New Obesity Medications Offer Hope But Not a Panacea
This week I am talking to Carolyn Jasik, MD, (@DrJasik) CMO for Omada Health, a virtual-first chronic care provider helping members make lasting changes to improve health and reduce care costs for organizations
Excitement is growing around new GLP-1 receptor agonist medications for treating obesity, with promising weight loss results. However, Carolyn cautions that while beneficial, these drugs are not a silver bullet solution to the obesity epidemic. She highlights concerns around side effects leading many to discontinue treatment, the high costs limiting access, and the need for continued lifestyle changes.
We discuss that “there is no panacea in weight loss.” Though medications like GLP-1 agonists can provide an effective “kickstart,” behavior changes around diet and activity levels remain crucial long-term. She notes bariatric surgery has shown weight often returns once interventions cease and the GLP-1 agonists are no different. Even for diabetes remission, success depends on maintaining lifestyle changes. it is important to address the root drivers like nutrition quality, food security, community design, and physical movement are imperative to create population-level change.
More Than a Pill
Listen in to hear how we are optimistic about the expanding drug pipeline, but systemic barriers must still be addressed to fully leverage new obesity treatments. This includes tackling prohibitive costs and targeting access, determining the appropriate duration of therapies, and embedding more comprehensive behavior change within standard care models. Though not a magic bullet, adding new pharmacological options to the toolbox, alongside policy changes enabling their smart deployment, can help confront the considerable individual and societal toll of obesity.
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Raw Transcript
Nick van Terheyden
And today I’m delighted to be joined by Dr. Carolyn Jaisik. She is the Chief Medical Officer for Omada. Health. Carolyn, thanks for joining me.
Carolyn Jasik
Thank you.
Nick van Terheyden
So as I do with all of my guests, if you would tell us just a little bit about your background and the context of how you arrived here, you’re a physician. But you know, it’s, it’s more than that. So tell us a little bit about your background. Thank
Carolyn Jasik
you. So I’m a pediatrician by training. And I came to medicine really from the gecko, because I was interested in impacting healthcare at scale. My undergraduate degree was in health policy. And I’ve always been thinking about how can I be a part of solutions that will change healthcare, in particular in the US for the better. And I started out in health policy and worked a lot and underserved communities thinking about community interventions for underserved groups. And then I got bit by the bug of technology, early in my career and realized, wow, technology is a way to reach even more people, especially in the community in their homes, where so much of healthcare happens that we’ve kept touch from traditional care. And from there started to incorporate technology into my research, and then ended up leaving academia and joining the circus, so to speak, and now work in virtual care at Omata health where I direct our clinical research, clinical innovation, and oversee the clinicians who work with our members.
Nick van Terheyden
Fantastic. So just to be clear, when you talk about, you know, the technology helping clinicians, I want to qualify that a little bit, because I certainly got bitten by the bug. And that’s part of me. But one of the things that I think we’ve certainly done with some of the technology has not helped clinicians. And I think the more that we see clinical input participation, the better because it really requires some insight. And even though I was involved, I’ll hold my hand up and say I was in part responsible for the electronic medical record, which I don’t think has been a outright win, unfortunately. So we’re here to talk about, you know, some of the management of chronic diseases, you know, there’s a host of them. And there’s lots of paths to uncover, but the reality is that an awful lot of them are tied back to an overwhelming problem that we see in this country, certainly around the world. And that’s obesity. And, you know, it felt intractable in many instances, we struggled with it, I think we’ve seen lots of examples of trying to address it. And I know that a martyr is certainly sees that as front and center. But just, I’m gonna say recently, it feels recently I know they have a long history to this point. But we’ve seen the emergence of these GLP drugs. And it’s like this sudden revolution, hey, we’ve got a pill for it. We’ve we’ve we finally have a solution. This is the answer. But it’s not quite as simple as that, is it?
