Dear insurers: it’s time to cover weight-loss drugs

A study published in the Journal of the American College of Cardiology revealed that only 6.8% of Americans are in optimal cardiometabolic health. As a family nurse practitioner practicing lifestyle medicine, I am extremely concerned about the 93.2% of Americans who are not in optimal cardiometabolic health.

Our healthcare system should also be affected. I was first introduced to the concepts of value-based care and accountable care organizations in 2013 as a performance improvement nurse. In 2022, as we continue to slowly move away from fee-for-service, improving cardiometabolic health will be a critical part of improving population health.

What is optimal cardiometabolic health?

So what exactly is cardiometabolic health and what is optimal? Good questions. Optimal cardiometabolic health is the absence of a range of disorders that increase the risk of heart disease or type 2 diabetes. These include hypertension, high fasting blood sugar, abnormal cholesterol levels, excess abdominal weight and high triglycerides.

The review study was based on the results of the National Health and Nutrition Examination survey. Cardiometabolic risk factors analyzed in this study included body weight, blood sugar, cholesterol, blood pressure, and clinical cardiovascular disease. According to the research, changes in average body weight and blood sugar levels were the two factors with the greatest impact on the decrease in cardiometabolic health of the population between 1999 and 2018. Optimal body weight was considered a body mass index (BMI) less than 25 and a waist circumference less than or equal to 88 cm for women and 102 cm for men. Criteria for optimal blood glucose included no diabetes medication, fasting blood glucose below 100 mg/dL, and hemoglobin A1C below 5.7%. A low level of body weight was considered a BMI above 30 and a waist circumference above the above threshold measurements. A poor blood glucose level was a fasting level greater than or equal to 126 mg/dL or a hemoglobin A1C greater than or equal to 6.5%.

Approaches to improving cardiometabolic health

Nine of the 10 leading causes of death in America have obesity and being overweight as a risk factor. These include heart disease, certain cancers, COVID-19, stroke, chronic lower respiratory disease, Alzheimer’s disease, diabetes, influenza, and nephrotic syndrome. Heart disease alone costs the United States hundreds of billions of dollars each year in treatments, medications, and lost wages due to death. In fact, 90% of healthcare spending in the United States is related to chronic disease and mental health.

The good news for the 73.6% of American adults who are considered overweight or obese, many of whom do not have optimal cardiometabolic health, is that there are FDA-approved weight loss drugs that can help supplement diet and lifestyle changes – especially when these alone are unsustainable or ineffective in improving various health conditions.

The bad news? Insurance coverage for these drugs varies by state, type of insurance, and employer plan. These drugs are generally not covered by Medicaid or Medicare, including where I practice in Illinois. Even for patients with an employer-based commercial plan, weight-loss drugs are often not covered.

I have had the opportunity to witness the power of lifestyle modifications combined with access to medication to help patients achieve their health goals. For example, a patient who had been diagnosed with diabetes 11 years earlier was having difficulty controlling her diabetes and losing weight. We worked together for 6 months, mostly adjusting our lifestyle, like increasing her water intake, reducing her sodium intake, adding vegetables to her daily diet, going to the gym four to five times a week, reducing her carbohydrate consumption and include more protein. and healthy fats in their diet. I also referred her to an endocrinology specialist to optimize her medications, such as reducing her diabetes medications associated with weight gain, and to include a GLP-1 agonist, a class of diabetes medications associated to weight loss.

These lifestyle changes as well as adjustments in her medications have allowed her to achieve her health goals. In 6 months, she was able to lose 25 pounds and 6.7 inches (17 cm) from her waistline. His hemoglobin A1C level had fallen to 5.6%, below the diagnostic level for prediabetes. She has better controlled her diabetes than in the past 11 years. She cried tears of joy in my office because she felt good. She thanked me, but I told her she was the hard worker.

Unfortunately, it’s a success that not everyone knows about.

For this particular patient, the GLP-1 receptor agonist drug was covered by her insurer because it is indicated for the treatment of type 2 diabetes. But there are other GLP-1 receptor agonists, such as liraglutide (Saxenda) and semaglutide (Wegovy), which are FDA approved but often not covered by insurance because their specific use is for weight loss.

This is just one example of how our healthcare system is reactive instead of proactive. Obesity has been recognized by the American Medical Association as a chronic disease since 2013. We need to start treating it as such by providing appropriate drug coverage and increasing the availability of comprehensive programs with lifestyle medicine. life, behavioral health and preventive cardiology. Certainly, the primary prevention of obesity and morbid obesity would be optimal and targeted initiatives should also be preferred.

Obesity is a complex chronic disease rooted in metabolic dysfunction and is influenced by the social determinants of health, socioeconomic status, access to healthy diets, corn and sugar corporate subsidies, convenience of fast food, stress, genetics, etc. It’s often not as simple as “eat less and exercise more” – and that’s where medication can provide another line of support.

We have safe and effective drugs that are FDA approved for weight loss and have been rigorously tested before approval. We need to expand access to these medicines by providing universal coverage.

Elizabeth Simkus, DNP, FNP-C, is a family nurse practitioner practicing lifestyle medicine at Rush University Medical Center, an instructor in the Department of Community Nursing, Systems and Mental Health at Rush University College of Nursing and a Public Voices Fellow through The OpEd Project.

Comments are closed.