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#FreeBritney activists protest outside the Los Angeles Superior Court during one of Britney Spears' hearings this April.; Credit: Matt Winkelmeyer/Getty Images

Pop star Britney Spears hasn't been in charge of her personal life or her finances for 13 years — that's how long she has been in a court-dictated legal arrangement called a conservatorship.

But on Wednesday, the artist will be speaking directly, albeit from a remote location, to a Los Angeles Superior Court judge about her situation. What exactly she intends to say in her appearance and what her goals might be are anyone's guess.

Before then, here's a quick look at what conservatorships are and why they exist, the specifics of Spears' arrangements, the #FreeBritney movement and what Spears and others have said publicly — and privately — about her conservatorship.

What is a conservatorship, and why does one get put in place?

Typically, legal and financial conservatorships are arranged for people who are unable to make their own decisions in their own best self-interest, such as in the case of an elderly person or someone with some kind of cognitive impairment.

Why does Britney Spears have one?

The exact reasons that the 39-year-old Spears is under a conservatorship have not been publicly disclosed. She lost her autonomy 13 years ago, in 2008, after apparently suffering a mental health crisis.

During the time that Spears has lived under this arrangement, though, she has released four albums (two of which, 2008's Circus and 2011's Femme Fatale, achieved platinum sales); appeared as a judge on both The X Factor and American Idol; and had a four-year residency in Las Vegas that reportedly grossed close to $138 million. Those accomplishments don't exactly line up with the typical profile of someone unable to look after themselves.

What does Spears' conservatorship cover?

Essentially, it controls all the major aspects of Spears' life, including decisions regarding her financial, medical and personal well-being. The conservators also oversee visitation arrangements with her two teenage sons, who are under the full custody of her ex-husband, Kevin Federline.

According to Forbes, Spears' current net worth is around $60 million.

Who controls Spears' conservatorship?

Up until recently, both the financial and personal arms of the conservatorship were controlled by Spears' father, Jamie Spears.

In 2020, her lawyer, Samuel D. Ingham III, stated in a filing that Spears "strongly opposed" her father as conservator and that she refused to perform if he remained in charge of her career. Spears asked the court for her father to be suspended from his role as conservator. (He had temporarily stepped away in 2019 for health reasons.)

In February, Los Angeles Superior Court Judge Brenda Penny overruled an objection from Jamie Spears to having a third party help look after his daughter's financial affairs. A wealth-management company, Bessemer Trust, is now a co-conservator for the financial side of Spears' situation. But Jamie Spears is still the main conservator for all other aspects of Spears' arrangement.

Why is Spears planning to talk to the court now?

Back in April, Spears' legal team asked Penny to allow her to speak to the court directly about the conservatorship, and they agreed that June 23 would be the date for this to happen. At the time, Ingham did not disclose why Spears wants to speak or what she intends to say.

Has Spears ever asked for the conservatorship to end?

Up until now, Spears has never voiced a desire for the conservatorship to be removed completely — at least not publicly. In a court filing, she has stated that the conservatorship "rescued her from a collapse, exploitation by predatory individuals and financial ruin" and allowed her to "regain her position as a world class entertainer."

But on Tuesday afternoon, The New York Times reported that it had obtained confidential court records that purport to show that Spears has opposed the conservatorship privately for years. The Times quoted a 2016 report from a court investigator assigned to Spears' case, in which the investigator wrote that Spears told her that the conservatorship had "become an oppressive and controlling tool against her" and that she wanted the arrangement to end quickly.

According to the Times, Spears told the court in 2019 that the conservatorship had forced her into a stay at a mental health facility, as well as into making public performances against her will. The article further reported that the conservatorship had dictated Spears' friendships, her dating life and her spending habits, even preventing her from refinishing kitchen cabinets according to her taste.

As early as 2014, the article states, Spears wanted to consider removing her father from his prime role in the conservatorship, citing his reportedly heavy drinking.

Does Spears herself support the #FreeBritney movement?

Certain Spears fans have organized themselves into a grassroots movement — #FreeBritney — to help Spears regain autonomy over her life. The dynamics between Spears and her dedicated #FreeBritney fans are murky, as are her various declarations on social media.

