美国国家公共电台 NPR--Wegovy works. But here's what happens if you can't afford to keep taking the drug

Wegovy works. But here's what happens if you can't afford to keep taking the drug

Transcript¹

From TikTok influencers talking it up to celebrities² worrying about "Ozempic face," drugs like Wegovy and Ozempic are being touted³ as weight-loss miracles in a country obsessed⁴ with slimness.

But, the drugs aren't intended for cosmetic⁵ weight loss. Ozempic is approved for diabetes⁶, and Wegovy is for people with obesity⁷ who also have weight-related conditions such as high blood pressure or high cholesterol⁸ that put them at risk of heart disease. That's millions of Americans.

And evidence shows the new class of drugs are far more effective than prior obesity medications. A landmark⁹ clinical trial published in The New England Journal of Medicine in 2021 found that the drug led to a 15% reduction in body weight, on average.

There's been such an increase in demand that an FDA database lists the medication's active ingredient, semaglutide, as "currently in shortage." Its manufacturer, Novo Nordisk, says keeping supplies stable is a priority. The company also markets Ozempic to treat diabetes, which is a lower dose of semaglutide.

But at a cost of about $1,400 a month — out of pocket when insurance doesn't cover it — many people can't afford to stay on the medication for the long term. And when people stop taking it, there's often rebound¹⁰ weight gain that's hard to control. In fact, a study found that most people gain back most of the weight within a year of stopping the medicine.

That's what is happening to Yolanda Hamilton from South Holland, Ill. Hamilton's doctor prescribed Wegovy because she had an elevated BMI, high blood pressure and elevated blood sugar. She lost 60 pounds and started feeling much better.

"It gave me more energy," she says, allowing her to exercise and do house chores. Her cravings for sugar subsided¹¹, and she felt satisfied from smaller meals. "I was very surprised by how good I felt," Hamilton says. The drug is administered by a once a week injection at home, which Hamilton says is easy to do.

Her Aetna insurance plan covered the cost of the medication, but when she changed jobs last fall, her new insurance plan through Blue Cross and Blue Shield of Illinois denied coverage¹². She now works in a hospital ER registering patients, which requires her to sit most of the day. And, after a few months of not taking the drug, she has gained back 20 pounds.

"I'm very frustrated¹³ about the weight coming back on in so little time," Hamilton says.

Blue Cross and Blue Shield of Illinois told NPR that benefits offered by employer plans can vary. "Weight-loss drugs like Wegovy may be covered, depending on the member's benefit plan," a spokesperson for the company said. Many other insurance carriers also determine coverage based on what employers are willing to cover.

Barriers to a life-changing drug

The rebound weight gain is not a surprise given how the medication works. Wegovy's active ingredient — semaglutide — is a GLP-1, or glucagon-like peptide-1, which mimics¹⁴ the GLP-1 satiety¹⁵ hormone¹⁶ in our bodies. When we eat, GLP-1 is released from our intestines¹⁷ and sends signals to our brain centers that control appetite.

"This hormone is telling your brain, I'm full, I don't need to eat anymore," explains Dr. Robert Kushner of Northwestern University, who treats Yolanda Hamilton. Kushner also serves on a Novo Nordisk medical advisory¹⁸ board, for which he receives an honorarium¹⁹.

"What the pharmaceutical²⁰ companies have done is taken this hormone that is naturally occurring and restructured it into a drug," he explains. So, it's not a surprise that when people stop taking the medicine, they start to feel hungrier, he says.

"I crave²¹ sweets," Hamilton says. And her appetite has increased. She no longer feels satisfied with small meals. "I'm losing my energy" as the weight comes back, she says.

Kushner's office is helping²² Hamilton appeal the insurance denial, but as she waits, she's worried that stopping the medication will also influence her blood pressure and blood sugar. "She is at risk of having these conditions worsen with regain²³ of weight," Kushner says.

"If I gain more weight, I will be on more medications," says Hamilton. Given her long struggle with weight loss, she'd finally found something that was working.

