After a pilot last year, the company is launching its Noom Med option that will include prescriptions for obesity drugs like Novo Nordisk A/Ss Wegovy for about $120 a month. Its the latest weight-loss company to join the lifestyle-focused industrys push into using highly effective, costly GLP-1 obesity drugs to help customers slim down. 

Noom is among a field of companies aiming to capitalize on the drugs that help people feel fuller and eat less with relatively few side effects. Patients who took the highest dose of Mounjaro, a diabetes drug from Eli Lilly & Co. thats in testing as an obesity treatment, lost an average of 50 pounds. Many one-time dieters see those results as far more reliable and easily obtained than from traditional habit-changing programs.  

With the new category of drugs, the weight-loss outcomes are so much better, and we listen to our users, our patients, said Linda Anegawa, Nooms chief of medicine. Patients are asking, How can Noom support us more?  

Traditionally, the weight loss industry has favored behavioral interventions like reduced-calorie diets and exercise programs over earlier medications that were often burdened with safety concerns or modest effectiveness. Now players like Noom see an opening to offer prescriptions alongside guidance on diet, behavior change and exercise.

Anti-obesity medicines without a doubt have revolutionized this landscape for sustainable weight loss, Anegawa said in an interview with Bloomberg Radio. But for the millions of Americans taking these medications, lasting success is really not often achievable without having that anchor in behavioral change.

Noom Med will be available initially in 32 states, including New York, Texas and California, with plans to expand further. Along with GLP-1s Novos Wegovy, Saxenda and Ozempic and Lillys Mounjaro the program will offer cheaper, less effective medications like Currax Pharmaceuticals LLCs Contrave, which reduces food cravings, and metformin, a generic diabetes drug thats also used for weight loss. 

Since 2016, Noom has offered an app powered by psychology to help customers shed weight. The move into telemedicine pits it against a slew of other services, including a familiar rival: WW International Inc. also known as WeightWatchers whose shares soared in mid-April after it acquired telehealth obesity-drug provider Sequence. Other competitors include startups Calibrate, an early leader in the space, and Ro. Shares of WW International fell as much as 3.9% Wednesday.

The proliferation of companies raises concerns about prescription oversight that earlier arose with some services providing medications for ADHD and erectile dysfunction. Medical supervision is critical as side effects like nausea and diarrhea are common with GLP-1 use, and the drugs are linked to rare risks like pancreatitis. Patients with obesity commonly need care for other other medical conditions that the telehealth firms arent set up to provide. 

While dozens of companies are writing weight-loss drug prescriptions, obtaining GLP-1 drugs remains a challenge for patients. Telemedicine platforms can cost about $100 to $140 a month, and often dont include the cost of drugs. Insurance coverage is limited, a legacy of obesity being treated as an aesthetic issue, and without it, patients out-of-pocket costs can range above $1,000 monthly. 

Weight loss medication customers will meet Nooms providers in an initial video visit, with subsequent communication through text-based chats and the option of additional follow-up video visits. Noom said it will continue to pair medical interventions with its behavioral program, Noom Weight, and believes the approach is essential to lasting, healthy change.  

I can throw all the Wegovy at you in the world, but if you dont have a comprehensive lifestyle program in place, people can still gain weight, Anegawa said. Nobody believes me, but they absolutely can.

GLP-1 drugs are seen as the next top-selling chronic disease treatment, with the potential to transform care the same way cholesterol-lowering statins did for patients at high risk of heart disease more than 30 years ago. The commercial potential is propelling drugmakers like Novo and Lilly to the top of the US and European markets. Investors are also eyeing Pfizer Inc.s experimental danuglipron after a mid-stage study yielded positive results. 

About 130 million American adults are eligible for treatment with the drugs under guidelines largely based on a persons weight. For example, a 5-foot, 9-inch man who weighs 210 pounds would be eligible based on body mass index alone, a measure based on height and weight thats used as a proxy for body fat. 

Users who sign up for Noom and qualify for medication will now be offered the option of joining the new program. Noom clinicians will follow those criteria and consider other factors, including underlying medical conditions and lab testing results, Anegawa said. They can also work with patients to manage common drug side effects like nausea and bloating, she said. 

