Tag Archives: Medicare

Weight Loss for Its Own Sake: At What Cost

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Several Ozempic pressure applicators, arranged loosely on a background of Rx labeled wallpaper

Laurie and Debbie say:

Ozempic: it’s a diabetes drug which also works for weight loss; it’s a wonder drug that will solve the obesity epidemic; it’s a rich people’s drug that will ensure that only poor people are fat; it’s a scam; it’s all things to all people.

We’ve been very skeptically watching Ozempic’s trajectory through the news since it started being regularly available (to some people) about two years ago. Weight loss wonder drugs tend to appear, fail, and vanish. Ozempic (also called Wegovy when it’s prescribed for weight loss) is lasting longer than most. So, the problems it causes are getting very obvious.

As we know so well, the vast majority of doctors believe that fat is, in itself, a disease and health risk which must be eliminated at all costs–and now the doctors have a drug that will actually “work” to meet the doctors’ goals–whether or not those are the patients’ goals. Angelina Chapin, writing for The Cut, has a heartbreaking set of stories of patients (generally women) pushed by their doctors into taking the drug. Chapin cites five examples–different stories, same underlying medical myth:

Marcy was diagnosed with lymphedema, a condition that causes fluid to build up in her legs, in 2021. The 53-year-old from Queens wanted to work with a nutritionist to follow an anti-inflammatory diet that she hoped would lessen the pain and swelling. Her primary-care doctor made a referral last year, but the callback came from an office administrator at a hospital weight-management center. The person told her that she’d need to be evaluated and then choose between having weight-loss surgery or going on Ozempic. Marcy, who describes herself as “visibly plus size,” told them there must be a misunderstanding. Her goal was to develop better eating habits, not to lose weight. But the administrator said that in order to work with a nutritionist, Marcy had to join the weight-loss program, which a nurse reiterated in a follow-up call.

It felt to Marcy like these health professionals had seen her BMI and made the assumption that “All fat people are unhealthy.” Though her medical chart says she’s obese, Marcy doesn’t have diabetes, high cholesterol, or high blood pressure. The swelling from lymphedema has made her gain weight, but she doesn’t eat regularly because the pain “kind of curbs my appetite.” And yet, medical workers are “focusing on the number on the scale,” she says. “You’re ignoring my diagnosis. How am I supposed to get better?”

Another example in Chapin’s article has high cortisol levels which the doctor told her “don’t matter.” More than one have eating disorder histories and are afraid of the psychological consequences of limiting their food intake.

This is bad enough. If Chapin found five examples, there are probably 5,000 people out there dealing with this right now. Or, there were about that many until last month, when Medicare approved the drug. Dylan Scott, writing for Future Perfect at Vox, has a powerful analysis of what Medicare approval means. Please note that Scott has a wide-eyed naive acceptance of the “obesity epidemic,” and thus of the medical value of Ozempic. Despite this shameful assumption, he comes away with major reservations about widespread prescription of Ozempic:

there is growing data that these drugs also reduce heart disease risk — one clinical trial involving more than 17,000 patients found Wegovy significantly reduced the chances of an adverse cardiovascular event such as heart attack or stroke. Just 6.5 percent of participants who received Wegovy experienced an acute cardiac emergency, compared to 8 percent of patients who took a placebo. …

The medications are extraordinarily powerful at controlling patients’ appetite and therefore aiding weight loss; in clinical trials, patients lost an average of 15 percent of their body weight in little over a year.

But that’s only as long as patients continue to take them — once a patient stops the drug, the benefits go away. And medication adherence is a struggle across the US health system.

And even if people do adhere to regular doses, taking Wegovy or Ozempic long-term may prove prohibitively expensive. Even Medicare enrollees can pay up to $2,000 out of pocket annually for their prescription drugs, depending on their specific plan.

The available evidence suggests patients will gain back some or all of the weight they had lost if they stop taking semaglutide. The whiplash of losing and then regaining weight may even be worse for a person’s health than if they had never lost the weight in the first place, Stacie Dusetzina, a health policy professor at Vanderbilt University, told me. Doctors call it “weight cycling.”

No reader of Body Impolitic is likely to be unfamiliar with the medical dangers of “weight cycling,” or “yo-yo dieting,” or whatever you want to call it. Scott apparently never heard of it. But look!

