Anti-Obesity Meds for those with HIV; Medicare Approval Likely for Wegovy; Amazon Delivery of GLP-1 Meds; Obesity Treatment in Primary Care


  • Nature journal reports ‘…People with HIV are the latest group to benefit from the new generation of anti-obesity drugs.’
  • STAT suggests FDA approval of Wegovy for heart benefits ‘…could provide a backdoor way to expand access to the drug for people on Medicare.’
  • Peter Loftus at The Wall Street Journal reveals those ‘…seeking a popular new weight-loss drug will have a new home-delivery option from a familiar name:’
  • In JAMA Internal Medicine, Drs. Susan and Jack Yanovski at the National Institutes of Health review an approach to obesity treatment in primary care.
  • What Ozempic can teach CFOs about drug costs is the focus at CFO Brew.


  • Nature journal reports ‘…People with HIV are the latest group to benefit from the new generation of anti-obesity drugs.’
    • In Denver, Colorado, at the Conference on Retroviruses and Opportunistic Infections, studies ‘…that the anti-obesity drug semaglutide not only helps people with HIV to lose weight but also reduces certain conditions associated with fat accumulation that are especially common in people infected with the virus.’
    • Dr. Daniel Lee, at the University of California San Diego Medical Center, treats people with metabolic complications of HIV therapies, and states around 20% of patients already receive semaglutide or other drugs of the same class.
    • Sadly, ‘…certain antiretroviral medications used to suppress HIV could contribute further to weight gain and weight-related conditions…’ including fatty liver.
  • Rachel Cohrs at STAT suggests the recent FDA approval of Wegovy for heart benefits ‘…could provide a backdoor way to expand access to the drug for people on Medicare.’
    • Medicare is prohibited by law from covering medications for obesity treatment alone, and of concern, are the drug prices to offer this medication to many millions of beneficiaries.
    • Indeed, the state of North Carolina will stop covering the drugs for state employees altogether this year after costs skyrocketed.
    • Stacie Dusetzina, a Vanderbilt University professor of health policy, said the new label ‘…greatly increases the chances that this drug will be reimbursed by Medicare…’ leading to much broader access for commercial health plans, as well as for constituents with kidney, liver and lung disease.
    • A recent publication from the Congressional Budget Office said ‘…its analysts expect that if the FDA approves anti-obesity medications for cardiovascular indications, Medicare will cover them.’
  • Peter Loftus at The Wall Street Journal reveals those ‘…seeking a popular new weight-loss drug will have a new home-delivery option from a familiar name:’
    • Amazon pharmacy will ‘…handle some of the home delivery of anti-obesity therapy Zepbound and other Eli Lilly drugs that are ordered through the drugmaker’s new direct-to-consumer service.’
    • Whilst I am all for greater access, there is obvious concern on how these patients are supported beyond the prescription script, in terms of their behavioral, nutrition, and lifestyle therapies that are a critical adjunct to weight management programs.
  • Fierce Pharma reviews a report from Moody’s Ratings on the ‘…commercial frenzy of GLP-1 medicines from Eli Lilly and Novo Nordisk…’ that is ‘… expected to be a major driving force behind the industry’s overall earnings growth over the next 12 to 18 months.’
    • There is an expectation of 4% to 6% overall earnings growth over the period, with GLP-1 medicines among the most successfully launched products ‘…in decades.’
    • To put this into context, Novo’s GLP-1 drugs picked up a combined $18.4 billion in sales, nearly double the prior-year haul of $9.3 billion.
    • Eli Lilly saw booming demand, netting $2.2 billion in fourth-quarter Mounjaro sales and $176 million from Zepbound after its November approval.
    • Third Bridge analyst Lee Brown wrote that diabetes med Mounjaro specifically ‘crushed’ consensus; be ready for even more impressive quarterly earnings reports in 2024.


  • In JAMA Internal MedicineDrs. Susan and Jack Yanovski at the National Institutes of Health review an approach to obesity treatment in primary care.
    • Firstly, they note ‘…that most medical care for adults with obesity is delivered in primary care settings…’ and as such ‘…guidance for integrating weight-management approaches is needed.’
    • Barriers including ‘…access to care, have a disproportionate influence on populations most affected by obesity and its consequences.’
    • Indeed, clinicians ‘…may lack guidance on how best to help patients with obesity beyond recommending changes in diet and physical activity…’ leading to suboptimal care.
    • Obesity is a chronic disease, and often stigmatized; people with obesity are often incorrectly considered to lack willpower.
    • patient-centered approach to discussing weight at clinical visits is provided, with relevance to dietary recommendations, and physical activity, onward to adjunctive anti-obesity medications, and MBS, or metabolic and bariatric surgery.
    • My colleague Dr. Angela Fitch is a strong proponent of comprehensive, patient-centered, and expert-led care in the primary care setting, delivered at her start-up venture, knownwell – I would love to have much more of the same, across the country.
  • What Ozempic can teach CFOs about drug costs is the focus at CFO Brew.
    • Weight loss medications ‘…increased employers’ prescription drug spending last year, according to Mercer…’ and is landing on the CFO’s desk.
    • The article states that ‘…while CFOs and other benefit decision-makers have no leverage to negotiate what they pay for the drugs, they can act to keep costs from rising more than they otherwise might.’
    • Coverage is going to increase, as are costs; these drugs will become the standard of care for employees with obesity and related metabolic diseases – hypertension, diabetes, and fatty liver.
    • In my opinion, risk stratification, with an intent to lower chronic disease burden, to drive lower total costs of care, and to enhance employee productivity, are the optimal approach, aligning costs and clinical care.
  • The New York Times notes in 2018, women with polycystic ovarian syndrome were told by experts to ‘…consider reducing their caloric intake by up to 750 calories a day.’
    • In 2023, the same group, called the International PCOS Network dropped all references to calorie restriction.
    • PCOS is a hormonal disorder that affects as many as five million women in the United States, characterized by irregular periods, infertility, excessive facial hair growth, acne, and scalp hair loss.
    • Dr. Anuja Dokras, director of the Penn Polycystic Ovary Syndrome Center at the University of Pennsylvania, notes after bariatric or weight loss surgical intervention and drastic weight reduction, those with PCOS ‘…start having very regular periods and the male hormone levels also drop.’
    • I have performed bariatric surgery on a number of patients dealing with PCOS, some of whom have had numerous failed IVF attempts, and then manage to conceive and deliver naturally – it is almost remarkable.
    • Indeed, there is ongoing research to study whether weight loss drugs like Ozempic can improve symptoms for PCOS; which will be a godsend to many millions of women, for sure.


  • Researchers from Rhode Island [shout out to twenty30 health colleague Chris Moore] evaluated the long-term effectiveness of an automated, online, behavioral obesity treatment program, reported in JAMA Internal Medicine.
    • From over 500 participants, there was clinically significant weight loss over 2 years in the primary care setting.
    • The program includes 12 weekly interactive 15-minute video lessons teaching evidence-based behavior change strategies for weight loss, such as goal setting and problem solving.



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