Patients hate drugs forever. Is Wegovy different?

Most people, study after study shows, do not take their prescribed medications. It doesn’t matter whether it’s statins, high blood pressure drugs, blood sugar lowering drugs, asthma drugs. Either patients never start taking them, or they stop.

It’s a problem doctors call nonadherence, the common human tendency to resist medical treatment, and it causes countless deaths and billions of dollars in avoidable medical costs each year.

But that resistance can be overcome with the obesity drugs Wegovy and Zepbound, which have surprised the world with how they help people lose weight and keep it off. Although it is still early days, and there is little data on compliance with the new drugs, doctors say they’re noticing another surprising effect: patients seem to take them faithfully, week after week.

Some patients may have to overcome an initial reluctance to start. A national survey showed that when people were told they would gain the weight back if they stopped taking the drugs, most lost interest in starting them.

In one small study, patients stopped refilling prescriptions for months at a time, perhaps because of side effects, lack of availability, or insurance and cost issues.

But anecdotally, doctors and patients say, those who start taking the drugs stay on.

I have no intention of stopping this medication, said Kimberly DelRosso of Pembroke, Mass., who takes Wegovy.

He has never forgotten to take his weekly injection. Instead, he says, he often neglected to take the blood pressure pills he was prescribed when he was heavier. (Now, after losing weight on Wegovy, she no longer needs them.)

So far, doctors report that, like Ms. DelRosso, most of their patients intend to take the obesity drugs forever, and many are thrilled when they no longer need other drugs.

Dr. David Cummings, a professor of medicine at the University of Washington and director of a weight management program at the VA Puget Sound Health Care System, chronicles his patients’ experiences with Wegovy and the diabetes drug Ozempic. So far he has prescribed the drugs to around 1,000 patients. At most 5% stopped because of side effects, he said. Others stopped because their insurance no longer covered their drug or because they couldn’t find a pharmacy that had it in stock, reflecting persistent drug shortages.

But those who do stop generally don’t do so voluntarily, he said. Other doctors prescribing Wegovy agreed.

Compliance is exceptional, said Dr. Diana Thiara, medical director of the weight control program at the University of California, San Francisco. People take it. They ask for refills. They take him on a trip.

There is a price to pay for not taking prescription drugs. A staggering 40 to 50 percent of people who receive medications for chronic conditions such as high blood pressure or diabetes do not take them, incurring at least $100 billion a year in avoidable medical costs as a result. This lack of compliance is estimated to result in at least 100,000 avoidable deaths each year.

Even a heart attack may not be enough to scare people off taking the current arsenal of heart drugs, which have been shown to prevent deaths from heart disease. Some studies show that only half of people who had heart attacks were still taking heart-protecting drugs two years later.

These patients have seen the bright lights, gotten into the ambulance, gotten a rescue PCI, attended to their families’ secondary heart attacks, glimpsed the Pearly Gates, but still can’t seem to take their statins and beta blockers, said Amitabh Chandra, professor of public policy and business administration at Harvard.

Even doctors stop taking their medications, challenging the assumption that people do it because they don’t really understand its importance.

And while cost plays a role, at least one study found that even when drugs are free, adherence can be abysmal.

One reason seems to be a kind of ingrained reluctance to take something that reminds people every day that they are sick, or that many patients can perceive it. Especially with what experts call forever drugs, taking them every day makes some patients feel abnormal.

People think they’re fine, so they don’t need the medicine, said Corrine Voils, a social psychologist at the University of Wisconsin who studies medication compliance. But medicine is what keeps them well.

Jalpa A. Doshi, a professor of medicine at the University of Pennsylvania’s Perelman School of Medicine, said patients make their own personal value judgments: the drug has side effects, requires co-payments and taking a daily pill it reminds me that I’m sick. But I have no symptoms, I don’t see my high blood pressure or high cholesterol.

And what are the benefits? she added. I don’t really see the benefits. I could eat less salt and fatty foods and do more walking or exercise instead of taking these medications.

These assessments that patients make in their heads make it much easier to stop, Dr. Doshi said.

This describes Mark Anthony Walker, 61, of Dublin, California, whose experience with heart disease is overshadowed by a troubling family history: his father died of a massive heart attack at age 47, his mother at 48.

When he was 26, Mr. Walker had a cholesterol level of 360.

It scared me, he said.

He has been on statins since then and is on one now. But he doesn’t plan to take it forever. He has come to the conclusion that his brain needs cholesterol. As for taking a drug for the rest of his life, I’m completely against it, he said.

Instead, she believes she will be able to control her heart disease and even reverse it with a strict diet, exercise and vitamins.

Mr. Walkers cardiologist, Dr. David J. Maron, director of preventive cardiology at Stanford, gently encourages him and others like him to take their medications. But as doctors know, if guns are blazing, their patients will go elsewhere.

So what can make obesity drugs different? For one thing, while doctors often recommend drugs like statins or blood pressure drugs, patients often ask for obesity drugs. Many have spent their entire lives trying every diet and exercise program they could find, and every time they lost weight, they gained it back.

Also, people who start taking the new obesity drugs can’t easily hide if they stop taking them: the weight they lost can come back, along with the stigma and shame and self-blame that often accompanies obesity. This makes these drugs very different from most others.

You don’t have a big sign on your chest that says, “Blood pressure medication stopped,” said Dr. Walid Gellad, a professor of medicine at the University of Pittsburgh who studies medication adherence.

On the downside, however, obesity drugs are expensive and often require doctors to fill out pre-authorization forms for insurance. Drugs have been consistently in short supply throughout the country. These impediments can make them difficult to achieve.

Other drawbacks of the drugs include side effects such as nausea and gastrointestinal problems, as well as the way they are administered patients must inject the drugs once a week.

In a study at the Cleveland Clinic, Hamlet Gasoyan and colleagues examined the electronic health records of 402 patients at sites in Ohio and Florida who were taking Wegovy or Ozempic for obesity. They found that only 161, or 40 percent, had continuously filled their prescriptions during the year. Side effects, availability or insurance, and cost may have played a role.

But there is a reason why patients are willing to call dozens of pharmacies to find the drugs and inject themselves more faithfully every week: without obesity, they feel that they look better and look differently. They are no longer rejected or shamed. People no longer look at the shopping cart or comment when eating a bowl of ice cream. The shame and self-blame and never-ending stigma of obesity is gone.

This is an important factor for Ms. DelRosso.

Obese people are treated differently, she said, adding: It’s horrible how people discount you because you’re heavy.

But he also revels in the health effects. He no longer has sleep apnea or high blood pressure, and his blood sugar, which was approaching the diabetic range, has come down.

I don’t have to take any medicine anymore, he said.

Except, of course, Wegovy.

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