The reimbursement for two obesity drugs is a godsend for people who are significantly overweight. But some patients are still left out, sees doctor Arianne van Bon. “I would like to be able to deliver custom work.”
Two obesity medicines have been included in the basic insurance since this year. “It is a very big problem, half of the Dutch are overweight,” says internist Arianne van Bon. She works at the Rijnstate Hospital and at Vitalys, a clinic for the treatment of overweight. “We really need to do something about this and for some people this drug is a huge kickstart to a different life and better health.”
‘I didn’t lose weight’
One of those people is 49-year-old Fleur van der Klei. She has been taking the obesity drug Saxenda for 1 year now. At first she paid for it herself, but since April this year it has been reimbursed. “A world has opened up for me. Because of the medication, I no longer think about food all the time.”
After Fleur stopped smoking, her weight went from 70 to 115 kilos and it has never gone off. “At the time I lost 10 kilos myself by following bad diets. Then I started yo-yoing. I stopped drinking alcohol and started exercising, but I couldn’t lose weight. Finally I went to the internist and he said: “We also have Saxenda. You can use that if you also take a healthy lifestyle course.”
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No more eating all day long
Fleur is not only eligible for the obesity drug because of her overweight. She also developed cardiovascular problems. “It was such a struggle, I lost 10 kilos and put on 12 again. 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 act as an appetite suppressant, explains Van Bon. “In the eating 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 develop serious overweight not only through lifestyle but also through hormonal influences, medication or stress.
Strict rules
“I know the drug is not a panacea,” says Fleur. “I also exercise weekly and walk a lot. You should also do this medicine in combination 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 followed a course for a healthy lifestyle for a year, have a too high BMI and additional physical problems. And if you can then start with the drug, it will be checked after 16 weeks whether you have lost at least 5 percent of your weight. If this is not successful, the treatment will stop.
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‘It helped them’
Van Bon often sees patients to whom she would like to prescribe the drug, but who just don’t comply with the rules. “These are, for example, people who have a slightly too low BMI, but who have already followed a number of lifestyle courses and have tried many diets,” says the internist. “It is sometimes quite difficult for me as a doctor to say to those people: just take another course, because you are not eligible for the medicine.”
According to Van Bon, some people with a BMI of over 35 would be well helped by the drug. “Those people have already done the lifestyle coaching eighty times, so to speak, and they become very sad if they have to do it again. I really think that those people should get a medicine quickly, they have just been helped with that.”
Delivering customization
On the other hand, the doctor does not advocate too smooth application of the drug. “I don’t want to see people with a BMI of 30. Unless they have a heart rhythm disorder, which makes it difficult for them to follow a course. 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 the medicine themselves. They have to set aside 120 to 150 euros per month for this.