Transitions in Obesity – an opportunity for GLP-1 drugs?

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Ian Duncan, PhD FSA MAAA David Kerr, MB ChB DM FRCP FRCPE Nhan Huynh, PhD

Abstract

Obesity is a major contributor to ill health. Until recently, the number of individuals developing obesity has continued to rise, contributing to the global burden of many common and serious conditions including premature cardiovascular disease, type 2 diabetes (T2D), and some cancers. However, in 2023 in the United States (U.S.), evidence suggests that there has been a decline in the number of obese adults. One factor to which this reduction has been attributed has been the introduction of a new class of drugs for the treatment of obesity and T2D, known as Glucagon Like Peptide-1 Receptor Agonists (GLP-1 RA’s). These drugs are undoubtedly effective in promoting weight loss 1, and clinical outcomes have been favorable (2-6), including reducing the risk of progression to T2D in adults with obesity and prediabetes 7  as well as beneficial effects on lowering the burden of cardio-renal disease.  Although there have been many studies of the clinical benefits of GLP-1 drugs, there have been fewer focusing on their economic effectiveness. There is also a paucity of published research into the potential of stratifying and targeting individuals with T2D and/or obesity into sub-populations to produce a focused financial return on investment.  Our analysis of US commercial claims data shows that many patients transition between different categories of obesity over time; only the highest obesity class (BMI 40.0 and over) show persistency in the highest class over time, indicating that the focus of treatment with GLP-1 RAs should be on the severely obese.

Article Details

How to Cite
DUNCAN, Ian; KERR, David; HUYNH, Nhan. Transitions in Obesity – an opportunity for GLP-1 drugs?. Medical Research Archives, [S.l.], v. 13, n. 1, jan. 2025. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/6138>. Date accessed: 10 feb. 2025. doi: https://doi.org/10.18103/mra.v13i1.6138.
Section
Research Articles

References

1. Bergmann NC Davies MJ Lingvay I Knop FK. Semaglutide for the treatment of overweight and obesity: A review. Diabetes Obes Metab. 2023;25(1):18-35.
2. Popoviciu M-S Păduraru L Yahya G Metwally K and Cavalu S. Emerging Role of GLP-1 Agonists in Obesity: A Comprehensive Review of Randomised Controlled Trials. Int. J. Mol. Sc. 2023;24:10449.
3. Ghusn W Hurtado MD. Glucagon-like Receptor-1 agonists for obesity: Weight loss outcomes, tolerability, side effects, and risks. Obes Pillars. 2024;12.
4. Moll H Frey E Gerber P Geidl B Kaufmann M Braun J Beuschlein F Puhan MA and Yebyoa HG. GLP-1 receptor agonists for weight reduction in people living with obesity but without diabetes: a living benefit–harm modelling study. Lancet eClinical Med. 2024;72.
5. Lincoff AM et al. Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes. NEJM. 2023;389:2221-2232.
6. Ghusn W De la Rosa A Sacoto D Cifuentes L Campos A Feris F Hurtado MD and Acosta A. Weight Loss Outcomes Associated With Semaglutide Treatment for Patients With Overweight or Obesity. JAMA Network Open. 2022;5(9).
7. Jastreboff AM le Roux CW Stefanski A Aronne LJ Halpern B Wharton S Wilding JPH Perreault L Zhang S Battula R Bunck MC Ahmad NN Jouravskaya I. SURMOUNT-1 Investigators. Tirzepatide for Obesity Treatment and Diabetes Prevention. . NEJM. 2024.
8. American Diabetes Association Professional Practice Committee. Summary of Revisions: Standards of Care in Diabetes—2025. Diabetes Care. 2025;48:S6-S13.
9. American Diabetes Association Professional Practice Committee. 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes—2025. Diabetes Care. 2025;48:S181-S206.
10. Weiss T Carr RD Pal S Yang L Sawhney B Boggs R Rajpathak S Iglay K. Real-World Adherence and Discontinuation of Glucagon-Like Peptide-1 Receptor Agonists Therapy in Type 2 Diabetes Mellitus Patients in the United States. Pat. Pref. and Adherence. 2020;14 2337–2345.
11. Blues Health Intelligence. Real-World Trends in GLP-1 Treatment Persistence and Prescribing for Weight Management. Chicago IL: Blues Health Intelligence;2024.
12. Rodriguez PJ Zhang V Gratzl S Duy Do D Cartwright BG Baker C Gluckman TJ Stucky N Emanuel EJ. Discontinuation and Reinitiation of GLP-1 Receptor Agonists Among US Adults with Overweight or Obesity2024.
13. Wilding JPH Batterham RL Calanna S et al. STEP 1 Study Group. Once-weekly semaglutide in adults with overweight or obesity. N Engl J Med. 2021;384(11):989-1002.
14. International Foundation of Employee Benefit Plans. GLP-1 Drugs: 2024 Pulse Survey Report (U.S. data). 2024; https://www.ifebp.org/resources---news/survey-reports/glp-1-drugs--2024-pulse-survey-report-(u.s.-corporate-data).
15. Deese B Gruber J and Cummings R. The miracle weight-loss drug is also a major budgetary threat. New York Times2024.
16. Robbins R. Buried in Wegovy costs North Carolina will stop paying for Obesity Drugs. New York Times. 2024-01-26, 2024.
17. Wilson R. More employers opt to cover weight loss drugs. 2024; https://www.beckerspayer.com/payer/more-employers-opt-to-cover-weight-loss-drugs.html.
18. Twenter P. The GLP-1 coverage dilemma for employers. 2024; https://www.beckershospitalreview.com/glp-1s/the-glp-1-coverage-dilemma-for-employers.html. Accessed November, 2024.
19. Lobstein TPowis J and Jackson-Leach R. World Obesity Atlas 2024: World Obesity Federation;2024.
20. Thorpe KE Joski PJ. Estimated Reduction in Health Care Spending Associated WithWeight Loss in Adults. JAMA Network Open. 2024;7(12): e2449200.
21. Atlas SJ Kim K Beinfeld M Lancaster V Nhan E Lien PW Shah K Touchette DR Moradi A Rind DM Pearson SD Beaudoin FL. Medications for Obesity Management: Effectiveness and Value; Final Evidence Report. Institute for Clinical and Economic Review. Boston MA: Institute for Clinical and Economic Review;2022.
22. Duncan I Kerr D Huynh N and Aggarwal R. New Drugs for Obesity, Is the Excitement Affordable? Pop. Health Manag. 2023;26(5).
23. Gleason P Urick B Marshall L Qiu Y Leslie RD Friedlander N Chodroff M. Real-World Analysis of Glucagon Like Peptide-1 (GLP-1) Agonist Obesity Treatment Year-Two Clinical and Cost Outcomes. Eagan MN: Prime Therapeutics, LLC;2024.
24. Gleason PP Urick BY Marshall LZ Friedlander Qiu NY Leslie RS. Real-world persistence and adherence toglucagon-like peptide-1 receptor agonists among obese commercially insured adults without diabetes. J. Manag. Care Spec. Pharm. 2024;30(8):860-867.