Do we need animal products to be healthy?

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Do we need animal products to be healthy?

We asked you for your (health-related) perspective on plant-based vs anima-based foods, and got the above-pictured spread of answers.

“Some or all of us may need small amounts of animal products” came out on top with more votes than the two more meat-eatery options combined, and the second most popular option was the hard-line “We can all live healthily and happily on just plants”.

Based on these answers, it seems our readership has quite a lot of vegans, vegetarians, and perhaps “flexitarians” who just have a little of animal products here and there.

Perhaps we should have seen this coming; the newsletter is “10almonds”, not “10 rashers of bacon”, after all.

But what does the science say?

We are carnivores and are best eating plenty of meat: True or False?

False. Let’s just rip the band-aid off for this one.

In terms of our anatomy and physiology, we are neither carnivores nor herbivores:

  • We have a mid-length digestive tract (unlike carnivores and herbivores who have short and long ones, respectively)
  • We have a mouthful of an assortment of teeth; molars and premolars for getting through plants from hard nuts to tough fibrous tubers, and we have incisors for cutting into flesh and (vestigial, but they’re there) canines that really serve us no purpose now but would have been a vicious bite when they were bigger, like some other modern-day primates.
  • If we look at our closest living relatives, the other great apes, they are mostly frugivores (fruit-eaters) who supplement their fruity diet with a small quantity of insects and sometimes other small animals—of which they’ll often eat only the fatty organ meat and discard the rest.

And then, there’s the health risks associated with meat. We’ll not linger on this as we’ve talked about it before, but for example:

If we avoid processed and/or red meat, that’s good enough: True or False?

True… Ish.

Really this one depends on one’s criteria for “good enough”. The above-linked studies, and plenty more like them, give the following broad picture:

  • Red and/or processed meats are unequivocally terrible for the health in general
  • Other mammalian meats, such as from pigs, are really not much better
  • Poultry, on the other hand, the science is less clear on; the results are mixed, and thus so are the conclusions. The results are often barely statistically significant. In other words, when it comes to poultry, in the matter of health, the general consensus is that you can take it or leave it and will be fine. Some studies have found firmly for or against it, but the consensus is a collective scientific shrug.
  • Fish, meanwhile, has almost universally been found to be healthful in moderation. You may have other reasons for wanting to avoid it (ethics, environmentalism, personal taste) but those things are beyond the scope of this article.

Some or all of us may need small amounts of animal products: True or False?

True! With nuances.

Let’s divide this into “some” and “all”. Firstly, some people may have health conditions and/or other mitigating circumstances that make an entirely plant-based diet untenable.

We’re going light on quotations from subscriber comments today because otherwise this article will get a bit long, but here’s a great example that’s worth quoting, from a subscriber who voted for this option:

❝I have a rare genetic disease called hereditary fructose intolerance. It means I lack the enzyme, Aldolase B, to process fructose. Eating fruits and veggies thus gives me severe hypoglycemia. I also have anemia caused by two autoimmune diseases, so I have to eat meat for the iron it supplies. I also supplement with iron pills but the pills alone can’t fix the problem entirely.❞

And, there’s the thing. Popular vegan talking-points are very good at saying “if you have this problem, this will address it; if you have that problem, that will address it”, etc. For every health-related objection to a fully plant-based diet there’s a refutation… Individually.

But actual real-world health doesn’t work like that; co-morbidities are very common, and in some cases, like our subscriber above, one problem undermines the solution to another. Add a third problem and by now you really just have to do what you need to do to survive.

For this reason, even the Vegan Society’s definition of veganism includes the clause “so far as is possible and practicable”.

Now, as for the rest of us “all”.

What if we’re really healthy and are living in optimal circumstances (easy access to a wide variety of choice of food), can we live healthily and happily just on plants?

No—on a technicality.

Vegans famously need to supplement vitamin B12, which is not found in plants. Ironically, much of the B12 in animal products comes from the animals themselves being given supplements, but that’s another matter. However, B12 can also be enjoyed from yeast. Popular options include the use of yeast extract (e.g. Marmite) and/or nutritional yeast in cooking.