Carolyn Jasik
No, it certainly is not what we’ve seen over and over with new OBC treatments, because of the prevalence. As you mentioned, there’s so much hope and expectation is a new treatment will come along, whether it’s a medicine or a surgery, and there will be so much hope and excitement that this will be the thing that will finally solve the challenge. And GLP ones are fantastic medications. They’re associated with a tremendous amount of weight loss. But they also come with some other components. And that was true for bariatric surgery as well. Bedrick surgery is very effective. But it came with lifelong alterations to people’s metabolism. GLP, same thing, they come with side effects, they come with a high costs, their supply chain challenges. And so the implementation and the rollout of these medicines has turned out to really shine a light on what is the true potential of treatments like this. And I would argue that there is no panacea and weight loss. treatments like VlPs are enormously helpful, especially as a kickstart for somebody who’s really struggling to get their lifestyle change going. But as we saw with bariatric surgery, eventually, after the weight comes off, or after you plateau on the medicine, you need to look again at behavior change, and you just can’t have one without the other. Yeah,
Nick van Terheyden
I would say maybe not after the fact I think it should be a concurrent I mean, maybe that’s one of the challenges that we have with this sort of our we’ve got a solution. I say pill I know it’s not pill at this point. But you know, it probably seems like it might move that way. Let’s talk just a little bit if you can about them. The backdrop to this. I mean, these are they’re not entirely new drugs. We’ve known about them. We’ve been using them for diabetes for a while very effective. And it was almost like a A side effect, we discovered that like, Viagra, if I recall, that was a side effect that, you know, unrecognized. And now it becomes a sort of primary use case. Are we moving to that point? Is it moving away from the diabetes? And now it’s, you know, serving to essentially work as an anti obesity medication?
Carolyn Jasik
Well, by the numbers, in a sense, yes, because there are so many more people who have obesity without diabetes, or who have pre diabetes with their obesity. I will say that, yes, we’ve known about these medications for over a decade, they’re enormously effective. And we need to, of course, get the medicines to the diabetes population first, and there have been supply chain issues due to the excitement on the obesity side. But absolutely, there’s there’s many, many more patients who can benefit from these medicines that have obesity alone obesity and overweight. And for that reason, a lot of the attention has shifted. And interestingly, when the manufacturers put in for the FDA approval, they applied separately for the obesity indication under a new brand name. And I think that that has further led to a lot of excitement within the obesity world that it felt like a new medicine, but they aren’t in fact, new. They’re the same agents that have been used for diabetes,
Nick van Terheyden
I imagine that even if it’s a different name, it’s still coming from the same supply manufacturer. So there’s still going to be the same problems that doesn’t solve the supply chain problem. So we’ve got a number of players in the space. I mean, we’re not here to sort of promote or, you know, deal with individuals. But, you know, there’s been a lot i It’s hard to keep up with the latest in terms of publications, you know, details. Share, if you will, a little bit of the backdrop as you’ve watched this, as we see more studies emerge, to give us better insight into the effectiveness of the drugs and how they work and what the sort of long term consequences are, if you could,
Carolyn Jasik
absolutely, well, first, I will give a brief shout out if it’s okay to close concerns. And Eric Topol, that’s where I get all my information. And the latest with GLP is
Nick van Terheyden
I’d be happy to shout out to him as well. Good friend, and I agree 100%.
Carolyn Jasik
Yeah. So whenever I want to know the latest, any study that has happened, I start with both of those newsletters and the research is overwhelming. The pipeline is enormous. There’s probably over 50 agents, I think, at the last time that I counted in this field. And it’s not just GLP alone mechanism, there are double agonist triple agonist coming out. We started with semaglutide, which was under the brand name will go be through Novo Nordisk we now have to his appetite, which is under a lily, that’s a that’s a dual agonist, we will have a triple agonist pretty soon. And it’s a very rich and busy pipeline of lots of different kinds of medications with many different mechanisms of action. And it seems that with each new agent that comes out, the primary difference is more weight loss. What I am hoping to see is medication to have less side effects and the GI side effects in particular, I’m especially excited to hope that we will have agents that will come with the benefit of the weight loss without the side effects.
