Who Should Read This Blog 

This blog is written for patients who want to understand more than headlines. These include those who are: 

  • Living with obesity or diabetes and considering treatment. 
  • Curious about the new weight loss medications like semaglutide (Ozempic/Wegovy) or tirzepatide (Zepbound). 
  • Concerned about the long-term costs of treatment and how insurance may or may not cover it. 
  • Interested in the bigger picture of how obesity affects healthcare spending in America. 

…then this blog is for you. This blog is especially for you if you live in and around Nashville, and are looking for a doctor in private practice (concierge medicine).

I, Dr. William Conway, believe that intelligent patients make better decisions when they see the medical facts and economic realities together.  

In my Nashville concierge medicine practice, I teach my patients the following:

  • key concepts necessary to understand and decide 
  • actionable steps  to be performed daily for improved health. 
  • the “Big Picture” necessary to be an effective decision maker. 

 

This blog focuses on the “Big Picture,” the broad macroeconomic and medical trends  of obesity. 

 

Executive Summary 

  1. Obesity is common in America, with 59% of Americans eligible for treatment. 
  2. The way these medications work is often effective, occasionally transformative, but always variable in individual patients. 
  3. Avoid irrational exuberance: Your response is individual and cannot be predicted. You must live within your budget. 
  4. These medicines are expensive. 
  5. Very few patients who are eligible are actually receiving these treatments. 
  6. Making GLP-1 medicines widely available through insurance can be expected to result in higher premiums, according to estimates used in modeling. 

 

Obesity Is Common, with 59% of Americans Eligible for Treatment 

The medical indication for treatment of obesity begins at a BMI of 27.5 Doctors can prescribe treatment starting at BMI>=27.5 if you have diabetes. 

Insurance coverage often requires a BMI=>35, or even >=40. A BMI>40 is labeled as morbid obesity.    

59% of Americans are medically eligible for treatment with obesity medications. 

Graph showing obesity in the United States, especially Tennessee.

59% of Americans are eligible for treatment of obesity

 

The Medicines Work  

If you take 100 Americans, each of whom wants to lose 100 lbs, here are the average outcomes using the older methods, as well as results using semaglutide, tirzepatide, and weight loss surgery: 

 

  • Healthy lifestyle changes: average  2–4% of your body weight (5-10 lbs if starting at 250 lbs). 
  • Older weight loss drugs: up to 10% of your body weight (25 lbs if starting at 250 lbs). 
  • Semaglutide (Wegovy): about 18% of your body weight on average (about 45 lbs if starting at 250 lbs).
  • Tirzepatide (Zepbound): about 22% of your body weight on average (about 55 lbs if  starting 250 lbs). 
  • Surgery results in a 30% loss of your body weight on average (about 75 lbs if starting at 250 lbs).

 

In my Nashville concierge medicine practice, I, William Conway, MD, have seen these weight losses in my patients. 

 

How the Medicine Will Work on You is Unpredictable; Track Your Weight Loss to See what is Realistic for You 

With healthy eating and exercise, there is a wide range of responses. Some people lose a lot. Some people gain. The average person loses 2-4 % of their body weight using these techniques. 

Using semaglutide as well as tirzepatide, there is a vey wide range of weight loss among patients. For a given person on semaglutide or tirzepatide, their response is unpredictable. The average patient will lose 18-22 lbs. Some patients lose much more. Some patients lose much less. Some patients continue to gain weight. 

In my concierge medicine practice in Nashville, I have seen this variability in weight loss between my patients, with some patients losing much more and some patients much less. 

 

 

The Treatment is Expensive and Long-Term 

The current market price for either semaglutide or tirzepatide is approximately $1,000 per month. If you stop the treatment, weight gain is common. The treatment is long-term. Most patients require ongoing treatment, similar to blood pressure or arthritis medications.  

To compare the treatment of obesity with the treatment of rheumatoid arthritis, current prices for weigh loss treatment over 10 years is approximately $70,000-$170,000. In contrast, the 10-year price for highly effective treatment for rheumatoid arthritis is approximately $500,000 to $ 900,000. 

Of course, prices vary, and health system costs are complex. Still, sustaining innovation for serious common diseases such as diabetes and obesity will require investment. As with many chronic conditions, effective treatment requires investment. 

 

The Treatment is not Widely Available 

Of the Americans with what is commonly labeled as extreme or morbid obesity, the vast majority are not receiving GLP-1 therapy. 

 

How Would Insurance Premiums Change if Weight Loss Medications Were Widely Available 

If half of eligible adults used GLP-1, the average family premium could rise 30-50%. These figures are from modeling, designed to show direction of change for rational decision making.Prediction of future costs is speculative 

 

Conclusion: 

There is always a budget. This blog has focused on the big picture: how common obesity is, how well medicines work, and the real costs involved.  

Understanding the context of your care is essential for your decisions. I, William Conway, MD, encourage my patients to consider the following commitments:

  • Weight is important. Make a commitment to follow the course of your weight. 
  • Make a commitment to your own self-management.  
  • Make a commitment to obtaining collaborative care from your physician.  

 

CTA: Call Nashville Concierge Medicines at 615-708-0390 to begin your personalized plan.  

Organized Citations (WSJ, 2024–2025) 

  1. Buck, Stephen. Your Wegovy May Pay for Itself. Wall Street Journal. August 5, 2025. Appeared in print Aug 6, 2025 as “Your Wegovy May Pay for Itself.” 
  2. Deighton, Katie. Serena Williams Is the Surprising New Face of Weight-Loss Drugs. Wall Street Journal. August 21, 2025. Appeared in print Aug 22, 2025. 
  3. Paul, Pamela. Weight-Loss Drugs Have a Surprising Foe: Fat Activists. Wall Street Journal. August 15, 2025. Appeared in print Aug 16, 2025. 
  4. Back, Aaron. Big Food Is Learning to Love Weight-Loss Drugs. Wall Street Journal. October 25, 2024. Appeared in print Oct 26, 2024 as “Ozempic Is Changing the Way We Eat.” 
  5. Hopkins, Jared S., and Brianna Abbott. Lilly’s First Pill for Diabetes, Weight Loss Shows Positive Study Results. Wall Street Journal. April 17, 2025. Appeared in print Apr 18, 2025. 
  6. Hamilton, Katherine. Omada Health Shares Soar After IPO as GLP-1 Drugs Fuel Interest. Wall Street Journal. June 6, 2025. 
  7. Graham, Megan. An Influencer Gained Followers as She Documented Her Weight Loss. Then She Revealed She Was on a GLP-1. Wall Street Journal. May 22, 2025. 
  8. LoSasso, Tony. How Markets Solved the GLP-1 Shortage. Wall Street Journal. April 7, 2025. Appeared in print Apr 8, 2025. 
  9. Seal, Dean. For Hims & Hers Stock, GLP-1 Giveth and GLP-1 Taketh Away. Wall Street Journal. October 3, 2024. 
  10. Loftus, Peter. Should Everyone Be Taking Ozempic? Doctors Say More People Could Benefit. Wall Street Journal. May 25, 2025. Appeared in print May 27, 2025.