This is partly because the effective treatment options for obesity that already exist are underutilized. Bariatric surgery, for example, is an effective way of dealing with excess weight. However, surgery is seen as a drastic option, and Americans tend not to think twice about weight loss surgery. Only a small percentage of those who require a BMI and are eligible undergo surgery. This is one reason why obesity experts see great potential in new drugs.
But there are significant hurdles to widespread adoption, not just the cost and approval issues that all medicines face before they reach the public. Weight loss drugs have had a troubled past. “If you look back at the history of obesity, approved drugs have been taken off the market,” he says. Dr. Spencer Nadolski, a doctor who runs an obesity program for telemedicine provider Weekend Health. Dangerous amphetamines were used as appetite suppressants, and recent drugs like the weight-loss drug Phenfen, which was widely used in the 1990s, caused heart problems and led to FDA bans. Safer weight loss drugs began reappearing in his 2000s, but their effects were often mild.
Meanwhile, incretins continue to be more and more effective. The latest of these drugs causes weight loss of about 20%, within the same range that bariatric surgery achieves. Dr. Fatima Stanford, an obesity expert at Harvard Medical School, says some patients responded so strongly to her one of the incretins, semaglutide, that they avoided surgery altogether. “They went from being severely obese with diabetes to being in a healthy weight range without being diabetic and without being severely obese,” she said. It’s changing the way our brains see weight.” This has a huge impact on quality of life. “Losing 15-20% of your body weight is a big deal when you’re overweight, right?
A 50-something Washington woman named Suzy, asked to specify only her first name, lost 26 pounds after starting tirzepitide. She has her three siblings with her type 2 diabetes and her two parents. With the drug, she believes that her illness can be avoided. Another woman, Rachel McLaughlin, who started oral incretin in 2021, said her weight loss gave her the confidence to attend art class: “I weigh the world.” It doesn’t look like you’re carrying it,” she said.
But even the most impressive advances in medical technology are meaningless without access. McLaughlin faced his setback when he lost his job earlier this year. When he lost his health insurance, the cost of his prescriptions increased from $25 a month to over $2,000 for him. Off her medication, she regained 15 of the 25 pounds she had lost. It was only in June when she found a new job and her coverage was restored that her progress resumed.
