"The BMI is calculated considering only the patient's height and weight, and it does not take into consideration the patient's body composition.
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The development of new weight loss medicines by pharma companies Novo Nordisk and Eli Lilly have been making great progress, but obesity care needs a much greater revolution, according to a report on Thursday. Novo Nordisk and Eli Lilly have been dominating the obesity drug market in the past year with the approval of their glucagon-like peptide-1 receptor (GLP-1R) agonists Wegovy and Zepbound.
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Although medicines with other mechanisms of actions are available on the market, GLP-1R agonists seem to have a greater impact on weight loss and the patient’s life. The report by GlobalData, a data and analytics company, showed that diagnostic and management tools for obesity need to be updated and patients are not receiving the appropriate support from health authorities and insurance companies.
"Obesity was previously considered a lifestyle choice to be corrected with diet and exercise. In 2013, the American Medical Association (AMA) voted to recognise obesity as a chronic metabolic disease needing treatment and prevention efforts, but no implementations have been made for medical practice," said Costanza Alciati, Pharma Analyst at GlobalData, in a statement.
"There isn't a specific medical figure specialised in obesity yet, most doctors still don’t recognise obesity as a true disease and in most countries a stronger network of obesity centers is missing to ensure patients are receiving the best possible care," Alciati added. Another issue in obesity management is the lack of accurate diagnostic methods, as the body mass index (BMI) is not considered to be accurate in many cases, according to a high-prescribers survey conducted by GlobalData in December 2023.
The survey included 151 prescribers from the US, Germany, France, Italy, Spain, the UK, Japan. "The BMI is calculated considering only the patient's height and weight, and it does not take into consideration the patient's body composition. "Patients with a healthy-range BMI might have a very high percentage of fat tissue, and in that case, they would be unhealthier than a bodybuilder, for example, who has a higher BMI but whose body composition is mostly lean muscle mass.
"There are methods used to calculate body composition, for instance bioelectrical impedance analysis (BIA) and DEXA scanning, and some physicians tend to use them in combination with BMI, but according to GlobalData’s high-prescribers survey, there is a need for more accurate and unified diagnostic criteria and methods for diagnosing obesity," Alciati said.
The report also raised concerns regarding the need for reimbursement strategies for obesity patients. In the US, the national insurance companies Medicaid and Medicare cover some obesity procedures and treatments, but only in some states. In Europe, the situation is very heterogenous: in the UK, the National Health Service (NHS) is required to cover pharmacotherapy for obesity patients, while the German legislature does not differentiate obesity treatment from the recreational pursuit of weight loss for vanity purposes, and consequently obesity medications are not covered by the national insurance.
This is a great limitation for obesity patients, especially if we think about the price of GLP1R agonist treatment. "Physicians' and public awareness of obesity as a chronic metabolic disease is still an unmet need in the healthcare sector," Alciati said. "Consequently, a lot of progress still needs to be made to ensure more efficient diagnosis, prevention, and treatment of obesity, including the implementation of wider coverage by national insurance companies on obesity medications and procedures. Obesity is frequently a socioeconomic issue, especially in the US, and the disparity in treatment access, as seen with GLP-1R agonists, only confirms that," Alciati added.
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