Newswise — Hyperthyroidism treatment like radioactive iodine or surgery was associated with a decreased risk for death, according to research being presented Saturday at ENDO 2023, the Endocrine Society’s annual meeting in Chicago.
“Hyperthyroidism or an overactive thyroid gland is common, affecting up to 3% of the population, and is associated with long-term adverse cardiac and metabolic consequences. The optimal treatment choice remains unclear,” said Kristien Boelaert, M.D., Ph.D., a professor of endocrinology from the University of Birmingham in the United Kingdom.
Boelaert and colleagues identified 55,318 patients with newly diagnosed hyperthyroidism, treated with antithyroid drugs (ATD; 77.6%), radioiodine (14.6%), or thyroidectomy (7.8%) from a U.K. population-based electronic health record database for the EGRET Study.
They examined all-cause mortality, major cardiovascular events (MACE: cardiovascular death, heart failure, or stroke), and post-treatment obesity. The average follow-up was roughly 12 years.
Those treated with antithyroid drugs had an estimated mean survival of 12 years, according to the data. Survival increased in those treated with radioiodine by 1.7 years and thyroidectomy by 1.1 years. People treated with antithyroid drugs had an estimated 10.2% risk of MACE, which significantly increased by an additional 1.3% with radioiodine but not with thyroidectomy.
These definitive treatments were associated with a significantly increased survival, despite a small increased risk for overall weight gain. For example, thyroidectomy was associated with an increased likelihood of obesity in both men and women. Radioiodine treatment led to increased obesity risk in women, but not in men.
“Our findings are important and will inform decision-making processes for patients and clinicians when considering optimal treatment options and are likely to impact clinical practice guidelines in the future,” Boelaert said.
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Endocrinologists are at the core of solving the most pressing health problems of our time, from diabetes and obesity to infertility, bone health, and hormone-related cancers. The Endocrine Society is the world’s oldest and largest organization of scientists devoted to hormone research and physicians who care for people with hormone-related conditions.
The Society has more than 18,000 members, including scientists, physicians, educators, nurses and students in 122 countries. To learn more about the Society and the field of endocrinology, visit our site at www.endocrine.org. Follow us on Twitter at @TheEndoSociety and @EndoMedia.
Newswise — CHICAGO—People with obesity may have lower work productivity due to increased risk of illness, contributing to increased costs for employers, according to industry-supported research being presented Saturday at ENDO 2023, the Endocrine Society’s annual meeting, in Chicago, Ill.
Obesity is a significant public health issue affecting approximately 42% of people in the United States. Employees with overweight or obesity are more likely to develop weight-related comorbidities such as type 2 diabetes, hypertension, sleep apnea, cardiovascular disease, and cancer, which all contribute to lower work productivity.
“Employees with overweight and obesity may have higher loss of work productivity as measured by absenteeism, short and long-term disability, and worker’s compensation compared to employees with normal weight,” said Clare J. Lee, M.D., of Eli Lilly & Company in Indianapolis, Ind.
Co-author Shraddha Shinde M.B.A, also of Eli Lilly & Company, added that, “Given the substantial burden of overweight and obesity on employee health and function that was demonstrated by this study, employers should focus on building tailored interventions that could be beneficial in improving the health of these individuals.”
The researchers evaluated 719,482 employees with and without obesity in the MarketScan databases. They determined the percentage of employees with work loss, number of hours/days lost from work, and costs associated with productivity loss were higher among people with overweight or obesity. The loss of work productivity was greater with each higher Body Mass Index (BMI) category.
The researchers found costs associated with absenteeism, short and long-term disability, and worker’s compensation were $891, $623, $41, and $112 higher per year (respectively) for people with obesity compared to those with normal weight.
Funding for this study was provided by Eli Lilly and Company.
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Endocrinologists are at the core of solving the most pressing health problems of our time, from diabetes and obesity to infertility, bone health, and hormone-related cancers. The Endocrine Society is the world’s oldest and largest organization of scientists devoted to hormone research and physicians who care for people with hormone-related conditions.
The Society has more than 18,000 members, including scientists, physicians, educators, nurses and students in 122 countries. To learn more about the Society and the field of endocrinology, visit our site at www.endocrine.org. Follow us on Twitter at @TheEndoSociety and @EndoMedia.
Newswise — CHICAGO—By being undiagnosed or untreated, a significant fraction of people with obesity or overweight are not getting the recommended care, despite an increase in new treatment options, according to research being presented on June 17 at ENDO 2023, the Endocrine Society’s annual meeting in Chicago, Ill.
“The number of people with obesity is high and rising in the adult U.S. population. Obesity is a complex and expensive disease that has been implicated in many chronic conditions including high blood pressure, diabetes, and cardiovascular diseases,” said Kyrian Ezendu, Ph.D., an Eli Lilly and Company advisor on benefit-risk research. “Medications to treat obesity are an integral part of long-term care for people with excess weight and are recommended for people with obesity or people with overweight and at least one obesity-related condition.”
