Hello everyone,
I hope this weekend finds everyone in good health, and hopefully enjoying the weather; which is beautiful here in the US Northeast.
This week, the news was largely focused on the benefits — and the challenges — of using GLP-1s. For many people who’ve struggled with obesity, these medications represent a transformational clinical advance. But, there remains too much focus on obesity interventions delivered in a siloed approach: GLP-1s versus metabolic / bariatric surgery versus other medications versus lifestyle modifications. Instead, what’s needed is a multimodal and holistic approach. A sustainable weight loss model should be characterized by delivering multimodal, whole person care, over a multi-year period to all those that suffer from obesity and related metabolic disease.
Kind regards, Raj.
AT A GLANCE
- In the UK, patients will be able to ‘use an app’ and ‘…access help online’ to access weight loss services, including drugs, under an NHS scheme ‘to ease [the] obesity crisis costing [the] country £27bn a year.’ From The Telegraph.
- There are ‘…dozens of websites selling knock-off versions of the popular [GLP-1 agonist] drugs without a prescription’ …. leading the US Food and Drug Administration to call their ‘research disclaimers “bogus” and … that customers shouldn’t buy their products, as they haven’t been tested by the agency.’ From Rolfe Winkler at The Wall Street Journal
- Obesity is at a turning point, writes David Wainer, with a new class of medications helping people lose weight; and this in turn could be a significant problem for ‘…industries whose bottom lines are directly tied to America’s love of sugary drinks and fatty foods.’ The Wall Street Journal
- An estimated population of 93 million Americans would fit eligibility criteria for semaglutide GLP-1 agonist therapy, or 38% of all adults, as per an evaluation from Dr. Wong and colleagues at the University of California, Irvine, and would save 1.5 million preventable CVD events over 10 years.
- Stars and Stripes begins with ‘American soldiers piled on the pounds during the pandemic, with about three-quarters of the roughly 192,000 active-duty subjects analyzed in a newly published study deemed overweight or obese during a nine-month stretch.’ 23% of soldiers were classified as obese, with ‘…largest changes in BMI occurred in junior enlisted soldiers between the ages of 20 and 24.’
NEWS
- A UK-based think tank, the Institute for Government which works to make government more effective, published a 52-page report on Tackling Obesity. The authors note ‘…government since 1992 has identified obesity as a major problem…’ with their intent to examine ‘…why efforts to date have not worked…’ and ‘…what government should do differently.’ One in three British adults live with obesity, ‘…driven by a combination of human biology and recent shifts in global food systems and lifestyles…’ and is ‘…heavily concentrated in the poorest areas and is increasingly prevalent among children, compounding existing inequalities.’
- No surprise to me, there have been ‘…14 strategies, containing hundreds of policies, and a succession of institutional reforms…’ though many ‘…key policies have since been delayed or dropped.’
- The report notes that government is ‘…still nominally committed to a target of halving childhood obesity by 2030 and increasing average healthy life expectancy (the number of years someone lives in good health) by five years by 2035…’ with ‘…little indication of how it intends meet either target.’
- The recommendations are broad and amorphous, to reform government through development of a long-term obesity strategy, to improve an understanding of how the public thinks about food and health, and third to strengthen evidence by establishment of a ‘What Works’ centre to strengthen the evidence base for tackling obesity.
- Whilst figure 11 provides a nice graphic timeline of government action on obesity since 1992, this 2023 Institute for Government report is just as likely to get filed into the bookshelves of government policy, with ‘…thousands of pages of government strategies – along with frequently changing targets and institutions [that] have resulted in little progress.’
- In continuance of reporting from the UK, The Telegraph newspaper notes patients ‘…will be able to access help online under NHS scheme to east obesity crisis costing country £27bn a year.’ New online clinics could benefit up to 50,000 people, in an effort to ‘…to skip the waiting list for in-person treatment…’ at hospital sites.
- Referral will require a body mass index of ‘…over 35 and a weight-related condition such as diabetes or high blood pressure.’
- Steve Barclay, Health Secretary said the ‘…use of apps in weight management services will improve access to support that, alongside life-changing drugs, can help tackle obesity…’ with ‘…four online apps being recommended, Liva, Oviva, Roczen, and Second Nature.’
