The mainstreaming of "Nuoli" weight loss miracle drugs faces new challenges such as applicability and medical insurance.

At this time last year, people were still debating whether Novo Nordisk A/S Sponsored ADR Class B (NVO.US) Wegovy and Eli Lilly's (LLY.US) Zepbound were a shortcut to weight loss or a medical breakthrough. However, with large amounts of data showing that these drugs have health benefits beyond just reducing obesity - including reducing heart disease, diabetes, chronic kidney disease, and sleep apnea - most people seem to have finally accepted their potential significant societal value. Now, the most difficult phase has arrived. These highly effective drugs - GLP-1 - are changing the way people view and treat obesity. These changes are happening so quickly that they may benefit many people, causing new challenges and ethical dilemmas for healthcare professionals, including who should receive drug therapy. In theory, the market for Wegovy and Zepbound is huge: approved by the Food and Drug Administration (FDA), people with a BMI of 30 or higher can take them, while those with a BMI of 27 or higher need to have weight-related diseases such as hypertension or sleep apnea. Approximately 57 million Americans with private insurance of working age meet these criteria, as well as nearly 14 million Americans of retirement age. For patients using these drugs, it is expected that once started, these drugs will need to be taken lifelong to maintain effectiveness. But the question is, does everyone who fits this broad description need the drugs? Doctors have varying opinions. Some strongly believe that everyone should receive treatment, while others differentiate between those at risk of weight-related health complications and those who are completely healthy with a BMI that meets the criteria for medication. Furthermore, within these two camps, drug shortages and high prices are also forcing doctors to come up with methods to prioritize which patients should receive treatment. These issues seem to indicate that the field needs an evidence-based approach to help better determine the appropriate population for GLP-1. For this reason, an international committee of obesity experts will release a midterm report in early 2025, listing criteria for diagnosing "clinical" obesity and the risks that overweight poses to other health problems. Robert Kushner, head of the committee and obesity expert at Northwestern University Feinberg School of Medicine, says ideally this will help doctors more easily differentiate "who are true obesity patients that we should treat early" and those who are overweight but still very healthy despite increasing their weight by 10 or 20 pounds and surpassing the BMI threshold. This will certainly raise other issues. In a situation of high demand and tight supply, no one wants the drug conditions to be too strict. However, this approach could be a big step towards a stricter evaluation of the connection between weight and health, making it easier and fairer for those who need the drugs most to obtain them, and providing guidance for insurance companies to expand their coverage. This may also help resolve tension between doctors and insurance companies. Typically, once the BMI drops below a certain level, patients lose insurance for GLP-1. But the reality is that without continued treatment, weight will return, increasing the risk of diseases such as diabetes and hypertension. Proposing a method to define obesity centered on disease risk may clarify the necessity of long-term treatment. The standard will also help doctors answer another important question: when is a person's weight loss complete? Not long ago, doctors treating obesity spent most of their time urging their patients to keep going - saying that if they could stick to lifestyle changes, their health would improve. However, there is concern that these drugs not only lead to a decrease in fat and muscle, but also affect nutrient intake. All of this must be considered in the patient's weight loss process. There is still a lack of consensus among doctors on how to properly use medications to control their patients' obesity problems. And, unlike other weight loss drugs, patients often have strong opinions on treatment goals, which may not align with the data (or their doctors') on the best course of action. Therefore, data will eventually become the best guide. But until then, doctors will continue to navigate in this new era.