Self-care and the Rapidly Changing Market of Obesity Drugs
Self-care and the Rapidly Changing Market of Obesity Drugs
Could 5 new anti-obesity drugs recently approved by the FDA and other regulators make a difference in one of the world’s biggest public health challenges? The quick answer is yes, for some patients this new group of weight management drugs could be life-changing. But the newly approved anti-obesity drugs – and additional similar drugs that are likely to follow in the near future -- are not a panacea. They will not replace healthy eating, nor enable patients to reach their ideal weight without effort.
Nearly one in three people worldwide have a body mass index of over 30 and are considered clinically obese. Not only this but these numbers are only projected to increase. In countries such as the United States, experts predict a 50% increase in people diagnosed with obesity by 2030. In Europe, obesity rates have increased 3-fold in the past 20 years. But these trends may be set to shift, not because of major public health changes, but because of a new set of weight management injectable medicines.
Why is obesity such an insidious problem for societies across the world? The bottom line is that, due to the range of chronic conditions obesity can cause, obesity is set to cost the healthcare systems across the world $3 trillion annually. This figure amounts to 3% of the global GDP.
But finding solutions for obesity is not just a health matter– it is a social matter as well. Obesity disproportionately impacts people along racial and socioeconomic lines. In the United States, non-Hispanic Black adults have the highest age-adjusted rates of obesity, as high as half of all Hispanic black adults. Additionally, obesity has an inverse correlation with education level, those with college degrees show lower rates of obesity. Data shows there is a 15% gap in obesity between those with a university degree and those without.
This new group of weight management drugs all started out as type 2 diabetes drugs that, as a side effect, also helped patients to lose weight. Now over five of these medications have been approved by the FDA for long-term use in treating obesity. These include orlistat (Xenical, Alli), phentermine-topiramate (Qsymia), naltrexone-bupropion (Contrave), liraglutide (Saxenda), and semaglutide (Wegovy). How do they work? Drugs such as Wegovy can mimic a hormone – Glucagon-like peptide-1 (GLP-1) – in your brain that regulates your feelings of hunger and satisfaction. GLP-1 is able to decrease your insulin levels and coincidentally your hunger, meaning that you are less likely to continue to eat past the recommended daily maintenance calories. Individuals who are suffering from obesity because of naturally low levels of these hormones will now be able to administer these medications themselves through daily injections.
And the data shows these medications can have important effects. In clinical trials, Wegovy (semaglutide) demonstrated that 50% of treated individuals lost 15% of their body fat, whereas for Contrave (naltrexone-bupropion) approximately 57% of participants lost 5% of body fat. Although patients are counseled to be conscious of side effects and make lifestyle changes alongside this medication, this does seem like the future of obesity treatment! With promising results like this, in 2022, these medications have already reached a market size of 2 billion USD and are projected to grow to 4 billion by 2028. Most importantly, patients themselves are managing their own medication and taking charge of their weight management through at-home injections. A typical regimen starts with a relatively low dose of .25 to .5 mg and increases several fold to the long-term maintenance dose.
Figure 1: The dosage escalation of once-a-week self-administered Wegovy
At the same time, opinions are varied in the scientific community about the potential impact of these drugs. Some doctors, psychologists and eating disorder experts worry these medications could have a dark side.
There is concern that this new class of medications may promote the notion that having a certain body mass index, or looking a certain way equates to health. This is not true. "Plenty of thin people have high blood pressure, for instance, and plenty of people who are considered medically overweight or obese don’t,” says Dr Adriane Fugh-Berman from Georgetown University. This can have major implications when it comes to attempts at combatting stereotypes and stigma surrounding obesity.
In addition, right now the pharmaceutical industry faces issues regarding the cost of these medications. Only 30-40% of commercial insurance companies in the U.S. have agreed to include the medications in their coverage packages. Among those whose insurance does not cover these drugs, only people who can afford to pay for them out-of-pocket have meaningful access. Of course, in many cases, those who are able to afford it are not the ones who most desperately need it. Moreover, several insurance experts have voiced concerns about the implications for overall premiums in including these medications. Finally, the increased demand for these medications has already resulted in some shortages, leaving those with type II diabetes without a crucial medication.
Finally, from a global perspective, we must be conscious of the full range of challenges facing populations and policymakers in food systems and health. Ironically, we have more people overweight and more people dying of starvation simultaneously now than at any time in global history. Starvation and obesity have now become two sides of the same coin as policymakers and global health advocates search for better designs for sustainable food systems to increase both access and quality of food.
The bottom line? When used appropriately these new weight management medications can decrease the strain on medical resources by improving people’s lifestyle and decreasing the risk of severe medical conditions for patients. Moreover, these drugs, if they continue to grow in use at their current pace, could be a major piece of the shift toward self-care and home health care. For the first time outside of diabetes treatment, patient self-injection could see much wider application.
These steps towards making self-administered medication more mainstream mean less strain on medical resources, create less costs to the system in the long run from reducing the health impacts of obesity, and improve individuals’ understanding of their treatment. Although there is some cause for concern when it comes to compliance and consistency, patients taking responsibility for their own care and self-managing their medication intake, while still being supported by healthcare professionals, is likely to be an increasingly crucial component of healthcare delivery in the future. This particularly comes into play as global healthcare shortages develop and gaps in system capacity appear.
Clearly, there is no “quick fix” in the case of obesity. Exercising and being conscious of the quality of food you are eating will always be important. Research on the genetic basis of obesity has also shown that genes can actually influence your hunger levels, contributing to inherited obesity. Other illnesses, such as Cushing’s Disease (an excess of cortisol), can cause obesity and rapid weight gain. Side effects from certain medications can also lead to weight gain and increased hunger levels. None of these situations would be “cured” by this new group of weight management medications. But their arrival is still one of the most significant steps in recent memory towards combatting the world’s obesity epidemic, a step that seems likely to reduce the pressure on healthcare systems globally while offering a new vision for patients managing their health for the future.
Sources
https://pubmed.ncbi.nlm.nih.gov/25292135/
https://www.jandonline.org/article/S0002-8223(07)01616-1/fulltext
https://www.frontiersin.org/articles/10.3389/fsufs.2020.00016/full
https://www.mdpi.com/2076-3417/9/6/1062
https://www.health.harvard.edu/blog/a-new-treatment-for-obesity-202109102589
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