Patients Forever Hate Drugs. Is Wegovy different?

Most people, study after study shows, do not take their prescribed medications. It doesn’t matter if it’s statins, high blood pressure drugs, blood sugar lowering drugs, asthma drugs. Either patients don’t start taking them, or they stop.

It’s a problem that doctors call a general human tendency to resist treatment and it leads to many deaths and billions of dollars in preventable medical costs each year.

But that resistance may be overcome by the obesity drugs Wegovy and Zepbound, which have surprised the world by helping people lose weight and keep it off. Although it is still early days, and there is a lack of data on compliance with new drugs, doctors say they noticed another surprising result: Patients seem to take them faithfully, week after week.

Some patients may have to go through initial hesitation to get started. A national study revealed that when people were told that they would gain weight again if they stopped using the medication, most of them lost motivation to start it.

In one small study, patients stopped refilling prescriptions for months at a time, perhaps because of side effects, lack of availability, or insurance and cost issues.

But statistically, doctors and patients say, those who start taking drugs continue.

I’m not ready to stop taking this drug, said Kimberly DelRosso of Pembroke, Mass., who takes Wegovy.

He never forgets to take his weekly injection. In contrast, he says he often did not take the blood pressure pills he was prescribed when he was overweight. (Now, after losing weight with Wegovy, he doesn’t need any more.)

So far, doctors report that like Ms. DelRosso, most of their patients intend to take obesity medications permanently, and many are happy when they stop needing other drugs.

Dr. David Cummings, a professor of medicine at the University of Washington and director of the weight management program at the VA Puget Sound Health Care System, records his patients’ experiences with Wegovy and the diabetes drug Ozempic. So far he has prescribed about 1,000 drugs for patients. He said 5% stopped because of negative results. Others stopped because their insurance no longer covered their medications or because they could not find a pharmacy that had them in stock, indicating ongoing drug shortages.

But those who quit often don’t do so voluntarily, he said. Some doctors who prescribe Wegovy agree.

Compliance with the law is unique, said Dr. Diana Thiara, medical director of the weight management program at the University of California, San Francisco. People take it. They ask for refills. They took it on a trip.

The Epidemic of Non-Compliance

There is a price to pay for neglecting to take prescription medications. A staggering 40 to 50 percent of people prescribed medications for chronic diseases like high blood pressure or diabetes fail to take them and incur at least $100 billion in preventable medical costs each year as a result. This lack of compliance is estimated to result in at least 100,000 preventable deaths each year.

Even a heart attack may not be enough to scare people away from taking the current arsenal of heart drugs, which are shown to prevent heart disease deaths. One study shows that only half of people who had a heart attack were still taking drugs to protect their heart two years later.

These patients have seen flashing lights, ridden in an ambulance, received rescue PCI, given their families a second heart attack, watched the Pearly Gates, but still haven’t taken statins and beta blockers, says Amitabh Chandra, professor of policy social and beta blockers. business administration at Harvard.

Even doctors stop taking their medication, contradicting the belief that people do so because they don’t really understand the importance of it.

And while cost plays a role, at least one study found that even when drugs are free, sticking to a prescription can be a bad thing.

One of the reasons seems to be a kind of ingrained reluctance to take something that reminds people every day that they are sick, even though many patients may recognize it. Especially with what experts call chronic drugs, taking them every day makes some patients feel out of sorts.

People think they’re doing well, so they don’t need the medication, says Corrine Voils, a social psychologist at the University of Wisconsin who studies medication compliance. But medicine is what keeps them healthy.

Jalpa A. Doshi, a professor of medicine at the University of Pennsylvanias Perelman School of Medicine, said patients make their own value judgments: Medicines have side effects, require co-payments, and the act of taking a pill every day reminds me of that. I’m sick. But I have no symptoms. I don’t see my high blood pressure or high cholesterol.

And what are the benefits? he added. I don’t really see the benefits. I would eat less salt and fatty foods and walk more or exercise instead of taking these medications.

These tests that patients do in their heads make it very easy to quit, says Dr. Doshi.

That explains Mark Anthony Walker, 61, of Dublin, Calif., whose experience with heart disease is overshadowed by a troubling family history: his father died of a fatal heart attack at the age of 47, his mother at the age of 48.

At the age of 26, Mr. Walker had a cholesterol level of 360.

I panicked, he said.

He has been on statins ever since and is now taking one. But he doesn’t plan to take it forever. He came to the conclusion that his brain needed cholesterol. As for taking medicine for the rest of his life, I am totally against it, he said.

Instead, he believes he can control his heart disease until it reverses with a healthy diet, exercise and vitamins.

Mr. Walkers cardiologist, Dr. David J. Maron, director of preventive cardiology at Stanford, gently encourages him and others like him to take their medication. But, as doctors know, if they come in guns blazing, their patients will simply go elsewhere.

Less Discrimination, Less Shame

So what might make obesity drugs different? For one thing, while doctors are usually the ones who recommend drugs like statins or blood pressure drugs, patients often ask doctors for obesity drugs. Many have spent their entire lives trying any diet and exercise plan they can find, and every time they lose weight, they gain it back.

Also, people who start taking new obesity medications can’t hide easily when they stop taking them: The weight they lost may come back, along with the stigma and shame and self-criticism that often accompanies obesity. That makes this medicine very different from many others.

You don’t get a big sign on your chest that says, Stop blood pressure medication, says Dr. Walid Gellad, a professor of medicine at the University of Pittsburgh who studies medication adherence.

However, on the minus side, obesity drugs are expensive and often require doctors to fill out pre-authorization forms that are burdensome for insurers. Drugs have been in short supply throughout the country. Those obstacles can make it difficult to find them.

Some of the disadvantages of the medication include side effects such as nausea and stomach problems, and the way it is treated is that patients must inject themselves with medication once a week.

In a Cleveland Clinic study, Hamlet Gasoyan and colleagues examined the electronic health records of 402 patients in Ohio and Florida who were taking Wegovy or Ozempic for obesity. They found that only 161, or 40 percent, kept refilling their prescriptions during the year. Side effects, availability, or insurance and cost issues may play a role.

But there is a reason that patients are willing to call dozens of pharmacies for medication and inject themselves faithfully every week: Without gaining weight, they feel like they look better and are looked at differently. They are no longer ignored or ashamed. People no longer stare at their grocery cart or comment when eating a bowl of ice cream. The shame and self-criticism and chronic stigma of obesity are gone.

That’s a big plus for Ms. DelRosso.

Fat people are treated differently, he said: It’s just surprising that people put you down because you are heavy.

But you also enjoy the health benefits. He no longer has apnea or high blood pressure, and his blood sugar, which was in the diabetic range, has dropped.

I don’t need to take any medicine anymore, she said.

Except, of course, Wegovy.