obesity

Posted on Patient Talk

The rising popularity of Ozempic and Wegovy among privately insured patients could exacerbate disparities.

A USC study of prescription data shows that people with Medicaid or Medicare Part D may be missing out on powerful new obesity and diabetes drugs
A study conducted by USC on prescription data indicates that individuals with Medicaid or Medicare Part D plans may not be benefiting from new, effective medications for obesity and diabetes.

A new study from USC suggests that individuals with public insurance who could benefit from new drugs for diabetes and obesity are less likely to receive them compared to those with private insurance.

Prescription fills for the drug known as Ozempic or Wegovy, also called semaglutide, surged by over 400% from January 2021 to December 2023, according to new research in JAMA Health Forum. 

Semaglutide was initially approved for type 2 diabetes and later for weight loss. Studies have shown that it also improves blood pressure and reduces the risk of cardiovascular disease, which are common issues for millions of Americans. However, the majority of prescriptions for semaglutide were given to individuals with private insurance.

“Considering the established cardiovascular advantages of Ozempic and Wegovy for treating diabetes or obesity, and the higher prevalence of diabetes and obesity in Black/Latinx Medicaid and Part D populations, these results indicate that their limited use in Medicaid and Part D could exacerbate disparities in diabetes and obesity outcomes,” explained Dima Qato, who is an associate professor at the USC Mann School of Pharmacy & Pharmaceutical Sciences and a senior scholar at the USC Leonard D. Schaeffer Center for Health Policy & Economics.

“While the media focuses on semaglutide’s anti-obesity effect, we should not overlook its significant role in treating diabetes. This medication has allowed me to help some of my patients reduce their reliance on insulin,” explained Christopher Scannell, a physician and postdoctoral researcher at the Schaeffer Center. He also highlighted the importance of ensuring broader access to these medications beyond just those with private insurance or more comprehensive health plans, as this is an issue of equity affecting a large portion of the U.S. population.

Please take note of the following information:Ozempic and Wegovy are both administered via once-weekly injections. Another form of semaglutide, Rybelsus, is available in the form of a daily pill. Ozempic was approved in 2017, followed by Rybelsus in 2019, both intended for the treatment of type 2 diabetes. Wegovy, approved in 2021, is a higher-dose version specifically designed for weight loss. As for pricing, Ozempic’s sticker price is approximately $1,000 per month, while Wegovy is listed at around $1,350.

For the study, researchers utilized data from IQVIA’s National Prescription Audit PayerTrak, which captures 92% of prescriptions filled and dispensed to individuals at retail pharmacies in the United States.

They calculated monthly medication fills for semaglutide under different drug brands (Ozempic, Wegovy, and Rybelsus) and payment methods (commercial insurance, Medicaid, Medicare Part D, and cash) from January 2021 to December 2023.

  • Please make a note of the following text: In 2023, Medicaid accounted for less than 10% of semaglutide prescriptions across all three drug brands. According to Scannell, access to these drugs through Medicaid is determined at the state level. Whether or not the drugs are covered depends on the budget and politics of your specific location. It’s important to note that Medicaid provides assistance to low-income individuals, the elderly, and some people with disabilities.
     
  • In 2023, Medicare Part D represented 28.5% and 32.9% of Ozempic and Rybelsus fills, respectively. However, it only made up 1.2% of Wegovy fills. It’s important to note that Medicare Part D does not cover drugs for obesity unless a patient also has a co-morbidity such as cardiovascular disease, which both Wegovy and Ozempic can help prevent. 
  • Approximately 1% or less of all semaglutide fills went to people paying cash in 2023.

In the context of treating obesity, Scannell stated, “If Medicare only covers these drugs for patients who have obesity and a co-morbidity, it may force patients who only have obesity to develop additional chronic conditions before they can access the medications. It’s like saying, ‘You have to be sick enough, then we’ll cover that medication for you.’”

The researchers suggested that future studies should investigate how changes in Medicare Part D and Medicaid coverage restrictions impact disparities in access to these important medications. Additionally, further research could explore individual-level variables like age, race, and ethnicity, as well as whether the drugs were prescribed for obesity or diabetes.

Posted on Diet, Weight Loss

Danish experiment reveals: You can satisfy your appetite just by looking at pictures of food on your phone.

The results may lead to a new form of treatment for overeating.
The results may lead to a new form of treatment for overeating.

The internet is overflowing with pictures of food: On news sites, social media and the banner ads that pop up everywhere.

Many of the food images are uploaded to sell specific foods. The idea is that the images on Facebook or Instagram will make us yearn for a McDonalds burger, for example. In other words, the image awakens our hunger.

New research from Aarhus University now shows that the images can actually have the opposite effect. At least if we see pictures of the same product repeatedly. 

A number of experiments reveal that we can get a sense of satiety if we see the same image more 30 times. Tjark Andersen, who recently defended his PhD at Department of Food Science at Aarhus University, explains more.

“In our experiments, we showed that when the participants saw the same food picture 30 times, they felt more satiated than before they had seen the picture. The participants who were shown the picture many times also chose a smaller portion than those who had only seen the picture three times, when we subsequently asked about the size of portion they wanted,” he says.