- Rolfe Winkler at The Wall Street Journal refers to ‘…dozens of websites selling knock-off versions of the popular drugs without a prescription.’ The websites sell raw ingredients to customers on social media ‘…emphasizing discounts and pharmaceutical grade quality while stating that their products are for research purposes only.’ Of the more than 50 websites identified, many ‘…include disclaimers that the substances are not for human consumption.’ Not only is this unsafe and likely illegal, the current state further exemplifies the desperation for patients who want and need highly effective medication to treat their obesity and related chronic disease.
- Stars and Stripes begins with ‘American soldiers piled on the pounds during the pandemic, with about three-quarters of the roughly 192,000 active-duty subjects analyzed in a newly published study deemed overweight or obese during a nine-month stretch.’ 23% of soldiers were classified as obese, with ‘…largest changes in BMI occurred in junior enlisted soldiers between the ages of 20 and 24.’
- Boehringer Ingelheim said on Thursday ‘…it would conduct three late-stage studies for its obesity drug candidate after it showed up to 19% weight loss after 46 weeks in a mid-stage trial…’ as per survodutide for weight loss and non-alcoholic fatty liver disease.
- Cardinal Health, a pharmaceutical distribution company based in Dublin, Ohio ‘…raised its 2024 profit expectations following strong demand for generic and specialty drugs such as GLP-1 medications…’ as per its earnings call earlier this week. Kristin White from Healthcare Brew quotes CFO Aaron Alt whereby the ‘…primary reason for the raise in the guidance on the revenue is related to the GLP-1.’
DATA
- In JAMA Internal Medicine, an intensive lifestyle intervention [ILI] was studied in just over 3,000 trial participants with type 2 diabetes and overweight or obesity, consisting of ‘…sessions with lifestyle counselors, dieticians, exercise specialists, and behavioral therapists on a weekly basis in the first 6 months, decreasing to a monthly basis by the fourth year…’. The intervention was compared to ‘…group-based diabetes education sessions 3 times annually during the first 4 years, with 1 annual session thereafter…’ in form of a comparison group. Data from all individuals was linked with Social Security Administration data, to ‘…estimate the association of an ILI for weight loss in type 2 diabetes with employment, earnings, and disability benefit receipt during and after the intervention.’
- There was a 2.9% increase in employment, with the conclusion that ‘…an ILI to prevent the progression and complications of type 2 diabetes was associated with higher levels of employment.’
- This is valuable data, if just from a conceptual level – we know that the direct medical costs of obesity and related chronic disease approach $500B in the United States; which is supplanted by indirect costs of lost economic productivity to $1.2Tr – the furtherance of economic analyses to chart the true return on investment to treat obesity and metabolic disease is necessary and timely, for all stakeholders.
- An estimated population of 93 million Americans would fit eligibility criteria for semaglutide GLP-1 agonist therapy, or 38% of all adults, as per an evaluation from Dr. Wong and colleagues at the University of California, Irvine. Considering the STEP 1 study results, published in 2021, for this cohort of 93 million eligible Americans, over 64 million would lose greater than 10% of their total body weight, and 47 million would lose 15% or greater.
- In addition, among those without cardiovascular disease [CVD], there would be a reduction in ten-year risk from 10.1% to 8.3% – an almost 20% relative risk reduction, that translates to 1.5 million preventable CVD events over 10 years.
- The real world application of such data is impactful and exciting; and should translate to lower healthcare costs, as well as healthier Americans.
- A comparison of list prices for semaglutide and tirzetapide found them to be ‘…significantly higher in the U.S. than in peer nations…’ in a report published by KFF Health System Tracker.
- For example ‘…one month of Ozempic in the U.S. ($936) is over 5 times that in Japan ($169)…’ and ‘…ten times more than in Sweden, the United Kingdom, Australia, and France.’
- In addition to individual drug pricing, the market size is critical too; for example the ‘…U.S. has by far the highest rate of obesity among peer nations — a third of adults (33.6%) have obesity in the U.S. compared to an average of 17.1% across peer nations.’
- Not mentioned though is the value creation, or impact, of such treatment – this will be greatest in the U.S. from a population health perspective, versus countries with smaller numbers of citizens suffering from obesity and related diseases.
Kind regards, Raj
