Every January the news and social media recap events from the year gone by and try to forecast the headlines of the year ahead. New Year’s Resolutions are always a popular topic even though most of us seem to recycle the ones we made last year. Statistica (a leading supplier of marketing and consumer data) tells us that this year’s top three resolutions were to exercise more, eat healthier, and lose weight—no surprise there. We recognize that excess weight and its associated health risks are a serious national problem. But 2023 may bring us new possibilities for treating obesity.
New Medication Earns FDA Approval
A little over a year ago, the FDA approved Wegovy (semaglutide) for adults with obesity and overweight individuals who have other health risk factors (ex., hypertension, type 2 diabetes, high cholesterol). The first medication in this class (called GLP-1 agonists) was approved in 2005 to treat type 2 diabetes, and others have followed. These medications improved the management of diabetes, but physicians noted that most patients were also losing weight.
GLP-1 agonists effect metabolism in several different ways. They increase the time food remains in the stomach and digestive system. The individual feels full longer. They also seem to affect the brain’s control of appetite.
The FDA’s recent action makes Wegovy the first of these drugs approved specifically for weight management. After a recent study reported that patients receiving a similar diabetes medication (Mounjaro) had lost over 20% of their body weight, the FDA has agreed to give Mounjaro an expedited review.
What the Future May Hold
Physicians specializing in obesity medicine are hopeful that the new medications may represent a real breakthrough; perhaps an alternative to weight-loss surgery. Dr. Timothy Garvey, Professor of Medicine—UAB Department of Nutrition Sciences, said “This is a game-changer,” and he added “I think this truly gives us a very powerful tool to treat obesity as a disease.” Note: specialists regard the medication as only one part of an effective treatment plan that also includes nutrition education, physical exercise, and attention to other medical needs.
Doctors also caution that defining how to best use the new drugs will require more research. It is not clear whether weight loss can be maintained after stopping the medication. It is possible that weight management with these medications might be life-long, as with diabetes management. Studies will provide more information about the safety of long-term use and patients’ tolerance of side-effects.
FDA approval means that the new drug is considered safe and effective for its intended use. Possible side-effects can include nausea, vomiting, diarrhea, constipation. Physicians increase the dose slowly or adjust it as needed to manage any side effects the patient experiences. Individuals with certain conditions in their medical history will not be eligible to use these medications.
We cannot say whether these medications will become the new future of weight-loss management. Both Wegovy and Mounjaro are taken by a once-weekly self-injection. Patients are monitored with regular lab work. The products are very expensive ($1000 +/- per month), and right now few insurance companies are covering their cost. Wegovy is in very short supply, since its manufacturer did not expect such high demand for their new product. Insurers will likely face enormous pressure from physicians and the general public to provide coverage if the news about weight-loss effectiveness continues to be so positive. (Note: manufacturers sometimes offer a trial period at a very reasonable cost enabling patients to see whether the drug is effective for them).
A Word of Caution
Despite the obstacles, demand has increased rapidly. The current high-cost and high-demand create some very real safety concerns. Online practitioners and others who may be underqualified to safely monitor a patient’s use of the drug are offering quick access to prescriptions. Internet ads claiming very discounted prices prey on individuals struggling with obesity. We strongly discourage purchasing any medication from an unknown online source! Here is the FDA’s guidance.
The public will need to rely on their trusted providers even as headlines forecast that these could be the highest-selling drugs of all time. Still, 2023 may bring a significant advance in obesity care. We hope so.