New weight loss drug treatments are presently (March 2023) all over the news and judging from the latest information it looks as if they will continue to gain traction.
But seemingly magical cures have often not lived up to the hype in the past. Nevertheless, these newer treatments appear to have the potential to help solve some of the most urgent and serious problems affecting global health caused by the alarming rise in obesity. This brings more into focus the delicate of balance of proactive government action in helping to prevent disease in populations on the one hand and pharmaceutical business profits that aid research on the other.
So it would be wrong to ignore them and instead look more closely at the long-term safety in their use and how to make them more affordable so as not to severely limit their use.
And in that sense, there remain a number of hurdles to pass before arriving at an acceptable level of efficacy as opposed to risk, not least in who and where the new treatments are for, and a careful study of any emerging side effects in their use. One recent example reported in the United Kingdom concerned a loss of appetite that made eating more of a chore than an enjoyment. If that kind of reaction becomes widespread there may be a reluctance to stick with the treatment.
There has probably been nothing in the recent past quite like the Covid-19 pandemic to raise awareness of the dangers posed by excess weight and obesity. Both have been recognized for some time as being largely responsible for ailments such as high blood pressure, heart disease, and diabetes. But those who carry excess weight or are obese are shown to have been at greater risk of complications arising from serious illnesses stemming from the virus, with an increased likelihood of being fatal.
Measures people have traditionally used to lose weight, such as dieting and exercise, have rarely been successful owing to how hard it can be to maintain the required lifestyle changes to keep the weight off. It’s not made any easier by healthy foods often being more expensive compared to quick and ready fast foods. For the most part they also won’t be as apetizing given the efforts food and drink manufacturers go to by, for example, loading their products with sugar and salt and spending millions on publicity, advertising and lobbying.
But there are other factors in play besides the sort of food we eat which come to light when digging into the reasons why people are obese. They include genetics that are hardwired in the human body which actually combat any efforts we make to reduce weight. This is because long ago food was so scarce that the body learned to protect itself by storing excess calories as fat to survive in leaner times. There isn’t much we can do about that as it is, and will always be, part of who we all are.
But a tendency toward being overweight or obese may also come other factors too. These include where and with whom we live, how active we are daily, our focus on saving time, our level of education, and how our brain manages this assortment of often conflicting and stressful situations.
Studies have revealed that being overweight or obese can worsen any pre-existing predisposition to mental health issues. And those already with mental health issues such as depression are much more likely to develop obesity.
We cannot underestimate the stigma attached to someone being overweight or obese. Discrimination can come in many forms all of which can affect their daily life and mental state. They may try to curtail normal social interactions so as to avoid being stared at and commented on. Onlookers who are unaware of the often complex factors surrounding the conditions can easily mistake someone who is either overweight or obese as being greedy, lazy, and not willing to take care of their body and wellbeing. And given that first impressions can significantly affect our attitudes on meeting someone new, appearance can play a major part in this process.
The United Nations predict that on present trends the world population will rise to 8,879,397,401 by 2035. Of this total the World Obesity Federation in their 2023 World Obesity Atlas predict nearly 2 billion having a Body Mass Index (BMI) of ≥30 kg/m2 (obese status) and another 2+ billion ≥25 kg/m2 (overweight status). This suggests an increase from 38% of the world’s population in 2020 to over 50% by 2035 (figures exclude children under 5 years old).
The prevalence of obesity alone is anticipated to rise from 14% to 24% of the population over the same period. It notes childhood obesity may more than double from 2020 levels, to 208 million boys and 175 million girls affecting mostly in low and middle-income countries in Asia and Africa.
With these sort of numbers the financial costs from having to deal with adverse health issues related to obesity could rise to more than $4 trillion annually by 2035. To put this figure more into perspective, that’s 3% of global GDP.
It has been known for some time that use of metformin, a drug used to treat diabetes, can lead to weight loss, but this is usually seen only after several years of use.
In relation to the newer treatments. at least one (Wegovy) has received FDA approval for weight loss while others, like Eli Lily’s Mounjaro used in Type-2 diabetes treatment, are now in process.
Their active ingredients may differ, and some are used now primarily in the treatment of Type-2 diabetes. But all seem to have shown, or are showing, promise in helping people to lose weight much more rapidly than ever before.
Wegovy’s active ingredient, which is found in Ozempic and Rybelsus, drugs also made by Novo Nordisk, and used to treat Type-2 diabetes, is semaglutide. Each of these products contain different quantities to target different diseases (Wegovy for obesity not simply weight loss, and the others for Type-2 diabetes). Wikipedia can provide you with more information on semaglutide, but it basically mimics the action of GLP-1, which according to the Mayo Clinic stands for glucagon-like peptide 1, a hormone that helps the pancreas release insulin and lower blood sugar and is used in the treatment of Type-2 diabetes.
Wegovy is a prescription injectable drug. It is specifically designed to work in combination with dietary changes and exercise to help obese people not only lose weight but also keep it off. We understand from their website that a package of four pens each containing 2.4mg of the drug (sufficient for a month of treatment) currently has an undiscounted cost of just over $1,300.
Some people have lost 15% to 20% of their original weight after 68 weeks demonstrating not only its effectiveness but the huge cost which is beyond the reach of most people without health insurance that specifically covers weight management.
However, it appears that if the treatment is stopped for any reason problems of weight control can return.
This appears to present a serious dilemma for governments about how they can fund treatments involving the new drugs. Lower income families who are most at risk from obesity-related diseases unfortunately make up the largest part of the population and they are most likely not able to access this kind of treatment, which in turn can lead to them being a bigger burden on an already overstretched health system.
The Economist has noted that it takes five years and around $2.5 billion for Novo Nordisk to set up factories in Denmark and the US to make the ingredients for their drugs. Pharmaceutical companies need substantial profits in order to finance not only the cost of new drugs they bring to the market but also to adequately fund future research. And they can demand high prices when there is little to no competition in an emerging market. This is why just in the US Wegovy sales are set to amount to $3 to $4 billion in 2023.
In August of 2023 Novo Nordisk is reported to be in the process of acquiring Inversago Pharma to extend its portfolio of weight loss treatments. Inversago Pharma is a Canadian privately owned business that focuses on developing experimental therapies using a different approach to most other treatments of metabolic diseases such as obesity and diabetes.
It’s no wonder that the company’s share price has doubled over the past 2 years reflecting a surge in investor interest in products likely to have a major impact on public health in the coming years.