Ezendu and colleagues used data from linked electronic health records and insurance claims of people ages 18 to 80 years who were eligible for obesity medications each year from 2016 to 2021. The anti-obesity medications included phentermine-topiramate, lorcaserin, orlistat, naltrexone-bupropion, liraglutide and semaglutide.
There were approximately 1.6 million to 2.2 million adults with overweight or obesity, eligible for obesity medications in the study cohort for each year.
The overall obesity diagnosis rate based on both electronic health records and claims increased from 39.4% in 2016 to 57.2% in 2021. However, diagnosis rates from insurance claims alone were only 33.5% in 2016 and 47.3% in 2021.
Similarly, the overweight diagnosis rate grew from 18.1% in 2016 to 31.2% in 2021. Meanwhile, the claims-based rate was 15.4% in 2016 and 29.2% in 2021.
Prescribing rates for anti-obesity medications were low, according to the researchers, ranging from 0.4% to 0.5% across all years. Much like the obesity diagnosis and overweight diagnosis rates, the prescription fill rates showed an increase from 0.4% in 2016 to 0.6% in 2021.
Of note, the prescribing and fill rates from 2016 to 2021 for liraglutide doubled (from 0.1% to 0.2%). For semaglutide, it quadrupled (from 0.1% to 0.4%).
“This research demonstrates a potential gap in clinical care for people with obesity and overweight. Proper documentation of the clinical diagnosis may facilitate guideline-based treatment of obesity and overweight, particularly with the availability of several FDA-approved medications for use as an adjunct to lifestyle changes in managing obesity or overweight,” Ezendu said.
You can’t deny the buzz. Credit Suisse analyst Trung Huynh has combed through social media and is impressed by the awareness — and demand — for GLP-1 medications such as Eli Lilly ‘s Mounjaro. “Although we caution posts may have responder bias, and comments are in the public domain and unconfirmed, nonetheless we have parsed through and curated an archive of the most interesting observations that provide an alternative perspective to traditional data, in our view,” Huynh said in a research note Thursday. Among those observations are reports of other potential benefits that patients taking Mounjaro, or tirzepatide, are seeing. To recap, Mounjaro has been approved as a treatment for type 2 diabetes, but the drug is expected to be cleared by the Food and Drug Administration, possibly by the end of this year, to treat obesity and overweight. Patients enrolled in Lilly’s studies have lost as much as 20% or more of their initial weight when taking the drug, topping results from other available medications. The company is also conducting several additional trials to explore the use of tirzepatide to treat other conditions like sleep apnea. Huynh reported seeing social media posts where people with sleep apnea said they were able to get better sleep quality or discontinue the use of a CPAP machine after losing weight on Mounjaro. Others taking the drug reported benefits such as a reduction in addiction behaviors such as smoking, drinking, gambling and shopping, among other things. “Although relatively unsurprising given the literature suggests GLP agonism suppresses hedonic food intake through the brain reward pathway, we are very interested in the potentially far-reaching effect beyond obesity and T2D,” Huynh said. He noted that other comments suggested uses for the drug to treat infertility and polycystic ovary syndrome, a condition that has a 50% to 60% overlap with obesity. Although Lilly hasn’t said it’s exploring this indication, Novo Nordisk — which has a rival GLP-1 medication, semaglutide — has registered a new study to evaluate this. The biggest point of caution is that social media chatter suggests that health insurance providers are becoming more restrictive with reimbursement. However, this may be a function of patients who are trying to use Mounjaro off-label for obesity, he said. GLP-1 medications carry hefty price tags. To assist with payments, Lilly is offering a $575 copay coupon that expires at the end of the year, Huynh said. Credit Suisse has an outperform rating on Lilly shares, with a $490 price target, which implies more than 9% upside from where Lilly shares closed Wednesday. LLY YTD mountain LLY in 2023 — CNBC’s Michael Bloom contributed reporting.
Newswise — Boston – Women with obesity when they are diagnosed with early breast cancer have a higher risk of recurrence or a second cancer compared to women whose weight is in the normal range and it can be hard to lose weight after being diagnosed with breast cancer. Now, a clinical trial has shown that a telephone-based weight loss program can help patients with breast cancer whose body mass index is in the overweight or obese range lower their weight by a meaningful degree.
The findings, to be reported by Dana-Farber Cancer Institute investigators at the American Society of Clinical Oncology (ASCO) Annual Meeting, set the stage for follow-up research into whether this type of program can extend patients’ survival and lower their risk of a breast cancer recurrence.
“We know that women with obesity when they are diagnosed with breast cancer have a higher risk of dying of the disease, of developing second cancers, and of dying from any cause,” says Dana-Farber’s Jennifer Ligibel, MD, the principal investigator of the trial, who will present the findings at ASCO. “But we don’t know whether helping patients lose weight after diagnosis will improve treatment outcomes. That’s what this study seeks to discover.”
