Exploring Access to Weight Loss Medications for Medicaid Patients
Della McCullough has struggled with her weight for most of her life. Like many others, she has tried various methods to lose weight, including supplements and diets, but none have been successful. Now at 53 years old, McCullough is interested in exploring new medications that can assist with weight loss and obesity management.
However, as she and her husband found themselves on Medicaid last year, they discovered that Colorado’s Medicaid plan does not cover Wegovy – an obesity medicine made by Novo Nordisk – which McCullough was eager to try. Wegovy is specifically approved for obesity and weight loss but falls under a decades-old law that excludes medicines treating anorexia, weight gain, and weight loss from required coverage.
“I’m not ashamed of the fact that I am on state assistance,” says McCullough. “What assistance they provide is not adequate, especially if you do have obesity.”
The Complexities of Medicaid Coverage
The exclusion of weight-related drugs from required coverage stems from a time when diet and exercise were considered the primary solutions for losing and maintaining weight. However, recent evidence challenges this belief. Robin Feldman from the University of California Law explains:
“So in that context, being overweight was viewed as lacking willpower and dedication.”
A study conducted at Brown University revealed that individuals on Medicaid are more likely to have obesity compared to those with commercial insurance.
The Value of Weight Loss Medication in Medicaid Programs
While the cost is a limiting factor in covering weight loss drugs like Wegovy, 16 state Medicaid programs currently provide coverage. The price of Wegovy exceeds $1,300 per month, but Medicaid programs typically negotiate significant discounts.
Kate McEvoy, executive director of the National Association of Medicaid Directors, emphasizes the need for states to examine investments in preventive health issues. She states:
“States are always having to grapple with this investment or that investment,” says McEvoy.
Improving Access and Coverage
Despite some limitations, progress is being made. Some state Medicaid programs cover Wegovy based on their respective laws, while others provide coverage for older weight loss drugs considered less effective. North Carolina’s Secretary of Health and Human Services aims to include Wegovy under their Medicaid program by this summer.
“We go through a standard policy process,” explains Kody Kinsley from North Carolina’s Health and Human Services. “We examine the actuarial impacts and negotiation rebates to evaluate the value-added by these drugs.”
In Colorado, where McCullough resides, her state’s current policy does not cover Wegovy for weight loss purposes. However,recent FDA approval has expanded usage.
“In Colorado, Wegovy is currently covered […] when used to reduce the risk of major cardiovascular events,” says Marc Williams from Colorado Department of Health Care Policy and Financing.
Despite these advancements, McCullough believes that there is still a need for policy changes to treat obesity as a complex chronic disease:
“Research shows us that obesity is driven by powerful biology, not by choice,” states Tracy Zvenyach from the Obesity Action Coalition.
A Call for Equal Treatment
McCullough feels that individuals with obesity are often treated differently and judged based on assumptions about their willpower. She shares her personal experiences:
“‘She’s just fat,’ you know? ‘It’s her problem. She’ll figure something out.’”
In conclusion, while progress has been made in expanding coverage for weight loss medications in Medicaid programs, there is still work to be done to ensure equal access and treatment options for individuals with obesity.
Medicaid’s Coverage Gap: Why Some Obesity Medications Are Not Available for Those in Need
Preventing Frailty and Sarcopenia: The Importance of Protein Intake and Exercise in Aging Adults
To manage frailty-sarcopenia, muscle mass decreases by 30% around age 70… Loss of energy and disability in daily life can be maintained normally if prevented in the pre-senescence phase… Eat protein like meat and eggs every day and do good aerobic, strength and flexibility exercises.
As you get older, it is essential to consume protein, which is the main ingredient for building muscles. The recommended daily protein intake is between 1.0 and 1.2 g per kg of body weight. In situations such as poor nutrition or acute chronic illness, the intake should be increased to 1.2-1.5 g. Provided by Seoul National University Bundang Hospital
If you continue to feel lethargic, lose your appetite, and lose weight as you age even though you have no particular illnesses, you need to look into frailty and sarcopenia. Senescence refers to a condition in which the function of the body’s organs declines due to aging, resulting in loss of weight and body strength, making it difficult to carry out daily activities such as walking, going out and preparing meals on your own. One of the main causes of frailty is sarcopenia.
Sarcopenia is a disease that causes loss of muscle mass and a decrease in muscle strength and function. In people in their 70s, muscle mass decreases by almost 30% compared to people in their 30s and 40s due to muscle aging, decreased amount of exercise, decreased protein intake, decreased muscle synthesis and changes in protein metabolism. Because fat fills the space where you lose muscle mass and maintain body weight, you may not be aware that you are losing muscle mass.
