Why Weight?

Investments and options in class of weight loss drugs showing efficacy

Obesity-related health complications cost the United States health care system over $173 billion per year according to the Centers for Disease Control and Prevention. Seventy-three percent of American adults over age 20 are overweight, while 42 percent are obese, according to the U.S. Food and Drug Administration.

The good news is, because of the prevalence and breadth of obesity, scientific breakthroughs are close to tackling the issue. One of the most recent and promising avenues is through the class of drugs called GLP-1 agonists.

For the past 15 years, glucagonlike peptide 1 agonists have been widely used for the treatment of type 2 diabetes. The medicine is typically administered through a daily or weekly injection. GLP-1 is a hormone produced in the gut and released in response to food intake. According to the Society of Endocrinology, it causes reduced appetite and the release of insulin.

According to Yale Medicine, individuals with type 2 diabetes give off less GLP-1 in reaction to eating compared to those without. Similarly, experts believe the same thing is true for individuals with obesity.

Because of this link, many GLP-1 agonists show success as weight loss drugs, as a common side effect of the diabetes drugs is weight loss.

In 2017, semaglutide, also known as Ozempic, was approved for diabetes treatment. In recent months, Ozempic has become the latest fad in dieting, as doctors prescribe it off label for weight loss, leading to shortages of the diabetes medication.

Novo Nordisk, the maker of Ozempic, announced it would invest $1.6 billion to expand capacity and address the shortage.

In June 2021, the FDA approved Wegovy – the first drug approved since 2014 – for chronic weight management in adults. It can be used to help treat general overweight and obesity with at least one weight-related condition, which includes high blood pressure, type 2 diabetes or high cholesterol. Wegovy is also semaglutide, just administered at a higher dose.

According to Harvard Health Publishing, injectable semaglutide eliminates the strict guidelines for ingesting on an empty stomach – required by oral semaglutide – while the higher-dose Wegovy allows for better crossing of the blood-brain barrier, which increases its weight-loss efficacy.

In a March 2021 study published in the New England Journal of Medicine, once weekly injection of semaglutide of adults with obesity and without diabetes had a mean weight loss of 14.9 percent in the 68-week trial. Eighty-six percent of participants had at least 5 percent weight loss.

“Weight loss with semaglutide stems from a reduction in energy intake owing to decreased appetite, which is thought to result from direct and indirect effects on the brain,” the study, OnceWeekly Semaglutide in Adults with Overweight or Obesity, states.

According to the results of the study, weight loss with semaglutide was greater than with the placebo regarding improvements to cardiometabolic risk factors, which include reductions in waist circumference, lipid levels, blood pressure and glycated hemoglobin levels. It also decreased C-reaction protein more, which is a marker of inflammation.

There are several diabetes medications that, at higher doses, are prescribed for weight loss or are in the process of being approved. Liraglutide is sold as Victoza for diabetes, and a higher dose, Saxenda, for weight loss.

Tirzepatide, which is expected to gain FDA approval for weight loss this year, is already approved and sold under the name Mounjaro for diabetes, as of May 2022. The GIP receptor and GLP-1 receptor agonist is in phase 3 development and results are anticipated in 2023. GIP is a hormone that may complement the effects of GLP-1.

Pharmaceutical company Eli Lilly was granted Fast Track designation by the FDA in October 2022 to investigate tirzepatide for the treatment of adults with obesity or overweight with weight-related comorbidities. Fast Track designation is granted to expedite the review of medicines for serious conditions and fill unmet medical needs, according to Eli Lilly. The phase 3 clinical trial of a high dose of tirzepatide led to participants losing 22.5 percent of body weight on average.

According to an estimate from Bank of America analyst Geoff Meacham, as reported by NBC News, annual sales of tirzepatide could hit a record $48 billion.

One of the largest barriers to access for weight-specific medications is cost. The Affordable Care Act doesn’t require insurance companies to cover obesity-related medication or surgeries.

GLP-1 agonists are long-term treatments for both diabetes and weight loss and are intended to be potentially lifelong medications, meaning there can be a significant or insurmountable cost to treatment. Wegovy costs around $1,627 a month before insurance, according to GoodRx.

While these drugs are approved or in the process of being approved by the FDA and offer potentially promising results for people struggling with weight loss and the obesity epidemic in the U.S. as a whole, it’s always important to talk with your doctor before you embark on a weight loss program of your own. Watch for more news on these groundbreaking medications in years to come.

Claire Miller is an editor at CityScene Media Group. Feedback welcome at cmiller@cityscenemediagroup.com.