The company will aim to rely more on GLP-1 drugs that have been specifically approved for obesity like Wegovy, she said; insurers are reluctant to cover diabetes drugs like Ozempic that havent been cleared for weight loss.

The cat is out of the bag on that, she said. Payers are really not allowing it anymore.

The shift toward drug treatment for obesity could lead the way to more expansion at Noom, she said. 

Were not specifically marketing ourselves at this time as a diabetes treatment or hypertension treatment yet, she said. But is that something were looking to for future iterations of this program? Quite possibly. 

There is zero chance the debt issue will not get resolved even though there will be posturing and debate right up to the last minute before timelines are extended or the debt limit is raised, Siegel wrote in his WisdomTree commentary this week.

Treasury Secretary Janet Yellen has been using extraordinary measures to keep the government running since hitting the $31.4 trillion national debt ceiling in January. Shes also repeatedly warned the U.S. faces economic and financial collapse if the deadline to increase the debt ceiling passes. That could be as soon as June 1, according to the Treasury Secretary, but Goldman Sachs estimates the true X-date wont be until mid-June.

Yellen isnt the only one worried about the fallout from the debt ceiling drama, of course. Economists across the nation have argued that a debt default could have disastrous consequences for the U.S. economy, with Moodys Analytics estimating in January that it could wipe out $12 trillion in household wealth in a job-killing recession that would be comparable to that suffered during the global financial crisis. 

Even though the debt ceiling has been raised or altered 78 times since 1960, this latest debt ceiling crisis is one of, if not the worst in history. Solita Marcelli, chief investment officer of the Americas at UBS Global Wealth Management, explained in a recent research note that the risks associated with the debt ceiling debate are admittedly higher today than at any time since 2011 when it took until just two days before the X-date for lawmakers to agree to raise the debt ceiling.

Still, Marcelli, and most Wall Streeters, continue to believe the debt ceiling will be raised in time. After some acrimonious exchanges in recent weeks, both political parties have arrived at the negotiating table and appear genuinely interested in avoiding a fiscal calamity, she wrote.

Whartons Siegel believes it all comes down to politics, and lawmakers dont want to look foolish, which ultimately will lead to another kick the can down the road measure to extend the debt ceiling at the last minute.

I believe Democrats feel pressured to meet the Republicans in some way. I think if they met them halfway, that is a good political position for the Democrats. If the Republicans get half of what they want, it can be regarded as a victory, he wrote in his Wisdom Tree commentary last week. Republicans have been pushing for the typical spending cuts, in addition to work requirements for Medicaid and other federal assistance programs, which Democrats have called a nonstarter, while the White House is seeking tax increases for the wealthy and some large companies while holding the line on spending.

George Mateyo, the chief investment officer at Key Private Bank CIO, a wealth manager with over $50 billion in assets under management, also believes lawmakers will ultimately come to an agreement.

The debt ceiling issue will get resolved, he told Fortune. But theres going to be some more market volatility in the near term. Mateyo pointed to 2011, where markets faced some pain as the debt ceiling came close to not being raised, but eventually resumed an upward trend and almost never looked back.

David Bahnsen, chief investment officer of the wealth management firm The Bahnsen Group,  told Fortune a debt ceiling deal is a certainty.

Every market actor knows it, he said. The only issue along the way is short-term traders playing the ebbs and flows of the process and we call that noise. Our main message to investors is to ignore the debt ceiling noise and pursue investments that provide growing cash flows, which largely coincide with companies that have a long history of growing their dividends.

As a scholar of global Christianity whose first book focused on apparitions and miracles of Mary in the modern Philippines, Ive spent years studying the ins and outs of how the Catholic Church authenticates apparitions and the impact of these decisions on devotion to the Virgin Mary. I believe that the creation of this office signals a major shift in how apparitions of Mary have been evaluated and authenticated in modern times.

Contrary to depictions in popular media that show the Vatican as the first and only arbiter in these matters, the actual process almost always takes place at the local level and only rarely reaches the Holy See.

