Study after study shows that most people don’t take their prescribed medications. It doesn’t matter what it is — Statin, high blood pressure medicine, drugs that lower blood sugar levels, asthma medicine. Patients either never start taking it or stop taking it.
This is a problem doctors call nonadherence, a common human tendency to resist medical treatment, and it leads to countless deaths and billions of dollars in preventable health care costs each year.
But that resistance may be overcome by blockbuster obesity drugs Wegovy and Zepbound, which have surprised the world with the way they help people lose weight and keep it off. Although it is still in its early stages and there is a lack of data on compliance with new drugs; Doctors say they’re noticing another surprising effect. The patient appears to be faithfully taking this medication week after week.
Some patients may initially need to overcome resistance to starting treatment. A national survey found that most people lost interest in starting medication if they were told that they would regain the weight if they stopped taking it.
In one small study, patients stopped refilling their prescriptions for months at a time, perhaps due to side effects, lack of availability, or insurance and cost issues.
But anecdotes from doctors and patients show that people who start taking the drug continue to take it.
“I’m never going to stop taking this drug,” said Kimberly DelRosso of Pembroke, Mass., who takes Wigovy.
She never forgot her weekly injections. In contrast, she says she often forgot to take her prescribed blood pressure medication when she gained weight. (Now that I’ve lost her weight on Wegovy, I don’t need Wegovy anymore.)
So far, doctors report that, like Del Rosso, most patients plan to take the obesity drugs permanently, and many are happy to no longer need other drugs.
Dr. David Cummings, a professor of medicine at the University of Washington and director of the VA Puget Sound Health Care System’s weight management program, has documented his patients’ experiences with Wegovy and the diabetes drug Ozempic. He has prescribed drugs to about 1,000 patients so far. At most, 5% of patients discontinued treatment due to side effects. Others quit because of ongoing drug shortages, either because their insurance no longer covered them or because they could not find pharmacies with stock.
But people who stop generally don’t do so voluntarily, he says. Other doctors prescribing Wegovy agreed.
“Compliance has been exceptional,” said Dr. Diana Tiara, medical director of the Weight Management Program at the University of California, San Francisco. “People accept it. They ask for refills. They take it with them on trips.”
Prevalence of non-compliance
there is price to pay For failing to take prescribed medication. An astonishing 40 to 50 percent of people prescribed medications for chronic conditions such as high blood pressure and diabetes do not take them, resulting in at least $100 billion in preventable health care costs annually. . It is estimated that this lack of compliance results in at least 100,000 preventable deaths each year.
Even a heart attack may not be enough to scare people away from taking today’s powerful heart drugs, which are proven to prevent death from heart disease. In some studies, half A higher proportion of people who had a heart attack were still taking medication to protect their hearts two years later.
“These patients have seen bright lights, been in an ambulance, had a family member have a second heart attack, glimpsed the Pearly Gates, and yet are still taking statins and beta-blockers. Apparently not,” said Professor Amitabh Chandra. in public policy and management from Harvard University.
flat the doctor will stop it Contrary to the assumption that people take drugs because they don’t really understand their importance, people take them.
Cost also plays an important role, but at least one study It turns out that even when drugs are free, compliance can be poor.
One reason is that there is some kind of deep-seated resistance to ingesting something that is a daily reminder that they are sick, or something that so many patients may be aware of. It seems. Some patients start to feel strange, especially when they take what experts call “permanent” drugs every day.
“People think they’re fine, so they don’t need drugs,” said Corinne Voyles, a social psychologist who studies medication adherence at the University of Wisconsin. “But the medicine is keeping them well.”
Jalpa A. Doshi, a professor of medicine at the Perelman School of Medicine at the University of Pennsylvania, said patients make their own personal value judgments. The act of taking medicine reminds me of that.” That I’m sick. But I have no symptoms, no high blood pressure or high cholesterol. ”
“And what are the benefits?” she added. “I really don’t see the benefit. Instead of taking these drugs, I could cut back on salty and fatty foods and walk and exercise more.”
This mental assessment that patients make “makes it easier to quit,” Dr. Doshi said.
Mark Anthony Walker, 61, of Dublin, California, explains. His history with heart disease is overshadowed by his troubled family history. His father died at the age of 47 and his mother at the age of 48 from a severe heart attack.
At age 26, Mr. Walker’s cholesterol level was 360.
“It was scary,” he said.
Since then, he has been on and off statins and is still on them. But he doesn’t plan on doing it forever. He came to his conclusion that his brain needed cholesterol. As for taking drugs for the rest of his life, “I’m absolutely against it,” he said.
Instead, he believes heart disease can be controlled and even reversed through a strict diet, exercise, and vitamins.
Mr. Walker’s cardiologist, Dr. David J. Maron, chairman of the Division of Preventive Cardiology at Stanford University, gently encourages Mr. Walker and others like him to take the drug. But as doctors know, when they come charging in with guns blazing, the patients just go away.
Less stigma and shame
So what makes obesity drugs different? First, while it’s usually doctors who recommend drugs like statins and blood pressure drugs, patients often ask their doctors for obesity drugs. there is. Many people spend their lives trying every diet and exercise program, losing weight only to gain it back.
Also, people who start taking new obesity drugs can’t easily hide it when they stop taking it. Lost weight can be regained, along with the stigma, shame, and remorse associated with obesity. Therefore, these drugs are very different from most other drugs.
“There’s no big sign in your chest that says, ‘I’ve stopped taking my blood pressure medication,'” says Dr. Walid Gerad, a professor of medicine at the University of Pittsburgh who studies medication adherence.
But on the downside, obesity drugs are expensive and often require doctors to fill out burdensome pre-approval forms for insurance coverage. This drug is consistently in short supply across the country. These obstacles may make them difficult to obtain.
Other disadvantages of this drug include side effects such as nausea and gastrointestinal upset, and the method of administration. That is, the patient must inject the drug himself once a week.
in the study Hamlet Gasoyan and colleagues at the Cleveland Clinic examined the electronic health records of 402 patients taking Wigovy or Ozempic for obesity at facilities in Ohio and Florida. They found that only 161 people (40%) refilled their prescriptions consistently throughout the year. Side effects, availability, or insurance and cost issues may be at play.
But there’s a reason patients call dozens of pharmacies for drugs and give themselves injections every week. Because without obesity, you look better and feel seen in a different way. They are no longer shunned or shamed. People no longer stare at the grocery cart or comment when they eat ice cream. Gone is the shame, remorse, and endless stigma around obesity.
That’s a big factor for Del Rosso.
Obese people “get special treatment,” she said, adding: “It’s really awful when people look down on you because you’re heavier.”
But she’s also happy with the health effects. She no longer has her sleep apnea or high blood pressure, and her blood sugar levels, which were approaching the diabetic range, have also decreased.
“I don’t need to take any more medication,” she said.
Except for Wegovy, of course.
