Health

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

Published

5 months ago

March 29, 2024

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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Health

Walmart Is Selling a $300 Power Tower for Just $128, and Shoppers Say It's 'Surprisingly Sturdy'

Published

17 hours ago

September 7, 2024

Michael Charboneau

Men’s Journal aims to feature only the best products and services. If you buy something via one of our links, we may earn a commission.

When building a home gym, it’s easy to get overwhelmed by all the equipment options, especially when you’re working with limited space and a tight budget. But when you focus on versatile gear and hunt for deals, creating a useful setup is easily doable. Thankfully, Walmart has been slashing prices on a ton of fitness equipment, including its bestselling adjustable dumbbells and even a complete home gym system. Now, it’s reduced the price of a popular power tower by over $170, and it even ships for free.

The Pooboo Body Champ Multifunction Power Tower is on sale for $128, a 57% discount on its normal price of $300. This incredibly versatile workout station has earned nearly 250 five-star ratings from Walmart shoppers who’ve praised its “strong and sturdy” build and “quality fit and finish,” and it’s currently one of the top 5 bestselling models on the site.

Pooboo Body Champ Multifunction Power Tower, $128 (was $300) at Walmart

Don’t let the brand’s bizarre name fool you—this power tower is a well-made piece of gym equipment. It features steel construction and is rated to hold up to 480 pounds (the tower itself weighs 66 pounds). A nearly 42-inch H-shaped base gives it excellent stability, so it won’t wobble or shake when you’re exercising, and anti-slip feet on the bottom keep it securely planted on the floor. It’s also adjustable (from 71.4 inches to 94 inches) to accommodate users of varying heights. And, once it’s set up, you can use it for a huge range of exercises, including dips, pull-ups, chin-ups, push-ups, vertical leg raises, knee raises, and more.

According to Walmart reviewers, the Pooboo Body Champ stands out for its solid build and usefulness. “It’s a surprisingly sturdy piece of equipment,” a shopper said. “Everything about this fitness tower is perfect. I originally purchased this with the intention of only doing pull-ups on it, but after quickly assembling the power tower, I came to realize just how versatile it is. It has cushions for knee and leg raises, it’s sturdy, and the perfect width for dips.” Another shopper agreed, saying, “This was a much-needed addition to my home gym.”

“This thing is amazing and worth every penny,” said another, who added that it’s “easy to install and can hold a lot of weight.”

At just $128, this Pooboo power tower is a screaming deal, and it’s sure to get lots of use during your workouts. But this discount won’t last long, so grab one today before the price pumps back up.

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Health

Alzheimer’s Drug May Save Lives Through ‘Suspended Animation’

Published

1 day ago

September 7, 2024

Harvard Gazette

By Lindsay Brownell | Wyss Institute Communications | Harvard Gazette

Could buy patients more time to survive critical injuries and diseases, even when disaster strikes far from a hospital

Donepezil, an FDA-approved drug to treat Alzheimer’s, has the potential to be repurposed for use in emergency situations to prevent irreversible organ injury, according to researchers at the Wyss Institute for Biologically Inspired Engineering at Harvard University.

Using Donepezil (DPN), researchers report that they were able to put tadpoles of Xenopus laevis frogs into a hibernation-like torpor.

“Cooling a patient’s body down to slow its metabolic processes has long been used in medical settings to reduce injuries and long-term problems from severe conditions, but it can only currently be done in a well-resourced hospital,” said co-author Michael Super, director of immuno-materials at the Wyss Institute. “Achieving a similar state of ‘biostasis’ with an easily administered drug like DNP could potentially save millions of lives every year.”

This research, published Thursday in ACS Nano, was supported as part of the DARPA Biostasis Program, which funds projects that aim to extend the time for lifesaving medical treatment, often referred to as “the Golden Hour,” following traumatic injury or acute infection. The Wyss Institute has been a participant in the Biostasis Program since 2018, and has achieved several important milestones over the last few years.

Using a combination of predictive machine learning algorithms and animal models, the Wyss’ Biostasis team previously identified and tested existing drug compounds that had the potential to put living tissues into a state of suspended animation. Their first successful candidate, SNC80, significantly reduced oxygen consumption (a proxy for metabolism) in both a beating pig heart and in human organ chips, but is known to cause seizures when injected systemically.

In the new study, they once again turned to their algorithm to identify other compounds whose structures are similar to SNC80. Their top candidate was DNP, which has been approved since 1996 to treat Alzheimer’s.

Achieving a similar state of ‘biostasis’ with an easily administered drug like DNP could potentially save millions of lives every year.

