Diet and weight-loss drugs—such as Novo Nordisk’s Wegovy (semaglutide)—have entered the public consciousness, particularly for their usefulness in treating obesity-related diabetes. The success of Wegovy has made Novo Nordisk the most valuable European company, with a market cap that at one time exceeded the GDP of Denmark, where the company is based.
Wegovy targets the glucagon-like peptide 1 (GLP-1) receptor, which suppresses appetite and increases insulin sensitivity. Elsewhere in the market, Wegovy’s competitor Mounjaro (tirzepatide)—developed by Eli Lilly—works by targeting both the GLP-1 and glucose-dependent insulinotropic polypeptide (GIP). This increases insulin sensitivity and secretion and suppresses appetite.
Could these drugs mark the end of obesity as a societal issue?
The weight-loss drug landscape
While Wegovy is the current industry leader, Mounjaro is expected to take a bite of the obesity market. GlobalData forecasts that total sales in the weight-loss market will reach $52bn by 2029, with Mounjaro as the premier weight-loss drug with total sales of $22bn, more than double those of Wegovy’s $12bn.
The growth of this market will coincide with an increase in the diabetic population and the accompanying risk factors, notably obesity.
Downstream effects
Obesity can cause and exacerbate other conditions such as heart disease, the world’s most fatal disease, responsible for 16% of deaths worldwide according to the World Health Organization (WHO). Therefore, this class of drug could relieve the stress on global healthcare systems and dramatically reduce all-cause mortality.
Another potential by-product of the adoption of these drugs is a decline in the use of other drugs that merely treat the symptoms of obesity. This may include blood pressure drugs like beta blockers or cholesterol drugs such as statins. This reduced use could negatively impact some companies’ bottom line. However, public health services, such as the UK’s National Health Service (NHS), would benefit from the success of weight loss drugs and would enjoy shorter waiting lists and a greater availability of human capital and medical equipment.
Market access and patient safety concerns
However, the current high cost of weight-loss drugs has already delayed their use in markets such as the UK. High prices combined with unfavourable outcomes (including patients gaining back lost weight) may complicate the social impact of these drugs, especially within the key markets of their adoption: the US, the UK, and Japan.
There are also reports of side effects such as severe gastroparesis, and an investigation by the European Medicines Agency (EMA), is ongoing into whether these drugs can lead to suicidal thoughts. It is unclear whether the benefits of weight-loss drugs will ultimately outweigh the negatives, especially considering that users will have to keep taking the drugs to achieve a sustained effect.
Potential solutions
Additionally, using these drugs may also cause a loss in muscle mass, which is harder to regain than fat. Muscle mass has various benefits, such as improving metabolic health, cognition, and insulin sensitivity.
However, the US Food and Drug Administration (FDA) and worldwide health services tend to overlook the loss of muscle mass. Instead, they focus on body mass index (BMI) and do not accept more costly dual-energy X-ray absorptiometry (DEXA) body composition scans as primary outcomes in weight loss studies.
Peter Attia, longevity expert and author of the seminal work Outlive: The Science and Art of Longevity, has suggested on his website that recipients can better preserve muscle mass and selectively reduce fat by supplementing their treatment with adequate protein and exercise.
Are these drugs the best option?
Ultimately, the question is are these drugs worth their high price? Yes, they can be a valuable tool provided certain behaviours—including but not limited to weight training, cardiovascular exercise, and the prioritisation of protein and fibre—are adopted alongside treatment. But perhaps healthcare providers and individuals could save money by simply encouraging and altering their behaviours.
If these drugs are to pull their weight, so must the individual.