Pharma Telehealth for Weight Loss Drugs: Ethicist

This transcript has been edited for clarity.

Hi. I’m Art Caplan. I’m at the Division of Medical Ethics at the New York University Grossman School of Medicine.

Obesity and overweight are horrible problems in both the United States and worldwide. All kinds of diseases and ailments are linked to obesity, including diabetes, osteoarthritis, heart disease, some cancers, gallbladder disorders, and even depression and mental health issues. The list goes on and on.

Something like $175 billion a year are spent on weight-related diseases in just the US alone. Worldwide, it’s estimated that almost 4 billion people are either obese or overweight. In the US, about 25% of us are obese, another 25% are overweight, and children are increasingly becoming obese. We have three times more kids with obesity today than we did 20 years ago.

This is a huge problem, and to date, nothing has solved it. Not surgery, not counting calories, not special diets, and not exercise regimens. No matter what is recommended by medicine, no matter what patients try to do, even when they get some weight loss, they usually revert back to old habits and end up being overweight again.

We have a gigantic public health problem, maybe one of the leading ones on the list of all public health problems, and we haven’t had any success in really reversing the trends and cutting the costs associated with obesity and overweight until now.

We all know, unless you’ve been visiting on another planet, that the injectable drugs semaglutide and tirzepatide, which include Wegovy, Mounjaro, and Ozempic, are approved by the US Food and Drug Administration (FDA) for people who are obese and have one of the health conditions like diabetes.

Very recently, the FDA approved a new injectable from Eli Lilly and Company, which is approved just for weight control and for those who are having issues with obesity, without even having any health conditions associated. That’s great because these injectable drugs really seem to be working super well. As long as you stay on them, they seem to cause people to lose weight. They help maintain blood sugar levels. They look like a magic bullet.

On the other hand, there are going to be plenty of people, I think, who are going to want to get these injectables prescribed to them just to maintain weight. Not because they’re obese, not because they’re even overweight, but they just want to make sure they don’t become either. There are going to be people out there clamoring for injectables for weight control. There even will be people — think of people in the armed forces who have strict weight requirements, or athletes — who may end up using these drugs just to maintain weight for their jobs.

The drugs are not really approved for weight maintenance. They’re approved for people who are trying to cut back on overweight. That poses an issue because in a way, we’re not really sure long term what they’re going to do. People are concerned about what’s going to happen in terms of safety if you use these injectables for 3 years, 5 years, or 10 years. We don’t know because no one’s used them that long.

Also, are people on these injectables just going to take them forever? Remember, you’re not really getting at the underlying causes of obesity or overweight if you’re slapping a Band-Aid on through the injectables. You haven’t really changed people’s diets, exercise patterns, or anything else so that, as soon as they were to stop using the injectable, maybe the weight is going to come right back.

I think there’s a problem here that isn’t really being paid attention to: If you look at the demand for these drugs, the fiscal consequences of moving toward these injectable drugs are staggering. I don’t think we’ve really laid out in our minds or in our health planning what is about to happen as these injectable drugs begin to appear.

Let’s assume that the price right now is about $1000 a month, conservatively, to take an injectable. There are usually four injections a month. Maybe you’ve got a doctor visit or two. I’m going to say, conservatively, this will cost $15,000 a year per person. If one third of the United States is obese or even weight conscious, that’s 100 million people. If every one of those people went on an injectable, it’s $1.5 trillion dollars per year to pay for these injectables.

Let’s assume the price comes down because there’s competition. Let’s assume that we’re going to see not all those people using injectables. Still, you could be looking at close to $1 trillion spent, and we only spend $4 trillion a year on all of healthcare. Yes, there will be some savings down the road from the cost of obesity and overweight to the healthcare system, that $175 billion, but that’s not going to show up for a while.

We are talking a gigantic expenditure here potentially. The medical war on weight could be the most expensive ever fought. That’s why companies like Lilly are starting to think about getting involved with direct-to-consumer sales. “We’re not going to sell these drugs,” Lilly says, “through pharmacies. We’re going to hire telemarketing partners. You can get your drugs sent to you directly, like we see with many other drugs online.”

Lilly is thinking that the benefits and the profits to them are so big that they want to make sure that people are aware of these injectables and drive business toward their particular injectable. This is quite a market, and I haven’t even gotten into worldwide costs. The numbers I’m giving you are just in the US.

We have some tough choices ahead of us. We can either continue to promote diet and try to figure out cheaper alternatives to losing weight and controlling obesity, or we can put half of America on injectable drugs and break the budget.

I’m Art Caplan at the Division of Medical Ethics at the New York University Grossman School of Medicine. Thanks for watching.