The Dutch Healthcare Institute is considering including two in the basic health insurance package. This concerns the Wegovy and Mounjaro funds, three other funds have already been reimbursed. Good news for everyone who is overweight? It is certainly good news, says internist-endocrinologist Liesbeth van Rossum. She is a professor in the field of obesity and stress research at Erasmus MC in Rotterdam.
The medicines are reimbursed for two patient groups: obese people (BMI from 30) who have a disease related to their weight (heart failure, apnea, knee osteoarthritis). And people who are severely or very severely obese (BMI from 35).
So not everyone who is overweight is reimbursed for obesity medication?
Liesbeth van Rossum: “The European medicines agency EMA already advises Mounjaro and Wegovy with a BMI of 27. In the Netherlands we are a bit stricter, and I understand that very well. Yes, science believes that obesity medication is effective, but it must also be affordable.” On average, obesity medication costs around 250 euros per month per patient, reimbursement for the 4.1 million Dutch people with a BMI of 30 or more, according to the Healthcare Institute, costs 10 billion euros per year.
It is difficult that the NHG recommends three medications, one of which, Wegovy, is not reimbursed
Only the severe cases receive medication?
“Before medication is even an option, someone must follow a combined lifestyle intervention for a year. If this has insufficient effect, then medication is an option. A BMI of 27 or 30 is not yet an insufficient indication. This causes related diseases such as sleep apnea syndrome, knee osteoarthritis, prediabetes, heart failure, fatty liver disease. Conditions that we now treat separately: we perform angioplasty, perform knee operations, prescribe other medications. We reduce or prevent these diseases by To combat obesity, medication is medically effective and cost-saving.”
Patients complain that GPs do not want to prescribe obesity medication.
“The brand new NHG guideline from Dutch general practitioners includes medication. I provide further training almost every day to general practitioners who sometimes do not know how to best tackle obesity. Their patients hear about medication through social media, they ask about it, and some start taking it on their own with illegally obtained substances. What makes it difficult is that the NHG recommends three obesity medications, one of which, Wegovy, is not reimbursed.
In 2024, the Healthcare Institute still gave negative advice about Wegovy. First the long-term effect had to be investigated.
“That is exactly what is still being carefully investigated. What is in favor of Wegovy is that the two currently authorized medications liraglutide [merknaam Saxenda] and naltrexone-bupropion [merknaam Mysimba] must be swallowed or injected daily. Wegovy and Mounjaro, by the way, only need to be injected once a week.”
The real problem is probably that people order the medication online and use it without proper guidance
More than 15 percent of Dutch adults suffer from obesity. Will medication eliminate obesity?
“With lifestyle intervention you lose an average of between 3.5 to 5 percent. Someone with a BMI 38 then has a BMI of 36 and is therefore still seriously obese. But physically and mentally someone is much healthier. With obesity medication, people can lose about 5 to more than 15 percent extra weight.
The National Poisons Information Center (NVIC) reported that the number of poisonings from obesity medications had doubled this year
“It concerns 105 individual cases in 2025, compared to 50 in 2024. In itself not surprising when you see that the number of users has risen from 80,000 to 170,000. And if you include the people who take a low dose of semaglutide [Ozempic] If you use it for diabetes, you will have 270,000 users. And furthermore, the term poisoning is misleading. People report vomiting and stomach and intestinal problems. These are indeed side effects that occur with obesity medication if the dosage is too fast, too high. But what also turned out is that many people order and use the medication online themselves without proper guidance.”
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