Yeast is a single-celled microorganism that’s taxonomically classified as a fungus, even though in many ways it behaves like an animal (which series of words may conjure an amusing image, but we mean, biologically speaking).

However, it’s also not technically a plant, hence the “No—on a technicality”

Bottom line:

By nature, humans are quite versatile generalists when it comes to diet:

  • Most of us can live healthily and happily on just plants if we so choose.
  • Some people cannot, and will require varying kinds (and quantities) of animal products.
  • As for red and/or processed meats, we’re not the boss of you, but from a health perspective, the science is clear: unless you have a circumstance that really necessitates it, just don’t.
    • Same goes for pork, which isn’t red and may not be processed, but metabolically it’s associated with the same problems.
  • The jury is out on poultry, but it strongly appears to be optional, healthwise, without making much of a difference either way
  • Fish is roundly considered healthful in moderation. Enjoy it if you want, don’t if you don’t.

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  • Physical Sunscreen or Chemical Sunscreen – Which is Healthier?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Our Verdict

    When comparing physical sunscreens to chemical sunscreens, we picked the physical sunscreens.

    Why?

    It’s easy to vote against chemical sunscreens, because it has “chemical” in the name, which tends to be offputting PR-wise no matter how healthy something is.

    But in this case, there’s actual science here too!

    Physical sunscreens physically block the UV rays.

    • On the simplest of levels, mud is a physical sunscreen, as you can see widely used by elephants, hippos, pigs, and other animals.
    • On a more sophisticated level, modern physical sunscreens often use tiny zinc particles (or similar) to block the UV rays in a way that isn’t so obvious to the naked eye—so we can still see our skin, and it looks just like we applied an oil or other moisturizer.

    Chemical sunscreens interact with the UV rays in a way that absorbs them.

    • Specifically, they usually convert it into relatively harmless thermal energy (heat)
    • However, this can cause problems if there’s too much heat!
    • Additionally, chemical sunscreens can get “used up” in a way that physical sunscreens can’t* becoming effectively deactivated once the chemical reaction has run its course and there is no more reagent left unreacted.
    • Worse, some of the reagents, when broken down by the UV rays, can potentially cause harm when absorbed by the skin.

    *That said, physical sunscreens will still need “topping up” because we are a living organism and our body can’t resist redistributing and using stuff—plus, depending on the climate and our activities, we can lose some externally too.

    Further reading

    We wrote about sunscreens (of various kinds) here:

    Who Screens The Sunscreens?

    And you can also read specifically about today’s topic in more detail, here:

    What’s The Difference Between Physical And Chemical Sunscreens?

    Take care!

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  • Cynthia’s Thoughts on Intermittent Fasting

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    The Myth of Breakfast and Snacking

    Here at 10almonds we love addressing misconceptions in the health world.

    When it comes to eating habits and fasting, we’ve written our own pieces on how to break your fast (otherwise known as break-fast, or breakfast), alongside a general breakdown of intermittent fasting, and a much-requested piece on fasting specifically for women.

    Cynthia Thurlow, though, instead of just writing a few articles, has dedicated the majority of her working years to intermittent fasting and, in her TEDx talk (below), makes a strong argument challenging the long-held belief that breakfast is the most important meal of the day.

    Cynthia Thurlow’s Two Main Points

    Thurlow argues that it’s not what you eat but when you eat that has a more profound impact on health and aging. And she argues this is crucial regardless of your age.

    Complementing her views on fasting are her views on snacking; she argues that snacking all day long is outdated advice and can overtax the digestive system, leading to various health issues.

    Practical Tips for Starting Intermittent Fasting

    To begin intermittent fasting, Thurlow suggests starting with a 12-13 hour fasting window and gradually increasing it to 16 hours.

    In terms of food choice, she recommends eating whole, unprocessed foods during eating periods as well as staying well-hydrated with water, coffee, or tea.

    But you won’t see results immediately; Thurlow advises giving the strategy a solid 30 days to see results and consulting a healthcare provider if there are any existing health conditions.

    You can dive deeper and join the 15 million other people who have listened to her thoughts on fasting by watching her TEDx talk below:

    How was the video? If you’ve discovered any great videos yourself that you’d like to share with fellow 10almonds readers, then please do email them to us!

