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Seeking help for obese federal employees

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An article published by FedSmith.com on April 5 regarding regarding obesity and federal employees noted that the U.S. Office of Personnel Management (OPM) is ramping up the health benefits program for federal employees to fight obesity.

According to a letter distributed to health insurance companies providing insurance under the Federal Employee Health Insurance Benefits Program (FEHB), the federal government, as least as far as federal employees are concerned, will not allow companies participating in the federal program to exclude weight loss drugs from FEHB coverage "on the basis that obesity is a ‘lifestyle’ condition and not a medical one or that obesity treatment is ‘cosmetic’..... In addition, there is no prohibition for carriers to extend coverage to this class of prescription drugs, provided that appropriate safeguards are implemented concurrently to ensure safe and effective use.”

Federal employee health insurance plans will not be able to exclude obesity drugs, such as the new drugs Qsymia and Belviq, from treatment according to John O’Brien, director of healthcare and insurance at OPM, on the basis that obesity is a lifestyle condition or that the drugs are for cosmetic purposes.

But these new drugs may not be a "magic pill" to cure obesity.

Those who are thinking about using Belviq may want to note that Consumer Reports advises against the drug. It states that "People who take the drug for a year can expect to lose just 3 to 3.7 percent of their weight, and may gain the weight back.... In one trial, patients taking Belviq did lose up to 5 percent of their body weight after 12 months, but gained back 25 percent of it by the end of the second year." The publication also noted numerous side effects of the drug including the fact that the Drug Enforcement Agency has classified the drug as a Schedule IV controlled substance because it poses a slight risk of dependence.

Belviq may also have other side effects. According to an FDA committee briefing, the possible increase in Valvular Heart Disease from Belviq is 67% above that seen in people receiving a placebo. The FDA has indicated a 50% increase as an acceptable limit for heart safety. Those concerned about their weight and their heart may disagree with the Food and Drug Administration's safety limits on this issue.

In reviewing Belviq, one review noted that in a test of the drug does work. In a clinical trial, "nearly half of dieters without Type 2 diabetes who used the medication lost at least 5% of their starting weight — or an average of 12 lbs. — over a year, compared with 23% of those taking a placebo." These results, when combined with the cost and potential side effects may not be worth it but, in any event, reviewers stress also participating in a "healthy diet and exercise program" in the effort to lose weight.

A specialist who focuses on psychological and nutritional therapies and who focuses on the "science of health and well-being" notes, with regard to Belviq, that seeing a specialist to prescribe and monitor the patient and paying the co-pay for the drug, can easily cost about $500 per year. "For that kind of money you could do a lot of things: hire a personal trainer and get a gym membership, see a life coach, therapist, or nutritionist, and take some cooking classes (or tennis lessons, martial arts lessons, etc) for an entire year and lose far more weight in a far safer, habit forming way that can last a lifetime."

Early estimates from the Food and Drug Administration put the retail cost of Belviq at $2.00 - $3.50 a pill. The dosage is two pills a day. Monthly estimates from other sources put the cost of Belviq at $150/month or $1800/year.

Obviously, no one would want to our would be able to purchase or use this drug without discussing it with medical professionals.

Qsymia is not inexpensive either and it can also have side effects. Here are some of the side effects that could reportedly be experienced by a person using this drug.

Here is the average retail cost for this drug according to a pharmacy website. Prices may differ among different pharmacies but this will provide an indication of the approximate cost. The per pill retail cost for a recommended dose of this drug is about $5.33.

  • Qsymia Low dose (3.75 mg phentermine/23 mg topiramate) — $139.99 per bottle
  • Qsymia Recommended dose (7.5 mg/46 mg) — $159.99 per bottle
  • Qsymia Three-quarter dose (11.25 mg/69 mg) — $194.99 per bottle
  • Qsymia Top dose (15 mg/92 mg) – $219.99 per bottle

It is not hard to understand why these drugs would have a popular appeal for people with a severe weight problem.

Obesity isn’t a situation in which a person needs to lose an extra five or 10 pounds. Obesity is weight at least 20% above a person's ideal weight taking into account height, gender, and age. Twenty to forty percent over ideal weight is considered mildly obese; 40-100% over ideal weight is considered moderately obese; and 100% over ideal weight is considered severely, or morbidly, obese.

More than two-thirds of U.S. adults are overweight or obese. According to the Food Research and Action Center, there are significant differences among groups of Americans in the percentage of people who are obese.

82.0 percent of black females and 77.2 percent of Hispanic females are overweight or obese compared to 63.2 percent of white females. Extreme obesity is higher among women (8.3 percent) than men (4.4 percent) and especially among black women (16.4 percent) who have more than double the rates of extreme obesity as white women (7.4 percent) and Hispanic females (7.6 percent). Rates of being overweight or obese are higher for Hispanic men (78.6 percent) compared to black men (69.2 percent) and white men (71.4 percent).

A weight loss drug is unlikely to be the complete cure for a person's weight problems. While the Office of Personnel Management has determined that these drugs cannot be excluded based on lifestyle or cosmetic issues, that does not mean that a person's overall lifestyle and diet does not play a big role in losing weight and in keeping the weight off after taking the drug. It is likely that a medical professional will not only monitor use of the drug but also prescribe lifestyle changes that would vary depending on the individual.

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