Nick van Terheyden
Yeah, so side effects is always important. And you know, that’s part of the risk reward that everybody thinks about. Well, at least I hope they do. I know I do. But as, as I’ve looked at the literature, it seems as if that’s having an impact, but it’s not always highlight. I mean, inevitably, it’s not except as the person that speaks faster than anything I can possibly understand on the advertising. What is the consequences of that? And how is that going to impact the long term of this? Are we are we going to see this as a tailor? How is all that playing out?
Carolyn Jasik
I think it’s well there there. There are several different aspects of GRPs that I feel like aren’t discussed enough. That’s the side effects are one of those. So we see in our members Omata is a lifestyle intervention and diabetes management solution for cardio, metabolic disease. So we have 1000s and 1000s of members going through we have enormous amount of information on these medications coming through. And what we’re hearing is nausea, vomiting, diarrhea, these are uncomfortable side effects for people who are trying to live their life now as people balance that against being able to lose weight that they have been trying to lose for many years. Many patients feel that the benefit outweighs the disadvantage of the side effects. However, as time goes on, and their weight start To get closer to their goal, and the expense starts to add up, that balance between those side effects and those other disadvantages starts to dwindle. And many patients decide to discontinue the medication because the side effects are no longer tolerable. There is a certain percentage of people in this is part of the titration process with the medicine, who do get through a side effect phase and are able to live without side effects on this medicine, but there are a substantial number of people that persist with with side effects and, and choose to discontinue once they’ve had the weight loss.
Nick van Terheyden
So a couple of things. So we’ll have to come back to the other risk reward, which is economic. But before we leave, you know, the side effects issue. You talk about the discontinuation, do we have a decent sense of what that means is this, Hey, I’ve taken it, I’ve achieved this, and I’m good to go. What’s where does that leave us?
Carolyn Jasik
All, we’re still waiting on definitive real world evidence for the indication of obesity. But if we look at the diabetes population, we see numbers as high as 50% of people who discontinue the medication. These are people who are taking the medicine for a very important chronic disease with life threatening complications. So for individuals who have achieved their treatment goal, and are added their goal weight and don’t need the medicine for something like diabetes, I worry that we will see even higher discontinuation rates, and after discontinuation there, many patients are really left to maintain that weight on their own. And it’s it’s a big ask.
Nick van Terheyden
So for those of you just joining, I’m Dr. Nick the incrementalist today I’m talking to Dr. Carolyn jaisa. She is the chief medical officer with Omata health, we were just talking about the GLP agonists. And the whole challenge of side effects, continuation of the therapy and the challenges of people sort of dropping off in you know, as you described for diabetics. So that’s a specific condition. And I imagine that, you know, if you cease the medication, assuming that the diabetes is resolved, and we’ve seen that with other therapies to be clear, are they maintaining that reversal of the diabetes and being diabetic free?