Given the evidence that people struggle to maintain weight loss over time, some experts have called for putting less emphasis on losing weight for people who are obese or overweight and more on improving their access to medical care.

Holding Chapin’s article next to Scott’s, we immediately see that Medicare’s coverage of this drug will result in tens of thousands of people being pushed by their doctors into taking it. Some of them will be aware enough to understand that their weight is not their problem, and at least try to push back. Others–the vast majority–will buy into the combination of the social conviction that fat is always and forever bad for you, and the pressure from their medical care team, and will not even have the tools to examine the recommendation.

At the end of her article, Chapin returns to Marcy:

Marcy, the woman with lymphedema, tells me she recently found a nutritionist who has agreed to discuss an anti-inflammation diet without pushing weight loss. She’s excited to finally work with a health professional who won’t jump to conclusions based on her size. “I’m not on a couch, eating a half-gallon of ice cream,” Marcy says. She now hopes to become more active with the help of a pump to massage the fluid in her leg and compression leggings. “I want to do Alaska next year,” she says, “and I want to be on a dog sled.” It’s something most doctors she’s been treated by didn’t see in her future.

The United States (and much of the world) is culturally incapable of separating fat from health, acknowledging that in some situations fat contributes to health issues and in other situations it does not. This country is medically incapable of expecting doctors to listen to patients’ concerns (such as wanting to be on a dog sled) and address them rather than jump to a sometimes completely inaccurate conclusion. It is also politically incapable of reining in Big Pharma and requiring affordable drugs and drug plans (although the Biden administration is addressing that issue with moderate success). Until all of these things change, Ozempic should be administered cautiously, to people who both need it and are not threatened by its side effects, and in ways that break no one’s pocketbook.

Fat chance.


Debbie has deleted her Twitter account. Follow her on Mastodon.

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Predatory Health Care

Lynne Murray says:

I am very proud of Marilyn Wann, Linda Bacon and many other fat activists whose refusal to shut up and be stigmatized has made it possible for the New York Times to seriously consider Health at Every Size in light of the way fat people have been demonized in debates on health care.

James Morone, a professor of political science and urban studies at Brown University makes a very good point (in the article linked above) that, “The best philosophical way to stop national health insurance is to say we’re not a community, it’s ‘us vs. them.’ ”

This past week I had a long conversation with a friend, who has given me permission to share an encounter she and her father, who is in his 90s, had with a predatory health marketing organization. He lives in a retirement community and she handles most of his financial affairs. She often receives anxious phone calls when her father is targeted by telephone or mail marketers disguised as official representatives. Sometimes she will visit to find that a telemarketer has duped him into signing up for some service that he did not understand. But this was different.

Her father worked for many years for a company that offered generous health care for retirees. He trusted the company and suddenly they seemed to be telling him that he would lose his insurance coverage. She’s been working to get all the documentation sent to her but her father got a scary notice that suggested his coverage might end if he didn’t sign up for a new option. The 800 number on the letter was the same as the one on his health care documentation but she couldn’t get a clear answer from their customer service.

I should mention that my friend has legal training.  She and I read the letter over and over many times before we realized that nowhere in it did it say, “Sign up for this OR you’ll lose your coverage.” Essentially it said, “You must sign up for this within two weeks.  You can always go back to regular Medicare if you don’t like it.”

As a student of words, I have to say that letter was state of the art coercive sales tactics. My friend and I decided that the lawyers had examined it carefully too, because it skated very close to threatening but never crossed the line.

There was a small-print sentence, “Sent by XYZ.” We did a little research and found that the company my friend’s father worked for had outsourced their benefits program to XYZ, and XYZ’s website once we found it, offered ways to cut cost on benefits. My friend is still researching it, but the option they were pushing on her father appears to be the controversial Plan D drug coverage option, which has been a fertile field for many scams, and evidently November is “Scam Season.”

This case doesn’t appear to be an outright fraudulent scam, but so far our best guess is that if her father had been intimidated into signed up for it, it that would mean more money for the insurer, and (in her father’s case) little or no savings compared to his current cost of prescription drugs.

What angered my friend, and me too, is how this sophisticated marketing effort is targeting seniors who are most vulnerable.