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  • Is Vitamin C Worth The Hype? (Doctorly Investigates)

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Double Board-Certified Dermatologists Dr. Muneeb Shah & Dr. Luke Maxfield weigh in on vitamin C; is it worth the hype?

    Yes it is, but…

    There are some caveats, for example:

    • It’s best to apply vitamin C on clean, dry skin and let it set before layering other products.
    • Avoid mixing with oxidants like benzoyl peroxide (cancels out antioxidant effects).
    • Avoid combining with copper (may negate brightening benefits).
    • Do not use with hypochlorous acid (oxidative reactions cancel out benefits).
    • Be cautious with retinol due to irritation risks.

    However, used correctly, it does give very worthy benefits, and they recommend:

    • Morning use: acts as an antioxidant, pairs well with sunscreen for better protection from sun and environmental damage.
    • Night use: maximizes functions like improving tone, collagen production, texture, and reducing wrinkles.

    That’s not to say that at night it stops being an antioxidant or during the day it isn’t critical for collagen synthesis, but it is to say: because of the different things our bodies typically encounter and/or do during the day or night, those are the best times to get the most out of those benefits.

    They also review some popular products; here are some notes on their comments about them:

    • Skinceuticals C E Ferulic: research-backed, $180, effective but potentially irritating.
    • Skinceuticals Phloretin CF: includes 0.5% salicylic acid, good for acne-prone skin.
    • Dermatology Vitamin C E Ferulic: relatively more affordable ($70), fragrance-free, includes peptides and ceramides.
    • Drunk Elephant C-Firma: powder-to-serum formula, sued for patent infringement.
    • Paula’s Choice C15 Booster: reformulated, fragrance-free, similar to Skinceuticals.
    • Neutrogena Vitamin C Capsules: stabilized 20% ascorbic acid, single-use, travel-friendly.
    • La Roche-Posay Vitamin C Serum: contains fragrance and alcohol, not ideal for sensitive skin.
    • Matter of Fact Vitamin C Serum: includes ascorbic acid and ferulic acid, oily texture for dry skin.
    • Medik8 Super C Ferulic: stable 30% ethyl ascorbic acid, lightweight texture.
    • Naturium Vitamin C Complex: multi-form Vitamin C with niacinamide, alpha arbutin, and turmeric.
    • Timeless Vitamin C Serum: affordable ($20), 20% ascorbic acid with E and ferulic acid.

    For more on all of this, enjoy:

    Click Here If The Embedded Video Doesn’t Load Automatically!

    Want to learn more?

    You might also like:

    More Than Skin-Deep: Six Ways To Eat For Healthier Skin ← this one’s about a lot more than just vitamin C 😎

    Take care!

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  • International Women’s Day (and what it can mean for you, really)

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    ‍ How to not just #EmbraceEquity, but actually grow it, this International Women’s Day!

    It’s International Women’s Day, and there’s a lot going on beyond the hashtagging! So, what’s happening, and how could you get involved in more than a “token” way in your workplace, business, or general life?

    Well, that depends on your own environment and circumstances, but for example…

    A feminist policy for productivity in the food sector?

    We tend to think that in this modern world, we all have equal standing when it comes to productivity, food, and health. And yet…

    ❝If women do 70 per cent of the work in agriculture worldwide, but the land is mainly owned by men, then we don’t have equity yet. If in Germany, only one-tenth of female farmers manage the farm on which they work on, while they also manage the household, then there is no equity yet❞

    ~ Lea Leimann, Germany

    What to do about it, though? It turns out there’s a worldwide organization dedicated to fixing this! It’s called Slow Food.

    Their mission is to make food…

    • GOOD: quality, flavorsome and healthy food
    • CLEAN: production that does not harm the environment
    • FAIR: accessible prices for consumers and fair conditions and pay for producers

    …and yes, that explicitly includes feminism-attentive food policy:

    Read all about it: Slow Food women forge change in the food system

    Do you work in the food system?

    If so, you can have an impact. Your knee-jerk reaction might be “I don’t”, but there are a LOT of steps from farm-to-table, so, are you sure?