"We're seeing a lot of patients have this rebound weight gain, and it can really be devastating," says Dr. Karla Robinson, a family physician based in Charlotte, N.C., and a medical editor at GoodRx, a company that helps people find the lowest prices for generic²⁴ and brand drugs. There's no generic version of semaglutide.

"Unfortunately, being a new medication, it's one of those that is subject to the pricing of the manufacturer," Robinson says.

A representative from Novo Nordisk notes that the company offers a $500 coupon²⁵ for Wegovy to reduce the cost for patients paying cash.

But, this chart from GoodRX shows the lowest price among all retailers²⁶ is $1,304 per month for people paying out of pocket, which is out of reach for most people — even with a coupon.

"I do feel like Wegovy is revolutionary," Hamilton says. But she says she definitely can't afford to pay for it.

"Some of the people who need it the most are unable to access it," Robinson says, pointing out that people with low incomes experience obesity at disproportionately higher rates.

"We're talking about a huge health equity²⁷ issue," she says. Black and Hispanic adults have higher rates of obesity, according to the CDC.

Since Wegovy was approved by the FDA in 2021, some insurance plans have begun to cover the medication for people who meet the clinical prescribing guidelines. According to the FDA, people are eligible²⁸ if they have a BMI of 27 or higher and also have at least one "weight-related ailment²⁹" such as hypertension, diabetes, or high cholesterol. Or they have a BMI of 30 or higher, regardless of weight-related ailments³⁰.

But insurance coverage is very spotty. Medicare does not cover Wegovy or other weight loss drugs, and many insurers follow Medicare's lead. Increasingly, there's pressure to change this. As STAT reported last week, the Moffitt Cancer Center in Florida is lobbying for legislation that would allow Medicare to pay for obesity drugs, citing the link between obesity and cancer risk. The NAACP is also registered to lobby on this issue.

In addition, the American Academy of Pediatrics has new guidance recommending that pediatricians offer weight loss drugs to adolescents 12 and older with obesity as an adjunct to behavior change and lifestyle interventions³¹.

Long-term unknowns

But the fact that people may need to stay on Wegovy indefinitely in order to maintain the weight loss has raised concerns about long-term use. The most common side effects of the drug are GI symptoms. "Nausea³², diarrhea, constipation, vomiting³³ in some people, or heartburn," Kushner says.

He says starting with a low dose and increasing it over time can help people tolerate the drug better. There's ongoing³⁴ research to evaluate the drug's effect on the cardiovascular system, which is positive so far.

But the drug does carry a black box warning because in rodent³⁵ studies it caused thyroid tumors. So, Kushner says doctors need to screen patients to find out if they have a family history of a specific kind of thyroid carcinoma, or another rare condition called multiple endocrine neoplasia syndrome³⁶ type 2 (MEN 2). "This would be an individual patient conversation," Kushner says. Generally, if you don't have a history of these conditions, "this medication is thought to be safe," he says.

If this sounds unsettling, it's a reminder³⁷ of how high the stakes are to combat obesity. The theoretical risk of thyroid tumors may be unnerving. But doctors point to the risks of leaving obesity untreated: Heart disease is the leading cause of death in the U.S., and obesity and weight-related conditions are top risk factors.

Of course, exercise and diet modification³⁸ are still the first strategies to try. But given that about 70% of Americans are overweight or obese³⁹, nearly half of adults in the U.S. have hypertension and more than 1 in 3 have pre-diabetes, doctors' groups cite an urgent need to layer on more interventions that can be helpful.

"We, as a society, are spending $173 billion in obesity-related health care costs," says Dr. Marcus Schabacker, CEO of ECRI, an independent, nonprofit group that has reviewed the evidence of new weight loss drugs.

He argues that the drugs can be part of destigmatizing obesity by treating it like any other disease that you treat with medicine. "We would not ask someone who has hypertension to just do exercises and change your diet and then you will be fine. No, we give them beta blockers. It's not different here. Exercise and diet are key components⁴⁰ of tackling obesity, but so are medications which have proven to be effective," he says.

