Are new weight loss drugs an answer or problem?

Worldwide obesity rates have tripled since 1975, with 650 million adults obese in 2016, according to the World Health Organization. In 2019, the OECD declared that developed countries’ plans to tackle the problem largely failed. And the Covid-19 pandemic only underscored that obesity puts people at greater risk for infectious disease but are new weight loss drugs the answer?

Wegovy arrived on the market amid a global obesity crisis. A Harvard study found that almost half of Americans are expected to be obese by 2030, accounting for up to 18 percent of healthcare spending on related conditions, ranging from heart disease and stroke to osteoarthritis.

So far, the data for Wegovy looks excellent.  Unpaid celebrity endorsements include venture capitalist Marc Andreessen, who says the drug completely changed his relationship with food, and Elon Musk, who has cited it on Twitter. Novo Nordisk more than doubled its sales targets for obesity drugs to $3.7bn by 2025. Its share price has risen 26 percent in the past year. But before the company can make Wegovy mainstream, it has to convince doctors to prescribe it and insurers and governments to pay for it. It has to persuade patients to sign up for some heinous side effects. And then there’s the small matter of overturning centuries of, as it turns out, inaccurate assumptions embedded in the Latin root of the word obesity: “having eaten until fat.”

But there are two potential problems. When patients stop taking Wegovy, their appetite returns within weeks, and they pack on weight. In one study, patients who came off the drug regained 7 percent of their body weight. Then there is the price. Wegovy’s monthly list price in the US is about $1,350, and some insurers are not yet covering the drug.

Even if Novo Nordisk can win doctors over, it faces a more significant challenge in convincing reluctant payers. Some 80 million obese Americans do not have insurers who will pay for Wegovy. While it is on most insurers’ lists of officially covered drugs, it is often in a lifestyle category, alongside treatments for issues such as erectile dysfunction. Payers also face hurdles, so patients must obtain permission before filling a prescription. One Maryland pharmacist told me she had seen many prescriptions for Wegovy, none of which had ever come back after being sent for authorization.

In addition, doctors may not be ready to prescribe the drug. As one told me, “I’m not sure it’s an answer as much as a temporary solution.” Novo Nordisk put “feet on the street” within 72 hours of Wegovy’s approval, sending what it calls “educators” into doctors’ offices around the US. Lamanna anticipates it could take two to three years to change the minds of primary care physicians.

Some critics fear that Novo Nordisk will be too successful in converting doctors. Clinicians often find drugs — such as overprescribed antidepressants — are a convenient crutch when they lack the time or skill to dig into the complex roots of a problem. Krista Varady, a professor of nutrition at the University of Illinois, recounts her “eye-opening” experience at a conference of diabetes specialists who have used GLP-1 for years. Some said they immediately put 95 percent of patients on the drug without waiting to see if diet or exercise would work. “I was shocked,” she says. “But our system is designed to treat the sick, not to do prevention.”

We’re a society that likes to take a pill for our failure to take responsibility for our health. Diet and exercise should always be the first choice, but if a drug with serious potential side effects has to be used every week, there are serious drawbacks.