Concerns remain over successful ‘cure’ for obesity

Lang has a background in investment banking and IT. He runs a family business, acting as the managing director of an illumination company in Friedrichsdorf while running restaurants in Frankfurt on the side. Lang is a busy man.

From his car, he tells EUobserver about his weight journey. Like many, Lang gained weight during the Covid pandemic, until he reached 120kg. In August 2022, he was hospitalised for psoriasis spreading out as arthritis and went through cortisone treatment, a steroid hormone that relieves pain and inflammation.

He started taking Ozempic, a diabetes drug commonly used to obtain weight-loss, to prevent gaining weight from the cortisone. When Wegovy (which contains the same active ingredient, semaglutide, in a higher concentration) was made available in Germany, he immediately took it.

“It worked well,” Lang says. Without implementing lifestyle changes, he quickly shed weight and is now at 105kg.

Ozempic and Wegovy mimic a hormone called glucagon-like peptide-1 which targets parts of the brain that regulate appetite. The hormone slows down the rate of ‘gastric emptying’, which means people feel fuller and have less desire to eat. It also encourages the body to break down fat.

In 2018, Ozempic was approved in the EU for type 2 diabetes, but not for weight-loss.

By the end of 2021, the European Medicines Agency (EMA)approved the drug in a higher concentration, under the brand name Wegovy, for chronic weight management in the EU.

The share price of Novo Nordisk, the company behind these popular weight-loss drugs, surged about 120 percent since the debut of Wegovy on the US market in June 2021, making it Europe’s second-most valuable listed company and transforming the economy of its home nation, Denmark.

Rival obesity drugs are already underway.

Mounjaru, a diabetes drug produced by Eli Lilly, an American drugmaker, was approved by the US Food and Drug Administration in May for diabetes and is expected to expand to weight loss soon. Novo Nordisk is currently advancing its next-generation offerings with high hopes for CagriSema, another obesity drug, currently in phase 3 development.

Amgen, AstraZeneca, and Pfizer as well as smaller biotech companies are racing to develop new drugs as well.

Appetite-suppressing drugs have generated popular excitement, and endless coverage in mainstream media, but potential side effects and addiction issues mean the drug revolution is not happening without concerns.

A growing problem

Globally, obesity rates have almost tripled since 1975. The Covid pandemic compounded this problem. A 2022 World Health Organisation report estimated that 59 percent of adults in the European region are overweight or obese.

Overweight can have devastating effects, causing more than 1.2 million deaths across the European continent every year, according to WHO estimates. Being overweight can lead to heart disease, stroke, diabetes, fatty liver, increased risk of cancer, knee pain and a myriad of other health issues.

The economic costs are considerable as well. The World Obesity Federation predicts that the global cost of overweight and obesity will reach more than $4 trillion [€3.7 trillion] annually by 2035 — almost three percent of global GDP.

Until now, many obese people felt they had few options to tackle their weight problems. But combatting obesity holds the promise of economic benefits, improved livelihoods — and ultimately saved lives.

Sky-high expectations

Last year, doctors granted more than five million prescriptions for key weight-loss drugs — a 2,000 percent increase from 2019, according to Komodo Health, a healthcare data-insights platform.

“In the first six months of 2023, our obesity care sales grew by 157 percent at constant exchange rates, mainly driven by Wegovy® in the US,” a spokesperson from Novo Nordisk wrote in an email statement.

The drugmaker is proud of its blockbuster drug: “Wegovy represents significant innovation for obesity treatment,” the spokesperson highlights. In phase 3 clinical trials, Wegovy led to an average of 17 to 18 percent weight loss over 68 weeks. Data shows the drug reduced the risk of major adverse cardiovascular events by 20 percent, according to the company.

“There’s a lot of excitement amongst people with diabetes,” says Tanja Thybo, head of research at the Danish Diabetes Association. She says general practitioners experience pressure to prescribe Ozempic to people with diabetes, who prefer it over other drugs due to its weight-reducing abilities.

Weight-loss drugs provide a solution for patients who are not overweight enough to undergo surgery, like Lang, and with a weekly jab, it’s less invasive too.

Wegovy allowed Lang to continue eating and drinking as he used to. He asked himself: “What’s the worst thing that can happen? Nothing. I can just go off the drug,” Lang concluded. He never experienced any issues.

But patient excitement may be grounded in the fact that risks are not discussed enough, says Kimberly Dennis, a doctor specialised in eating disorders.

Dennis says there have been aggressive marketing campaigns from Big Pharma. “I get suspicious when Big Pharma advertises drugs at bus stops,” she says. Novo Nordisk and other drugmakers have been criticised for lobbying doctors and insurers, as well as running biassed educational campaigns for patients.

Risks and rewards

Since July, several weight-loss drugs are undergoing a review by the EMA, after reports about suicides among users. In an email response, the EMA says the review is expected to conclude in November 2023.

Nausea, diarrhoea, vomiting, constipation, and stomach pain have been reported as common side effects of the weight-loss drugs. The drugs also come with warnings about more serious side effects such as increased risk of thyroid cancer, inflammation of the pancreas, gallbladder issues, low blood sugar, damage to kidneys and retinas, and suicidal thoughts.

“Patient safety is a top priority for Novo Nordisk,” the company spokesperson writes, explaining that Novo Nordisk collaborates closely with authorities. “EMA continuously monitors for safety signals and so does Novo Nordisk. Novo Nordisk remains confident in the benefit-risk profile of the products.”

Dennis however fears these drugs are too radical for many patients, and that they’ll create severe addiction problems. “Like what we saw with the opioid crisis.”

Doctors warn about hitting a weight plateau; the body acclimates to the drug and establishes a new normal. “If you stop taking the drug, you’ll regain weight,” Thybo explains. These drugs are thus intended for lifelong use.

In our fat-phobic society, weight-loss drugs may reinforce weight stigma. Sylvia Weiser, who runs an obesity clinic near Frankfurt, fears the drugs will be misused by individuals who are not obese. “The body adapts to the drugs. Giving the medicine to people without disease may actually cause the disease,” she says.

Weiser says obesity must be recognised as a disease. “People often think it’s just about lifestyle and mindset, about willpower. That’s simplified and wrong.” She says underlying biology can keep people from losing weight, and that gut hormones are responsible for most obesity cases. It’s often because of miscommunication between the brain, the gut, the liver, and the pancreas. “The body simply won’t accept weight-loss,” she says.

“If you have a disease, medicine will help,” Weiser says. “Medicine is a way of accepting obesity as a disease,” she adds.

Weiser says these drugs can finally help struggling, stigmatised patients. “About 80 percent of my patients who took the drugs don’t feel hungry anymore. It’s really impressive, they feel better,” she says.

What awaits

However effective these drugs are at treating obesity, we need to intervene earlier, according to Dennis. Structural inequalities like limited access to affordable healthy food, limited access to quality healthcare, particularly mental health care, and limited access to green spaces to exercise for some population groups exacerbate obesity issues.

But the drugs are not here to tackle the root causes of obesity. They’re here to profit from the treatment of it. While there’s a huge potential to help obese patients, there’s a need for caution too.

“This looks different for each patient. Why they’re obese and how they’re best treated,” Weiser says. She hopes there’ll be more research on the topic and better patient and doctor education.

For Philipp Lang, the drugs have made his life better. But perhaps the pharmaceuticals’ promises won’t hold for everyone.