GPBCH Speakers Support Design of Potential Obesity Benefits

Speakers from the Greater Philadelphia Business Coalition on Health (GPBCH) discussed lifestyle data, economic trends, and presented real-world obesity treatment examples, as well as insight into the benefits of obesity .

Data presented to the Greater Philadelphia Business Coalition on Health (GPBCH) described epidemiological and economic trends in obesity, treatment and lifestyle options, and how benefit design can help providers manage obesity. obesity as a chronic disease.

Niki Patel, PharmD, MBA, Associate Director of Medical Accounts at Novo Nordisk, began by discussing the drivers of obesity and the effects weight loss can have on health outcomes.

Approximately 42% of American adults suffer from obesity, and this percentage is expected to rise to 50% within the next decade. According to Patel, the main problem with obesity is that it is not managed like the chronic disease that it is. In addition, the social determinants of health influence the prevalence of obesity, which increases with the cost of the disease.

“Currently, 2 in 5 white adults are obese compared to 1 in 2 black adults, and yet black patients are less likely to receive obesity diagnosis or treatment than white patients, and even fewer people receive a treatment,” Patel said.

Patel further explained that dietary changes are one of the main reasons obesity rates are high in the United States, particularly the increase in portion sizes over time and the accessibility of foods. less healthy foods. Between the 1950s and the 2010s, the average restaurant meal has quadrupled, and the average American adult is 26 pounds heavier.

Stress, sleep deprivation and inactivity are also major lifestyle factors contributing to America’s obesity epidemic, along with genetic factors such as epigenetic changes. Neil Goldfarb, President and CEO of GPBCH, presented data from a study on weight changes during the COVID-19 pandemic, noting how the pandemic has affected these lifestyle factors which, in turn , triggered undesirable weight changes.

According to data from the American Psychological Association that stratified people by sex, race and age, the percentage of people who reported unwanted weight gain during the pandemic was higher overall than people who reported weight loss. unwanted weight. Overall, 61% of American adults in the study reported unwanted weight change during the pandemic.

“The impact of the pandemic on obesity – which was already an epidemic – is really pronounced and that’s why we think it’s as important a topic as ever,” Goldfarb said.

Going deeper into strategies and clinical outcomes, speakers noted that obese people can experience substantial benefits even when they lose small percentages of body weight. The data showed improved outcomes in the following comorbidities by percentage reduction in body weight:

  • 0%-5%; hypertension, hyperglycemia
  • 5%-10%; polycystic ovary syndrome, dyslipidemia, prevention of type 2 diabetes (T2DM), asthma, atopic dermatitis, non-alcoholic fatty liver disease
  • 10%-15%; stress urinary incontinence, obstructive sleep apnea, gastroesophageal reflux disease, knee osteoarthritis, cardiovascular disease, non-alcoholic steatohepatitis
  • 15% or more; T2D remission, cardiovascular mortality, heart failure with preserved ejection fraction

Anastassia Amaro, MD, medical director of Penn Metabolic Medicine and associate professor of medicine at the University of Pennsylvania, discussed how to help obese people lose weight. One strategy is the stepwise approach, which begins with lifestyle changes and progresses to drug therapy and bariatric endoscopy. She discussed at length the challenges of getting patients to start taking drugs to treat obesity.

Obesity drugs are a tough sell to some doctors, she said. They may have “therapeutic pessimism” because they have tried therapies in the past that were later taken off the market. And just getting drugs approved by an insurance plan is a process.

“I have an assistant who calls the insurance company and finds out what’s covered,” Amaro said. “What are the conditions of the prior authorizations to have this drug reimbursed? So that work is done before we even start discussing medications… So that’s hours of work for a single patient-doctor intervention to happen.

Patients at his center have access to clinical trials, some were able to participate in trials of semaglutide 2.4 mg (Ozempic), Novo Nordisk’s glucagon-like peptide-1 receptor agonist which has since received approval from the FDA to treat obesity; she noted that the average weight loss in her patients was equal to or greater than the overall weight loss in the trial, which was 12.4%.

“I’m pretty sure we can replicate that in real life if we have access to this drug,” she said.

If drug therapy is ineffective for some reason, then patients become candidates for bariatric surgery. However, bariatric surgery is not a permanent solution for everyone.

“At this point, we already know that about 30 percent of people with a history of bariatric surgery will regain some or all of the weight they lost through bariatric surgery treatment,” Amaro explained. “So a new type of patients that we see in our clinic are patients who regain weight after surgery, and we need to prescribe medications and implement self-directed, professional-led lifestyle changes, as well as dietary and exercise advice.”

Amaro also suggested a more cyclical approach, saying an obese person could receive treatment at any stage and “enter” or “exit” the circle at any time. General phases within the circle include obesity assessment, intense weight loss intervention, weight loss maintenance intervention, and prevention of weight gain or regain.

Goldfarb concluded the seminar by outlining what a comprehensive obesity benefits design should include:

  • Prevention and promotion of healthy lifestyles
  • Case identification and data management
  • Supplier network support and referencing
  • Support for mental health services
  • Pharmacological benefit, including anti-obesity medication coverage
  • Surgical benefit
  • Recognition of social determinants of health and health equity
  • Follow-up support

“We don’t want doctors prescribing and thinking they’ve cured obesity or done their part,” Goldfarb said. “We want to make sure doctors are actively monitoring patients.”

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