The Breast Cancer Weight Loss (BWEL) trial, a Phase III trial supported by the National Cancer Institute, enrolled nearly 3,200 women from more than 600 cancer treatment centers in the U.S. and Canada. The participants, who had been diagnosed with stage 2 or 3 HER2-negative breast cancer, had completed chemotherapy and radiation therapy (if it was to be administered) and were randomly assigned to receive either a telephone-based weight-loss program plus health education or health education alone. The weight-loss program, conducted by phone, coached patients in reducing their calorie intake and increasing exercise.
Participants’ height and weight were measured when they entered the study and 12 months later. At the 12-month mark, researchers checked the weight of nearly 2,400 patients who were free of breast cancer.
“We found the weight-loss program was highly successful in helping patients lower their weight,” Ligibel says. Women who received the telephone-based intervention lost an average of 4.8% of their baseline body weight, compared to an average 0.9% increase in body weight among those in the control group.
The findings were especially noteworthy in that they were consistent regardless of patients’ age, race, ethnicity, socioeconomic status, and education level, and type of breast cancer they had.
Within this overall trend, however, researchers noticed some differences in patterns of weight change among the participants. While the weight-loss program was effective in both older and younger patients, younger women experienced a somewhat smaller weight loss. Younger women who didn’t receive weight-loss coaching gained a bit more weight than older participants, so the amount of weight change was relatively similar in older and younger patients.
A similar pattern occurred among Black patients, who made up 13% of trial participants. Black women in the weight-loss program group lost less weight, on average, than others but Black women in the control group gained more weight than control participants of other races and ethnicities. However, women in the weight loss program lost more weight than women in the control group, regardless of their age, race, ethnicity, or other characteristics.
The results provide a lead-in to the next phase of the study. “We’ll continue to follow patients who enrolled in the BWEL trial to determine whether the weight-loss program reduces the risk of cancer recurrence and cancer-related mortality,” Ligibel remarks. “We hope this research ultimately shows that healthy lifestyle change after a cancer diagnosis has a positive impact on outcomes, so we’ll be able to routinely offer this type of program to patients as a part of their breast cancer care.”
Ligibel will present results from the BWEL trial during the Oral Abstract Session on Symptoms and Survivorship (Abstract 12001) during ASCO in Chicago on June 5, 2023, 9:12am ET.
About Dana-Farber Cancer Institute
Dana-Farber Cancer Institute is one of the world’s leading centers of cancer research and treatment. Dana-Farber’s mission is to reduce the burden of cancer through scientific inquiry, clinical care, education, community engagement, and advocacy. We provide the latest treatments in cancer for adults through Dana-Farber Brigham Cancer Center and for children through Dana-Farber/Boston Children’s Cancer and Blood Disorders Center. Dana-Farber is the only hospital nationwide with a top 5 U.S. News & World Report Best Cancer Hospital ranking in both adult and pediatric care.
As a global leader in oncology, Dana-Farber is dedicated to a unique and equal balance between cancer research and care, translating the results of discovery into new treatments for patients locally and around the world, offering more than 1,100 clinical trials.
Somehow, America’s desire for Ozempic is only growing. The drug’s active ingredient, semaglutide, is sold as an obesity medication under the brand name Wegovy—and it has become so popular that its manufacturer, Novo Nordisk, recently limited shipments to the U.S. and paused advertising to prevent shortages. Its promise has enticed would-be patients and set off a pharmaceutical arms race to create more potent drugs.
Part of the interest stems from Ozempic’s potential in teens: In December, the FDA approved Wegovy as a treatment for teenagers with obesity, which affects 22 percent of 12-to-19-year-olds in the United States. The drug’s ability to spur weight loss in adolescents has been described as “mind-blowing.” In January, in its new childhood-obesity-treatment guidelines, the American Academy of Pediatrics (AAP) recommended that doctors consider adding weight-loss drugs such as semaglutide as a treatment for some patients.
But although many doctors and obesity experts have embraced semaglutide as a treatment for adults, some are concerned that taking it at such a young age—and at such a precarious stage of life—could pose serious risks, especially because the long-term physical and mental-health effects of the medication are still unknown. Others, however, believe that not using this medication in adolescents is riskier, because obesity makes teens vulnerable to serious health conditions and premature death. In part because of the apprehension among doctors, prescriptions for semaglutide in teens are not taking off like they are for adults. At this point, whether these drugs will ever catch on as a treatment for teens remains deeply uncertain.
Semaglutide isn’t just effective for teens; it may be even more effective than it is in adults. In a large Novo Nordisk–funded study published in The New England Journal of Medicine, “the degree of weight reduction in adolescents was better than what was observed in the adult trials,” Aaron S. Kelly, a co-director of the Center for Pediatric Obesity Medicine at the University of Minnesota Medical School, told me. In another Novo Nordisk–funded study published last week, a team led by Kelly showed that the drug, combined with counseling and exercise, nearly halved the number of teens with obesity after they received 68 weeks of treatment. Both for adolescents and adults, the weekly injection doesn’t “magically melt away body fat,” Kelly said; instead, it works by triggering a sense of fullness and quieting hunger pangs.