Carolyn Jasik
Well, so we, it’s a semantics issue, but we talk about remission of diabetes, more than reversal, I don’t have that little bit of a hot button. For me,
Nick van Terheyden
my apologies, I’m sorry, I didn’t mean to jump over
Carolyn Jasik
there to calves. They’re the ones that use the word revision to the ones that use the word reversals. So the data are that the primary mechanism for putting your diabetes in remission is weight loss. So patients who are able that we’ve had that are able to lose the weight and maintain it absolutely can keep their diabetes in remission. But if they regain the weight, the diabetes will come back. And that’s why i i prefer the word permission is because the physiology of diabetes remains your insulin resistance, your risk for insulin resistance that doesn’t reverse that goes into hibernation. And the way that you keep that at bay is maintaining the important lifestyle changes that got you to the point of losing the weight. I will also add, the GLP ones are in the diabetes population do result in weight loss, but they do not result in the level of weight loss that we see for the obese, obesity alone indication. There’s a few reasons for that there’s some dosage differences, there’s physiological barriers, but in the diabetes population, when people put their diabetes in remission, it’s not necessarily just because of GLP ones, it more than likely came with a huge commitment by the individual into lifestyle change. And that puts them in a good position to be able to maintain that afterward, just as you said, it needs to go along together right at the same time. But these are highly motivated patients because they have a serious disease, diabetes, and so they will often engage in those lifestyle changes because they’re so committed. So
Nick van Terheyden
essentially, you know, buried within that, I think good news, you know, the opportunity to put patients into remission. And I, you know, there’s a part of me that would say that’s true for obesity. If you know, for most of us, I know there are some people that seem to navigate life without those challenges. But you know, I think most of us will hold up our hand and say that, you know, we have those challenges. What about the issue of economics? I mean, this this is a fundamental challenge, and particularly given that I’m not going to say the majority but a large proportion of our population and is not able to access just general healthcare, let alone a very expensive drug, as these are, where are we on the economic justification and, you know, capability to be able to offer this as a realistic solution?
Carolyn Jasik
Well, if you are a policy long health policy wonk like me, this is just if anybody is this is, this is just a really interesting time right now. And I’m so glad that I have a front row seat to it, because it is pushing to the very forefront of people’s attention, at least in the United States, some major challenges we have around access to health care. So we have an enormously expensive and effective medication for for an indication that the probably about 50 to 60% of America could be eligible, right? Adult America because of the levels of obesity and overweight, if you took the FDA in, you know, approval by to the letter in it, even just to be conservative, let’s say half of America could be eligible for adult could be eligible for this medicine. How do you solve that? How do you solve that problem, it’s a public health emergency, it’s highly prevalent. But then you also have a medication that is enormous ly expensive. And this is a healthcare system that we have our amazing advances that we have that the entire world benefits from, from our science and research that comes out of from pharmaceutical manufacturing organizations, we all benefit from those developments, but they come with a price tag, and that price tag in this case is untenable for the system.
Nick van Terheyden
So I mean, I think I knew the numbers that you were talking about when you talk about the percentages, but even hearing it so starkly is still shocking. Let’s be frank, huge need economic impossibility, I think is how I would define it, not least of all given that we have the most expensive system with you know, inordinate amounts of waste, amongst any any other reasons for unable to afford, adding more cost is just not viable. Where is this going to go? How are we going to allow for this given that it as you describe it, you’re right, it is a public health emergency. It’s it’s it’s an epidemic, when you plotted in any of the forms that epidemic charts are shown on maps.
Carolyn Jasik
That’s right, I believe obesity is a chronic disease, I believe that it requires lifelong treatment, whether you are successful in your weight loss are not the predisposing genetics and the behavior and the risk is, is there regardless of whether the person loses the weight, it’s absolutely an epidemic, because you might consider any other disease. And where we go from here and what the solution is, this is why I’m so glad I have a front row seat is because really exciting and important conversations are happening all across the healthcare ecosystem, I tend to spend my time with health health insurance sponsors, employers in the in the private insurance space, I know it’s happening at the government level as well. What are we going to do about drug pricing? How are we going to think about generic entry? How are we going to think about targeting access to medication to populations that will most benefit? How can you utilize data to do that? And then finally, as we think about access to these medications, how do we think about discontinuation? What’s the duration of the therapy? That makes sense? should someone be on it for their entire life? Should they be on it for a short period of time? And what does that look like? And then from the government perspective, you know, you could look at some historical examples like Hepatitis C medication and insulin, is there a role for the government in a public health emergency to enter and say, Hey, we’re gonna get involved in pricing discussions, and we’re going to implement some bespoke reform. We’ve seen that, for example, with dialysis, where the government stepped in and said, this is like life saving people need access for it, we’re going to, we’re going to figure it out. So I think all of those things are possible. It’s an enormously dynamic environment. And we’ve already seen some big moves. So for example, Lily. When they came out with tears appetite, they implemented a savings card to drop the price to $500. The price at the time through Goby was upwards of 1000 plus, and so we’re already seeing some big moves on the manufacturing side to meet the price expectations of the market, but even at $500 It’s not affordable. Yeah.
