Most people, according to study after study, do not take their prescribed medications. It doesn’t matter what it is – statins, high blood pressure medication, blood sugar lowering medication, asthma medication. Either patients never start taking them, or they stop.
It’s a problem doctors call nonadherence—the common human tendency to resist medical treatment—and it leads to countless deaths and billions of dollars in preventable medical costs each year.
But that resistance can be overcome by blockbuster obesity drugs Wegovy and Zepbound, which have amazed 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 the new drugs, Doctors say they notice another surprising result: patients seem to take them faithfully, week after week.
Some patients may need to overcome initial reluctance to start. A national survey showed that when people were told they would gain weight back if they stopped taking the drugs, most lost interest in starting them.
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 anecdotally, doctors and patients say, those who start taking the drugs continue.
“I don’t plan to ever stop taking this drug,” said Kimberly DelRosso of Pembroke, Mass., who takes Wegovy.
She never forgot to get her weekly injection. Instead, she says, she often neglected to take the blood pressure pills she was prescribed when she weighed more. (Now, after losing weight with Wegovy, he no longer needs them.)
So far doctors report that like Ms. DelRosso, most of their patients intend to take their obesity drugs forever, and many are thrilled when they stop needing other drugs.
Dr. David Cummings, a professor of medicine at the University of Washington and director of a weight management program at the VA Puget Sound Health Care System, chronicles his patients’ experiences with Wegovy and the diabetes drug Ozempic. So far he has prescribed the drugs to about 1,000 patients. At most 5 percent stopped because of side effects, he said. Others stopped because their insurance no longer covered their drug or because they couldn’t find a pharmacy that had it in stock, reflecting persistent drug shortages.
But those who do stop generally don’t do so voluntarily, he said. Other doctors who prescribe Wegovy agreed.
“Compliance is excellent,” said Dr. Diana Tiara, medical director of the weight management program at the University of California, San Francisco. “People are getting it. They want spare parts. They take it on trips.”
An epidemic of non-attachment
There is a price to pay for neglecting to take prescription drugs. A staggering 40 to 50 percent of people prescribed medications for chronic conditions like high blood pressure or diabetes fail to take them—and as a result incur at least $100 billion in preventable medical costs annually. This lack of compliance is estimated to lead to at least 100,000 preventable deaths each year.
Even a heart attack may not be enough to scare people off taking the current arsenal of heart drugs, which are proven to prevent deaths from heart disease. Some studies show 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 the bright lights, they’ve driven the ambulance, they’ve had rescue PCI, because of secondary heart attacks, they’ve seen the pearly gates, but they still don’t seem to be taking the statins and beta blockers,” said Amitabh Chandra, a professor. in Public Policy and Business Administration at Harvard.
Even doctors stop taking their medications, defying the assumption that people do so because they don’t really understand their importance.
And while cost plays a role, at least one study found that even when drugs are free, compliance can be abysmal.
One reason seems to be a kind of ingrained reluctance to take something that reminds people every day that they’re sick, or that many patients might be aware of it. Especially with what experts call “forever” drugs, taking them daily makes some patients feel abnormal.
“People think they’re doing well, so they don’t need the medication,” said Corrine Voils, a social psychologist at the University of Wisconsin who studies medication adherence. “But the medicine is what keeps them well.”
Jalpa A. Doshi, a professor of medicine at the University of Pennsylvania’s Perelman School of Medicine, said patients make their own personal value judgments: “Drugs have side effects, they require copayments, and the act of taking a pill every day reminds me 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?” she added. “I really can’t see the benefits. I could eat less salt and fatty foods and do more walking or exercise,” instead of taking these drugs.
Those estimates that patients make in their heads “make it much easier to quit,” Dr. Doshi said.
That describes Mark Anthony Walker, 61, of Dublin, California, whose experience with heart disease is overshadowed by a troubling family history — his father died of a massive heart attack at age 47, his mother at 48 years old.
When he was 26, Mr. Walker had a cholesterol level of 360.
“I was terrified,” he said.
Since then she has been on and off statins and is on one now. But he doesn’t plan to take it forever. He has concluded that his brain needs cholesterol. As for taking a drug for the rest of his life, “I’m totally against it,” he said.
Instead, he believes he will be able to control his heart disease—and even reverse it—with a strict diet, exercise and vitamins.
Mr. Walker’s 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 Stigma, Less Shame
So what can obesity drugs do differently? For one, while doctors are usually the ones to prescribe drugs like statins or blood pressure drugs, patients often ask doctors for obesity drugs. Many have spent a lifetime trying any diet and exercise program they could find, and every time they lost weight, they gained it back.
Also, people who start taking the new obesity drugs can’t easily hide if they stop taking them: The weight they lost can come back, along with the stigma and shame and self-blame that often accompanies obesity. This makes these drugs very different from most others.
“You don’t see a big sign on your chest that says, ‘Blood pressure medication stopped,'” said Dr. Walid Gellad, a professor of medicine at the University of Pittsburgh who studies medication adherence.
On the downside, though, obesity drugs are expensive and often require doctors to fill out burdensome pre-authorization forms for insurance. Drugs were constantly in short supply throughout the country. These barriers can make them difficult to obtain.
Other disadvantages of the drugs include side effects such as nausea and gastrointestinal problems, as well as the way they are administered — patients have to inject themselves with the drugs once a week.
In a study at the Cleveland Clinic, Hamlet Gasoyan and colleagues reviewed the electronic health records of 402 patients at sites in Ohio and Florida who were taking Wegovy or Ozempic for obesity. They found that only 161, or 40 percent, had continuously renewed their prescriptions during the year. Side effects, availability, or insurance and cost issues may have played a role.
But there is a reason that patients are willing to call dozens of pharmacies in search of the drugs, and the most faithful inject themselves every week: Without obesity, they feel that they look better and are seen differently. They are no longer shunned or ashamed. People don’t stare at their cart or comment when eating a bowl of ice cream anymore. Gone is the embarrassment and self-blame and never-ending stigma of obesity.
This is a big factor for Ms. DelRosso.
Obese people “get treated differently,” she said, adding: “It’s awful how people discount you because you’re heavy.”
But it also enjoys the health effects. She no longer has sleep apnea or high blood pressure, and her blood sugar, which was hovering in the diabetic range, has dropped.
“I no longer need to take medication,” she said.
Except for Wegovy of course.
