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The news about anti-obesity drugs keeps getting better. In November, data presented at the American Heart Association meeting added cardiovascular benefit to value in combating obesity and diabetes. This comes on the heels of news that Novo Nordisk halted a clinical trial to test Wegovy’s impact on renal function early because the results they were seeing were so strong.

Yet beneath the hype lies a real fear. Unless we reverse the rising tide of metabolic syndrome, Medicare will be crushed, with tens of millions of Americans having shorter, harder lives. The new drugs offer the first real chance to deploy at scale treatments to halt a seemingly unstoppable trend.

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That will be costly. But so is the status quo. Medicare spending on people with advanced metabolic disease is sobering. Beneficiaries with two or more of the costliest conditions — diabetes, heart failure, or chronic kidney disease — comprise just 10% of beneficiaries, according to the NIH’s Renal Data System 2022 Annual Data Report. Yet they account for 25% of total costs. Those with all three conditions are 2% of beneficiaries but almost 7% of costs. And remember, the current cohort of Medicare beneficiaries turned 65 when obesity and diabetes rates were lower, meaning unless we do something dramatic, and fast, these percentages will balloon.

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