Official and unofficial judgment

The Council of Trent, held between 1545 to 1563, first gave bishops the authority to recognize new miracles or relics. In the 1970s, the Vaticans Congregation for the Doctrine of the Faith, the office charged with defending and promulgating Catholic doctrine, established a set of norms prescribing how alleged apparitions should be judged at the local level.

However, most apparition claims dont rise to the level of being investigated. Of the countless apparitions that have been reported throughout church history, only 25 have been approved by the local bishop, and 16 of those have been recognized by the Vatican.

Yet, throughout the Catholic world, hundreds of shrines commemorating a miraculous appearance of Mary enjoy devotional followings. What accounts for the difference between tacit and official church approval, and what is at stake when the church investigates an alleged sighting?

When personal revelations become public

Catholics the world over engage in deep relationships with Mary and the saints and take it for granted that their presence is real. In many places, furthermore, Catholic beliefs blended with Indigenous cultures and practices to produce apparition legends around which devotion has flourished for centuries.

Local priests and bishops navigate a fine line between popular religiosity and doctrinal orthodoxy. They readily accept diversity in how believers venerate Mary. But they also must remain vigilant against phenomena and messages that contradict the churchs teachings and threaten to undermine their authority. For many supernatural claims, the tipping point for investigation comes when a limited experience turns into a mass phenomenon.

To take two examples from my research in the Philippines: In Quezon City, northeast of Manila, in the early 2000s, a neighborhood group that met weekly to pray the rosary was led by a woman who, while in trance, claimed to channel the Virgin Mary. Although officials from the Archdiocese of Manila were aware of the groups activities, they left them alone, since their devotional practice had little impact beyond their immediate circle, and the content of Marys messages gave no cause for concern.

By contrast, after tens of thousands of people journeyed to the small Philippine coastal town of Agoo, in the northwestern province of La Union, to witness an appearance of Mary foretold by the visionary Judiel Nieva in March 1993, the presiding bishop immediately formed an official commission to investigate. Two years later, the commission declared it a hoax.

The difference between how local church authorities treated the two cases came down to the scale of the phenomenon, whether profit was made from peoples beliefs, and the content of the messages allegedly spoken by Mary. As with most apparitions found not worthy of belief that is, not supernatural in origin the Agoo phenomenon eventually died down.

Who determines devotion?

Occasionally, however, devotees remain steadfast in their belief that Mary appeared despite a negative judgment from the Catholic Church. For example, the devotional figure of Mary as the Lady of All Nations, a title associated with the visions of Dutch woman Ida Peerdeman, who claimed to have sighted the Virgin 56 times between 1945 and 1959, maintains a robust global following to this day. This is in spite of the fact that Dutch bishops and the Vaticans doctrinal office have urged Catholics not to promote the apparitions associated with that particular title.

Likewise, in Lipa, the Philippines, there was in the 1990s a revival of devotion and belief that Mary had appeared to a Filipino novice of the religious order of the Carmelites in 1948. The devotion continued even though a commission of Filipino bishops investigated the phenomenon and declared that it excluded any supernatural intervention in 1951.

In both cases, popular support for the apparitions influenced sitting bishops to reconsider, and even overturn, a previously negative judgment.

But the bishops approval didnt last long. Asserting the hierarchy of the Catholic Church, the Vaticans doctrinal office stepped in to uphold the original rulings that the apparitions were not authentic. Even so, many devotees remain undeterred in their belief.

Balancing act

According to the proposed Vatican observatorys president, the Rev. Stefano Cecchin, the new office will serve both academic and pastoral purposes, acting as a centralized task force for the systematic and multidisciplinary study of apparition claims worldwide.

It remains to be seen how precisely they will coordinate with local bishops who have until now enjoyed the authority to determine whether the mother of God appeared in their jurisdiction.

For those of us observing from the outside, the new observatory is an intriguing development in the long history of balancing the universal claims of the Catholic Church with the myriad expressions of local devotion and belief.

Deirdre de la Cruz is Associate Professor of History and Asian Languages and Culture, University of Michigan.

This article is republished from The Conversation under a Creative Commons license. Read the original article.