人面对他们，并为他们做好准备。
4) You need a holistic plan for weight loss and management
4)你需要一个全面的减肥和管理计划
All of the doctors I spoke with lastly emphasized that patients need a comprehensive plan for weight management, including for their diet and to make sure they are getting exercise.
我最后交谈过的所有医生都强调，病人需要一个全面的体重管理计划，包括他们的饮食和确保他们得到锻炼。
That’s not because weight loss is as simple as eating right and working out; all of these physicians wanted to break that misconception. But these drugs “are gonna work best in patients who also do diet and exercise,” Apovian said. “You can’t just prescribe these meds.”
这并不是因为减肥就像合理饮食和锻炼一样简单; 所有这些医生都想打破这种误解。但是这些药物“对那些同时进行节食和锻炼的病人效果最好,”Apovian 说。“你不能随便开这些药”
Exercise has well-documented health benefits, particularly for the conditions associated with obesity, such as hypertension and diabetes. Building muscle makes it slightly easier for your body to burn calories.
运动对健康有益，尤其是对与肥胖有关的疾病，如高血压和糖尿病。锻炼肌肉使你的身体更容易燃烧卡路里。
And being sedentary, even at a lower weight, brings health risks of its own.
久坐不动，即使体重较轻，也会带来健康风险。
People may also start to notice a change in their palate after taking these medications, and so finding a diet that is satisfying and helps them manage their appetite in conjunction with the drugs is beneficial as well.
服用这些药物后，人们也可能开始注意到他们的味觉的变化，因此找到一个令人满意的饮食，并帮助他们管理他们的食欲与药物结合起来也是有益的。
Strategies for achieving better sleep and managing stress can also help patients get the most out of these drugs and manage the other conditions that they may be contending with.
获得更好的睡眠和管理压力的策略也可以帮助患者从这些药物中获得最大收益，并管理他们可能要面对的其他情况。
Doctors and patients need to be thinking about how to treat the whole person, rather than count on the new treatments, promising though they may be, to act as miracle drugs.
医生和病人需要思考如何治疗整个人，而不是指望新的治疗方法，虽然它们可能是有希望的，作为神奇的药物。
“Obesity treatment is an ongoing treatment ... You can’t prescribe this once and not have a follow-up,” Grieleber said. “We have to use this medicine as a tool.”
“肥胖症的治疗是一个持续的治疗... 你不能开这个处方一次，没有后续行动,”格里勒伯说。“我们必须把这种药物作为一种工具。”
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