–Michael Super

“Interestingly, clinical overdoses of DNP in patients suffering from Alzheimer’s disease have been associated with drowsiness and a reduced heart rate — symptoms that are torpor-like. However, this is the first study, to our knowledge, that focuses on leveraging those effects as the main clinical response, and not as side effects,” said the study’s first author, María Plaza Oliver, who was a postdoctoral fellow at the Wyss Institute when the work was conducted.

The team used X. laevis tadpoles to evaluate DNP’s effects on a whole living organism, and found that it successfully induced a torpor-like state that could be reversed when the drug was removed. The drug, however, did seem to cause some toxicity, and accumulated in all of the animals’ tissues. To solve that problem, the researchers encapsulated DNP inside lipid nanocarriers, and found that this both reduced toxicity and caused the drug to accumulate in the animals’ brain tissues. This is a promising result, as the central nervous system is known to mediate hibernation and torpor in other animals as well.

Although DNP has been shown to protect neurons from metabolic stress in models of Alzheimer’s disease, the team cautions that more work is needed to understand exactly how it causes torpor, as well as scale up production of the encapsulated DNP for use in larger animals and, potentially, humans.

“Donepezil has been used worldwide by patients for decades, so its properties and manufacturing methods are well-established. Lipid nanocarriers similar to the ones we used are also now approved for clinical use in other applications. This study demonstrates that an encapsulated version of the drug could potentially be used in the future to buy patients critical time to survive devastating injuries and diseases, and it could be easily formulated and produced at scale on a much shorter time scale than a new drug,” said senior author Donald Ingber, the Judah Folkman Professor of Vascular Biology at Harvard Medical School and Boston Children’s Hospital, and the Hansjörg Wyss Professor of Bioinspired Engineering at Harvard’s John A. Paulson School of Engineering and Applied Sciences.

This research was supported by DARPA under Cooperative Agreement Number W911NF-19-2-0027, the Margarita Salas postdoctoral grant co-funded by the Spanish Ministry of Universities, and the University of Castilla-La Mancha (NextGeneration EU UNI/551/2021).

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This story is reprinted with permission from The Harvard Gazette.

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Health

Can Stuff in Rosemary Extract Fight Cocaine Addiction?

Published

2 days ago

September 5, 2024

Futurity

Researchers have discovered that an antioxidant found in rosemary extract can reduce intakes of cocaine by moderating the brain’s reward response, offering a new therapeutic target for treating addiction.

September 5, 2024 by Futurity Leave a Comment

By Pat Harriman-UC Irvine

The study in the journal Neuron describes researchers’ focus on a region of the brain called the globus pallidus externus, which acts as a gatekeeper that regulates how we react to cocaine.

They discovered that within the GPe, parvalbumin-positive neurons are crucial in controlling the response to cocaine by changing the activity neurons releasing the pleasure molecule dopamine.

“There are currently no effective therapeutics for dependence on psychostimulants such as cocaine, which, along with opioids, represent a substantial health burden,” says corresponding author Kevin Beier, an associate professor of physiology and biophysics at the University of California, Irvine.

“Our study deepens our understanding of the basic brain mechanisms that increase vulnerability to substance use disorder-related outcomes and provides a foundation for the development of new interventions.”

Findings in mice revealed that globus pallidus externus parvalbumin-positive cells, which indirectly influence the release of dopamine, become more excitable after being exposed to cocaine. This caused a drop in the expression of certain proteins that encode membrane channels that usually help keep the globus pallidus cell activity in check. The researchers found that carnosic acid, an isolate of rosemary extract, selectively binds to the affected channels, providing an avenue to reduce response to the drug in a relatively specific fashion.

“Only a subset of individuals are vulnerable to developing a substance use disorder, but we cannot yet identify who they are. If globus pallidus cell activity can effectively predict response to cocaine, it could be used to measure likely responses and thus serve as a biomarker for the most vulnerable,” Beier says. “Furthermore, it’s possible that carnosic acid could be given to those at high risk to reduce the response to cocaine.”

The next steps in this research include thoroughly assessing negative side effects of carnosic acid and determining the ideal dosage and timing. The team is also interested in testing its efficacy in reducing the desire for other drugs and in developing more potent and targeted variants.

Scientists from the University of West Virginia and the University of Colorado participated in the study.

Support for this work came from the National Institutes of Health, One Mind, the Alzheimer’s Association, New Vision Research, BrightFocus Foundation, and the Brain & Behavior Research Foundation.

Source: UC Irvine

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Previously Published on futurity.org with Creative Commons License

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