March 29, 2024 – It could be a case of: if you can’t beat ’em, join ’em. Commercial weight loss companies such as WW (formerly Weight Watchers), Noom and Calibrate, which existed before the explosion in popularity of some weight loss medications, now offer them to their members.
Providing glucagon-like peptide 1 (GLP-1) receptor agonists such as semaglutide (Wegovy) or tirzepatide (Mounjaro) to the right candidates gives their subscribers as many weight management options as possible, according to company representatives. They emphasized that their companies carefully screen people and refer them to medical professionals who work with their organizations.
While applauding the role these behaviorally based weight management programs play in a comprehensive approach, one academic weight loss clinician believes the sequence is backwards. Instead, people with obesity should consult a primary care physician or obesity expert Firstthen be referred to these commercial programs, said Caroline M. Apovian, MD, co-director of the Center for Weight Management and Wellness at Brigham and Women’s Hospital in Boston.
“These types of partnerships are important,” she says. “It should be a medical treatment program first, as the main event, and then the behavioral program [a supplement] – not the other way around.”
For example, Brigham and Women’s Hospital refers patients to a weight management company, Restore Health, to provide the medications.
“I am in no way saying that the behavioral treatment that Weight Watchers and Noom offer is not important. It is extremely important,” said Apovian, who is also a spokesperson for the Obesity Society, a professional organization dedicated to the treatment and prevention of obesity.
Bottleneck in primary care?
“In an ideal world that would be wonderful. However, the truth is that now less than 1% of healthcare providers are actually trained to provide obesity care,” said Amy Meister, DO, Chief Medical Officer at WW.
According to the American Board of Obesity Medicine, this is the case 8,263 certified physicians in obesity medicine in the US and Canada. There are more than 1.1 million active physicians in the US only.
“Honestly, a lot of people come to us and our competitors because they can’t get into the traditional brick-and-mortar environment. Access is probably the most important thing we bring to the table – and not just access to care, but access to healthcare providers who are specifically trained with that expertise,” Meister said.
Noom’s chief doctor reflected this view of the situation. “Primary care physicians are terribly strapped for bandwidth,” says Linda Anegawa, MD. Treating obesity takes time, sensitivity and experience. She estimated that most physicians receive only about 10 hours of obesity-specific instruction during their medical education and training.
“As a GP, in terms of background and training, I cannot emphasize enough the importance of a GP. I do know that many primary care physicians feel ill-equipped to manage the needs of the medical patient undergoing obesity treatment. They do not feel they have the specialized knowledge or training to fully support these patients.”
At the same time the most recent CDC estimates shows that 42% of Americans are obese, including 9% who are severely obese.
“Finally we have effective treatments. But this is happening in the context of enormous need, enormous demand and enormous costs,” Anegawa said.
The response so far
In May 2023, WW purchased telehealth company Sequence, a medical group that can prescribe medications in 50 states and Washington, DC. They launched WW Clinic in December of the same year. Last year, Noom also launched a medical weight management program, Noom Med. The telehealth weight-loss company Calibrate, founded before these drugs became so popular, now also offers them.
“We’ve actually had a better response than we predicted,” Meister said. By the end of 2023, 67,000 people had subscribed to the WW Clinic program. An estimated 70% of this came from the 3.8 million active unemployment benefits members, or from dropped members who returned because of the new offer. “Unfortunately, the diet-lifestyle solution didn’t work for them. Now they are meeting with our doctors and nurses to try a medical solution.”
Because of what Kristin Baier, MD, Calibrate’s vice president of clinical development, calls their extensive screening process before signing up with Calibrate, an estimated 90% of potential candidates attending their doctor’s appointments are considered eligible for GLP-1 medications .
Obesity the disease
For years, obesity was seen as a lifestyle problem. More recently, it is considered a complex and chronic disease, requiring a comprehensive medical approach and personalized treatment. “There is a dysfunction in the energy regulation pathway that runs from the gut to the brain,” Apovian explains. The drugs are analogues of intestinal hormones that our body normally releases when we eat. The hormones “tell the brain that you have eaten enough, that you are full. So these drugs correct a dysfunction of a serious disease.”
The anti-obesity drugs therefore play an important role, agreed Katherine H. Saunders, MD, an obesity expert at Weill Cornell Medicine in New York and co-founder of Intellihealth, a company that provides virtual medical obesity treatment. “Most people with obesity are unable to lose a significant amount of weight and maintain their weight loss over the long term with lifestyle interventions alone.”
Even though the GLP-1s are in the spotlight, they are not the whole story, says Saunders, who also serves as spokesperson for the Obesity Society. “It is important to note again that treating obesity does not involve just one class of medications. There is so much we can do to treat obesity without it [GLP-1s].”
“Because obesity is a complex, chronic disease, treating obesity requires more than just medication for long-term, sustainable results,” Baier said.
That could be good news for people who can’t get or afford these medications.
What about the costs?
GLP-1 medications are expensive and only a minority of insurance companies cover them for weight management. We asked these companies how they handle their members on an estimated $1,000 to $1,500 per month.
“The cost of medications is a major problem, but it is just one barrier that prevents people with obesity from accessing life-saving medical treatments,” said Saunders. Other issues include the need to train more physicians in comprehensive and long-term obesity care, the need for more payers and employers to cover the care, and an increase in drug supply to meet demand, she said.
Apovian agreed that the costs could be prohibitive.
“Nobody wants to pay for these drugs out of their own pocket, even people with a lot of money. They cost $1,500 a month, and you have to stay on them forever,” she said.
She predicted that people who want to lose 10 pounds before an event will spend a few months doing so, expecting to regain the weight when they stop. But she said, “That’s not what these drugs are for.”
Noom also offers medications “that are less expensive for that patient, but can also be effective,” Anegawa said. “This can help maximize the effectiveness of GLP-1s while keeping costs in check.”
Pursue insurance coverage
WW, Noom and Calibrate each emphasized that they have staff dedicated to pursuing insurance coverage for obesity medications for their members. For example, the companies handle the paperwork for prior authorization and resubmission of denied claims. “That’s part of our secret sauce,” Meister said.
Yet only about 20% to 30% of private insurers cover obesity medications, Apovian said.
“Physicians don’t have time to deal with prior authorizations,” Anegawa says. Most doctors don’t have the staff trained and equipped “to actually get these appeals and denials out there and handle the mountains of paperwork. This gives us a unique advantage in prescribing.”
“Paying out of pocket for GLP-1s is not feasible for most people,” Baier said. “Navigating the red tape that insurance has created around access to these life-changing medications is daunting.”
She said Calibrate helps members access medications by navigating their forms to find out which GLP-1 medications are covered based on their specific health history and insurance coverage.
“We must demand greater access to our life-saving medicines,” Apovian said. For example, in a clinical trial, semaglutide reduced major problems in the heart and blood vessels by 20%. “So now… 70% of insurance companies do not cover these drugs, denying life-saving medications to patients with significant obesity. That’s a problem, right?”
Meister said WW also helps patients find medications during shortages by calling up to nine pharmacies within driving distance or contacting mail-order pharmacies when possible. “If you miss doses because you can’t get the medicine, sometimes you have to start over,” she said. “That can be very frustrating for both the doctor and the patient because it will affect their care and their outcome.”
“Obesity is a complex chronic disease. It is a treatable disease, but a holistic approach is needed.” Anegawa said. “While the GLP-1s have definitely been therapeutic game changers for those of us in obesity medicine, they are not a cure. So you really need that anchor in behavior change to help along with the medication, rewire the brain’s craving pathways, improve insulin resistance and deliver those long-term improvements and the health outcomes that we’re all looking for.
