Expanding access to the new generation of weight-loss medications could prevent more than 40,000 deaths a year in the US, according to a study led by researchers at Yale School of Public Health and the University of Florida. The findings highlight the critical need to remove existing barriers that are hindering people's access to effective weight-loss treatments and impeding public health efforts to address the national obesity crisis, the researchers said.
"Expanding access to these medications is not just a matter of improving treatment options but also a crucial public health intervention," said Dr Alison P Galvani, one of the study's corresponding authors and the Burnett and Stender Families Professor of Epidemiology (Microbial Diseases) at the Yale School of Public Health. "Our findings underscore the potential to reduce mortality significantly by addressing financial and coverage barriers."
Recent advancements in pharmaceutical interventions, however, particularly the introduction of glucagon-like peptide-1 (GLP-1) receptor agonists, such as Ozempic and Wegovy, and dual gastric inhibitory polypeptide and GLP-1 (GIP/GLP-1) receptor agonists, such as tirzepatide, have demonstrated substantial efficacy in weight loss. These medications have shown promise in clinical trials and are increasingly being used for weight management.
In conducting their study, the researchers aimed to quantify the potential mortality impact of increased access to these weight-loss drugs. They integrated data on mortality risk associated with different body mass index (BMI) categories, obesity prevalence, and the current limitations on drug access due to high costs and insurance restrictions.
In the US, more than 40% of adults are classified as obese (BMI ≥ 30; Figure 1. By applying the hazard ratio for mortality across different BMI categories relative to the normal BMI category (BMI: 18.5 to 25), they estimated that 49.6% of the total annual deaths in the US occur among individuals categorized as obese (BMI ≥ 30) According to FDA guidelines, more than 45% of the adult US population is eligible for the new weight-loss drugs, encompassing everyone with a BMI of 30 and above, as well as individuals with diabetes with a BMI between 25 to 30 (Figure 1).
They estimated annual deaths averted under two scenarios: the current uptake and expanded access. The current uptake reflects the proportion of eligible individuals who are currently using the weight-loss drugs and in their expanded access scenario, they took into account that drug uptake is contingent upon eligibility, the ability to obtain healthcare services and individual willingness to take the medication.
As individuals gain access to these drugs, the distribution of the population by BMI categories is expected to shift toward healthier BMI ranges. Accounting for the adherence rate of people who take obesity drugs (27.2%) and diabetes drugs (48.9%), they projected how the US population’s BMI distribution would shift:
The change in population distribution by BMI categories is expected to be only marginal (with approximately 1.8% of obese individuals lowering their BMI below 30. If the uptake is scaled up to all eligible individuals who have the ability to avail health care, it would lead to a greater shift in the population distribution by BMI categories, with 10.6% of obese individuals moving to healthier BMI categories below 30.
Moreover, 16.6% of those severely obese (BMI ≥ 40) would reduce their BMI below 40
Under a more optimistic scenario of higher willingness to take the drugs (89%) and 100% adherence rate, BMI distribution would shift substantially with 41.3% of obese individuals lowering their BMI below 30.
According to the findings, if access to these new medications were expanded to include all eligible individuals, the US could see up to 42,027 fewer deaths annually. This estimate includes approximately 11,769 deaths among individuals with type 2 diabetes. Even under current conditions of limited access, the researchers project that around 8,592 lives are saved each year, primarily among those with private insurance.
With the expanded access, 9,977 deaths averted would be among Medicare beneficiaries and 2,804 would be among uninsured. To account for the impact of socioeconomic factors on individuals’ mortality risk beyond access to these drugs, they adjust individuals’ mortality reduction based on their income status, leading to a conservative estimate of 32,906 fewer annual deaths. In contrast, as many as 165,574 annual deaths could be averted under the optimistic scenario of willingness and adherence.
The study highlights a critical disparity in drug access. Currently, the high cost of these medications, which can exceed $1,000 per month without insurance, limits their availability. For example, Medicare, does not cover these drugs for weight loss, impacting many who could benefit from them. Medicaid coverage varies widely by state, and private insurance often imposes high deductibles and copays, further restricting access, the researchers said.
The study also explored how expanded access could affect different regions and socioeconomic groups. States with high obesity and diabetes rates, such as West Virginia, Mississippi and Oklahoma, stand to benefit the most from increased medication availability. In these areas, expanding access could lead to the largest per capita reductions in mortality.
However, the study's authors caution that while the potential benefits are substantial, several challenges remain. The high price of these medications is a significant barrier, and there are concerns about the pharmaceutical industry's profit margins. Furthermore, supply constraints and production limitations continue to hamper widespread availability.
“Our findings provide compelling evidence for the transformative impact that expanded access to these medications could have on improving the public health of the nation,” the authors noted. “This underscores the urgency of addressing access barriers, including affordability, insurance coverage, and prescriber awareness. Such policies could galvanize a new era of American well-being and prosperity.”
"Addressing these challenges requires a multifaceted approach," said Dr Burton H Singer, another corresponding author of the study and adjunct professor of mathematics at the Emerging Pathogens Institute at the University of Florida. "We need to ensure that drug prices are more aligned with manufacturing costs and increase production capacity to meet demand. At the same time, we must tackle the insurance and accessibility issues that prevent many people from getting the treatment they need."
The researchers also considered the impact of socioeconomic factors on the effectiveness of expanded drug access. They adjusted their estimates to account for income disparities, finding that even with these adjustments, the potential for lives saved remains significant. The results suggest that improving access to these medications could reduce health care costs associated with obesity-related conditions and improve overall quality of life for many Americans.
The findings were published in a paper, ‘Estimating the lives that could be saved by expanded access to weight-loss drugs’, published in the Proceedings of the National Academy of Sciences. To access this paper, please click here
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