The Growing Appetite For Obesity Drugs

By Ben Comer, Chief Editor, Life Science Leader

Are humans getting softer as a species? We’ve definitely upped our adiposity, so much so that being overweight is now linked to more deaths worldwide than being underweight, according to a 2021 WHO report. It’s tempting to think that our collective mental fortitude is softening along with our midsections; after all, couldn’t everyone just decide to eat less and exercise more?

Evidently not, according to a thickening body of research. “Numerous studies show that diet, exercise, and behavioral counseling, in the best of cases, only leads to 5% – 10% average weight loss, and few patients with significantly elevated initial weights achieve and maintain an ‘ideal’ body weight,” according to a 2018 study published by researchers at NIH and Johns Hopkins. Obesity is a complex condition; diet and exercise play a key role in weight reduction and management, but medications may be needed to really tip the scales.

Last summer, the NEJM published results of a global Phase 3 trial of once-weekly tirzepatide, the active ingredient in Eli Lilly’s Mounjaro, which received FDA approval in May 2022 for type 2 diabetes (T2D). Results from the trial, which included more than 2,500 overweight and obese patients without diabetes, showed that participants receiving tirzepatide — a combination GLP-1 and GIP receptor agonist — lost between 16% and 22.5% of their body weight in 72 weeks. A second Phase 3 trial, which does include T2D patients, is expected to read out at the end of this month.

Novo Nordisk’s semaglutide, a GLP-1 receptor agonist and the active ingredient in Ozempic and Wegovy (approved for T2D and obesity, respectively), has become the lead driver of growth for the company, despite challenges in meeting patient demand. Celebrity buzz, including a tweet from Elon Musk last October about Wegovy, has bolstered promotional efforts for both products. Obesity is second only to oncology in terms of projected growth in spending between 2023 and 2027, according to IQVIA.

Anecdotally, people are asking for it. My brother, a GP in Columbia, SC, told me that a lot of his patients are requesting semaglutide and tirzepatide unprompted, and that the tirzepatide NEJM publication made a big splash. It will be important for physicians to moderate pent-up desire to lose weight with the label criteria and safety profiles of these new drugs, particularly since they have largely been tested on obese patients, not those simply hoping to drop some weight for summertime. Conversely, these drugs may substantially improve the quality of life for patients facing entrenched barriers to weight loss, such as genetic predisposition or social determinants of health. Access and affordability, not safety and efficacy, may turn out to be the biggest near-term challenges to combating the world’s expanding obesity epidemic.