key takeaways

Sarah Bramblette has long sought a sustainable way to manage her weight. She lives with obesity, lipedema, andlymphedema–conditions that cause swelling and fat buildup. Over the years, she had tried bariatric surgery and various medications, only to see her weight return.

Then, in June 2021, a drug called Wegovy (semaglutide) was approved for weight loss, making it the first anti-obesity medication in the U.S. since 2014. Bramblette was hopeful that Wegovy would give her the support she needed to shed some pounds and care for her heart health.

But Bramblette is on Medicare for disability, and the government health program doesn’t cover medications for obesity. Paying for a month of the drugs would wipe out a whole disability check, she said.

Her doctor discovered there was coverage for diagnosed insulin resistance, which allowed her to get a prescription forOzempic (semaglutide), a type 2 diabetes drug that is simply a low-dose version of Wegovy. Medicare covers diabetes medications, but not those indicated for weight loss.

GLP-1 Receptor Agonists for Type 2 Diabetes

Now at 400 pounds, Bramblette said she hopes to continue to lose weight, with the help of medication, to keep from developing diabetes and liver problems.

“It’s not a fad,” she said. “There’s a difference between treatment of obesity and diet culture,” she said.

What Is Obesity Treatment Like?

Weight Loss Drugs Can Be Powerful, but Hard to Come By

In May, Eli Lilly’s Mounjaro (tirzepatide) received FDA approval to treat type 2 diabetes. The drug has also shown great success as a weight loss medication, and the company is now seeking an indication for obesity. From its very debut, Mounjaro has been in high demand, partially as an off-label diet pill, and it’s now also on the FDA drug shortage list.

Despite these medications’ effectiveness in promoting weight loss, they’re often underprescribed for patients with obesity, according to Bessesen.

More than 70% of people with type 2 diabetestake drugsto treat their condition, whileonly about 3%of people with obesity can say the same.

Part of the reason, Bessesen said, is that providers may recall the fraught history of weight loss drugs. In the late 1990s, “fen-phen,” a combination of fenfluramine and phentermine, was pulled from the market after it was linked to heart valve problems. There are other weight loss drugs still on the market, but they tend to be less effective or come with undesirable side effects compared with semaglutide and tirzepatide.

How Do These Drugs Promote Weight Loss?Tirzepatide and semaglutide, the drugs that comprise the new weight loss drugs, belong to a class of medications that mimic natural hormones involved with insulin production and appetite. They create a feeling of being full when patients eat less than usual.Tirzepatide achieved a more than 20% body weight reduction in clinical trials, while semaglutide achieved a 17% reduction.

How Do These Drugs Promote Weight Loss?

Tirzepatide and semaglutide, the drugs that comprise the new weight loss drugs, belong to a class of medications that mimic natural hormones involved with insulin production and appetite. They create a feeling of being full when patients eat less than usual.Tirzepatide achieved a more than 20% body weight reduction in clinical trials, while semaglutide achieved a 17% reduction.

Tirzepatide and semaglutide, the drugs that comprise the new weight loss drugs, belong to a class of medications that mimic natural hormones involved with insulin production and appetite. They create a feeling of being full when patients eat less than usual.

Tirzepatide achieved a more than 20% body weight reduction in clinical trials, while semaglutide achieved a 17% reduction.

Reshmi Srinath, MD, director of the Mount Sinai weight and metabolism management program,  said that many patients she treats have already tried lifestyle changes. Medications are a “crucial step in their path to weight loss.”

“Metabolically, these drugs help to protect the liver, reducing the risk of what’s called nonalcoholic fatty liver disease. They’re potentially beneficial for the heart, they’re helping protect the pancreas and reduce insulin resistance—they’re doing multiple actions at once.” Srinath said.

Some providers argue that prescribing the drugs will distract people from making important lifestyle changes, like adhering to a healthy diet and exercise. Bessesen said that weight bias and stigma often factor into providers’ decisions not to prescribe weight loss medications.

Sarah Bramblette

“Diabetes could be treated with diet exercise. But people don’t say, ‘I’m not going to give you any medicine until you prove to me that you’re not eating any sugar,’ or something like that. And yet that kind of language gets used all the time with people with obesity,” Bessesen said.