Teenagers’ experience with obesity is different—in some ways more intense—than that of older people. Puberty is a time of lots of growth and development, so the body fights off attempts at weight loss “with every mechanism that it has,” Tamara Hannon, a pediatric endocrinologist at the Indiana University School of Medicine, told me. Teenagers may also have less control than adults over what they eat or how much activity they get, because these are largely circumscribed by their family and school, as well as by social pressure to conform to how their peers eat. “Making good choices means doing something different than the majority of the other kids,” Hannon said. “At every corner, there’s something that is in direct opposition to losing weight.”
Because obesity is a chronic disease, developing it early can be devastating. In many cases, it can result in illnesses such as type 2 diabetes and fatty liver at a young age. Children with obesity are five times more likely than their peers to have it in adulthood; as teens with obesity become adults with obesity, they can “develop very, very aggressive disease,” Fatima Stanford, an obesity-medicine physician at Massachusetts General Hospital and Harvard Medical School, told me. Weight-loss drugs give doctors the ability to intervene before the effects of obesity snowball, she said, which is why AAP’s new childhood-obesity guidelines advocate for using them as part of early, aggressive treatment—along with many hours of in-person health and lifestyle therapy. Used early enough, semaglutide or other medications could possibly reroute the trajectory of a teenager’s entire life.
But semaglutide could also possibly throw a teen’s trajectory off course. Because treatment is considered a lifelong endeavor—stopping usually leads to rapid weight regain—adolescents who start the medication will be taking it for many decades. “We have no way of knowing whether these drugs, used so early in life for so long, could have unanticipated adverse effects,” David Ludwig, an endocrinologist at Boston Children’s Hospital, told me. Although adults face many of the same unknowns, the risks for teens could be more severe, because their body and brain are in constant flux. Of particular concern are the drug’s potential impacts on physiological changes specific to adolescence. “We need to keep an eye on pubertal development and menstrual history for girls,” Hannon said. In addition, the drugs can lead to unsavory side effects such as gastrointestinal issues and may have other impacts, including significant muscle loss and rewiring of the brain’s reward circuitry. Scientists are just beginning to understand these effects; at this point, only two major studies have been conducted on semaglutide in teens, and neither has involved a long follow-up period.
The repercussions of semaglutide treatment on mental health, an important aspect of obesity care, are even less understood. Teens are “more likely than an adult to have intermittent access to medication,” Kathleen Miller, an adolescent-medicine specialist at Children’s Minnesota hospital, told me—and skipping several doses in a row could pose physical and well as psychological risks. Another concern is that the overall effect of taking semaglutide—a decreased appetite, which leads to eating less—is essentially the same as that of dieting. When teens go on very restrictive diets, whether or not they involve weight-loss medications, “we know that may be harmful to their mental health and promote disordered eating,” Hannon said. Because their brain is so plastic during puberty, “there’s a risk of ingraining those patterns in adolescence,” Miller said.
With so many unknowns, would teens with obesity be better off avoiding semaglutide? At least for now, many pediatricians are reluctant to prescribe it. “The idea of using anti-obesity pharmacotherapy was challenging even in adults a couple of years ago,” says Angela Fitch, an assistant professor at Harvard Medical School and the president of the Obesity Medicine Association; acceptance of its role in pediatric care is even further behind. But denying teens the drug, she told me, is the biggest risk: Teens develop an unhealthy mentality about their body when they don’t get help losing weight. Explaining to a teen that obesity is not their fault, and correcting the underlying biological issue with medication or other treatment, helps them to develop “a better body image about themselves,” she said.
None of the experts I spoke with flat-out said that semaglutide should never be used in adolescent treatment. Even those who were wary of the drug acknowledged that it might be medically appropriate in teens who really struggle with their weight and have little success losing it through any other means. That argument may only strengthen as more convenient drugs—or those with fewer side effects—are approved for teen use. This week, both Novo Nordisk and Pfizer announced that pill versions of these medications were successful in early trials.
Even without all of the answers on how this drug might affect teens in the long term, Fitch predicted that “the uptake of semaglutide and other anti-obesity medications in pediatric clinical care will be slow and gradual.” Eventually, they may come to be seen as just one of several weight-loss tools to help set up kids for healthier lives. Treating adolescent obesity shouldn’t be an “either-or” choice, Ludwig said: “It’s everything-and.” He has proposed that combining semaglutide with a low-carbohydrate diet, for example, could have synergistic effects on adolescent weight loss.
For the foreseeable future, semaglutide isn’t poised to take off for teens in the way that it has for adults. In spite of all the hype surrounding Ozempic, experts and their patients are left with a difficult choice based on different assessments of risk: what might happen if teens are treated with drugs, and what might happen if they’re not. Either way, teenagers have the most to benefit—and the most to lose.
