Burtis: Follow The Science, Restore Medicaid Coverage For GLP-1s For Obesity

By Matija Burtis, NH Journal

As a physician treating the chronic disease of obesity for patients across New England, including New Hampshire, I strongly urge New Hampshire’s state leaders to reconsider their decision to eliminate Medicaid coverage for GLP-1 medications to treat obesity.

Patients for whom I’ve prescribed GLP-1s, such as Zepbound and Wegovy, finally found a path to weight loss and improved health that were previously unavailable with diet and exercise alone. Patients felt heard, and it even seemed that some of the stigma and bias around obesity were diminishing. Yet New Hampshire blocked this path to health for many.

What is it about obesity that makes it such an easy target for budget-minded state leaders? No other disease state or medication has been so aggressively singled out in discussions about our many healthcare crises. When someone has cancer, we don’t tell them their medication is too expensive and to find another way to treat their disease. Or when patients have asthma, we don’t expect them to do without their inhaler and medications.

We need to change the conversation based on the full breadth of science around obesity and GLP-1 effects.

Studies show that, in patients with obesity, dietary restriction and increased exercise result in only a 2% reduction in body weight. With GLP-1s, reductions of 20% or more have been achieved. There are also proven benefits of GLP-1s for other diseases, such as diabetes, obstructive sleep apnea, fatty liver disease, and secondary cardiovascular events like heart attacks and strokes, which are direct results of obesity.

Do you also know that eating significantly fewer calories may, in fact, be harmful to the body when you have the disease of obesity? The phenomenon of “persistent metabolic adaptation,” in which the body fights back and regains the weight lost after a restrictive diet and physical activity have stopped, has been documented.

GLP-1 is a naturally occurring hormone in the body. People living with obesity have very low levels of this hormone, which plummet further after restrictive dieting. This causes increased “food noise” because a body with this disease defends a high weight “setpoint”. Removing GLP-1 therapy from treatment not only perpetuates weight gain but causes tremendous psychological stress because “food noise” and cravings often worsen.

Since New Hampshire dropped Medicaid coverage, my clinic has received panicked calls from patients who have lost their coverage, asking, “What are we going to do now?” These are patients who showed up at their appointments willing to cut calories and exercise more but simply could not achieve health improvements without GLP-1 medication.

Now, many patients are resorting to unregulated compounded medications, which are drugs mixed by specialty pharmacies, in hopes of continuing their treatment at an affordable price. But compounded medications are not evaluated or approved by the FDA for safety, effectiveness, and quality, and the Obesity Medicine Association has taken a position against this practice due to lack of regulations and safety concerns.

In addition to the medical and mental health impacts, there are real quality of life implications to taking away treatment, which, if you live without obesity, you might not understand. Patients who have seen real health benefits from GLP-1s are now able to enjoy simple things in life that many of us take for granted, like riding a roller coaster with their kids or not having to ask for a seatbelt extender to be safely seated in a car or on a plane.

We know that GLP-1s are the most effective medications we can prescribe for chronic obesity as part of a comprehensive treatment plan with diet and exercise. Patients with Medicaid need help accessing these medications.

The decision to provide Medicaid coverage for GLP-1s doesn’t have to be an all-or-nothing proposition. We need a thoughtful discussion grounded in the science of obesity, rather than in societal misperceptions and bias. Obesity experts and physicians need to be more deeply integrated into policy deliberations about GLP-1 coverage, so that state leaders fully understand what these decisions mean for their constituents living with the chronic disease of obesity.

There are guardrails that can be established, such as prior authorization, more clearly defined medical criteria, and outcome measures. The long-term benefits to the state and its Medicaid recipients far outweigh the short-term budget solution the state is seeking.

In the interest of a healthier New Hampshire, state leaders must consider a more thoughtful and informed approach to safeguard care for Medicaid patients with a significant burden from the disease of obesity.

Matija Burtis, MA, DO, is a bariatric and family medicine physician with Knownwell, a Boston-area obesity medicine clinic serving patients in southern New Hampshire and Maine. She wrote this for NHJournal.com.

This story was originally published by the NH Journal, an online news publication dedicated to providing fair, unbiased reporting on, and analysis of, political news of interest to New Hampshire. For more stories from the NH Journal, visit NHJournal.com.