AT A GLANCE…
- At the Fortune Brainstorm Health conference, I put Chelsea Clinton on the spot for her suggestions to manage the looming four billion people across the globe who will be living with obesity by the year 2035.
- In The Atlantic, Yasmin Tayag leads with ‘We’ve had a cheaper, more potent Ozempic alternative for decades…’ on bariatric surgery ‘…to be the “gold standard” for treating obesity.’
- Eli Lilly reports highlights of tirzetapide (Mounjaro) outcomes in the SURMOUNT-2 study, of 938 participants who lost over 15% total body weight, compared to 3% for those on the placebo drug.
- In the UK, the Daily Mail reports that women with a BMI of 25 and above will be told they are more likely to need emergency caesareans and their babies require specialist care.
- In a shifting of the deck chairs, and maybe more, CNN Business reports on Jenny Craig having alerted employees to potential mass layoffs as it begins winding down physical operations.
- Ro Health partners with Obesity Action Coalition to present results of a survey of over 1,000 subjects on weight loss journeys, motivations and GLP-1 medications… though only half of the those surveyed were people with obesity?
EVENTS
- I was invited to attend the Fortune Brainstorm Health conference earlier this week in Los Angeles, and was thrilled to engage with a number of high-profile leaders in healthcare.
- To my delight, there was a panel specific to metabolic and obesity care, with spirited discussions on a drive toward multimodal and whole-person care. Thanks and great to meet and connect with Saeju Jeong at NOOM, Zachariah Reitano at Ro, Dr. Gary Foster at WeightWatchers, Dr. Disha Narang at Northwestern Medicine, Dr. Nisha Patel at Sutter Health.
- A call-out to Dr. Chelsea Clinton for your comprehensive response to my question on the looming four billion people who will be living with obesity in the year 2035, and the need to focus upon health policy, generic drug manufacturing and supply chains, to meet people where they are, and where they want to be.
NEWS
- Big news in the GLP-1 weight loss market this week, from Eli Lilly, that ‘…tirzepatide (10 mg and 15 mg) achieved superior weight loss compared to placebo at 72 weeks of treatment in results from SURMOUNT-2.’ As a reminder, ‘tirzepatide’ is the active ingredient in ‘Mounjaro’, Eli Lilly’s trade name for its injectable prescription medicine that is used to improve blood sugar (glucose) in adults with type 2 diabetes mellitus. Tirzepatide is a GIP-analogue that activates both the GLP-1 and GIP receptors.
- In 938 participants with obesity or overweight and type 2 diabetes, those ‘…taking tirzepatide lost up to 15.7% of body weight…’ in reference to those taking the higher 15mg dose, compared to 3.3% weight loss for those on the placebo drug. And almost 50% of patients on the higher 15mg does achieved total body weight reductions of over 15%.
- This is impressive data, and adds great urgency for FDA approval as a treatment for people with obesity, as mentioned by Eli Lilly in the release such that ‘…We expect regulatory action as early as late 2023.’ The story was covered with gusto as you can imagine by The Wall Street Journal, Reuters, CNN, STAT News and many others.
- The Mounjaro / tirzepatide / Eli Lilly story was covered with gusto as you can imagine by The Wall Street Journal, Reuters, CNN, STAT News and many others:
- Peter Loftus writes in The Wall Street Journal that Mounjaro ‘…helped people who are also overweight or obese lose up to 15.7% of their body weight.’ such that Eli Lilly ‘…will complete in the coming weeks an application to the U.S. Food and Drug Administration to market Mounjaro as an anti-obesity treatment, which could enable an FDA decision by the end of the year.’
- Analysts have quoted Mounjaro’s promise to ‘…become one of the biggest-selling prescription medicines in history, with annual sales exceeding $25 billion.’
- Reuters focused upon Eli Lilly ‘…rais(ing) its annual revenue and profit forecasts after topping first-quarter sales estimates on demand for its closely watched diabetes drug Mounjaro, ahead of a decision on its use as a treatment for obesity.’
- Brenda Goodman at CNN quotes Dr. Nadia Ahmad, medical director of obesity clinical development at Eli Lilly, in that ‘…We have not hit 15% in any other phase three trial for weight management in this type two diabetes population.’ There is a further quote from Dr. Kimberly Gudzune, medical director of the American Board of Obesity Medicine, which continues on the positive angle ‘…In the last year has been really exciting just to have more tools in the toolbox, so to speak. And tools that, you know, we’re seeing really achieving outcomes that patients for the longest time have been hoping to achieve.’
- As with the rest of the roundup on the Eli Lilly press release, Matthew Herper reports that ‘…Analysts at SVB Securities projected in December that Mounjaro sales could reach $26.4 billion by 2030’, with sales of Mounjaro for the first quarter of 2023 tallying in at just over half a billion dollars.
- In other news this week, Liz Essley Whyte at the Wall Street Journal refers to ‘…law governing Medicare’s prescription-drug benefit (currently) excludes weight drugs. If that changed, demand from the 65 million older and disabled people insured through Medicare could push (GLP-1) sales even higher.’