    Story time: me, I’m a writer (you’d never have guessed, right?) and wouldn’t immediately think of myself as working “in the food system”.

    But! Not long back I (a woman) was contracted by a marketing agent (a woman) to write marketing materials for a small business (owned by a woman) selling pickles and chutneys across the Australian market, based on the recipes she learned from her mother, in India. The result?

    I made an impact in the food chain the other side of the planet from me, without leaving my desk.

    Furthermore, the way I went about my work empowered—at the very least—myself and the end client (the lady making and selling the pickles and chutneys).

    Sometimes we can’t change the world by ourselves… but we don’t have to.

    If we all just nudge things in the right direction, we’ll end up with a healthier, better-fed, more productive system for all!

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  • Can you get sunburnt or UV skin damage through car or home windows?

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    When you’re in a car, train or bus, do you choose a seat to avoid being in the sun or do you like the sunny side?

    You can definitely feel the sun’s heat through a window. But can you get sunburn or skin damage when in your car or inside with the windows closed?

    Let’s look at how much UV (ultraviolet) radiation passes through different types of glass, how tinting can help block UV, and whether we need sunscreen when driving or indoors.

    Zac Harris/Unsplash

    What’s the difference between UVA and UVB?

    Of the total UV radiation that reaches Earth, about 95% is UVA and 5% is UVB.

    UVB only reaches the upper layers of our skin but is the major cause of sunburn, cataracts and skin cancer.

    UVA penetrates deeper into our skin and causes cell damage that leads to skin cancer.

    Graphic showing UVA and UVB penetrating skin
    UVA penetrates deeper than UVB. Shutterstock/solar22

    Glass blocks UVA and UVB radiation differently

    All glass used in house, office and car windows completely blocks UVB from passing through.

    But only laminated glass can completely block UVA. UVA can pass through other glass used in car, house and office windows and cause skin damage, increasing the risk of cancer.

    Car windscreens block UVA, but the side and rear windows don’t

    A car’s front windscreen lets in lots of sunshine and light. Luckily it blocks 98% of UVA radiation because it is made of two layers of laminated glass.

    But the side and rear car windows are made of tempered glass, which doesn’t completely block UVA. A study of 29 cars found a range from 4% to almost 56% of UVA passed through the side and rear windows.

    The UVA protection was not related to the car’s age or cost, but to the type of glass, its colour and whether it has been tinted or coated in a protective film. Grey or bronze coloured glass, and window tinting, all increase UVA protection. Window tinting blocks around 95% of UVA radiation.

    In a separate study from Saudi Arabia, researchers fitted drivers with a wearable radiation monitor. They found drivers were exposed to UV index ratings up to 3.5. (In Australia, sun protection is generally recommended when the UV index is 3 or above – at this level it takes pale skin about 20 minutes to burn.)

    So if you have your windows tinted, you should not have to wear sunscreen in the car. But without tinted windows, you can accumulate skin damage.

    UV exposure while driving increases skin cancer risk

    Many people spend a lot of time in the car – for work, commuting, holiday travel and general transport. Repeated UVA radiation exposure through car side windows might go unnoticed, but it can affect our skin.

    Indeed, skin cancer is more common on the driver’s side of the body. A study in the United States (where drivers sit on the left side) found more skin cancers on the left than the right side for the face, scalp, arm and leg, including 20 times more for the arm.

    Another US study found this effect was higher in men. For melanoma in situ, an early form of melanoma, 74% of these cancers were on the on the left versus 26% on the right.

    Earlier Australian studies reported more skin damage and more skin cancer on the right side.

    Cataracts and other eye damage are also more common on the driver’s side of the body.

    What about UV exposure through home or office windows?

    We see UV damage from sunlight through our home windows in faded materials, furniture or plastics.

    Most glass used in residential windows lets a lot of UVA pass through, between 45 and 75%.

    Woman looks out of sunny window
    Residential windows can let varied amounts of UVA through. Sherman Trotz/Pexels

    Single-pane glass lets through the most UVA, while thicker, tinted or coated glass blocks more UVA.

    The best options are laminated glass, or double-glazed, tinted windows that allow less than 1% of UVA through.

