This is the first article in a series about new obesity drugs that are transforming patients’ lives, dividing medical experts, and spurring one of the biggest business battles in years. Read more about The Obesity Revolution.
A two-part message is permeating the halls of medicine and the fabric of society, sliding into medical school lectures, pediatricians’ offices, happy hours and social feeds: Obesity is a chronic biological disease — and it’s treatable with a new class of medications.
The condition has long been framed as a result of poor lifestyle decisions and a failure of willpower — eating too much and exercising too little. But a new generation of highly effective obesity medications, and the overt and subtle messaging from the pharmaceutical companies making them, are starting to change the narrative.
History has shown that new blockbuster drugs can alter how people think about health. Valium changed society’s views on anxiety in the 1960s and Prozac on depression in the 80s. People worried about their cholesterol a lot more after ads for Zocor ended up on NFL games. Now, the new obesity drugs are hitting the market, heating up one of the biggest pharmaceutical competitions in history and raising profound questions of cost, equity and cultural bias. And like previous blockbusters, these drugs may also end up changing how people think about what it means to be sick and what it takes to be healthy.
“This is really changing the conversation, changing the understanding of the fact that this is an actual disease and not something that’s just a matter of a moral failing on the individual patient’s part,” said Fatima Cody Stanford, an obesity medicine physician-scientist at Massachusetts General Hospital who also consults for companies making the new medicines.
“I have never seen a conversation surrounding obesity, obesity as a disease, the treatment of excess weight in a way that I see now,” she said.
The new obesity drugs are in a class called incretin mimetics or GLP-1 based drugs, which emulate the effects of a hormone called glucagon-like peptide 1 that can help people feel full. They can lead to a startling amount of weight loss, up to a fifth of body mass, but have to be taken regularly by injection to avoid regaining pounds. They could reach staggering numbers of people: the worldwide obesity rate has surged to 13%, nearly tripling since 1975. In the U.S., 42% of adults and 20% of children are estimated to have obesity.
Both genetic and observational data link obesity to a wide range of diseases, including heart disease, diabetes and many types of cancer. The World Health Organization estimates that 2.8 million people a year die as a result of being overweight or obese. (Obesity for adults is defined as having a body mass index — weight divided by the square of their height, in metric measures — of more than 30.)
The first new highly effective drug, semaglutide, sold as Wegovy by Novo Nordisk, won regulators’ approval for obesity in mid-2021. A few months ago, Wegovy was approved for use by adolescents, too.
For drugmakers, this represents one of the biggest financial opportunities ever. The GLP-1 medicines are already used to treat diabetes, and they generate $23 billion in annual sales. But using the same drugs to also treat obesity could result in a much larger market. Pfizer, which is developing an oral GLP-1, estimates the total market could approach $100 billion in less than a decade, bigger than any other drug market and nine times Major League Baseball’s annual revenue.