Weight Loss Before Afib Ablation Procedure Results in Improved Outcomes Among Obese Patients
Results from a new clinical trial found overweight and obese patients with persistent and paroxysmal atrial fibrillation (AF) who lose weight prior to a catheter ablation procedure have improved clinical outcomes. The study, led by researchers with UHealth – the University of Miami Health System and the Miller School of Medicine, identifies weight loss before undergoing an ablation procedure as a risk-factor reduction tool for AF patients. Findings were presented today as a late-breaking clinical trial during Heart Rhythm 2023.
Expert: Jeffrey Goldberger, M.D., M.B.A, Director, Center for Atrial Fibrillation, Professor of Medicine & Biomedical Engineering at UHealth – the University of Miami health System and the Miami Miller School of Medicine.
Quote:
“We are constantly evolving our approach to AF to identify new ways to prevent recurrence and improve long term outcomes. While we already know the impact weight can have on overall outcomes, we believe the magnitude of the effect during this study is quite striking and that the findings show that even moderate weight loss may lead to a positive effect, but further analysis incorporating the potential independent contribution of Liraglutide is necessary” said Dr. Goldberger. “We hope that our findings will encourage physicians to integrate weight loss and risk factor modification into their treatment plans for patients undergoing catheter ablation and drive even more research dedicated to finding additional supportive solutions for patients living with AF.”
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University of Miami Health System, Miller School of Medicine
Newswise — Results from a new clinical trial found overweight and obese patients with persistent and paroxysmal atrial fibrillation (AF) who lose weight prior to a catheter ablation procedure have improved clinical outcomes. The study, led by researchers with UHealth – the University of Miami Health System and the Miller School of Medicine, identifies weight loss before undergoing an ablation procedure as a risk-factor reduction tool for AF patients. Findings were presented today as a late-breaking clinical trial during Heart Rhythm 2023.
AF is the most common type of arrhythmia. There are approximately 2.3 million people in the United States who have AF, with 160,000 new cases diagnosed every year. Catheter ablation is a frequently used treatment for people with arrhythmias that can’t be controlled by medication or with certain types of arrhythmias from the heart’s upper chambers.1 While catheter ablation is a common AF treatment option, researchers are continuously evaluating how to improve AF ablation patient outcomes. This trial sought to determine whether additional non-ablation therapy targets can be integrated into treatment plans for patients undergoing catheter ablation for persistent AF and paroxysmal AF.
In the study, 65 patients with BMI≥27 kg/m2 who opted for catheter ablation to treat AF were enrolled and randomized to a 3-month pre-ablation period of standard risk factor modification (RFM) or RFM plus Liraglutide. From the enrolled participants, there were 59 patients (age 62±9 years, 27% female) weighing 106.4±18.5 kg (BMI 36.1±5.8 kg/m2); 79% had persistent AF and 21% had paroxysmal AF with 85% having hypertension, 27% diabetes, and 44% obstructive sleep apnea. Patients with a <3% weight change prior to their ablation procedure were labeled as Group 1 and patients with a ≥3-10% weight change were classified as Group 2.
The results showed AF status from enrollment to 6 months post-ablation. Group 1 had 29 patients with 0.2±2.7% weight gain and Group 2 had 30 patients with 5.6±1.8% weight loss. Freedom from AF off antiarrhythmic drugs at 6 months was 61% in Group 1 versus 88% in Group 2 (Fisher’s Test p=0.046, OLR p=0.0431). For patients with persistent AF treated with ablation (including one whose AF resolved with weight loss), freedom from AF off antiarrhythmic drugs at 6 months was 61% in Group 1 versus 90% in Group 2 (Fisher’s Test p=0.058, OLR p=0.051) and at 12 months was 42% in Group 1 versus 81% in Group 2 (Fisher’s Test p=0.050, OLR p=0.038).1 Catheter ablation. Catheter Ablation | Johns Hopkins Medicine. (2021, February 22)
“We are constantly evolving our approach to AF to identify new ways to prevent recurrence and improve long term outcomes. While we already know the impact weight can have on overall outcomes, we believe the magnitude of the effect during this study is quite striking and that the findings show that even moderate weight loss may lead to a positive effect, but further analysis incorporating the potential independent contribution of Liraglutide is necessary” said Jeffrey Goldberger, M.D., M.B.A, Director, Center for Atrial Fibrillation, Professor of Medicine & Biomedical Engineering at UHealth – the University of Miami health System and the Miami Miller School of Medicine. “We hope that our findings will encourage physicians to integrate weight loss and risk factor modification into their treatment plans for patients undergoing catheter ablation and drive even more research dedicated to finding additional supportive solutions for patients living with AF.”
The authors of this trial would like to see additional trials focused on assessing the role of weight and weight loss in improving AF ablation outcomes and potentially identifying novel procedural approaches.
