By Dr. Arnold Saperstein, CMO
It may be a surprise to many that obesity is only recently recognized—in the last 10 years—as a complex chronic disease, not a behavior-driven condition. Having excess weight affects nearly all facets of an individual’s physical and mental health, and obesity is considered a risk factor for other health complications including diabetes, heart disease, high blood pressure, high cholesterol, sleep apnea, and certain cancers. Given this complexity, management of obesity requires the consideration of many factors.
There is a tremendous demand for anti-obesity medications (AOMs) such as the GLP-1s semaglutide, tirzepatide, and liraglutide to help manage obesity. Coverage for AOMs has historically been slow due to high cost. However, recent studies reveal new potential of these medications to address a range of chronic diseases and provide wider benefits than previously expected.
I am energized and encouraged by the recent findings from the SELECT study, published in the New England Journal of Medicine, conducted by researchers at the Cleveland Clinic and Yale University. The SELECT study was performed in patients with a BMI over 27 and a significant cardiovascular risk history of a prior myocardial infarction (Ml), stroke, or peripheral vascular disease but no diabetes.
The studied patient group was treated with semaglutide 2.4 mg per week and had a 20% reduction in cardiovascular complications including Ml, stroke, or death over a four-year study period. There were also secondary effects revealed in the study, including significant weight loss and a much-reduced progression of the prediabetes population to diabetes.
Even with these potential results, anti-obesity medications have a high side effect complication rate, requiring close monitoring and appropriate titration to be well tolerated and achieve the best outcomes. Additionally, patients with comorbidities on AOMs require a cross-specialty approach.
The results are compelling; however, further study is needed to determine the appropriateness of care for patients. At Cecelia Health, our deep experience working with pharma in launching weight management therapies and supporting patients on their weight management journey provides us with a unique perspective on this rapidly evolving market. We plan to observe our own patient outcomes for those with a similar clinical phenotype and will explore the impact of these drugs for adults with obesity who have not yet had a cardiovascular event.
It is exciting to see this new evidence that the efficacy of AOMs extends well beyond weight loss. AOMs in conjunction with providing patients the clinical support and tools they need for a healthy lifestyle addresses the whole person and their risk of numerous diseases and morbidities. The full health impact of AOMs is just emerging and will compel clinicians to rethink or modify patient treatment plans.
About the Author
Dr. Saperstein began his managed care career in 1992 and continues to dedicate his expertise to developing programs that ensure the highest quality of care. He joined Cecelia Health in 2019 as Chief Medical Officer, where he built the first national virtual Endocrinology telemedicine practice. Dr. Saperstein has expanded the company’s chronic disease management approach beyond Diabetes to include Cardiovascular risk reduction, Congestive Heart Failure, Obesity, Chronic Kidney Disease, Asthma, and COPD programs. He leads Cecelia Health’s national network of expert clinicians and specialty providers, achieving excellent clinical results for patient populations across the country. Prior to Cecelia Health, Dr. Saperstein held leadership positions at MetroPlus Health Plan, joining in 1995 as Chief Medical Officer, next serving as President and CEO from 2006 until 2019. Under his leadership, MetroPlus ranked as one of the highest scoring plans for quality of care (measured by the New York State Department of Health Medicaid Incentive Program and by the Medicaid Consumer Guide for New York City) and rose to the forefront of Value Based Purchasing. During his tenure, Dr. Saperstein developed a groundbreaking quality incentive pay for performance program across the entire network of an estimated 32,000 providers and grew the member population 1100% to serve more than 500,000 people.