- In a precise statement, ‘…treating Medicare recipients with the drugs would reduce other healthcare costs…’ none more so than when the data for the semaglutide trial is published later this year on a proposed reduction in major adverse cardiac events for patients on GLP-1 medications.
- News to me, was that Novo Nordisk ‘…spent about $4.6 million on lobbying last year and has spent about $3 million annually on lobbyists since 2013’ with respect to Medicare coverage of weight loss drugs, with Eli Lilly joining the lobbying effort in 2021.
- The Investor’s Business Daily reports on Eli Lilly posting ‘…details of its head-to-head study comparing Mounjaro with Wegovy in obesity treatment’, also known as the SURMOUNT-5 study, to recruit 700 patients and to report its results in 2025. The stock prices of both Eli Lilly and Novo Nordisk dropped on the same day, though the drop was higher for Novo Nordisk; I am unfazed about this news – essentially, we will need to see more data before the speculative nature of the stock market sways any scientific approach to the medications, their outcomes and application to patient care.
- In the United Kingdom, an article in the Daily Mail newspaper leads with ‘Mums-to-be with a BMI over 25 to be warned of risks in pregnancy.’ This is in reference to new national guidelines out for public consultation, in reference to ‘…women with a BMI of 25 and above will be told they are more likely to need emergency caesareans and their babies require specialist care, when deciding where to give birth.’
- With over half of the UK population overweight or obese, and the numbers steadily rising, it is well known that ‘…obesity in pregnancy substantially increases the risk of maternal complications such as gestational diabetes, pre-eclampsia, miscarriage and postpartum haemorrhage.’
- And furthermore, that ‘…babies born to overweight parents are much more likely to become overweight children and suffer from life-long conditions such as type 2 diabetes.’
- We are truly at the verge of crisis upon crisis, from the obesity pandemic to an increase in frequency and severity of complications during pregnancy, childbirth and for the growing baby. Of immense interest is that rates of gestational diabetes are increasing at twice the rate of obesity in the United States. Further, there is an over 50% likelihood for a woman who experiences gestational diabetes to develop full-blown type 2 diabetes within the next five to ten years – the overused term ‘canary int eh coalmine’ comes to mind here.
- Jenny Craig, a forty-year-old weight loss and nutrition company with a bumpy corporate and financing ride over the past twenty years, was reported in CNN Business that it ‘…alerted employees to potential mass layoffs as it begins “winding down physical operations” and hunts for a buyer.’ In addition, the Company added ‘…we’re currently transitioning from a brick-and-mortar retail business to a customer-friendly, e-commerce driven model.’ There is certainly a shifting of priorities in the weight-loss industry, that has been pretty lackluster over the past many decades.
OPINION
- In a media environment increasing saturated with GLP-1 medication mania, BRAVO to The Atlantic and Yasmin Tayag for highlighting an alternative and multi-modal approach to the medical challenge of managing obesity in ‘We’ve had a cheaper, more potent Ozempic alternative for decades.’
- Ms. Tayag successfully captures the current hype with, ‘A highly public ad campaign from one start-up, Ro, banks on the drug’s simple premise: “A weekly shot to lose weight”’ followed by ‘…All signs suggest that America is on the verge of a weight-loss revolution.’
- The author precisely states bariatric surgery ‘… is considered to be the “gold standard” for treating obesity’, though a point of clarity regarding the data on weight loss at 50% to 80% – this is actually the percentage of excess weight that is lost, not the total percentage of weight that is lost; which is more accurately between 25% and 30% for those undergoing bariatric surgical procedures, in comparison to between 15% and 20% for individuals taking GLP-1 medications.
- As per my two decades of experience in performing bariatric surgery in the UK, US and Canada, I can confirm that we have long hoped for ‘… new weight-loss drugs [that] are essentially trying to re-create the effects of bariatric surgery.’
- From a cost and value perspective, the article adds ‘In addition to sheer potency, surgery is also much more affordable than these weight-loss drugs…’ continuing with the data that ‘…out of pocket, surgery costs $15,000 to $25,000 – not cheap, but still cheaper than shelling out more than $1,000 per month indefinitely.’
- Continuing this thread, Dr. Holly Lofton, an obesity medicine physician at New York University, adds ‘…The patient must understand that they have to continue taking medication forever…’
- In reference to the risks and acceptance of bariatric surgery, Ms. Tayag relays ‘…many surgeries are done laparoscopically – using only tiny incisions – mortality is vanishingly low, and many patients go home after two or three days; full recovery usually takes four to six weeks. (Incidentally, the vast majority of patients now spend only one night in the hospital; some even go home the same day; many are back at a desk able to work within two to four weeks).
- The follow-up insights from the article are spot on to acknowledge: ‘…the most pervasive issue is a lack of awareness that surgery is even a safe or realistic option for weight loss. Bariatric surgery is plagued by stigma even within the medical community: In the 1990s, it was dismissed as a “barbaric” way to address an issue that, many believed, could be treated with diet and exercise.’
