New drugs could end the global obesity epidemic

A new type of drug is all the rage among the rich and handsome.

Oliver Thansan
Oliver Thansan
13 March 2023 Monday 23:58
17 Reads
New drugs could end the global obesity epidemic

A new type of drug is all the rage among the rich and handsome. One puncture a week, and the weight drops suddenly. Elon Musk swears by him; influencers sing his praises on TikTok; the suddenly thinner Hollywood stars deny taking it. However, the latest weight-loss drugs are not just cosmetic enhancements. The biggest beneficiaries will not be the celebrities in Los Angeles or Miami, but the billions of ordinary people around the world whose health is jeopardized by their weight.

Weight loss treatments have long ranged from the well-intentioned and ineffective to the downright dubious. The new class of drugs, called GLP-1 receptor agonists, seems to really work.

Semaglutide, developed by the Danish pharmaceutical company Novo Nordisk, has shown weight loss of around 15% in clinical trials. It is already sold under the Wegovy brand in the United States, Denmark and Norway, and will soon be available in other countries; Ozempic, a lower-dose version, is a diabetes drug that is also being used "off-label" for weight loss.

A rival GLP-1 drug made by the US company Eli Lilly, which is even more effective, will go on sale later this year. Analysts believe the market for GLP-1 drugs could reach $150 billion by 2031, not far from the current market for cancer drugs. Some believe that they could become as common as beta-blockers or statins.

Those drugs couldn't have come at a better time. In 2020, two fifths of the world's population was overweight or obese. By 2035, according to the NGO World Obesity Federation, that number could rise to more than half the population, with a staggering 4 billion people being overweight or obese.

People get fat everywhere. The fastest growing populations are not those of the wealthy West, but those of countries like Egypt, Mexico and Saudi Arabia.

These trends are alarming because obesity causes a multitude of health problems, including diabetes, heart disease, and high blood pressure, as well as scores of diseases such as stroke, gout, and various types of cancer. Being overweight increased the chances of dying from covid-19. And then there's the suffering that stems from the stigma attached to being fat, which hits children especially cruelly in schools and on playgrounds.

The consequences of obesity for public coffers and the economy in general are enormous. According to a model made by university researchers, the annual cost to the global economy of being overweight could reach $4 trillion by 2035 (2.9% of global GDP, up from 2.2% in 2019). That number includes both health care spending and lost work time due to obesity-related illnesses and premature deaths.

The growing waistline around the world is not a sign of the moral failure of the billions of overweight people, it is the result of biology. The genes that were vital in helping humans survive winters and famines continue to help the body maintain weight today.

In recent decades, the glut of processed foods that are hard to resist has brought greater convenience and lower costs, but it has also triggered overeating just as lifestyles have become more sedentary. Once it has gained weight, the body fights any attempt to lose weight beyond a small fraction of its total weight.

Despite the $250 billion consumers around the world spent last year on diets and achieving weight loss, the battle to lose weight was largely lost.

The new anti-obesity drugs have arrived by chance, after it was observed that treatments for diabetics caused weight loss. Semaglutide mimics the release of hormones that stimulate feelings of satiety and reduce appetite. They also turn off the powerful drive to eat that lurks in the brain, waiting to ambush even the most zealous dieter.

There is already a huge demand for doses, and investors are almost as excited as newly slimmed down users. The market capitalization of Novo Nordisk, the company leading the gold rush, has doubled in two years to $326 billion, making it the second most valuable listed pharmaceutical company in the world.

Analysts predict that half of obese Americans seeking help will be taking GLP-1 drugs by the end of the decade.

Now, as with any new drug that holds so much promise for so many people, there are uncertainties. Two big ones are safety and affordability.

First of all, security. The novelty of these drugs means that their long-term consequences are not yet known. For the lower doses prescribed for diabetes, side effects (such as vomiting and diarrhea) have been mild. However, others could appear as their use becomes more widespread and the doses are increased.

Animal studies have shown an increased incidence of thyroid cancer, and semaglutide is associated with rare pancreatitis. Little is known about the effects of its use during or just before pregnancy. All of that will require careful analysis through controlled longitudinal studies.

It will be important to understand the risks, because many patients who take these drugs may need them for the rest of their lives. As with stopping a diet, stopping a high dose of semaglutide is associated with regaining much of the weight lost. Some people even gain more weight than they originally lost.

Another concern for policy makers is cost. In the United States, Wegovy's bill is around $1,300 a month; that of Ozempic, the 900 dollars. Judging by those prices, lifetime prescriptions seem prohibitively expensive. However, the long-term outlook is more encouraging.

Over time, companies can make agreements with governments and healthcare providers to cover the entire population and guarantee large volumes at low prices.

The profit prospect already attracts competition and stimulates innovation. Amgen, AstraZeneca and Pfizer are working on rival drugs; Novo Nordisk has a complete portfolio of maintenance drugs. Later, the patents will expire, allowing the development of lower-priced generics.

What to do in the meantime? Governments must ensure that medicines reach those who need them most and let those who take them for cosmetic purposes pay out of pocket. Long-term effects should be carefully studied.

States must continue to insist on other measures against obesity, such as exercise, healthy eating and better food labeling, which can help people not gain weight in the first place.

However, let us also take a moment for celebration. These new drugs mean that the global fight against fat may end up being won.

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Translation: Juan Gabriel López Guix