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University of Miami Health System, Miller School of Medicine
Title 42, the United States pandemic rule that had been used to immediately deport hundreds of thousands of migrants who crossed the border illegally over the last three years, has expired. Those migrants will have the opportunity to apply for asylum. President Biden’s new rules to replace Title 42 are facing legal challenges. The US Homeland Security Department announced a rule to make it extremely difficult for anyone who travels through another country, like Mexico, to qualify for asylum. Border crossings have already risen sharply, as many migrants attempted to cross before the measure expired on Thursday night. Some have said they worry about tighter controls and uncertainty ahead. Immigration is once again a major focus of the media as we examine the humanitarian, political, and public health issues migrants must face.
Below are some of the latest headlines in the Immigration channel on Newswise.
In recent months, there has been a swelling interest in using diabetes drugs to treat weight loss.
Drugs with brand names such as Ozempic and Wegovy have become so popular with Hollywood celebrities and TikTokers; it’s led to a nationwide shortage for diabetics.
But the anti-obesity drug craze is about to be rocked by another major development. The diabetes drug Mounjaro could be approved by the U.S. Food and Drug Administration (FDA) for weight loss later this year, according to manufacturer Eli Lilly. The company just completed a late-stage study of the drug for weight loss and found the participants lost more than 50 pounds in nearly 17 months.
“We have not seen this degree of weight reduction,” Dr. Nadia Ahmad, Lilly’s medical director of obesity clinical development, told CBS News.
Analysts predict that Mounjaro, tirzepatide generically, could become one of the biggest-selling drugs ever. Evaluate Pharma estimates as much as $50 billion in sales by 2028. To put this in perspective, Novo Nordisk, which makes Ozempic and Wegovy, reported combined sales of about $2.4 billion in 2022.
How does Mounjaro work?
Mounjaro was approved by the FDA last year to treat Type 2 diabetes. Patients take it via injection once per week. The drug works by activating two hormones naturally produced in the body that help to reduce appetite and increase feelings of fullness. It also curbs craving signals chemically sent from the gut to the brain.
“Psychologically, you don’t want to eat,” said Matthew Barlow, a health technology executive, told CBS News. “Now I can eat two bites of a dessert and be satisfied.”
Though trials have shown the drugs to be safe, side effects include nausea and constipation.
Mounjaro isn’t cheap. A monthly dose can run as much as $1,400. But if the FDA approves it for weight loss, people prescribed the medication for obesity could more easily be covered by insurance.
As a growing number of overweight Americans clamor for Ozempic and Wegovy — drugs touted by celebrities and on TikTok to pare pounds — an even more powerful obesity medicine is poised to upend treatment.
Tirzepatide, an Eli Lilly and Co. drug approved to treat Type 2 diabetes under the brand name Mounjaro, helped people with the disease who were overweight or had obesity lose up to 16% of their body weight, or more than 34 pounds, over nearly 17 months, the company said on Thursday.
The late-stage study of the drug for weight loss adds to earlier evidence that similar participants without diabetes lost up to 22% of their body weight over that period with weekly injections of the drug. For a typical patient on the highest dose, that meant shedding more than 50 pounds.
Having diabetes makes it notoriously difficult to lose weight, said Dr. Nadia Ahmad, Lilly’s medical director of obesity clinical development, which means the recent results are especially significant. “We have not seen this degree of weight reduction,” she said.
Last August, Rachel Graham’s doctor told her she was prediabetic and about 65 pounds overweight. She told CBS News she asked her doctor about taking Mounjaro, and said she saw consistent result while taking the medication.
“The weight loss was slow and steady, two or three pounds a week, consistently until I had lost 65 pounds,” Graham said.
Based on the new results, which have not yet been published in full, company officials said they will finalize an application to the U.S. Food and Drug Administration for fast-track approval to sell tirzepatide for chronic weight management. A decision could come later this year. A company spokeswoman would not confirm whether the drug would be marketed for weight loss in the U.S. under a different brand name.
Game changer for obesity treatment
If approved for weight loss, tirzepatide could become the most effective drug to date in an arsenal of medications that are transforming the treatment of obesity, which affects more than 4 in 10 American adults and is linked to dozens of diseases that can lead to disability or death.
“If everybody who had obesity in this country lost 20% of their body weight, we would be taking patients off all of these medications for reflux, for diabetes, for hypertension,” said Dr. Caroline Apovian, a director of the Center for Weight Management and Wellness at Brigham and Women’s Hospital. “We would not be sending patients for stent replacement.”
Industry analysts predict that tirzepatide could become one of the top-selling drugs ever, with annual sales topping $50 billion. It is expected to outpace Novo Nordisk’s Ozempic — a diabetes drug used so commonly to shed pounds that comedian Jimmy Kimmel joked about it at the Oscars — and Wegovy, a version of the drug also known as semaglutide approved for weight loss in 2021. Together, those drugs made nearly $10 billion in 2022, with prescriptions continuing to soar, company reports show.
In separate trials, tirzepatide has resulted in greater weight loss than semaglutide, whose users shed about 15% of their body weight over 16 months. A head-to-head trial comparing the two drugs is planned.