Choi Jeong-yeon, professor of geriatric medicine at Seoul National University Bundang Hospital (pictured), said: “As we get older, we think that our energy naturally decreases and we tend to ignore it,” adding: “If the frailty is not If managed correctly, it can lead to serious disabilities and make us vulnerable to other diseases, shortening our lifespan.” “You can do it,” he said. ● Prevent frailty and sarcopenia through protein intake
After frailty and sarcopenia have progressed to some extent, it is difficult to return to normal. Unfortunately, a drug that slows or reverses aging and sarcopenia has not yet been developed. For this reason it is important to recognize the signs of aging early, take appropriate measures and prevent them. When the signs of aging appear, if you manage them well with diet and exercise, there is a high chance that your health will return to normal.
Elderly people often think that it is okay to only eat kimchi with rice and soup, but protein, the main ingredient that builds muscles, should not be excluded from the diet. You need to consume more meat than the appropriate amount.
The recommended daily protein intake is between 1.0 and 1.2 g per kg of body weight. In case of malnutrition or acute chronic disease, the intake should be increased to 1.2-1.5 g. Typically, the protein content per 100g is 20-25g for beef, pork and chicken, around 10g for egg whites and tofu and 3g for milk. A 60kg adult should consume 60-72g of protein per day. To meet this requirement, you need to consume 200g of beef (50g of protein), 1 egg (5g of protein), tofu (5g of protein) and 200ml of milk. (6 g of protein) every day.
In particular, consuming proteins high in leucine, an essential amino acid, is effective in building muscle. You also need to consume more than the minimum amount of protein at each meal. Professor Choi said: “If it is difficult to eat meat and tofu, you can consume them in powder form” and added: “The best way to consume protein is through food.”
● “Sarcopenia should be seen as a disease, not as aging”
It is very important to eat well, sleep well and exercise adequately for a healthy old age. Exercise should include aerobic exercises to increase cardiorespiratory endurance, resistance exercises to improve muscle strength, flexibility exercises to expand the range of motion of the joints, and balance exercises to maintain the body’s center of gravity.
Aerobic exercises include cycling, swimming and walking, while strength exercises include dumbbell exercises. Additionally, flexibility exercises that increase the range of motion of the joints by relaxing the body to the point where resistance or slight discomfort is felt are important, as are balance exercises such as walking in a straight line or standing on one foot holding a hand chair.
In the past, it was thought that the phenomenon of muscle loss as we age was a natural aging process. However, recently, there are voices arguing that sarcopenia should be viewed as a “disease”. In the medical field, aging is also a phenomenon of decline in physical function, distinct from healthy aging, and efforts are needed to prevent and delay it. Professor Choi said: “You can live a healthy old age by consuming enough protein, maintaining a balanced diet and improving muscle quality through appropriate physical activities such as strength training.”
Jinhan Lee, medical journalist and doctor [email protected]
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Preventing Frailty and Sarcopenia: The Importance of Protein Intake and Exercise in Aging Adults
Feminist Collective and Socialist Youth Denounce Professor for Harassment at University of Girona
The feminist collective Les Metzines and the Socialist Youth Organization have publicly denounced a case of harassment to a student by a professor at the Faculty of Medicine, University of Girona (UdG). The events allegedly took place last June, and the victim reported the incident to the Mossos d’Esquadra. The attack occurred within a “university context” in a UdG building, and the victim immediately reported it to the building’s management, who then advised her to report it to the police.
Feeling “raped” by the situation, the victim reached out to the entities, who called on the university to take action. The UdG decided to separate the teacher from the activity involving the student but failed to provide any further support. Both the student and the entities criticized the lack of accompaniment in this case, with the victim feeling unprotected.
Despite resorting to university-established mechanisms for such cases, the student was told that filing a police report meant the university couldn’t intervene. The professor in question continued to teach normally during this time.
In response to the incident, both groups have organized an open meeting this Friday at 11 a.m. on the stands of the Campus Centre. They argue that while feminism has been institutionalized, universities and other institutions still allow such attacks to occur.
This isn’t the first case affecting UdG. Earlier this year, the university’s Feminist Platform exposed two cases of sexual harassment by a professor of the master’s degree in Teaching Spanish and Català with Segones Llengües, particularly through WhatsApp messages. The professor admitted to making sexual advances but denied harassment. Additionally, a medical professor was publicly accused of making obscene comments to students in 2022.
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Feminist Collective and Socialist Youth Denounce Professor for Harassment at University of Girona