- In the words of obesity medicine experts such as Dr. Fatima Cody Stanford in Boston, ‘…more widely, these drugs will likely be used in tandem with bariatric surgery to produce more dramatic, longer-lasting results…’ and ‘…I see it as surgery plus medicine.’ (emphasis added)
- In The Washington Post, after a very reasonable rant at mostly the food industry, Tamar Haspel writes in reference to the new weight-loss drugs, ‘…The best thing about them is that they’re changing people’s lives.’ Tamar’s refreshing honesty continues, with ‘…I’m cheering for them, loudly. I’ve heard from a lot of people who are taking them, and marvel that, beyond making weight-loss possible, these meds change their relationship with food.’ I have seen the same sentiments with many of my patients having undergone gastric bypass, who finally feel in control of their urges to eat and overeat; in our clinical practice, our patients would say, ‘I don’t want to eat burgers and fries anymore’, I want to stay healthy and live longer. Bravo!
- The recounting of the experience of ‘…Renata Lavach-Savy, 37, a medical writer in North Bergen, N.J…’ after starting Ozempic, relates to her state that she ‘…was left without any semblance of appetite. She started setting alarms to remind herself to eat.’ Dani Blum in The New York Times iterates that ‘…it is important that people are given clear guidance on proper diet and nutrition while on the medication…’ and from Dr. Kraftson at Michigan Medicine, for ‘…people are on a drug like Ozempic, doctors need to monitor them closely with regular check-ins.’ This just underscores the need for whole-person medical support for patients on GLP-1 and derivative medications, including nutritional, behavioral and exercise therapy – something that I think may be under-valued for a number of the tele-health companies offering such medications to their online customers.
- Dr. Melissa Suran, senior staff writer at the Journal of the American Medical Association, writes a ‘what you need to know’ article on semaglutide and weight loss. The history of various brand name forms of semaglutide are covered, from Ozempic, to the lesser known oral verion Rybelsus, to Wegovy, and as a key reminder on indication [note to those Hollywood types!], ‘…people without type 2 diabetes can be candidates for Wegovy if their body mass index is 30 or higher or if it’s 27 or higher and they also have a weight-related condition.’ Risks including the much-mentioned Ozempic face are noted as a general risk of weight loss, and not specific to semaglutide, with additional warning on unregulated compounded versions that may be available online. The reporter continues to importantly state ‘…semaglutide is only effective for weight loss for as long as it’s used. In the follow-up study, published last year, participants who had been randomized to receive 2.4 mg of semaglutide regained up to two-thirds of their weight within a year of stopping the drug when the trial ended.’ With the follow-up that ‘…semaglutide should not be prescribed in isolation but as an adjunct to dietary changes and exercise.’ The final sentence has been heard repeatedly over the last many months, and we need to take heed ‘…Anti-obesity medications aren’t a magic bullet.’
DATA
- Telehealth company Ro Health partnered with the Obesity Action Coalition, a national non-profit organization, ‘…to survey people with obesity across the country to understand more about their weight loss journeys, motivations to address their health, plus how they feel about new GLP-1 medications.’ There were ‘…1,022 total participants of which 53% were living with obesity (BMI >30)…’
- It seems odd to me why only have half of the respondents surveyed would be classed as obese, and the rest are presumed to be overweight, of normal weight or underweight – at the very least, the report should include a sub-group analysis of just the 53% of respondents who were actually obese.
- Anyhow, the key takeaways are upon primary drivers for weight loss, the lack of a ‘quick fix’, continued weight stigma and judgement, and the open questions on GLP-1 medications. While health is the primary driver of weight loss in two-thirds, over half wanted to ‘change the way that I look’ and just less than half, at 45% wanted to ‘prevent or reduce a chronic condition.’
- The quote from Dr. Goldman, a licensed psychologist and Ro advisor is key ‘…Whenever a patient tells me that they want to lose weight, I follow that up by asking ‘why’. I’m looking for their motivating factor…’ to which I would also add ‘Why now?’ as there is generally a trigger or life event, such as new onset angina, inability to close an airline seatbelt, or to play with your young child. The data point that ‘…87% of people with obesity have tried to lose weight in the past five years, and have tried an average of 3 different weight loss methods…’ is just so true, and pertains to the fact that, in the main, diet and exercise are failing many of our patients.
- The remainder of the article includes quotes from past Ro patients and ambassadors, together with Ro advisors, including Joe Nadglowski of the Obesity Action Coalition, Dr. Beverly Tchang at Weill Cornell Medicine, Dr. Ted Kyle at Conscien Health, and Dr. Caroline Apovian at Harvard Medical School.
- Researchers from the University of Michigan surveyed just over one hundred primary care practitioners [PCPs] to ‘…to understand PCPs’ perspectives on obesity treatment barriers and opportunities to overcome them.’ Publishing in the PLOS One Journal, alarmingly, ‘…less than 10% (n = 8) used evidence-based guidelines to inform obesity treatment decisions.’ Suggested opportunities to improve obesity treatment were based upon education on local resources and counselling strategies, and team-based care with expertise in obesity medicine, and dieticians, together with policy changes such as reimbursement for obesity treatment. Finally, 40% of respondents had interest in pursuing Board certification status in obesity medicine, which is highly encouraging, with the caveat that this would necessitate dedicated time and financial support.
Kind regards, Raj