But this mindset appears to be shifting, at least among some providers, Bessesen said. Last week, the American Diabetes Associationreleased new guidancefor providers, emphasizing the importance of pharmacotherapy for treating obesity and diabetes.

“I am a firm believer that it’s taken this long to get effective treatments for obesity because of weight stigma,” Bramblette said. “There’s always been this idea that we just needed to eat less and move more.”

Insurance Often Doesn’t Cover Weight Loss Medications

Medicare does not cover weight-loss drugs, though the program pays for bariatric surgery. List prices for the drugs run upwards of $1,300 per month. Plus, providers aren’t usually compensated for the cost of a weight loss drug for patients with obesity, which may dissuade them from prescribing the medication in the first place.

“The medicine is being selectively prescribed to people who pay for it out of pocket,” Bessesen said. “If you have diabetes and the only way you get a good diabetes medicine is if you pay for it out of pocket, and everybody else gets one that’s less effective, I think that’s a health equity issue.”

For the weight loss drugs to work, patients must take the drug consistently for life. The cost to insurers of covering the 40% of Americans who have obesity,Bessesen said, is “untenable.”

If Eli Lilly wins approval to sell tirzepatide as a weight loss drug, Srinath said she is hopeful that it’s somewhat affordable for patients.

FDA Clears Diabetes Medication for Obesity in Adolescents

“With other pills, we sometimes can use generics, but there are no generic forms of some of these newer medications. I’m really hopeful that some of that will change in the near future.” Srinath said.

Bramblette said she’s reliant on medication to continue improving her health. With the existing accessibility challenges, the cost barriers add insult to injury.

“As someone who’s on disability and is on a fixed income, knowing that they’re not just getting this written off label, but that it’s not covered…it kind of makes it burn even more,” Bramblette said. “It’s just the fact that they’re laying down thousands of dollars a month for maybe 15 pounds. I’ve never only been 15 pounds overweight.”

What This Means For YouIf you have obesity or type 2 diabetes and are looking for support with managing your weight, talk to your provider about the possibility of taking a weight loss medication. They can help you come up with a diet and exercise plan and can recommend a weight loss drug that’s right for you.

What This Means For You

If you have obesity or type 2 diabetes and are looking for support with managing your weight, talk to your provider about the possibility of taking a weight loss medication. They can help you come up with a diet and exercise plan and can recommend a weight loss drug that’s right for you.

3 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Food and Drug Administration.FDA Drug Shortages: Current and Resolved Drug Shortages and Discontinuations Reported to FDA.Courcoulas AP, Gallagher JW, Neiberg RH, et al.Bariatric surgery vs lifestyle intervention for diabetes treatment: 5-year outcomes from a randomized trial.J Clin Endocrinol Metab. 2020;105(3):866-876. doi:10.1210/clinem/dgaa006Centers for Disease Control and Prevention.Adult Obesity Facts.

3 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Food and Drug Administration.FDA Drug Shortages: Current and Resolved Drug Shortages and Discontinuations Reported to FDA.Courcoulas AP, Gallagher JW, Neiberg RH, et al.Bariatric surgery vs lifestyle intervention for diabetes treatment: 5-year outcomes from a randomized trial.J Clin Endocrinol Metab. 2020;105(3):866-876. doi:10.1210/clinem/dgaa006Centers for Disease Control and Prevention.Adult Obesity Facts.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Food and Drug Administration.FDA Drug Shortages: Current and Resolved Drug Shortages and Discontinuations Reported to FDA.Courcoulas AP, Gallagher JW, Neiberg RH, et al.Bariatric surgery vs lifestyle intervention for diabetes treatment: 5-year outcomes from a randomized trial.J Clin Endocrinol Metab. 2020;105(3):866-876. doi:10.1210/clinem/dgaa006Centers for Disease Control and Prevention.Adult Obesity Facts.

Food and Drug Administration.FDA Drug Shortages: Current and Resolved Drug Shortages and Discontinuations Reported to FDA.

Courcoulas AP, Gallagher JW, Neiberg RH, et al.Bariatric surgery vs lifestyle intervention for diabetes treatment: 5-year outcomes from a randomized trial.J Clin Endocrinol Metab. 2020;105(3):866-876. doi:10.1210/clinem/dgaa006

Centers for Disease Control and Prevention.Adult Obesity Facts.

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