New medications that reduce appetite, food intake, body fat, and weight by mimicking a gut hormone are reshaping the treatment of obesity and its associated co-morbidities.
KEY INSIGHTS
- New drugs like semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound) are reshaping obesity treatment.
- Initially designed for diabetes management, these medications promote weight loss but also reduce the risks of heart attacks and strokes.
- These drugs are viewed as preventative interventions to manage obesity and reduce its associated health risks.
- But there are rising concerns about improper use leading to severe side effects and potential misuse for aesthetic purposes by those who are not clinically obese.
Semaglutide (marketed as Ozempic, and Wegovy) and tirzepatide (under the brand names of Mounjaro and Zepbound) are currently making waves for their resounding successes. Yet, as Hollywood stars and other celebrities herald their own achievements with injections of these drugs, there are also concerns about misuse and potential serious side effects.
How Do the Drugs Work?
The drugs work by activating the receptors for the naturally occurring hormones gastric inhibitory polypeptide (GIP) and glucagon-like peptide-1 (GLP-1). These help control appetite and blood sugar by slowing the movement of food through the digestive system. This, therefore, leaves patients feeling fuller for longer.
Originally developed for diabetes and blood sugar regulation, the drugs have now been approved as anti-obesity medications (AOMs). This resulted in an unprecedented surge in global demand.
Besides, clinical trials have found they reduce the risk of heart attacks and strokes in high-risk individuals. And they could also have a future in the treatment of diseases such as Alzheimer’s and Parkinson’s, as well as substance abuse.
Transformative Effects and Preventative Intervention
Prof. Frank Joseph, a Consultant Physician in Endocrinology and Diabetes in the UK, has been involved in clinical trials in this field for almost 20 years. He told MedicalExpo:
“I first started working with the group of medications that semaglutide and tirzepatide belong to back in 2006, when the first of this group, called exenatide, was released for use in type 2 diabetes management. It was exciting to be able to offer a treatment that improved glucose control and helped weight loss in people living with type 2 diabetes. Over the years, my team and I have been involved in several clinical trials with this group of medications and seeing the transformative effects that the newer medications have had – not just on glucose control and weight loss in people with Type 2 diabetes, but also people living with obesity – has been really gratifying as a physician.”
Prof. Joseph has held positions at Britain’s NHS Countess of Chester Hospital, the University of Chester and the University of Liverpool. He is also the founder and clinical lead at Dr Frank’s Weight Loss Clinic. According to him,
“Obesity is associated with so many co-morbidities: type 2 diabetes, high blood pressure, high cholesterol, heart disease, strokes, various cancers, arthritis and sleep apnoea syndrome to list but a few. The effect it has on people’s mental health is immeasurable. Treating people with these medications should not only be looked at as treating obesity, which we all agree is a chronic relapsing and remitting disease but as a preventative intervention to prevent the consequences of obesity and overweight.”
Concerns Over Misuse
But with the many success stories to be hitting headlines also come concerns over misuse of the medication. This treatment is administered via self-injection pen, by those not under strict medical supervision.
Side effects, such as nausea and other gastrointestinal problems, have been documented. There have also been reports of people who are not clinically obese managing to source the drugs without a prescription via the Internet. There is also alarm over fake versions of the drugs being sold. And there is heated discussion over the long-term costs of treatments if patients need to continue to take the medications to retain lower body weights.
Current prices of the drug vary widely. Some countries’ health insurance programs agree to cover it while others refuse. In Europe, a month’s supply comes in at between €150 and €350. In the US, the cost is around US$1,000 to US$1,400.
Both medical professionals prescribing the drugs and the pharmaceutical companies behind their development are very clear. They say only a very specific group of patients should be taking them.
For Prof. Joseph,
“The patients who benefit from these medications are people living with obesity – that is anyone with a BMI over 30 kg/m2 – or living with overweight – with a BMI over 27 kg/m2 and a weight-related condition. The BMI criteria need to be adjusted based on ethnicity as well. Medical history should also be taken into account when embarking on treatment as there are certain conditions where you wouldn’t use these medications.”
He believes that when used safely, and by medical professionals with the right support structures, there is no issue.
“The problem is the fact that people are getting these medications from untrained professionals with no back-up. This can result in people getting side effects and some of these are severe enough to require hospitalization. They are being given to people who should not be getting them, i.e. they are already at a normal weight and are taking them for aesthetic purposes.”
He calls for medical monitoring and supervision.
“Without the right guidance on diet, physical activity, and behavioral support you reduce the efficacy of the medications; people often get more side-effects and they can lose muscle mass.”
Challenging Attitudes
The laboratories heading the current wave of AOMs are within Danish Novo Nordisk (Ozempic and Wegovy) and US-based Eli Lilly (Mounjaro and Zepbound). Both pharmaceutical companies have long histories as medical pioneers. These latest successes are resulting in soaring demand for their products and in their profits. But, they say, in addition to having long-term global health implications, the medications are also challenging attitudes to obesity.
Prof. Rachel Batterham, Senior Vice President of International Medical Affairs, at Eli Lilly and Company, says:
“Obesity is a chronic, progressive disease, and despite its increasing prevalence globally, it is still widely misunderstood and undertreated. Lilly aims to shift misperceptions of obesity as a lifestyle choice and help people understand how to treat it for the disease that it is. It can lead to life-limiting complications, reduced quality of life, and premature death, with at least 2.8 million adults with overweight or obesity dying each year.”
Yet, she says, this stigmatized, disease does not receive the same level of diagnosis, medical care, insurance coverage or long-term care as other chronic diseases.
“Obesity is also a driver of other diseases, with as many as five million deaths per year from cardiovascular disease, cancer, type 2 diabetes and other chronic diseases attributable to obesity.”
Like Prof. Joseph, she stresses tirzepatide is indicated only as an adjunct to a reduced-calorie diet and increased physical activity for chronic weight management in adults with obesity or overweight who have at least one weight-related comorbid condition.
And she is excited about its potential in other areas.
“Lilly is further investigating tirzepatide for chronic weight management, as well as for additional indications, including heart failure with preserved ejection fraction and obstructive sleep apnea.”
A Scientific Solution
Prof. Joseph says both medical practitioners and patients have been desperate for AOMs like these to be widely available.
“The platitude of just eat less and do more – or blaming people for not having enough willpower – is still used by those who don’t understand the biology of weight gain and loss. People don’t choose to become obese or choose to not want to lose weight. What this group of medications has done has given us a scientific solution to what is essentially a hormone imbalance that does not allow people to lose weight effectively and keep it off.”
For him, the impact of these medications should not be understated.