1 transcript   

n.抄本，誊本，副本，肄业证书

参考例句：

• A transcript of the tapes was presented as evidence in court.一份录音带的文字本作为证据被呈交法庭。
• They wouldn't let me have a transcript of the interview.他们拒绝给我一份采访的文字整理稿。

2 celebrities   

n.（尤指娱乐界的）名人( celebrity的名词复数 )；名流；名声；名誉

参考例句：

• He only invited A-list celebrities to his parties. 他只邀请头等名流参加他的聚会。
• a TV chat show full of B-list celebrities 由众多二流人物参加的电视访谈节目

3 touted   

v.兜售( tout的过去式和过去分词 )；招揽；侦查；探听赛马情报

参考例句：

• She's being touted as the next leader of the party. 她被吹捧为该党的下一任领导人。
• People said that he touted for his mother and sister. 据说，他给母亲和姐姐拉生意。 来自辞典例句

4 obsessed   

adj.心神不宁的,鬼迷心窍的,沉迷的

参考例句：

• He's obsessed by computers. 他迷上了电脑。
• The fear of death obsessed him throughout his old life. 他晚年一直受着死亡恐惧的困扰。

5 cosmetic   

n.化妆品；adj.化妆用的；装门面的；装饰性的

参考例句：

• These changes are purely cosmetic.这些改变纯粹是装饰门面。
• Laughter is the best cosmetic,so grin and wear it!微笑是最好的化妆品，所以请尽情微笑吧！

6 diabetes   

n.糖尿病

参考例句：

• In case of diabetes, physicians advise against the use of sugar.对于糖尿病患者，医生告诫他们不要吃糖。
• Diabetes is caused by a fault in the insulin production of the body.糖尿病是由体內胰岛素分泌失调引起的。

7 obesity   

n.肥胖，肥大

参考例句：

• One effect of overeating may be obesity.吃得过多能导致肥胖。
• Sugar and fat can more easily lead to obesity than some other foods.糖和脂肪比其他食物更容易导致肥胖。

8 cholesterol   

n.（U）胆固醇

参考例句：

• There is cholesterol in the cell of body.人体细胞里有胆固醇。
• They are determining the serum-protein and cholesterol levels.他们正在测定血清蛋白和胆固醇的浓度。

9 landmark   

n.陆标，划时代的事，地界标

参考例句：

• The Russian Revolution represents a landmark in world history.俄国革命是世界历史上的一个里程碑。
• The tower was once a landmark for ships.这座塔曾是船只的陆标。

10 rebound   

v.弹回；n.弹回，跳回

参考例句：

• The vibrations accompanying the rebound are the earth quake.伴随这种回弹的振动就是地震。
• Our evil example will rebound upon ourselves.我们的坏榜样会回到我们自己头上的。

11 subsided   

v.（土地）下陷（因在地下采矿）( subside的过去式和过去分词 )；减弱；下降至较低或正常水平；一下子坐在椅子等上

参考例句：

• After the heavy rains part of the road subsided. 大雨过后，部分公路塌陷了。 来自《简明英汉词典》
• By evening the storm had subsided and all was quiet again. 傍晚， 暴风雨已经过去，四周开始沉寂下来。 来自《现代汉英综合大词典》

12 coverage   

n.报导，保险范围，保险额，范围，覆盖

参考例句：

• There's little coverage of foreign news in the newspaper.报纸上几乎没有国外新闻报道。
• This is an insurance policy with extensive coverage.这是一项承保范围广泛的保险。

13 frustrated   

adj.挫败的，失意的，泄气的v.使不成功( frustrate的过去式和过去分词 )；挫败；使受挫折；令人沮丧

参考例句：

• It's very easy to get frustrated in this job. 这个工作很容易令人懊恼。
• The bad weather frustrated all our hopes of going out. 恶劣的天气破坏了我们出行的愿望。 来自《简明英汉词典》

