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How WW, Noom Say They’re Filling Obesity Medicine Gaps

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March 29, 2024 – It could be a case of: if you can’t beat ’em, join ’em. Commercial weight loss companies like WW (formerly Weight Watchers), Noom, and Calibrate, which were around before the explosion in popularity of some weight loss medications, now offer them to their members. 

Providing glucagon-like peptide 1 (GLP-1) receptor agonists like semaglutide (Wegovy) or tirzepatide (Mounjaro) to the right candidates gives their subscribers as many options for weight management as possible, company representatives said. They emphasized that their firms carefully screen and refer people to medical professionals who work with their organizations. 

While applauding the role that these behavior-based weight management programs play in a comprehensive approach, an academic weight loss doctor thinks the order is backward. Instead, people with obesity should see a primary care or obesity expert doctor first, then get referred to these commercial programs, said Caroline M. Apovian, MD, co-director of the Center for Weight Management and Wellness at Brigham and Women’s Hospital in Boston.

“These kinds of partnerships are important,” she said. “It should be with a medical treatment program first, as the main event, and the behavioral program as [a supplement] – not the other way around.” 

Brigham and Women’s Hospital, for example, refers patients to a behavioral weight management company, Restore Health, to provide the medications.

“I am in no way saying that the behavioral treatment that Weight Watchers and Noom offer is not important. It’s extremely important,” said Apovian, who is also a spokesperson for the Obesity Society, a professional organization dedicated to obesity treatment and prevention. 

Primary Care Bottleneck? 

“In an ideal world, that would be wonderful. However, the truth is that now less than 1% of providers are actually trained to provide obesity care,” said Amy Meister, DO, chief medical officer at WW. 

According to the American Board of Obesity Medicine, there are 8,263 doctors certified in obesity medicine in the U.S. and Canada. There are more than 1.1 million active physicians in the U.S. alone. 

“A lot of people come to us and our competitors quite frankly because they can’t get into traditional brick-and-mortar settings. Access is probably the number one thing that we bring to the table – and not just access to care, but access to providers which are specifically trained with that expertise,” Meister said.

The chief medical officer at Noom mirrored this take on the situation. “Primary care physicians are terribly strapped in terms of their bandwidth,” said Linda Anegawa, MD. Treating obesity takes time, sensitivity, and experience. She estimated that most doctors only receive about 10 hours of obesity-specific instruction during medical school and training. 

“As a primary care doctor myself by background and training, I cannot overemphasize the importance of having a primary care doctor. I do know that many primary care doctors feel ill-equipped to deal with the needs of the medical patient who is undergoing obesity treatment. They don’t feel that they have the specialized knowledge or training to fully support these patients.”

At the same time, the most recent CDC estimates reveal that 42% of Americans are obese, including 9% who are severely obese. 

“Finally, we have effective treatments. But this is in the context of tremendous need, tremendous demand, and a tremendous cost,” Anegawa said. 

The Reaction So Far

In May 2023, WW purchased the telehealth company Sequence, a medical group that can prescribe drugs in 50 states and Washington, DC. They launched WW Clinic in December the same year. Last year, Noom also launched a medical weight management program, Noom Med. The telehealth weight loss company Calibrate, established before these medications became so popular, now offers them as well.

“We’ve actually had a better response than we predicted,” Meister said. By the end of 2023, 67,000 people had subscribed to the WW Clinic program. An estimated 70% of them came from the 3.8 million active WW members, or from lapsed members who returned because of the new offerings. “Unfortunately, the diet lifestyle solution just wasn’t cutting it for them. Now they meet with our doctors and nurse practitioners to try a medical solution.”

Due to what Kristin Baier, MD, Calibrate vice president of clinical development, calls their extensive screening process before sign-up at Calibrate, an estimated 90% of prospective candidates who attend their doctor appointments are considered eligible for GLP-1 medication. 

Obesity the Disease

For many years, obesity was viewed as a lifestyle problem. More recently, it is considered a complex and chronic disease, one that calls for a comprehensive medical approach and personalized treatment. “There’s a dysfunction in the energy regulation pathway that goes from the gut to the brain,” Apovian explained. The medications are analogs of gut hormones that our body normally releases when we are eating. The hormones “let the brain know that you’ve eaten enough, that you’re full. So, these medications are correcting a dysfunction for a serious disease.”

The anti-obesity medications, therefore, play an important role, agreed Katherine H. Saunders, MD, an obesity expert at Weill Cornell Medicine in New York and co-founder of Intellihealth, a firm that delivers virtual medical obesity treatment. “Most people with obesity are unable to lose a significant amount of weight and maintain their weight loss long-term with lifestyle interventions alone.” 

Even though the GLP-1s are in the spotlight, they’re not the whole story, said Saunders, who also serves as a spokesperson for the Obesity Society. “It’s important to note again that obesity treatment isn’t about just one class of medications. There is so much we can do to treat obesity without [GLP-1s].”

“Because obesity is a complex, chronic disease, obesity treatment requires more than just medication for long-term sustainable results,” Baier said. 

That could be good news for people who cannot access or afford these medications.