In a court filing last September, her lawyer, Ingham, wrote: "At this point in her life when she is trying to regain some measure of personal autonomy, Britney welcomes and appreciates the informed support of her many fans."

On the other hand, Spears to date has never publicly asked to be released from the conservatorship and regain her autonomy — which is the main goal of #FreeBritney.

A very sympathetic New York Times television documentary, Framing Britney Spears, debuted on FX in February. The project reckons with the way the media, comedians and the music industry itself characterized Spears during her ascent to global fame and during her later, very public struggles — and it also profiles some #FreeBritney activists.

After it aired, Spears wrote on Instagram: "My life has always been very speculated [sic] ... watched ... and judged really my whole life !!! ... I didn't watch the documentary but from what I did see of it I was embarrassed by the light they put me in ... I cried for two weeks and well .... I still cry sometimes !!!!"

Some #FreeBritney supporters don't believe Spears writes her own Instagram messages, leaving them to speculate about the pop star's true feelings. But Spears reportedly told TMZ in April that she writes her own captions.

What's next for Britney Spears?

Unclear. In an Instagram video posted last week, a visibly jittery Spears professed to be answering fans' most burning questions, including her shoe size and her favorite business trip (answer: "a trip to Italy [to] Donatella Versace. ... She fined [sic] and dined us").

The last question Spears put forward to herself was a crucial one: Would she ever return to the stage again?

"I have no idea," she said. "I'm having fun right now. I'm in transition in my life, and I'm enjoying myself."

This content is from Southern California Public Radio. View the original story at SCPR.org.

Famed investor and commentator Jim Rogers talks his preference for tangible assets, why he's leaning toward silver over gold, and uranium's role in the energy transition.

When a promising new drug to treat obesity was approved by the Food and Drug Administration for sale in the U.S. last month, it was the first such treatment to gain approval since 2014.

In clinical trials, weekly injections of semaglutide — or Wegovy, as it's been branded -- helped people drop an average of 15% of their body weight. That's an average of about 34 pounds over 16 months, before their weight plateaued, a far greater weight loss, obesity specialists say, than achieved with other drugs on the market. At least as important, Wegovy raised none of the alarm bells with the FDA or obesity doctors that it might trigger serious side effects of the sort experienced by some people taking fen-phen or some previous medical treatments for obesity.

But with a price tag for Wegovy of $1,000 to $1,500 a month, a very big question remains: Will insurers cover its significant cost for the many millions of people like Marleen Greenleaf, who might benefit?

Greenleaf grew up on the island of Trinidad, where her entire family paid little heed to what they ate and paid a high medical price, she says: "My husband has diabetes, my sister has diabetes, my brother has diabetes."

Since then, she's tried — and failed — at numerous diets, says Greenleaf, now 58 and an administrator at a charter school in Washington, D.C. Then, in 2018, she signed up for the clinical trial of a new drug — a once-weekly shot that changes the way her brain signals hunger.

A drug that finally stops her cravings

She noticed the change soon after her first injection of Wegovy: "For me, there was something that triggered in my brain to tell me that I was not hungry," she says. No more fierce cravings for the chocolate chip cookies she adores. Without the cravings she was able to slow down and reconsider the foods she'd been reaching for.

"I also wanted to eat healthier," she says. "I was looking at options, reading labels, looking at the calories — not just the calories, but also the sugar."

Over the 68-week research trial, Greenleaf dropped 40 pounds. Her blood pressure fell, which meant she qualified to donate her kidney to her husband, who was on dialysis.

"It was one of the best gifts of life that I could have ever given," she says.

But after that study ended, Greenleaf regained some of the weight. Wegovy is considered a long-term, possibly lifelong medication to treat chronic obesity. In the pre-marketing clinical studies, weight loss topped out at a total average weight loss of 15-18%, even as people continued to take the drug. And, as was the case with Greenleaf, once they stopped getting the weekly injections some of that weight came back.

Now, Greenleaf wants to resume the Wegovy shots.

"My only challenge actually is getting the insurance company to approve it," she says.

Reimbursement for obesity drugs' cost is patchy

Insurance coverage, it turns out, is a giant question — not just with Wegovy, but with obesity drugs in general. Some private insurers do include some prescription obesity drugs in the list of medicines they'll cover; it's too early to tell whether Wegovy will make those lists. Many doctors and patients are optimistic, because it is a higher dose of an existing diabetes medication called Ozempic, which is often covered by insurers.