“Mounjaro affects two hormone receptors that affect appetite and satiety,” Dr. Scott Isaacs, associate professor of medicine at Emory University, told CBS News. “So it turns out the combination works a little bit better.”
Mounjaro was first approved to treat diabetes last year. Since then, thousands of patients have obtained the drug from doctors and telehealth providers who prescribed it “off-label” to help them slim down.
Drug suppresses appetite
In California, Matthew Barlow, a 48-year-old health technology executive, said he has lost more than 100 pounds since November by using Mounjaro and changing his diet.
“Psychologically, you don’t want to eat,” said Barlow. “Now I can eat two bites of a dessert and be satisfied.”
Rather than relying solely on diet, exercise and willpower to reduce weight, tirzepatide and other new drugs target the digestive and chemical pathways that underlie obesity, suppressing appetite and blunting cravings for food.
“They have entirely changed the landscape,” said Dr. Amy Rothberg, a University of Michigan endocrinologist who directs a virtual weight loss and diabetes program.
Research has shown that with diet and exercise alone, about a third of people will lose 5% or more of their body weight, said Dr. Louis Aronne, director of the Comprehensive Weight Control Center at Weill Cornell Medicine. In the latest tirzepatide trial, more than 86% of patients using the highest dose of the drug lost at least 5% of their body weight. More than half on that dose lost at least 15%, the company said.
The obesity medications help overcome a biological mechanism that kicks in when people diet, triggering a coordinated effort by the body to prevent weight loss.
Potentially serious side effects
“That is a real physical phenomenon,” Aronne said. “There are a number of hormones that respond to reduced calorie intake.”
Ozempic and Wegovy are two versions of semaglutide. That drug mimics a key gut hormone, known as GLP-1, that is activated after people eat, boosting the release of insulin and slowing release of sugar from the liver. It delays digestion and reduces appetite, making people feel full longer.
Tirzepatide is the first drug that uses the action of two hormones, GLP-1 and GIP, for greater effects. It also targets the chemical signals sent from the gut to the brain, curbing cravings and thoughts of food.
Though the drugs appear safe, they can cause side effects, some serious. Most common reactions include diarrhea, nausea, vomiting, constipation and stomach pain. Some users have developed pancreatitis or inflammation of the pancreas, others have had gallbladder problems. Mounjaro’s product description warns that it could cause thyroid tumors, including cancer.
There are other downsides: Versions of semaglutide have been on the market for several years, but the long-term effects of taking drugs that override human metabolism are not yet clear. Early evidence suggests that when people stop taking the medications, they gain the weight back.
Plus, the medications are expensive — and in recent months, hard to get because of intermittent shortages. Wegovy is priced at about $1,300 a month. Mounjaro used for diabetes starts at about $1,000 per month.
Apovian said that only about 20% to 30% of patients with private insurance in her practice find the medications are covered. Some insurers who previously paid for the drugs are enacting new rules, requiring six months of documented lifestyle changes or a certain amount of weight loss for continued coverage. Medicare is largely prohibited from paying for weight-loss drugs, though there have been efforts by drugmakers and advocates for Congress to change that.
Chronic disease, not a character flaw
Still, experts say that the striking effects of tirzepatide — along with Ozempic, Wegovy and other drugs — underscore that losing weight is not merely a matter of willpower. Like high blood pressure, which affects about half of U.S. adults and is managed with medication, obesity should be viewed as a chronic disease, not a character flaw, Aronne emphasized.
It remains to be seen what effect new drug treatments will have on pervasive bias against people with obesity, said Rebecca Puhl, a professor in the Rudd Center for Food Policy and Health, who studies weight stigma. U.S. culture has “deep-rooted beliefs about body weight and physical appearance” that are hard to change, she said.
“Weight stigma could persist or worsen if taking medication is equated with ‘taking the easy way out’ or ‘not trying hard enough,’” she said.
The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group.
As a growing number of overweight Americans clamor for Ozempic and Wegovy — drugs touted by celebrities and on TikTok to pare pounds — an even more powerful obesity medicine is poised to upend treatment.
Tirzepatide, an Eli Lilly and Co. drug approved to treat type 2 diabetes under the brand name Mounjaro, helped people with the disease who were overweight or had obesity lose up to 16% of their body weight, or more than 34 pounds, over nearly 17 months, the company said on Thursday.
The late-stage study of the drug for weight loss adds to earlier evidence that similar participants without diabetes lost up to 22% of their body weight over that period with weekly injections of the drug. For a typical patient on the highest dose, that meant shedding more than 50 pounds.
Having diabetes makes it notoriously difficult to lose weight, said Dr. Nadia Ahmad, Lilly’s medical director of obesity clinical development, which means the recent results are especially significant. “We have not seen this degree of weight reduction,” she said.
Based on the new results, which have not yet been published in full, company officials said they will finalize an application to the U.S. Food and Drug Administration for fast-track approval to sell tirzepatide for chronic weight management. A decision could come later this year. A company spokeswoman would not confirm whether the drug would be marketed for weight loss in the U.S. under a different brand name.