    Skylights are made from laminated glass, which completely stops UVA from passing through.

    Most office and commercial window glass has better UVA protection than residential windows, allowing less than 25% of UVA transmission. These windows are usually double-glazed and tinted, with reflective properties or UV-absorbent chemicals.

    Some smart windows that reduce heat using chemical treatments to darken the glass can also block UVA.

    So when should you wear sunscreen and sunglasses?

    The biggest risk with skin damage while driving is having the windows down or your arm out the window in direct sun. Even untinted windows will reduce UVA exposure to some extent, so it’s better to have the car window up.

    For home windows, window films or tint can increase UVA protection of single pane glass. UVA blocking by glass is similar to protection by sunscreen.

    When you need to use sunscreen depends on your skin type, latitude and time of the year. In a car without tinted windows, you could burn after one hour in the middle of the day in summer, and two hours in the middle of a winter’s day.

    But in the middle of the day next to a home window that allows more UVA to pass through, it could take only 30 minutes to burn in summer and one hour in winter.

    When the UV index is above three, it is recommended you wear protective sunglasses while driving or next to a sunny window to avoid eye damage.

    Theresa Larkin, Associate Professor of Medical Sciences, University of Wollongong

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • The push for Medicare to cover weight-loss drugs: An explainer

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    The largest U.S. insurer, Medicare, does not cover weight-loss drugs, making it tougher for older people to get access to promising new medications.

    If you cover stories about drug costs in the U.S., it’s important to understand why Medicare’s Part D pharmacy program, which covers people aged 65 and older and people with certain disabilities, doesn’t cover weight-loss drugs today. It’s also important to consider what would happen if Medicare did start covering weight loss drugs. This explainer will give you a brief overview of the issues and then summarize some recent publications the benefits and costs of drugs like semaglutide and tirzepatide.

    First, what are these new and newsy weight loss drugs?

    Semaglutide is a medication used for both the treatment of type 2 diabetes and for long-term weight management in adults with obesity. It debuted in the United States in 2017 as an injectable diabetes drug called Ozempic, manufactured by Novo Nordisk. It’s part of a class of drugs that mimics the action of glucagon, a substance that the human body makes to aid digestion. 

    Glucagon-like peptide-1 (GLP-1) drugs like semaglutide help prompt the body to release insulin. But they also cause a minor delay in the pace of digestion, helping people feel sated after eating.

    That second effect turned Ozempic into a widely used weight-loss drug, even before the Food and Drug Administration (FDA) gave its okay for this use. Doctors in the United States can prescribe medicines for uses beyond those approved by the FDA. This is known as off-label use.

    In writing about her own experience in using the medicine to help her shed 40 pounds, Washington Post columnist Ruth Marcus in June noted that Novo Nordisk mentioned the potential for weight loss in its “ubiquitous cable ads (‘Oh-oh-oh, Ozempic!’)” 

    The American Society of Health-System Pharmacists has reported shortages of semaglutide due to demand, leaving some people with diabetes struggling to find supply of the medicine.

    Novo Nordisk won Food and Drug Administration (FDA) approval in 2021 to market semaglutide as an injectable weight loss drug under the name Wegovy, but with a different dosing regimen than Ozempic. Rival Eli Lilly first won FDA approval of its similar GLP-1 diabetes drug, tirzepatide, in the United States in 2022 and sells it under the brand name Mounjaro.

    In November of 2023, Eli Lilly won FDA approval to sell tirzepatide as a weight-loss drug, soon-to-be marketed under the brand name Zepbound. The company said it will set a monthly list price for a month’s supply of the drug at $1,059.87, which the company described as 20% discount to the cost of rival Novo Nordisk’s Wegovy. Wegovy has a list price of $1,349.02, according to the Novo Nordisk website. 

    Even when their insurance plans officially cover costs for weight loss drugs, consumers may face barriers in seeking that coverage for these drugs. Commercial health plans have in place prior authorization requirements to try to limit coverage of new weight-loss shots to those who qualify for these treatments. The Wegovy shot, for example, is intended for people whose weight reaches a certain benchmark for obesity or who are overweight and have a condition related to excess weight, such as diabetes, high blood pressure or high cholesterol.