A few select state Medicaid programs will cover medications that treat obesity, in some circumstances. But, significantly, Medicare does not cover obesity drugs — and many private insurers typically follow Medicare's lead.

Yet the demand for a good treatment is there, says Dr. Fatima Cody Stanford, a leading obesity researcher at Harvard. She was not involved in conducting the Wegovy clinical trial, but closely followed it. "I'm excited about it," she says, because of the dramatic weight loss.

The drug acts on the brain so people eat less and store less of what they eat. That helps address the excess weight as well as helping with numerous related diseases of the liver or heart, for example.

Why the FDA has been slow to approve obesity treatments

There is a long history of drugs that have looked like promising treatments for obesity, then failed. Decades ago, amphetamines, were prescribed, until their addictive properties became apparent. In the 1990s, the combination of fenfluramine and phentermine — administered as the diet drug fen-phen — was heavily marketed, only to later be pulled from the market for causing heart valve problems.

Those experiences and others have made physicians skeptical.

"In obesity medicine field, we've learned to be cautiously optimistic each time we have a new medication that looks promising," says Dr. Ihuoma Eneli, director of the Center for Healthy Weight and Nutrition at Nationwide Children's Hospital in Columbus, Ohio, who was not involved in the study of Wegovy.

So far, Eneli does not see any obvious concerns with the class of drugs that includes Wegovy, and calls the results so far "very promising." Wegovy is similar to another drug made by Novo Nordisk — Saxenda — which has been on the market since 2014, and which Eneli occasionally prescribes to her pediatric patients who are struggling with obesity.

In clinical research studies, the primary side effects reported after taking Wegovy affected the digestive system: nausea, diarrhea, vomiting, constipation, abdominal pain or intestinal infections.

Eneli says such side effects and their frequency are milder than the problems that have arisen in the past. That good safety profile may mean the drug is "less likely to come up with unanticipated risks," she says.

But, the new drug will be of little use, she and other doctors who treat obesity say, if it's not also affordable for patients.

"Before I even bring up that drug with my patients, I'm looking to see which insurance they are having on the left side of my screen — because that will determine whether I bring it up," Stanford, the Harvard physician, says. "If it's out of reach, like I said, I won't bring it up."

Stanford says her patients on existing obesity medications do extraordinary things to keep their coverage so they can afford to stay on the drugs.

"Several nurses here at the hospital that are my patients stayed working — they were supposed to retire — so they could stay on their injectable medication," Stanford says,"because that's how beneficial it was to them."

Why some are willing to pay out of pocket

Some people, like David Scheesley, 42, says he would consider paying for Wegovy, even if he had to pay the full sticker price. The Hanford, Calif., correctional officer has tried since 2019 to lose weight on various diets — low-fat, all-meat, all-vegetable — without success. His weight has led to other health concerns — with his blood fats and his heart — which makes Scheesley think of his 5-year-old son.

"I want to see him for a lot of years; I don't want to have a stroke," he says. "I don't want to have diabetes. I want to be there for him. So, for me personally, that [monetary cost] is not astronomical, if it can give me some more time."

Novo Nordisk, the company that makes Wegovy, is in talks with insurers, and acknowledges that ensuring health insurance coverage of its drug is critical. The challenge, says Douglas Langa, executive vice president of Novo Nordisk North America, is getting doctors, patients, and politicians to recognize obesity as a disease — and that therefore insurance should cover the cost of medicine to treat it.

"There's a medical component to [obesity] that needs to be recognized; this is a disease state like we should be treating any other disease state," Langa says. He says about 40% of private insurers cover Saxenda, the similar weight-loss medication the company makes.

Langa tells insurance companies this, making the case for why prescriptions for Wegovy should be covered. His company is also heavily lobbying Congress to pass legislation to allow Medicare to cover obesity medications. It makes sense from a financial perspective, he argues, because obesity is the root disease underlying so many other diseases.

"We do believe insurers understand that [untreated obesity] is a gateway into 60 other health conditions," Langa says. The need is hard to ignore, he adds. More than 100 million people in the U.S. alone struggle with obesity.

This content is from Southern California Public Radio. View the original story at SCPR.org.

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