What About the Cost?

GLP-1 medications are expensive, and only a minority of insurance companies cover them for weight management. We asked these companies how they address the estimated $1,000 to $1,500 per month with their members. 

“Medication cost is a huge problem, but it’s just one barrier preventing individuals with obesity from accessing life-saving medical treatment,” Saunders said. Other problems include a need to train more clinicians in comprehensive and long-term obesity care, a need for more payers and employers to cover care, and an increase in medication supply to meet demand, she said. 

Apovian agreed the cost can be prohibitive. 

“Nobody wants to pay out of pocket for these drugs, not even people with a lot of money. They’re $1,500 a month, and you have to be on them forever,” she said. 

She predicted people who want to lose 10 pounds before an event will pay for a few months, and they expect to regain the weight after they stop. But, she said, “That’s not what these medications are for.”

Noom also offers medications “that are less costly for that patient but that can also be effective,” Anegawa said. “This can help maximize the effectiveness of GLP-1s while helping to contain cost.”

Pursuing Insurance Coverage

WW, Noom, and Calibrate each highlighted that they have staff dedicated to pursuing insurance coverage for anti-obesity medications for their members. The companies handle the paperwork for prior authorizations and resubmitting denied claims, for example. “That’s part of our secret sauce,” Meister said.

Even so, only about 20% to 30% of the private insurers cover anti-obesity medications, Apovian said. 

“Doctors do not have the time to deal with prior authorizations,” Anegawa said. Most doctors do not have the staff trained and equipped “to really pump out these appeals and denials and handle the mountains of paperwork. This gives us a unique advantage in prescribing.”

“Paying out-of-pocket for GLP-1s isn’t feasible for most people,” Baier said. “Navigating the red tape insurance has placed around access to these life-changing medications is daunting.” 

She said that Calibrate helps members access medication by navigating their formularies to figure out which GLP-1 medications are covered based on their specific health history and insurance coverage. 

“We have to demand better access for our lifesaving medications,” Apovian said. For example, in a clinical trial, semaglutide lowered major problems in the heart and blood vessels by 20%. “So now … 70% of insurance companies are not covering these agents – denying life-saving drugs to patients with significant obesity. That’s a problem, right?” 

Meister said that WW also helps patients find medication during shortages by calling up to nine pharmacies within driving distance or contacting mail-order pharmacies if that is an option. “If you miss dosages because you can’t get the drug, sometimes you have to start over,” she said. “That can be really frustrating to both the doctor as well as the patient, because it’s going to impact their care and their outcome.”

“Obesity is a complex chronic disease. It’s a treatable disease, but a holistic approach is needed.” Anegawa said. “While the GLP-1s have absolutely been therapeutic game-changers for those of us in obesity medicine, they’re not a cure. So you really do need that anchor in behavioral change to help along with the medication, rewire the brain’s craving pathways, improve insulin resistance, and drive those long-term improvements and the health outcomes that we are all looking for.” 

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The Truth About Whole-Body Scans

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Take a drive around certain neighborhoods in Los Angeles and you may spot as many signs advertising body scans as burger joints. Or maybe you’ve seen the ads on TV or the internet: “Protect your health! Get a body scan now!” 

Are whole-body CT scans really able to do that – and what are the risks? And are DEXA scans a good way to check on your body composition?

While technologies vary, most of these high-tech checkups use computed tomography (CT) scans to examine your entire body or specific parts, such as the heart and lungs, to try to catch dangerous diseases in earlier, more curable stages.

During the 15- or 20-minute scan, you lie inside a doughnut-shaped machine as an imaging device rotates around you, transmitting radiation. The technique combines multiple X-ray images and, with the aid of a computer, produces cross-sectional views of your body. By examining the views, a doctor can look for early signs of abnormalities.

The scans aren’t cheap – whole-body scans run anywhere from $500 to $1,000 per scan and usually aren’t reimbursed by insurance. And the question of how helpful these scans really are is a matter of debate among medical experts.

Advocates promote scans as a smart part of a routine physical exam. But if you’re healthy, with no worrisome symptoms, a scan is usually not warranted, says Arl Van Moore, MD, a radiologist and clinical assistant professor of radiology at Duke University Medical Center in Durham, NC, who is also a spokesman for the American College of Radiology (ACR).

According to the ACR’s official position, there’s not enough evidence to recommend scans for those with no symptoms or family history suggesting disease. But Van Moore sees a possible exception. “There may be a benefit to people at high risk of lung cancers, such as current smokers or those with a long history of smoking,” he says. 

For healthy people, the scans may cause undue worry – for instance, by finding something that turns out to be benign. Plus, the amount of radiation exposure, especially with frequent scans, is another concern. If scans are done too often, the radiation exposure may actually increase the number of cancer cases over the long term, according to a 2004 report in the journal Radiology.

The American College of Preventive Medicine says that whole-body scans “aren’t very good at finding cancer in people without symptoms” and that the radiation you get from these scans can increase your risk of cancer.

