Reimbursement for two obesity medicines is a godsend for people who are significantly overweight. But some patients still fall by the wayside, sees Dr. Arianne van Bon. “I’d like to be able to provide custom work.”
Since this year, two medicines for obesity are included in the basic insurance. “It’s a big problem, half of the Dutch are overweight,” says internist Arianne van Bon. She works at Rijnstate Hospital and Vitalys, an overweight clinic. “We really need to do something about it, and for some people, this drug is a huge stepping stone to a different life and better health.”
“I haven’t lost weight”
One such person is 49-year-old Fleur van der Klei. She has been on the obesity drug Saxenda for 1 year. At first she paid for it herself, but since April of this year she has been reimbursed. “A world has opened up to me. Thanks to the medicines, I no longer think about food all the time.”
After Fleur quit smoking, her weight went from 70 to 115 pounds and never dropped. “At that time I lost 10 pounds myself on poor diets. Then I started yo-yoing. I stopped drinking alcohol and started exercising, but I just couldn’t lose weight. Eventually I ended up with the an internist and he said, “We also have Saxenda, which you can use if you’re also taking a healthy lifestyle course.”
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No more eating all day
Fleur is not suitable for obesity medicine solely because of her overweight. She also developed cardiovascular problems. “It was such a struggle, I lost 10 pounds and put 12 back on. I was very unhappy,” she says. “But now I’ve lost 20 pounds and I’m jumping out of the car again instead of crawling out like an old man.”
The drugs work like an appetite suppressant, explains Van Bon. “In the food center, the medicine creates a feeling of satiety that these people often no longer have. So they can experience peace and are no longer busy eating all day.” According to Van Bon, many people not only develop severe obesity as a result of their lifestyle, but also as a result of hormonal influences, medications or stress.
Severe rules
“I know the drug is not a panacea,” says Fleur. “I also train weekly and walk a lot. You also need to take this medicine in conjunction with a healthy lifestyle and see it more as a support for sustainable weight loss. No more yo-yoing with my weight.”
But the drug is not available to everyone who is overweight. The rules are strict. For example, you must have taken a healthy lifestyle course for a year, have a BMI that is too high, and have other physical problems. And if you are allowed to start taking the drug, it will be checked after 16 weeks whether you have lost at least 5 percent of your weight. If this is unsuccessful, the treatment will be stopped.
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‘they helped’
Van Bon often sees patients he would like to prescribe the drug for, but who simply don’t play by the rules. “For example, these are people who have a BMI that is a little too low, but who have already taken several lifestyle courses and tried many diets,” says the internist. “Sometimes it’s quite difficult for me as a doctor to tell those people: Take another course, because you’re not eligible for medicine.”
According to Van Bon, some people with a BMI over 35 would be well helped with the drug. “Those people have, shall we say, already done lifestyle coaching eighty times and they get very saddened if they have to do it again. I really think those people should take medicine quickly, they’re just helped by that.”
Offer customization
On the other hand, the doctor does not advocate too lenient use of the drug. “I don’t want to see people with a BMI of 30. Except if they have a heart rhythm disorder, which makes it difficult for them to take a class. I just want to be able to provide tailor-made solutions,” concludes Van Bon.
Van Bon now also sees a group of patients who choose to pay for their medicines themselves. For this they have to set aside between 120 and 150 euros per month.