14 mimics   

n.模仿名人言行的娱乐演员，滑稽剧演员( mimic的名词复数 )；善于模仿的人或物v.（尤指为了逗乐而）模仿( mimic的第三人称单数 )；酷似

参考例句：

• Methods:Models were generate by CT scan,Mimics software and Abaqus software. 方法：采用CT扫描，Mimics软件和Abaqus软件的CAD进行三维有限元模型的创建。 来自互联网
• Relaxing the mind and body mimics the effect that some blood-pressure pills would have. 放松身心会产生某些降压药才能产生的效果。 来自辞典例句

15 satiety   

n.饱和；(市场的)充分供应

参考例句：

• There is no satiety in study.学无止境。
• Their presence in foods induces satiety at meal time.它们在食物中的存在诱导进餐时的满足感。

16 hormone   

n.荷尔蒙，激素，内分泌

参考例句：

• Hormone implants are used as growth boosters.激素植入物被用作生长辅助剂。
• This hormone interacts closely with other hormones in the body.这种荷尔蒙与体內其他荷尔蒙紧密地相互作用。

17 intestines   

n.肠( intestine的名词复数 )

参考例句：

• Perhaps the most serious problems occur in the stomach and intestines. 最严重的问题或许出现在胃和肠里。 来自辞典例句
• The traps of carnivorous plants function a little like the stomachs and small intestines of animals. 食肉植物的捕蝇器起着动物的胃和小肠的作用。 来自辞典例句

18 advisory   

adj.劝告的，忠告的，顾问的，提供咨询

参考例句：

• I have worked in an advisory capacity with many hospitals.我曾在多家医院做过顾问工作。
• He was appointed to the advisory committee last month.他上个月获任命为顾问委员会委员。

19 honorarium   

n.酬金，谢礼

参考例句：

• Travel and hotel costs as well as an honorarium will be provided.我们提供旅费和住宿费以及酬金。
• A group of residents agreed to conduct the survey for a small honorarium.一部分居民同意去进行这样的一个调查，在支付一小点酬金的情况下。

20 pharmaceutical   

adj.药学的，药物的；药用的，药剂师的

参考例句：

• She has donated money to establish a pharmaceutical laboratory.她捐款成立了一个药剂实验室。
• We are engaged in a legal tussle with a large pharmaceutical company.我们正同一家大制药公司闹法律纠纷。

21 crave   

vt.渴望得到，迫切需要，恳求，请求

参考例句：

• Many young children crave attention.许多小孩子渴望得到关心。
• You may be craving for some fresh air.你可能很想呼吸呼吸新鲜空气。

22 helping   

n.食物的一份&adj.帮助人的，辅助的

参考例句：

• The poor children regularly pony up for a second helping of my hamburger. 那些可怜的孩子们总是要求我把我的汉堡包再给他们一份。
• By doing this, they may at times be helping to restore competition. 这样一来, 他在某些时候,有助于竞争的加强。

23 regain   

vt.重新获得，收复，恢复

参考例句：

• He is making a bid to regain his World No.1 ranking.他正为重登世界排名第一位而努力。
• The government is desperate to regain credibility with the public.政府急于重新获取公众的信任。

24 generic   

adj.一般的，普通的，共有的

参考例句：

• I usually buy generic clothes instead of name brands.我通常买普通的衣服，不买名牌。
• The generic woman appears to have an extraordinary faculty for swallowing the individual.一般妇女在婚后似乎有特别突出的抑制个性的能力。

25 coupon   

n.息票，配给票，附单

参考例句：

• The coupon can be used once only.此优惠券只限使用一次。
• I have a coupon for ten pence off a packet of soap.我有一张优惠券买一盒肥皂可以便宜十便士。

26 retailers   

零售商，零售店( retailer的名词复数 )

参考例句：

• High street retailers reported a marked increase in sales before Christmas. 商业街的零售商报告说圣诞节前销售量显著提高。
• Retailers have a statutory duty to provide goods suitable for their purpose. 零售商有为他们提供符合要求的货品的法定义务。