Tricking your brain into feeling full
It may sound strange that the participants felt full without actually eating anything. But this is really quite natural, explains Tjark Andersen. How we think about food has a large influence on our appetite. 

“Your appetite is more closely linked with your cognitive perception than most of us think. How we think about our food is very important,” he says, and continues:

“Studies have shown that if you make people aware of different colours of Jelly Beans, even if they have eaten all they can in red Jelly Beans, will still want the yellow ones. Even if both colours taste completely the same.”

Within brain research, these findings are explained with so-called grounded cognition theory.  For example, if you imagine putting your teeth in a juicy apple, the same areas of the brain are stimulated as if you actually take a bite of an apple.

“You will receive a physiological response to something you have only thought about. That’s why we can feel fully satisfied without eating anything,” he says.

A large online experiment
Tjark Andersen and his colleagues are not the first to discover that we can get feel full by looking at pictures of food. Other research groups have previously shown this. 

The new research from Aarhus University is that they examined the number of repetitions needed – and whether variation in the images removes the sense of satiety.

“We know from previous studies that images of different types of food don’t have the same effect on satiety. That’s why you can really feel full after the main course but still have room for dessert. Sweet things are a completely different type of food,” he says.

To investigate whether variation in food completely removes the sense of satiety, Tjark Andersen and his colleagues designed a number of online experiments. They ended up getting more than 1,000 people through their digital experiments.

First they showed a picture of just orange M&Ms. Some participants were shown the picture three times, others 30 times. The group that saw most pictures the M&M felt most satiated afterwards, explains Tjark Andersen.

“They had to answer how many M&Ms between 1 and 10 they wanted. The group which had seen 30 images of orange chocolate buttons, chose a smaller amount than the other two groups.”

Afterwards, they repeated the experiment. This time with M&Ms in different colours. The colours did not change the result.

Finally, they replaced the M&Ms with Skittles. Unlike M&Ss, Skittles taste different depending on the colour.

“If colour didn’t play a role, it must be the imagined taste. But we found no major effect here either. This suggests that more parameters than just colour and flavour have to change before we can make a effect on satiety,” he explains.

Could be used as a weight loss strategy
Since 1975, the number of overweight people worldwide has tripled. According to the WHO, obesity is one of the biggest health challenges facing humans. And the reason why we become too fat is that we eat too much food and too much unhealthy food and we do not take enough exercise.

This is where Tjark Andersen’s results come into the play. Perhaps they can be applied as a method to control appetite, he says. 

“Think if you developed an app based on a Google search. Let’s say you wanted pizza. You open the app. Choose pizza – and it shows a lot of photos of pizza while you imagine eating it. In this way, you could get a sense of satiety and maybe just stop wanting pizza.”

Perhaps his results can best be used to ensure that you don’t start a meal. The participants in the study only chose slightly fewer Skittles or M&Ms, corresponding to less than 50 calories.

“You won’t save many calories unless you completely refrain from starting a meal. But perhaps the method can be used for this as well. It’d be interesting to investigate,” he says.

Social media are overflowing with food
Tjark Andersen and a number of other researchers are studying how food advertisements on social media affect us, because we are constantly being confronted with delicious food. 

A few years ago, an American research group tried to find out how many advertisements with food we encounter on average when we are on social media. The researchers monitored a number of young people and mapped out the content they met.

On average, the young people saw 6.1 of food-related posts in 12 hours. The vast majority of the posts were pictures of food – and more than a third were about desserts or other sweet food.

The internet and, in particular, social media can be a contributory factor in our becoming increasingly overweight. But it may also be the solution.

Only the future will tell.

Posted on Diabetes

Obesity is more prevalent in people with type 1 diabetes than previously thought


People with type 1 diabetes should be screened regularly for obesity and chronic kidney disease, according to a study published in the Endocrine Society’s Journal of Clinical Endocrinology & Metabolism.

Almost half of the adults in the United States have obesity, a chronic progressive disease characterized by an individual having an excess of body fat. Obesity is one of the leading causes of death in the United States, and people with obesity are at an increased risk for many serious diseases and health conditions such as diabetes, heart and liver disease. Obesity is a main risk factor for developing type 2 diabetes, but it has not been previously seen as a major complication in type 1 diabetes.

In type 1 diabetes, the body completely stops making insulin. In type 2 diabetes, the body produces insulin, but the cells do not respond to insulin as well as they should and later in the disease often do not make enough insulin. Type 2 diabetes is more likely to occur in people who are over the age of 40, overweight, and have a family history of diabetes, although more and more younger people, are developing type 2 diabetes.

“Our study shows that obesity rates in adults with type 1 diabetes are increasing and mirror the rates in the general adult population,” said Elizabeth Selvin, Ph.D., M.P.H., of Johns Hopkins Bloomberg School of Public Health and John Hopkins University in Baltimore, Md. “Our research also highlights the high risk of kidney disease in people with type 1 diabetes. Kidney disease is often considered more common in people with type 2 diabetes, but our data shows adults with type 1 diabetes actually had a higher risk of kidney disease than those with type 2.”

