As an obesity medicine specialist, I’ve spent my career taking an integrative approach to care, using every tool at my disposal to address one of our society’s most pressing health issues and empower my patients to achieve their health goals and lead better lives.
For many of my patients with obesity, diet and exercise alone don’t get them to the full health we all deserve. The introduction of GLP-1 medications like Zepbound and Wegovy has opened a realm of new possibilities for my patients. It’s more than just a number on the scale: many of the patients benefiting from GLP-1s have experienced emotional and psychological impacts alongside their physical changes.
GLP-1 medications are a gamechanger, to say the least. But let’s be clear: GLP-1s are not a cure for obesity. There is no “cure” for obesity — only treatment. They are a powerful tool, an integral part of a balanced approach to obesity management that includes lifestyle changes such as nutrition quality and physical activity.
Since the State of New Hampshire’s decision to end Medicaid payments for GLP-1 medications solely for the treatment of obesity, I’ve seen and heard my patients’ distress as they rapidly regain the weight they’ve lost. Many feel that they’ve lost control of a situation that finally had them on a healthier and more sustainable life path.
This sense of loss of control is felt by clinicians too: it is increasingly difficult for me to see my patients reach their scale and non-scale victories, only to watch them succumb to the biology of the chronic disease of obesity that renders them increasingly susceptible to preventable complications such as diabetes and heart and liver disease. The answer is right in front of us, but since the State’s January decision, it’s frustratingly and disturbingly out of reach for New Hampshire residents relying on Medicaid.
Much research shows that GLP-1s can produce significant weight loss. At the same time, research also shows that at least 60% of the weight patients lose is regained when they stop the medication. This leads to a lose-gain-lose-gain cycle that drives metabolic disease.
Data on GLP-1 success shapes how my colleagues and I think about access. In almost any other chronic disease, we wouldn’t stop effective therapy once we see positive results. Do we stop treating hypertension once we see a patient’s blood pressure decline with medication? No. As a chronic disease, obesity requires the same perspective.
The state’s goal of containing costs is understandable. But the money projected to be saved by ending Medicaid coverage for GLP-1s to treat obesity will likely be offset by weight regain and the progression of obesity related complications, such as diabetes, hypertension, obstructive sleep apnea and fatty liver disease later. The legislature has kicked the can down the road, addressing a short-term problem while setting up conditions for another, larger health crisis in the future.
Looking ahead, decision-makers need to consider evidence-based metrics to determine coverage. We can establish clearer, more reasonable guardrails for coverage; guardrails that account for the costs and benefits of GLP-1s. Those making coverage decisions should also incorporate the voices of patients whose lives have changed through these new therapies, as well as the scientific and medical perspectives of the clinicians who work with them.
As New Hampshire considers the costs and benefits of Medicaid coverage, those clinical realities, and the experiences of patients and families living with obesity, deserve to be part of the calculation.
Elena Sullivan, MMSc, PA-C, is an advanced practice clinician specializing in obesity medicine with knownwell, treating patients in southern New Hampshire.