    State Medicaid programs, meanwhile, have taken approaches that vary by state. For example, the most populous U.S. state, California, provides some coverage to new weight-loss injections through its Medicaid program, but many others, including Texas, the No. 2 state in terms of population,  do not, according to an online tool that Novo Nordisk created to help people check on coverage. 

    Medicare does cover semaglutide for treatment of diabetes, and the insurer reported $3 billion in 2021 spending on the drug under Medicare Part D. Congress last year gave Medicare new tools that might help it try to lower the cost of semaglutide.

    Medicare is in the midst of implementing new authority it gained through the Inflation Reduction Act (IRA) of 2022 to negotiate with companies about the cost of certain medicines.

    This legislation gave Medicare, for the first time, tools to directly negotiate with pharmaceutical companies on the cost of some medicines. Congress tailored this program to spare drug makers from negotiations for the first few years they put new medicines on the market, allowing them to recoup investment in these products.

    Why doesn’t Medicare cover weight-loss drugs?

    Congress created the Medicare Part D pharmacy program in 2003 to address a gap in coverage that had existed since the creation of Medicare in 1965. The program long covered the costs of drugs administered by doctors and those given in hospitals, but not the kinds of medicines people took on their own, like Wegovy shots.

    In 2003, there seemed to be good reasons to leave weight-loss drugs out of the benefit, write Inmaculada Hernandez of the University of California, San Diego, and coauthors in their September 2023 editorial in the Journal of General Internal Medicine, “Medicare Part D Coverage of Anti-obesity Medications: a Call for Forward-Looking Policy Reform.”

    When members of Congress worked on the Part D benefit, the drugs available on the market were known to have limited effectiveness and unpleasant side effects. And those members of Congress were aware of how a drug combination called fen-phen, once touted as a weight-loss miracle medicine, turned out in rare cases to cause fatal heart valve damage. In 1997, American Home Products, which later became Wyeth, took its fen-phen product off the market.

    But today GLP-1 drugs like semaglutide appear to offer significant benefits, with far less risk and milder side effects, write Hernandez and coauthors.

    “Other than budget impact, it is hard to find a reason to justify the historical statutory exclusion of weight loss drugs from coverage other than the stigma of the condition itself,” they write.

    What’s happening today that could lead Medicare to start covering weight loss drugs?

    Novo Nordisk and Eli Lilly both have hired lobbyists to try to persuade lawmakers to reverse this stance, according to Senate records.  Pro tip: You can use the Senate’s lobbying disclosure database to track this and other issues. Type in the name of the company of interest and then read through the forms. 

    Some members of Congress already have been trying for years to strike the Medicare Part D restriction on weight-loss drugs. Over the past decade, senators Tom Carper (D-DE) and Bill Cassidy, MD, (R-LA) have repeatedly introduced bills that would do that. They introduced the current version, the Treat and Reduce Obesity Act of 2023, in July. It has the support of 10 other Republican senators and seven Democratic ones, as of Dec. 19. The companion House measure has the support of 41 Democrats and 23 Republicans in that chamber, which has 435 seats.

    The influential nonprofit Institute for Clinical and Economic Review conducts in-depth analyses of drugs and medical treatments in the United States. ICER last year recommended passage of a law allowing Medicare Part D to cover weight-loss medications. ICER also called for broader coverage of weight-loss medications in state Medicaid programs. Insurers, including Medicare, consider ICER’s analyses in deciding whether to cover treatments.

    While offering these calls for broader coverage as part of a broad assessment of obesity management, ICER also urged companies to reduce the costs of weight-loss medicines.

    Most people with obesity can’t achieve sustained weight loss through diet and exercise alone, said David Rind, ICER’s chief medical officer in an August 2022 statement. The development of newer obesity treatments represents the achievement of a long-standing goal of medical research, but prices of these new products must be reasonable to allow broad access to them, he noted.

    After an extensive process of reviewing studies, engaging in public debate and processing feedback, ICER concluded that semaglutide for weight loss should have an annual cost of $7,500 to $9,800, based on its potential benefits.

