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.
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.
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。”。
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.
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.
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.
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.
1) These weight-loss drugs are not a short-term fix
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.
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.
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.
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.
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.
But take away those hormones and the body starts to work in reverse.
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.
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.
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.”
2) Your health insurer might not want to cover these treatments
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.
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.
For private insurers, the picture is more mixed, but most commercial health plans also do not cover weight-loss drugs.
Even if they technically do, securing coverage can still be an administrative hassle.
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.
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.
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.
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.
After several volleys with the plan, Fox sought the intervention of an independent arbiter who oversees the program.
“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.”
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.
But they come with the catch that they are not as effective as these new treatments attracting so much attention.
3) Your own experience with these drugs can vary significantly
Another thing patients should be aware of, obesity doctors say, is that their individual experience may not match the hype.
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.
“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.”
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.
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.
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.
She has also had a small number of patients experience very severe constipation that had to be treated in the hospital.
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.
4) You need a holistic plan for weight loss and management
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.
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.
And being sedentary, even at a lower weight, brings health risks of its own.
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.
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.
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.
“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.”
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