In July, the New England Journal of Medicine published a study regarding the use of recently approved type 2 diabetes drug tirzepatide to treat obesity. As a specialist in obesity medicine, I am excited about the potential impact that new drugs like this can have in fighting the global obesity epidemic.
Tirzepatide is a new type of medicine that helps regulate appetite, blood sugar and energy balance. When initial clinical trials involving individuals with type 2 diabetes suggested that tirzepatide use also led to significant weight loss, the drug’s maker, Eli Lilly, initiated a separate study to test the drug as a specific treatment for obesity in people without diabetes.
The study included more than 2,500 volunteers, each with a body mass index of 30 or more or 27 or more and at least one weight-related health problem, excluding diabetes. Participants received a once-weekly injection of tirzepatide or a placebo for 72 weeks. All participants also received regular counseling sessions to help them maintain a healthy, low-calorie diet and engage in at least 150 minutes of exercise per week. Participants who completed the trial lost a significant percentage of their body weight, with those in the cohort receiving the highest dose (15 mg) losing 20.9%, while those in the placebo group who were on the program for diet and physical activity alone, they lost an average of 3.1%. In addition, weight loss with tirzepatide was accompanied by improvements in all cardiovascular and metabolic risk factors measured.
In summary, the trial produced very promising results, leading the editors of the New England Journal of Medicine to write that it was “remarkable that the rate of weight loss with tirzepatide was similar to that with gastric bypass, raising the potential for alternative medical approaches to treatment of obesity.” Dr. Louis J. Aronne, director of Weill Cornell Medicine’s Comprehensive Weight Management Center and the study’s principal investigator, told me that “we’ve known for a long time that treating obesity also treats all the complications associated with weight, but we didn’t have therapies that were effective enough. Now with the advent of drugs like tirzepatide, we can achieve much greater weight loss, which allows our patients to achieve all the health benefits we’re looking for. These new highly effective drugs may finally change the treatment paradigm to focus on weight first, instead of treating only a small number of conditions separately weight related harvests.
The successful action of this new drug is potentially important for a number of reasons. First and most immediately, helping obese people lose significant amounts of weight can allow these people to live healthier lives and avoid many of the complications—such as cardiovascular disease, type 2 diabetes, and various cancers—that usually accompany obesity. Given how complex the disease is and how highly personalized treatment must be, what works for one individual may not be appropriate for another, so any new anti-obesity drug is welcome; the more options we have the better. And these trial results suggest that tirzepatide may be not just another option, but a significantly more effective one.
Second, the more anti-obesity drugs are available and the more effective they are, the more health insurance companies will see the value in covering the medical treatment of obesity and seek to address this chronic disease early before it develops. additional complications. The older drugs Contrave and Qsymia are approved to treat chronic obesity and typically result in weight loss in the 5-10% range. A new drug, Wegovy, approved last year, was the first breakthrough drug to produce 15 percent weight loss and proved so successful that it doubled the number of prescriptions for the brand-name anti-obesity drug in one year. Although the American Medical Association recognized obesity as a chronic disease in 2013, many health plans still exclude obesity drugs from coverage because they view obesity as a simple lifestyle problem or consider weight loss to be “cosmetic” or ” vanity’ treatment. As insurance coverage expands, more people will have access to care, which should lead to improved individual health outcomes and ultimately a reduction in the overall burden of health care costs.
Finally, wider recognition in the health care and insurance industry that obesity is indeed a complex chronic disease may help reduce weight bias and stigma. More than 42% of American adults are obese, but less than 2% of those eligible receive medical treatment for obesity. Most providers have received little education in treating obesity, and among some the perception persists that obesity is the result of a lack of willpower: If their patients simply exercised more and ate less, they would lose all those extra pounds. But the reality is much more complicated than “calories in, calories out.” The human body has evolved a wide variety of hormonal, metabolic, and neurobehavioral mechanisms to actively resist weight loss, and lifestyle interventions alone do not work for most people with obesity. As providers, we should neither shame our patients for being overweight nor simply ignore the problem. We must treat obesity like any other medical condition—with compassion and following the best evidence-based standards of care.
The medical approach to weight loss is not just about drugs; there is no miracle substance that will magically shed the pounds. Instead, it’s a multifaceted approach that uses every tool in the toolbox to identify and comprehensively address all of the factors contributing to a person’s weight gain. Diet and physical activity will be key components of any long-term weight management plan, but the drivers of obesity include a wide range of additional variables, including other health conditions, medications, genetics, sleep patterns, previous experience with weight loss, socio- economic circumstances and many others. Providers must consider all of these factors to determine which interventions—including pharmacotherapy when appropriate—will be most effective for a given patient.
For people who have tried and failed to succeed with diet and exercise alone, we now have another weapon and another reason for hope.
Photo: puhimec, Getty Images