    What does academic research say about the benefits and the potential costs of new obesity drugs?

    Here are a couple of studies to consider when covering the ongoing story of weight-loss drug costs:

    Medicare Part D Coverage of Antiobesity Medications — Challenges and Uncertainty Ahead
    Khrysta Baig, Stacie B. Dusetzina, David D. Kim and Ashley A. Leech. New England Journal of Medicine, March 2023

    In this Perspective piece, researchers at Vanderbilt University create a series of estimates about how much Medicare may have to spend annually on weight-loss drugs if the program eventually covers these drugs.

    These include a high estimate — $268 billion — based on an extreme calculation, one reflecting the potential cost if virtually all people on Medicare who have obesity used semaglutide. In an announcement of the study on the Vanderbilt website, lead author Khrysta Baig described this as a “purely hypothetical scenario,” but one that “ underscores that at current prices, these medications cannot be the only way – or even the main way – we address obesity as a society.”

    In a more conservative estimate, Bhaig and coauthors consider a case where only about 10% of those eligible for obesity treatment opted for semaglutide, which would result in $27 billion in new costs.

     (To put these numbers in context, consider that the federal government now spends about $145 billion a year on the entire Part D program.)

    It’s likely that all people enrolled in Part D would have to pay higher monthly premiums if Medicare were to cover weight-loss injections, Baig and coauthors write.

    Baig and coauthors note that the recent ICER review of weight-loss drugs focused on patients younger than the Medicare population. The balance of benefits and risks associated with weight-loss drugs may be less favorable for older people than the younger ones, making it necessary to study further how these drugs work for people aged 65 and older, they write. For example, research has shown older adults with a high blood sugar level called prediabetes are less likely to develop diabetes than younger adults with this condition.

    SELECTing Treatments for Cardiovascular Disease — Obesity in the Spotlight
    Amit Khera and Tiffany M. Powell-Wiley. New England Journal of Medicine, Dec. 14, 2023
    Semaglutide and Cardiovascular Outcomes in Patients Without Diabetes
    A Michael Lincoff, et. al. New England Journal of Medicine, Dec. 14, 2023.

    An editorial accompanies the publication of a semaglutide study that drew a lot of coverage in the media. The Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes (SELECT) study was a randomized controlled trial, conducted by Novo Nordisk, which looked at rates of cardiovascular events in people who already had known heart risk and were overweight, but not diabetic. Patients were randomly assigned to receive a once-weekly dose of semaglutide (Wegovy) or a placebo.

    In the study, the authors report that of the 8,803 patients who took Wegovy in the trial, 569 (6.5%)  had a heart attack or another cardiovascular event, compared with 701 of the 8801 patients (8.0%) in the placebo group. The mean duration of exposure to semaglutide or placebo in the study was 34.2 months.

    The study also reports a mean 9.4% reduction in body weight among patients taking Wegovy, while those on placebo had a mean loss of 0.88%.

    The findings suggest Wegovy may be a welcome new treatment option for many people who have coronary disease and are overweight, but are not diabetic, write Khera and Powell-Wiley in their editorial. 

    But the duo, both of whom focus on disease prevention in their research, also call for more focus on the prevention and root causes of obesity and on the use of proven treatment approaches other than medication.

    “Socioeconomic, environmental, and psychosocial factors contribute to incident obesity, and therefore equity-focused obesity prevention and treatment efforts must target multiple levels,” they write. “For instance, public policy targeting built environment features that limit healthy behaviors can be coupled with clinical care interventions that provide for social needs and access to treatments like semaglutide.”

    Additional information:

    The nonprofit KFF, formerly known as the Kaiser Family Foundation, has done recent reports looking at the potential for expanded coverage of semaglutide:

    Medicaid Utilization and Spending on New Drugs Used for Weight Loss, Sept. 8, 2023

    What Could New Anti-Obesity Drugs Mean for Medicare? May 18, 2023

    And KFF held an Aug. 4 webinar, New Weight Loss Drugs Raise Issues of Coverage, Cost, Access and Equity, for which the recording is posted here.

    This article first appeared on The Journalist’s Resource and is republished here under a Creative Commons license.

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