27 equity   

n.公正，公平，（无固定利息的）股票

参考例句：

• They shared the work of the house with equity.他们公平地分担家务。
• To capture his equity,Murphy must either sell or refinance.要获得资产净值，墨菲必须出售或者重新融资。

28 eligible   

adj.有条件被选中的；(尤指婚姻等)合适(意)的

参考例句：

• He is an eligible young man.他是一个合格的年轻人。
• Helen married an eligible bachelor.海伦嫁给了一个中意的单身汉。

29 ailment   

n.疾病，小病

参考例句：

• I don't have even the slightest ailment.我什么毛病也没有。
• He got timely treatment for his ailment.他的病得到了及时治疗。

30 ailments   

疾病（尤指慢性病），不适( ailment的名词复数 )

参考例句：

• His ailments include a mild heart attack and arthritis. 他患有轻度心脏病和关节炎。
• He hospitalizes patients for minor ailments. 他把只有小病的患者也送进医院。

31 interventions   

n.介入，干涉，干预( intervention的名词复数 )

参考例句：

• Economic analysis of government interventions deserves detailed discussion. 政府对经济的干预应该给予充分的论述。 来自辞典例句
• The judge's frequent interventions made a mockery of justice. 法官的屡屡干预是对正义的践踏。 来自互联网

32 nausea   

n.作呕，恶心；极端的憎恶(或厌恶)

参考例句：

• Early pregnancy is often accompanied by nausea.怀孕期常有恶心的现象。
• He experienced nausea after eating octopus.吃了章鱼后他感到恶心。

33 vomiting   

吐

参考例句：

• Symptoms include diarrhoea and vomiting. 症状有腹泻和呕吐。
• Especially when I feel seasick, I can't stand watching someone else vomiting." 尤其晕船的时候，看不得人家呕。”

34 ongoing   

adj.进行中的，前进的

参考例句：

• The problem is ongoing.这个问题尚未解决。
• The issues raised in the report relate directly to Age Concern's ongoing work in this area.报告中提出的问题与“关心老人”组织在这方面正在做的工作有直接的关系。

35 rodent   

n.啮齿动物；adj.啮齿目的

参考例句：

• When there is a full moon,this nocturnal rodent is careful to stay in its burrow.月圆之夜，这种夜间活动的啮齿类动物会小心地呆在地洞里不出来。
• This small rodent can scoop out a long,narrow tunnel in a very short time.这种小啮齿动物能在很短的时间里挖出一条又长又窄的地道来。

36 syndrome   

n.综合病症；并存特性

参考例句：

• The Institute says that an unidentified virus is to blame for the syndrome. 该研究所表示,引起这种综合症的是一种尚未确认的病毒。
• Results indicated that 11 fetuses had Down syndrome. 结果表明有11个胎儿患有唐氏综合征。

37 reminder   

n.提醒物，纪念品；暗示，提示

参考例句：

• I have had another reminder from the library.我又收到图书馆的催还单。
• It always took a final reminder to get her to pay her share of the rent.总是得发给她一份最后催缴通知，她才付应该交的房租。

38 modification   

n.修改，改进，缓和，减轻

参考例句：

• The law,in its present form,is unjust;it needs modification.现行的法律是不公正的，它需要修改。
• The design requires considerable modification.这个设计需要作大的修改。

39 obese   

adj.过度肥胖的，肥大的

参考例句：

• The old man is really obese,it can't be healthy.那位老人确实过于肥胖了，不能算是健康。
• Being obese and lazy is dangerous to health.又胖又懒危害健康。

40 components   

（机器、设备等的）构成要素，零件，成分； 成分( component的名词复数 )； [物理化学]组分； [数学]分量； （混合物的）组成部分

参考例句：

• the components of a machine 机器部件
• Our chemistry teacher often reduces a compound to its components in lab. 在实验室中化学老师常把化合物分解为各种成分。