An effective approach to obesity does not involve medication alone. It must go hand in hand with prevention, a healthier lifestyle. That should sound as often as the call for medicine, says Mark Janssen.
Mark Janssen is chairman of the Dutch Healthcare Institute.
The first price reductions for obesity medicines have become a reality this month. It is incorrect and also too simplistic to assume that this will lead to faster admission of obesity medicines into the basic package.
You would almost forget, given all the attention for new drugs, but two obesity medications are already reimbursed through basic insurance in the Netherlands: Saxenda and Mysimba. Since 2022, almost 2.3 million Dutch people have been eligible for this.
The Dutch Healthcare Institute is currently assessing the drug Mounjaro and we expect to reassess Wegovy soon. The latter drug received a negative recommendation from us in 2024.
Too little was known about long-term effects and therefore about the ultimate health benefits, while the annual costs to society were estimated at over 1 billion, with an estimated 4.1 million people eligible.
Approach that puts people first
We are now two years further. Time that healthcare professionals, patient associations and the Healthcare Institute have used to devise an approach that puts people with the greatest burden of disease due to their obesity first. And at the same time keeps the pressure on healthcare professionals and the healthcare budget manageable.
The new obesity drugs are now being assessed for reimbursement for people with a BMI from 35 or from 30 with certain conditions associated with their obesity or overweight.
Obesity is not only a problem for those who suffer from it, but for society as a whole
The pressure on healthcare will still be great, because it concerns 1 million people. In addition to prescribing, general practitioners must provide medical guidance to these patients. Yet we think this is the best route to take. The group of people who are eligible for obesity medication may expand at a later stage. Whether compensation will come and how quickly that will happen should depend not only on new research and not only on price reductions.
Unhealthy lifestyle
In our society, obesity is seen too much as the problem of the person who struggles with it. But it is society’s problem. We have known for years that obesity is largely caused by our unhealthy living environment and lifestyle.
So an effective approach cannot be limited to medicines alone. Moreover, these are never reimbursed for those who want to lose some kilos quickly, which is what a frequently used word such as ‘slimming medication’ suggests.
Without tackling the unhealthy living environment, combating obesity remains a matter of sweeping the table. Obesity and conditions associated with it will then eat up an increasing share of healthcare dollars.
The puzzle is complicated, but not impossible. First we have to stop procrastinating. The United Kingdom has had a ban on advertising unhealthy products to children since January. The first fines have been imposed.
The Jetten cabinet is also focusing on the youth with ‘the healthiest generation ever’ and wants to introduce a sugar tax from 2030. Medicalization seems to be the easiest way. But it’s both-and. The call for better prevention through a healthier living environment should be heard as often as the current call for faster access to obesity medication.
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