2024-09-29 23:04:21
Losing weight when you are obese is not a simple question of will or changing lifestyle habits, recalls an expert from CHU Sainte-Justine, who pleads for easier access to molecules like semaglutide , which could give these patients the little extra boost they need.
“The Hollywood use of semaglutide has really restricted its use,” lamented Dr. Mélanie Henderson, pediatric endocrinologist at CHU Sainte-Justine.
“What we want is to treat children whose lifestyle changes remain inadequate to improve their trajectories in terms of […] metabolic health. It’s not for the 18 year old who wants to get into her ball gown, it’s not for the superstars who want to look good on the red carpet. »
The body’s homeostatic mechanisms, she explained, will always defend the higher weight. Very briefly, believing itself to be in danger, the body defends itself with measures that go against weight loss, such as increasing the hunger it feels.
So some patients need a little extra “push,” explained Dr. Henderson.
“There are young people, like adults, who, despite their efforts to improve their lifestyle habits and really promote a healthy weight, simply cannot do it,” said Dr. Henderson.
Semaglutide has been used for several years in the treatment of type 2 diabetes. However, it has been noted in recent years that the molecule can help lose weight considerably by increasing the feeling of satiety, which explains all the current frenzy that surrounds it.
Here is finally the Holy Grail, a way to lose weight without making the slightest effort! Absolutely not, says Dr. Henderson.
There are young people, like adults, who, despite their efforts to improve their lifestyle habits and truly promote a healthy weight, simply cannot do so.
“It is not a miracle molecule, because [perdre du poids] This cannot be done without changing our lifestyle habits, we really always have to work, she added. It remains a constant struggle to improve our lifestyle habits, but the fact remains that it can really change a lot of things in the life of a young person or an adult. »
She and her colleagues are therefore absolutely not in favor of absolute liberalization of access to semaglutide for all those who request it, for example to lose a few kilos before a trip to Mexico.
However, it would be possible to guide the use of semaglutide based on serious medical criteria, she believes, as is done with growth hormone, another very expensive molecule.
“We have very specific instructions on how to prescribe growth hormone,” emphasized Dr. Henderson. This is how we could ensure that there is no abuse, because that’s not what we want. The vast majority of doctors would have no interest in using this inappropriately. »
INESSS report
The National Institute of Excellence in Health and Social Services (INESSS) recently examined, at the request of the Ministry of Health and Social Services of Quebec, the modalities which could govern a possible reimbursement of semaglutide by the public drug insurance plan.
“This document and the proposals it sets out were written in response to a request from the Ministry of Health and Social Services to support its reflections regarding the implementation of a pilot project on the integration of pharmacotherapy in the treatment of obesity”, we can read in the report published by INESSS.
Lasting two years, the project envisaged by the MSSS and which INESSS looked into would allow a thousand people living with obesity to benefit from interdisciplinary care including pharmacotherapy, adds- your. Ultimately, “the project could allow the MSSS to take a position on whether or not to maintain this service offering and to define its form if necessary,” indicates the document.
INESSS was particularly interested in anti-obesity medications to consider; eligibility criteria; the duration of the pilot project; and the monitoring indicators that would be relevant to collect in order to assess the feasibility, costs, benefits and issues related to the targeted use of pharmacotherapy to treat obesity.
But this pilot project, if it ever goes ahead, will only concern the adult population.
“Regarding the pediatric population, adolescents aged 12 and over have been the subject of few clinical studies and very few jurisdictions have approved the use of pharmacology in this age group,” indicates the report of the INESSS. Furthermore, no pharmaco-economic study has been identified to evaluate the effectiveness of medications against obesity in children and adolescents. »
Several members of the committee finally raised concerns about the proposed duration of two years for the pilot project. They fear, for example, that the automatic cessation of pharmacological treatment at the end of the planned two years of the project could lead to harmful consequences on the health of participants (weight gain, damage to quality of life), particularly for those awaiting treatment. ‘a transplant.
They estimate that “this duration of follow-up could […] not allow the clinical benefits to be fully appreciated in the medium or longer term. We could then consider a period of up to five years to complete the evaluation of the clinical benefits of pharmacotherapy.
A question of costs
Semaglutide treatment can cost up to $400 or $500 per month and is therefore not affordable for everyone. Various bureaucratic obstacles, but probably also budgetary ones, mean that the molecule is currently not reimbursed by the public drug insurance plan in Quebec, although it is in Ontario.
This situation can therefore lead to variable access to this medication, in particular favoring people who can afford the costs, who are covered by private insurance or who have type 2 diabetes.
“Not many people have $400 a month in their budget,” said Dr. Henderson. And when we know that obesity more significantly affects people who are less financially well off, we have just increased health inequities. »
The government’s reluctance to reimburse semaglutide could therefore be explained, at least in part, by a fear of seeing costs explode if we start prescribing it “like water” to everyone, believes the specialist. “We must have criteria that are medically defined and not defined by the cost to society,” she said.
We must also ask ourselves the following question, believes Dr. Henderson: how much will a child taken into care at the age of 8 for an obesity problem that will follow him throughout his life cost the health system and society?
“Type 2 diabetes, which occurs in children, is a much more aggressive disease than what we see in adults,” she recalled. So, if we succeed in preventing these diseases early in life, we gain not only by preventing this disease, but all the complications, for example, associated with type 2 diabetes.
“We need to look further than just the immediate in relation to this. The risk-benefit does not extend over a period of three months, it extends over a long course in children. It is on the life cycle that we can consider the benefits. »
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