Before scheduling a body scan, talk to your doctor about your overall health risks and how a scan may or may not help you. In particular, ask yourself:

  • What’s your history? Do you have a personal or family history of lung disease, heart disease, or specific cancers?
  • Did you inhale? Are you a longtime smoker?
  • If so, how long? Even if you’ve quit smoking, for how many years were you an active smoker?

 

This is a different type of scan, called DEXA (dual energy X-ray absorptiometry). You might have heard of DEXA scans to check on bone density to see if you have osteoporosis or osteopenia. It uses low-level X-rays to check on your body composition, like how much body fat you have and where it is in your body. 

There are various ways to measure your body fat. Experts have told WebMD in the past that DEXA scanning is a “very good technique” and “one of the most accurate methods out there.” And researchers have called it the “gold standard” for checking on body composition – specifically, for bone, fat, and muscle. But it’s not covered by insurance, unless you’re getting a DEXA scan to screen for bone density. The cost of a DEXA scan varies, starting around $75 in some cases.

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5 Family and Community Engagement Strategies to Improve Student Outcomes

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Strong school-family-community partnerships bring exceptional value to children’s education. A recent book by Karen L. Mapp, a senior lecturer at the Harvard Graduate School of Education, and four other co-collaborators synthesizes the available research to explain who benefits from these partnerships and the many advantages of family and community engagement.

Everyone Wins! The Evidence for Family-School Partnerships & Implications for Practice (Scholastic, 2022) cites various research to demonstrate how family-community-school partnerships benefit all stakeholder groups when they’re approached effectively:

  • Students have higher grades, better attendance, deeper engagement in school, greater self-esteem, and higher rates of graduation and college attainment.
  • Educators enjoy better job satisfaction, better success motivating students from different backgrounds, more family support, and an improved mindset about students and their families.
  • Families have stronger relationships with their children and better rapport with educators. They can navigate school policies and advocate for their children more effectively.
  • Schools enjoy a better climate, more support from their community, and improved staff morale—leading to better teacher retention.
  • School districts and communities become better places to live and raise children. They experience fewer disciplinary problems, greater participation in afterschool programs, and more family and student involvement in decision-making.
community members talking and hugging in matching green volunteer t-shirts in front of an outdoor mural

What elements make school-family-community partnerships particularly effective? Here are five tips for how school systems can successfully promote family and community engagement in education and drive better student outcomes.

1. Successful Family Engagement Requires Intentional Leadership

Engaging with families has to be a core activity and not just an afterthought. It requires a total commitment by school and district leaders, and this commitment must include investing in the tools and training needed to help educators effectively engage with families from all backgrounds. It must be a real and intentional focus, and as Mapp says: “It’s real when I see it on your budget sheets.”

2. Teachers and Administrators Must Communicate Clearly and Consistently

To encourage family involvement in their children’s education, educators must interact with families frequently—and in many ways. For instance, teachers and administrators might engage with families in person during school drop-off and pick-up periods, set up a Family Information Board in the school’s lobby, write and distribute regular newsletters or blog posts, and/or send emails or text messages to parents.

Communicating effectively is one of the National PTA’s “National Standards for Family-School Partnerships,” which guides how schools and families should work together to support student success. Teachers and administrators should learn about and meet families’ preferred methods of communication, and families should be able to share and receive information in culturally and linguistically relevant ways.

3. Develop Healthy, Positive Relationships Based on Mutual Trust and Respect

Interactions between educators and families should be positive and reciprocal, with families feeling valued and supported. Educators can establish trust and encourage healthy, two-way communications with families by sharing information about their children’s positive behaviors and accomplishments and which skills may need work. Listen to all parents and provide opportunities for shared decision-making.

4. Be Mindful of Diversity, Equity, and Inclusion

Welcoming all families and fostering a sense of belonging is another National PTA standard. When families engage with your school, do they feel respected, understood, and connected to the school community?

To ensure equity and inclusion, learn about the families you serve and their unique needs and challenges. Use culturally responsive engagement practices. Create opportunities for connection, especially with historically marginalized families and students. Learn about and seek to remove barriers for families to participate fully in their children’s education.

5. Help Families Support and Extend the Learning at Home

Students learn more effectively when they have opportunities at home to practice, reinforce, or extend the skills and lessons they’ve learned in school. Educators can facilitate this process by giving families specific ideas for expanding their children’s learning at home, such as by incorporating core math and literacy concepts into everyday routines.

Schools can also make instructional resources such as take-home packs, activity sets, and other materials available to families to support their children’s education.

How School Specialty® Can Help

School Specialty has more than six decades of experience in providing tools, resources, and strategies that promote successful education both in school and at home. We offer arts and crafts, early childhood, ELA, math, science, STEM/STEAM, physical education, special needs, and social emotional learning resources for families, as well as games, puzzles, and general supplies.

How do you promote family engagement in your classroom and community? Let us know in the comments!



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Preteens and skincare: What parents should know – CHOC

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Published on: April 16, 2024
Last updated: April 9, 2024

Should teens and preteens be using so many skincare products with fancy ingredients? A pediatric dermatologist answers parents’ questions.

Link: https://health.choc.org/preteens-and-skincare-what-parents-should-know/

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