Weight-Loss Drugs Like Wegovy Help With Losing Weight—and Potentially Much More
Ozempic, Wegovy, Zepbound and Mounjaro and have become household names. And for good reason.
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Business News/ Special Report / Weight-Loss Drugs Like Wegovy Help With Losing Weight—and Potentially Much More
Obesity treatment took a leap forward in 2023, propelled by advancements that are reshaping conventional approaches to managing this complex condition.
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The treatments offer hope to the hundreds of millions of people who have obesity. For them, successful weight loss could mean a decrease in cancer and heart-disease risk and longer life expectancy, not to mention easing the psychological stigma that our culture too often, and unfairly, imposes on people living in larger bodies.
Until now, long-term weight reduction has been possible for few patients, given the body’s natural tendency to put weight back on once lost—an evolutionary byproduct of our fight to survive. When people intentionally lose weight, the body slows down the metabolism and releases chemical transmitters that increase appetite and decrease our sense of fullness. All of this drives us to regain our lost weight.
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By contrast, these new drugs help people lose weight and not regain it, provided patients stay on the medicine and can tolerate the side effects. That’s a life-changer.
Key breakthrough
The breakthrough has been the advent of innovative medications, notably semaglutide (sold under the brand names Ozempic for diabetes and Wegovy for weight management) and tirzepatide (sold under the brand names Zepbound for diabetes and Mounjaro for weight management). In clinical trials with tirzepatide, an unprecedented 60% of patients achieved a substantial 20% reduction in weight, a contrast to older therapies and lifestyle interventions, where about 5% to 15% of patients lost this amount of weight.
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In other words, before these drugs, if you are a person who weighs 200 pounds, the chances of you losing 40 pounds and not gaining it back with lifestyle changes alone has been only 5% to 10% (or 15% with previous medications). If you have been one of the lucky treatment responders, good for you! Yet society somehow believes that almost everyone can lose this much weight with a diet or exercise program. The other 85% to 95% are believed not to have the willpower.
Now, if that same person adds one of the newer medications, there’s perhaps a 60% chance of losing the 40 pounds.
The medications work by activating our GLP-1 or GIP receptors in the body, which decreases appetite, increases fat burning and promotes weight loss in addition to decreasing inflammation and blood clotting.
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The use of the medications have been held back by shortages. But as more of these drugs are approved and reach pharmacies, those shortages will hopefully ease. More important, these drugs need to be added to insurance formularies. Until that happens, only the wealthy can afford them, creating more inequities in care.
Beyond weight loss
As noted, the importance of these drugs goes well beyond weight loss, as crucial as that is for many people. Data from the so-called Select trial—a study of over 17,000 patients with obesity and known cardiovascular disease—found a strong correlation between the use of semaglutide for obesity treatment and a remarkable 20% reduction in major adverse cardiovascular events among patients with a history of cardiovascular disease. This is akin to the effects observed with statins in cardiovascular disease prevention.
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The Select trial findings also shed light on the potential protective effects of activating the GLP-1 receptor in the human body. Researchers found that for those on the drug, there were cardiovascular benefits even before significant weight reduction—underscoring the need to reframe obesity treatment as a chronic disease, shattering the archaic perception of episodic, short-term solutions centered on intermittent dieting.
We also saw a semaglutide trial showing improvements in heart-failure outcomes as well as chronic kidney disease, once again highlighting that obesity treatment is about gains in health and not loss of weight.
All of these results will force a paradigm shift in the way we view obesity, pushing patients and society to accept that what we are trying to do isn’t lose weight per se but improve our long-term health. Right now, society tends to overfocus on those people who are trying to achieve a cultural desire for thinness.
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This has been a longstanding misguided cultural construct that being thin is somehow better. We are working hard to get away from this idea such that body acceptance and treatment of obesity to improve health outcomes can live together without a need to follow restrictive dietary patterns that aren’t sustainable or healthful psychologically.
As if all that wasn’t enough, this year also witnessed a marked shift away from using body-mass index (BMI) as a primary metric as a weight-loss target. BMI can be useful at times, but it shouldn’t be a diagnostic holy grail. It was never created for that, even if many believe it to be so.
Lifting the stigma
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The availability of newer treatments—and the growing acceptance of a need for medication and surgery as tools to treat a chronic disease—is lifting some of the stigma of the disease (much like the advent of SSRIs for the treatment of mental-health conditions). What’s more, it has been accompanied by a surge in physician certifications in obesity treatment, making it one of the fastest-growing medical specialties. This increased medical attention signals a reinvigorated commitment to address obesity as a chronic, multifaceted condition demanding comprehensive, specialized care.
All of this, though, comes with one big caveat. An increasing number of employers have opted to retract coverage for obesity treatment, citing the cost of these newer therapies. This regression contradicts the evident benefits of obesity management, which lead to improved productivity, reduced health risks, and a better quality of life for affected individuals. Additionally, certain employers have adopted restrictive and stigmatizing programs, limiting access to care and imposing unwarranted hurdles in a field where compassion and holistic support are crucial.
If ever there was a time to elevate obesity treatment to the status of a standard essential health benefit across all insurance plans, this is it. For the first time, we have evidence that medical interventions work—achieving dramatic improvements for most people. Even better treatments, with higher success rates and fewer side effects, are likely coming soon. This will be forever remembered as the year when such treatments became available. Let’s hope that the next few years will be remembered as when they became available to all.
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Angela Fitch is the president of the Obesity Medicine Association and co-founder and chief medical officer at Knownwell. She can be reached at reports@wsj.com.
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