Nick van Terheyden
So we’ve we’ve talked extensively about the backdrop to this and you know, for me, it sort of leads up to the front The mental point here, which is, it’s not a silver bullet, it’s never going to be the ultimate solution. And, you know, to that point, you have spent a large part of your career focusing on fulfilling the requirements to deliver healthcare to the chronically sick. And I think prior to any of these solutions been successful. Tell us a little bit about that and how that needs to be incorporated. Because I think that, to me, is part of the essential conversation that you’re describing, you know, for us going forward.
Carolyn Jasik
Thanks for that question. I’ve always felt that the most important parts of health care happen outside the walls of hospitals and clinics, it’s in our communities, it’s in our households, it’s in our homes and the way that we act and behave. So my interest in using technology in the home has really been around behavior change. And so behavior change is really what is the epidemic, it’s our built environment, it’s how we manufacture food, it’s how we use food, for more than just meeting our metabolic needs, it needs some emotional need in our lives. If we don’t address those fundamental components of the epidemic, we’re really just putting a bandaid and that bandaid wants to remove the GLP as an example, the weight will come back. And we’ve already seen that two thirds of the weight loss comes back a year after discontinuing will go be and we’re seeing similar results without bound. And there’s appetite. And so I really believe that behavior change needs to be more embedded in our healthcare in general, as a core part of what we do, and in particular, within obesity.
Nick van Terheyden
So if you were to pick one thing, or two or three, you know, but just a short list of key things that need to be incorporated. I mean, you mentioned a bunch of them. And I you know, I almost I’m, I’m depressed when I think about food and our food supply and what that delivers to us. I just am I mean, I’m we’re doing ourselves a disservice. Where would you start? What would be your policy changes to all of this? Yeah,
Carolyn Jasik
so I think the first thing that I would change is access to fresh and healthy food, food insecurity in the US and worldwide is an enormous problem. It the lower your income, the worse your food quality, we seem to have solved in many places, not everywhere, the issue of malnutrition, but we’re we’re over, we’re sort of over nourished, not malnourished, with unhealthy food. So I would solve there. And then the second piece is activity. When you look at obesity, weight maintenance in a in a post GLP world activity is number one, we are so sedentary work from home, zooming for work, zooming for school, we have made everything so convenient that our communities are unsafe, there aren’t places to move, we don’t have access to sports and movement, we work too much. So movement is the other piece. So food quality and movement. You
Nick van Terheyden
know, it’s funny, you bring that up. And it’s only as you’re saying that, that it I recall, when I first moved to this country, one of the things that I really genuinely love was the convenience factor. But it came at a price that I don’t think I fully understood at the time, which was you know, weight gain and lack of activity, you have to sort of take time out to go do this, you know, joining a gym was not a thing that I necessarily did when I came from other places. So I, you know, I think those two for me, if we solve that we might actually solve the well not solve the obesity problem, but certainly make a big, big dent in it. So overall, I think, you know, I’m excited because there’s a new tool in the box to apply for this. I think people struggle and, you know, I’ve seen it with many friends and you know, the challenges of sort of breaking that cycle, we see the sort of yo yo activity, it sounds like there’s still a bit of that. But now the renewed focus and I think, you know, the opportunity for the policy, so that we can make this not just available to those that can afford it, but accessible to everyone and deliver it in a way that all can access it, I think, you know, represents a tremendous opportunity to break this cycle and, you know, combat this epidemic of obesity, unfortunately, as we do each and every week, we’ve run out of time, so just remains for me to thank you for joining me on the show. Carolyn, thanks for joining me. Thank
Carolyn Jasik
you so much for having me
