geoff: The nation's obesity
epidemic is growing. Nearly 42%
of all adults are considered
obese.
Now, new findings about an fda
approved weight-loss medication
may lead to even more demand for
a medication that can be both
life-changing and expensive.
William brangham has the latest.
William: Roughly 100 million
Americans suffer from obesity
and its many associated health
risks. Obesity takes a terrible
economic toll as well, costing
this country an estimated $200
billion a year.
A new weight loss drug called
wegovy has shown, according to
one study, that it not only can
help with obesity, but it might
also cut the risk of heart
attacks, strokes, and other
heart problems by 20%. But there
are real concerns about
potential side effects.
For a closer look, we are joined
by Dr. Michael Blaha.
He's director of clinical
research at the Johns Hopkins
chika Roni center for the
prevention of cardiovascular
disease.
Dr. Blaha, very good to have you
on the news hour.
Before we get to talking about
this drug, could you just remind
us of the connections between
obesity and heart disease?
>> Yeah, sure. As you said, rbc
-- obesity is extremely common,
and it's linked with so many
forms of cardiovascular disease.
Obesity itself is an
inflammatory condition. It
raises your blood pressure, can
cause diabetes and other risk
factors, and it's linked to
atherosclerosis of the arteries,
which puts you at risk for heart
attacks and strokes.
It also raises the risk of heart
failure and atrial fibrillation.
Heart rhythm abnormality, too,
so really, obesity underpins
many of the chronic
cardiovascular conditions that
we treat in a cardiology
practice.
William: According to this
study, only parts have been
released, it indicates this drug
could prevent 1.5 one million
heart attacks, strokes, and
other events over the course of
10 years, if that's true, with
all the caveats there.
How big a deal is that?
>> This is a really big deal. In
my opinion, we've waited for a
long time to build a treat
obesity and clinical medicine
and actually lower
cardiovascular events. And as a
cardiologist, you know we
haven't paid much attention to
obesity because we couldn't do
anything about it and affect our
outcomes. But now, with the
potential on the horizon about a
treat obesity and lower
cardiovascular disease, you have
the attention of cardiologists
and other specialists who treat
cardiovascular disease. So this
is a really big deal, and I
think it's finally going to
change the paradigm on the way
we think about obesity, the
way we treat obesity and there's
a lot more to work out. And as
you mentioned, we need to see
the results of the actual study.
William: Walk me through the
ways in which it might be a
paradigm shift for your
profession.
>> Most of our patients don't
lose weight.
In fact, most of our patients
gain weight over time.
Obesity underpins so many of the
chronic diseases that we treat
obstructive sleep apnea is one
that can lead to hypertension
becoming hard to treat.
Cholesterol abnormalities, of
course diabetes. And I mentioned
before, myocardial infarction
and heart attacks and strokes.
But also the heart failure, the
chronic heart failure that's
troubling for many of our
patients.
And atrial fibrillation, which
is becoming an epidemic so
it underpins so much of what we
do. So we treat many of the
complications of obesity in our
practice right now, but we never
get to the root cause and this
is what has been frustrating
over so long.
We are just treating the
manifestations of obesity. It's
a very costly way of doing
things compared to actually
treating the underlying causes
of all the problems.
William: As I mentioned, there
are some concerns about
complications or side effects
with these drugs. What is your
understanding of those? And what
do people need to know about
that part of it?
>> These drugs are really well
known actually, because we've
been using them in the diabetes
space for over a decade. So now
we have approval to use some of
the same medications at higher
doses for weight loss, or at
least one in particular. So
we've learned a lot in the
clinical arena about how to use
these drugs. And absolutely
there are side effects. In fact,
the side effects are closely
associated with their mechanism
of action. And if I could
briefly say that the way these
medications work is, they slow
the emptying of food from the
stomach. They signal hormonal
changes that put us in their fed
states. We feel satiated and not
hungry anymore, and they also
work directly on the brain to
reduce hunger. So some of the
side effects are those very
things.
If they are beyond what a
patient can tolerate, you can
get a full bloating feeling in
, the stomach after a big meal.
You can get nausea, sometimes
vomiting or diarrhea. They are
largely controlled with diet
changes. So it's very important
if a patient were to consider a
medication like this, that this
isn't in lieu of diet and
exercise.
It is with diet changes.
William: And if someone starts
on these drugs, do they take
them for a short period of time?
Are they taking them for the
rest of their life? What is
that?
>> If you stop taking these
medications, patients do regain
weight.
Most of them have regained
weight, maybe not all of it but
much of it.
So it's really shifting the
thinking about obesity towards
that of a chronic disease. You
know, we take blood pressure
medications for hypertension. We
expect that our blood pressure
will go back if we stop them.
And same with our cholesterol
medications. We sort of assume
that if you stop taking them the
cholesterol goes up. But this
hasn't really been worked out so
much in the obesity space. But
as we learn more about the
disease and think of it as a
chronic disease, it sort of
makes sense, then, that the
medications need to be there to
exert their effect. So we hope
we will learn a lot more about
the maintenance phase of
pharmacologic treatment for
obesity over time, but right now
it looks like you do need to
stay on the drug to get the
maximum benefit.
In the meantime, we like our
patients to have a thorough
diet and lifestyle change that
might help them keep the weight
off. So it's really once again
about diet, exercise and drugs.
William: You are not in the
business of health insurance,
per se. But there is a question
as to whether these drugs show
their promise, whether or not
health insurance, and
particularly, whether medicare
ought to cover them.
Is it your opinion that these do
offer enough benefit that that
really ought to be a
consideration?
>> It is my opinion, based on
this trial that's been running,
the size of that trial and how
well it was run, that the
evidence is going to be
sufficient for the fda to
approve these weight loss drugs,
wegovy particularly, for
cardiovascular risk reduction.
And having that fda approval for
cardiovascular risk reduction
will then open up an opportunity
or at least put pressure on
payers like medicare to cover
this medication more broadly,
and we've been waiting for this.
We've anticipated this trial as
a pivotal moment to see, is this
going to be a drug that many
people will benefit from? Or is
this one that you know will keep
as more of a niche product for
maybe severe obesity, and it
looks like we're going to have a
broad based cardiovascular
benefits. So absolutely, we're
going to see much broader
coverage I think.
William: All right, Dr. Michael
Blaha. Johns Hopkins medicine.
Thank you so much for being
here.
>> My pleasure. Thank you.
♪♪