The researchers studied data from 4,060 people with type 1 diabetes and 135,458 people with type 2 diabetes from the Pennsylvania based Geisinger Health System between 2004-2018. They found 37% of people with type 1 diabetes had obesity, and the prevalence of kidney disease was higher in people with type 1 diabetes than those with type 2 after adjusting for age differences (16% vs. 9% in 2018).

“Our results highlight the need for interventions to prevent weight gain and end-stage kidney disease in people with type 1 diabetes,” Selvin said.

Posted on Diabetes

Obesity is a critical risk factor for type 2 diabetes, regardless of genetics


Obesity increases the risk of developing type 2 diabetes by at least 6 times, regardless of genetic predisposition to the disease, concludes research published in Diabetologia (the journal of the European Association for the Study of Diabetes [EASD]). The study is by Dr Theresia Schnurr and Hermina Jakupovi?, Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark, and colleagues.

Using data from a case-cohort study nested within the Diet, Cancer and Health cohort in Denmark, the authors examined the joint association of obesity, genetic predisposition, and unfavourable lifestyle with incident type 2 diabetes (T2D). The study sample included 4,729 individuals who developed type 2 diabetes during a median 14.7 years of follow-up, and a randomly selected cohort sample of 5,402 individuals (the control group).

The mean age of all participants was 56.1 years (range 50-65) and 49.6% were women. Overall, 21.8% of all participants were classified as obese, 43.0% as overweight and 35.2% as having normal weight; and 40.0% of the participants had a favourable lifestyle, 34.6% had an intermediate lifestyle and 25.4% had an unfavourable lifestyle.

Genetic predisposition was quantified using a genetic risk score (GRS) comprising 193 known type 2 diabetes-associated genetic variants and divided into 5 risk groups of 20% each (quintiles), from lowest (quintile 1) to highest (quintile 5) genetic risk. Lifestyle was assessed by a lifestyle score composed of smoking, alcohol consumption, physical activity and diet. Statistical modelling was used to calculate the individual and combined associations of the GRS, obesity and lifestyle score with developing T2D.

Compared with people of normal weight, those with obesity were almost six times more likely to develop T2D, while people who were overweight had a 2.4 times increased risk. For genetic risk, those with the highest GRS were twice as likely to develop T2D as those with the lowest, while those with the unhealthiest lifestyle were 18% more likely to develop T2D than those with the healthiest.

Individuals who ranked high for all three risk factors, with obesity, high GRS and unfavourable lifestyle, had a 14.5 times increased risk of developing T2D, compared with individuals who had a normal body weight, low GRS and favourable lifestyle. Notably, even among individuals with a low GRS and favourable lifestyle, obesity was associated with 8.4 times increased risk of T2D compared with normal weight individuals in the same genetic and lifestyle risk group.

The authors conclude: “The results suggest that type 2 diabetes prevention by weight management and healthy lifestyle is critical across all genetic risk groups. Furthermore, we found that the effect of obesity on type 2 diabetes risk is dominant over other risk factors, highlighting the importance of weight management in type 2 diabetes prevention.”

Posted on Diabetes

Does primary ovarian insufficiency affect your risks for obesity and diabetes?

Obesity
Obesity

Are overweight women less fertile? Does primary ovarian insufficiency increase risks for obesity and diabetes? For years the controversy regarding the connection between reproductive health and body mass index has continued. A new study assessed the effect of ovarian reserve on obesity and glucose metabolism and found no correlation. Study results are published online today in Menopause, the journal of The North American Menopause Society (NAMS).

Ovarian reserve has been defined as the number and quality of a woman’s eggs. A low ovarian reserve means that the number and/or quality of eggs a woman has is low for her age, making it more difficult for her to become pregnant. But low ovarian reserve can have other health ramifications beyond fertility. A number of previous studies have suggested that a lower reserve is linked to an increase in the storage of fat and impaired ability to process insulin, putting a woman at greater risk for diabetes.

However, in this latest study involving more than 1,000 participants and follow-up of 16 years, researchers concluded that a woman’s level of ovarian reserve was not associated with her risk of becoming obese or diabetic. The study specifically evaluated changes in a woman’s level of antimüllerian hormone (AMH), which is found in the blood and helps to estimate the duration of a woman’s reproductive lifespan, ultimately determining that this biomarker does not predict cardiometabolic risk.

Study results appear in the article, “Do trends of adiposity and metabolic parameters vary in women with different ovarian reserve status? A population-based cohort study.”

“Although previous research has clearly established a link between early menopause and cardiovascular disease risk, the present study showed that lower ovarian reserve, as measured by a single AMH level, was not associated with greater over time trends in adiposity and markers of glucose metabolism. Additional study is needed to determine how best to predict cardiometabolic risk in women with and without primary ovarian insufficiency in order to initiate appropriate risk reduction strategies,” says Dr. Stephanie Faubion, NAMS medical director.