The proliferation of weight-loss injections is bringing hope but lifestyle medicine provides real sustainable health effects, hears Owain Thomas.
Weight-loss injections are high profile around the world and have the potential to significantly help people with critical health conditions and ease demands on healthcare.
However, concerns were raised by attendees at Health & Protection’s Middle East Forum that some doctors were prescribing these GLP-1 receptor agonist medications where not medically necessary.
This was causing conflicts with clients where advisers and insurers were holding firm and declining the treatments while patients were also paying for it themselves.
Instead, it was highlighted that by changing lifestyles people could improve their health significantly without medication and this is doubly important when using the injections.
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The issue was raised by Burns & Wilcox senior account manager and corporate wellness leader Veena Kuma who warned prescribing was not being done by the book.
She described the journey of one client whose glycosylation was not high enough to meet the requirements for GLP-1 receptor agonists but who was eventually prescribed it.
After the first doctor prescribed a common diabetes control medication Metformin, the patient went to a second doctor and then a third doctor to get what they wanted.
“The patient went to doctor three and that doctor prescribed Mounjaro. Now the question is, why? Where is the evidence-based practice?” Kuma asked.
Malakut Insurance Brokers head of employee benefits Michael Plaugmann had a similar experience, but in this circumstance the prominent IPMI insurer refused to pay for the treatment.
“We’ve had big arguments with a client who insisted on having it, who was bullying his doctor,” he said.
“The doctor didn’t want to talk to anybody and just hid because the patient didn’t qualify but wanted Mounjaro.
“We ended up losing the client because of this one guy who happened to be a very senior leader for the company.
“So it depends on the insurer; in this instance they stood their ground and said ‘absolutely not, you don’t qualify’.”
Attendees also noted that some people saw these medications as a lifestyle or cosmetic treatment while doctors were being put under pressure with revenue targets to continue working at hospitals and clinics.
And they added there had been many cases of private doctors or hospitals approving patients for Manjaro and Ozempic outside the medical criteria.
Health risk burden
It is not surprising these new medications are in demand as the Middle East region has some of the highest risk factors in the world for serious health conditions.
Howden Insurance Brokers lifestyle medicine and wellbeing lead MEA Dr Arti Rampaul (pictured) explained the burden of disease in the UAE and larger Mena region.
For example, in 2021 around 10% of people globally had diabetes while in the Middle East and North Africa it was significantly higher at around 17%.
For obesity the figures are even more stark.
Globally around 14% of men and 18% of women were assessed as being obese in 2024, but in the Middle East figures are at least double that reaching 41% of men and 52% of women in Qatar. The same trend is being found in children as well.
Dr Rampaul noted that using lifestyle medicine approaches had successfully reduced diabetes occurrence rates over the long-term and was twice as successful as Metformin in doing so.
“I’m not anti-medication at all and lifestyle medicine is not anti-medication, it’s very much in support of it when needed, but not excluding the root cause,” she said.
“If a patient comes in with type two diabetes and you prescribe the first line medication Metformin, a year or two later they’re going to need another medication and another and another.
“That’s their trajectory.
“A decade or two later, they’ve now developed end stage renal failure, cataracts, and so on and all the complications that we see with diabetes.“
Dr Rampaul added that this should only be a small number of cases that were poorly managed.
“Now, when you implement lifestyle medicine, you’re actually changing that trajectory for the patient,“ she continued.
“Yes, you’re using medication to start with but you don’t want to continue that path for the patient.”
And Dr Rampaul emphasised that undertaking lifestyle changes with the GLP-1 injection medications was just as important.
“What we’ve seen sometimes is that patients have lost more muscle mass than fat mass and then when they regain weight because the weight regain is actually more fat because they’ve lost that muscle mass, and they regain more visceral fat as well, which is a lot more inflammatory and then puts you at even higher risk.
“You can’t do it without the lifestyle as well.”
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