In July, the New England Journal of Medicine published a study on the use of the recently approved type 2 diabetes drug tirzepatide for the treatment of obesity. As an obesity medicine specialist, I’m excited about the potential impact that novel drugs like this can make in combating the global epidemic of obesity.
Tirzepatide is a new type of drug that helps regulate appetite, blood sugar and energy balance. When initial clinical trials involving individuals with type 2 diabetes suggested that use of tirzepatide also resulted in considerable weight loss, the drug maker, Eli Lilly, initiated a separate study to test the drug as a specific treatment for obesity in individuals without diabetes.
The trial involved 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 either a once weekly injection of tirzepatide or placebo for 72 weeks. All participants also received regular counseling sessions to help them maintain a healthful, lower-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 percent, while those in the placebo group, who were on the program of diet and physical activity only, lost an average of 3.1%. In addition, weight loss with tirzepatide was accompanied by improvements in all measured cardiovascular and metabolic risk factors.
In short, the trial produced highly promising results, leading the New England Journal of Medicine’s editors to write that it is “remarkable that the magnitude of weight loss with tirzepatide was similar to that with gastric bypass, which raises the potential for alternative medical approaches to the treatment of obesity.” Dr. Louis J. Aronne, director of Weill Cornell Medicine’s comprehensive weight control center and the study’s principal investigator, told me that “for a long time, we’ve known that treating obesity also treats all of the weight-related complications, but we haven’t had therapies that have been effective enough. Now with the advent of drugs like tirzepatide, we can achieve much greater weight loss, which enables our patients to attain all of the health benefits that we’ve been seeking. These new highly effective medications can finally change the treatment paradigm to focus on weight first instead of treating just a small number of the weight-related complications separately.”
The successful performance of this new drug is potentially important for a number of reasons. First and most immediately, helping people with obesity to lose a substantial amount of weight can enable these individuals to live healthier lives and avoid many of the complications — such as cardiovascular disease, type 2 diabetes, and various kinds of cancer — that commonly accompany obesity. Considering how complex the disease is and how highly personalized treatment needs to be, what works for one individual may not be appropriate for another, so any new anti-obesity medication is welcome; the more options we have, the better. And these trial results suggest that tirzepatide may be not just another option but a notably more effective one.
Second, the more anti-obesity medications that are available, and the more effective they are, the more health insurance companies will see the value of covering medical obesity treatment and seeking to tackle this chronic disease early, before further complications develop. Older drugs Contrave and Qsymia are approved for chronic obesity treatment and generally produce weight loss in the range of 5-10%. A new medication, Wegovy, approved last year, was the first breakthrough drug to produce 15% weight loss and it has proven so successful that it doubled the number of prescriptions for branded anti-obesity medications in one year. Although the American Medical Association recognized obesity as a chronic disease in 2013, many health plans still exclude obesity medications from coverage, as they view obesity as a mere lifestyle issue or consider weight loss to be a “cosmetic” or “vanity” treatment. As insurance coverage expands, more people will be able to access care, which should lead to improved individual health outcomes and ultimately a reduction in the overall healthcare cost burden.
Finally, broader recognition within healthcare and the insurance industry that obesity is indeed a complex chronic disease can help reduce weight bias and stigma. More than 42% of American adults have obesity, but fewer than 2% of those eligible are receiving medical obesity treatment. Most providers have received little education on treating obesity, and the perception endures among some that obesity is the result of a lack of willpower: if their patients would just exercise more and eat less, they’d drop 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 losing weight, and lifestyle interventions alone do not work for most people with obesity. As providers, we should neither shame our patients for having excess weight nor simply ignore the issue. We need to treat obesity like any other medical condition — with compassion and following the best evidence-based standards of care.
A medical approach to weight loss is not just about drugs; there’s no miracle substance that will magically take the pounds off. Instead, it’s a multifaceted approach that uses every tool in the toolbox to identify and comprehensively address all 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 weight-loss experience, socioeconomic circumstances and many others. Providers must take all these factors into account in order to identify which interventions — including pharmacotherapy, when appropriate — will be most effective for any given patient.
For individuals who have tried and failed to find success with diet and exercise alone, we now have one more weapon and one more reason for hope.
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