If approved for weight loss, tirzepatide could become the most effective drug to date in an arsenal of medications that are transforming the treatment of obesity, which affects more than 4 in 10 American adults and is linked to dozens of diseases that can lead to disability or death.
“If everybody who had obesity in this country lost 20% of their body weight, we would be taking patients off all of these medications for reflux, for diabetes, for hypertension,” said Dr. Caroline Apovian, a director of the Center for Weight Management and Wellness at Brigham and Women’s Hospital. “We would not be sending patients for stent replacement.”
Industry analysts predict that tirzepatide could become one of the top-selling drugs ever, with annual sales topping $50 billion. It is expected to outpace Novo Nordisk’s Ozempic — a diabetes drug used so commonly to shed pounds that comedian Jimmy Kimmel joked about it at the Oscars — and Wegovy, a version of the drug also known as semaglutide approved for weight loss in 2021. Together, those drugs made nearly $10 billion in 2022, with prescriptions continuing to soar, company reports show.
In separate trials, tirzepatide has resulted in greater weight loss than semaglutide, whose users shed about 15% of their body weight over 16 months. A head-to-head trial comparing the two drugs is planned.
Mounjaro was first approved to treat diabetes last year. Since then, thousands of patients have obtained the drug from doctors and telehealth providers who prescribed it “off-label” to help them slim down.
In California, Matthew Barlow, a 48-year-old health technology executive, said he has lost more than 100 pounds since November by using Mounjaro and changing his diet.
“Psychologically, you don’t want to eat,” said Barlow. “Now I can eat two bites of a dessert and be satisfied.”
Rather than relying solely on diet, exercise and willpower to reduce weight, tirzepatide and other new drugs target the digestive and chemical pathways that underlie obesity, suppressing appetite and blunting cravings for food.
“They have entirely changed the landscape,” said Dr. Amy Rothberg, a University of Michigan endocrinologist who directs a virtual weight loss and diabetes program.
Research has shown that with diet and exercise alone, about a third of people will lose 5% or more of their body weight, said Dr. Louis Aronne, director of the Comprehensive Weight Control Center at Weill Cornell Medicine. In the latest tirzepatide trial, more than 86% of patients using the highest dose of the drug lost at least 5% of their body weight. More than half on that dose lost at least 15%, the company said.
The obesity medications help overcome a biological mechanism that kicks in when people diet, triggering a coordinated effort by the body to prevent weight loss.
“That is a real physical phenomenon,” Aronne said. “There are a number of hormones that respond to reduced calorie intake.”
Ozempic and Wegovy are two versions of semaglutide. That drug mimics a key gut hormone, known as GLP-1, that is activated after people eat, boosting the release of insulin and slowing release of sugar from the liver. It delays digestion and reduces appetite, making people feel full longer.
Tirzepatide is the first drug that uses the action of two hormones, GLP-1 and GIP, for greater effects. It also targets the chemical signals sent from the gut to the brain, curbing cravings and thoughts of food.
Though the drugs appear safe, they can cause side effects, some serious. Most common reactions include diarrhea, nausea, vomiting, constipation and stomach pain. Some users have developed pancreatitis or inflammation of the pancreas, others have had gallbladder problems. Mounjaro’s product description warns that it could cause thyroid tumors, including cancer.
There are other downsides: Versions of semaglutide have been on the market for several years, but the long-term effects of taking drugs that override human metabolism are not yet clear. Early evidence suggests that when people stop taking the medications, they gain the weight back.
Plus, the medications are expensive — and in recent months, hard to get because of intermittent shortages. Wegovy is priced at about $1,300 a month. Mounjaro used for diabetes starts at about $1,000 per month.
Apovian said that only about 20% to 30% of patients with private insurance in her practice find the medications are covered. Some insurers who previously paid for the drugs are enacting new rules, requiring six months of documented lifestyle changes or a certain amount of weight loss for continued coverage. Medicare is largely prohibited from paying for weight-loss drugs, though there have been efforts by drugmakers and advocates for Congress to change that.
Still, experts say that the striking effects of tirzepatide — along with Ozempic, Wegovy and other drugs — underscore that losing weight is not merely a matter of willpower. Like high blood pressure, which affects about half of U.S. adults and is managed with medication, obesity should be viewed as a chronic disease, not a character flaw, Aronne emphasized.
It remains to be seen what effect new drug treatments will have on pervasive bias against people with obesity, said Rebecca Puhl, a professor in the Rudd Center for Food Policy and Health, who studies weight stigma. U.S. culture has “deep-rooted beliefs about body weight and physical appearance” that are hard to change, she said.
“Weight stigma could persist or worsen if taking medication is equated with ‘taking the easy way out’ or ‘not trying hard enough,’” she said.
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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.
The Ozempic craze shows no signs of slowing. Demand for the drug, popularly used for weight loss, is so monumental that it is already changingthe diet industry and spurring a “marketing bonanza” among the dozens of telehealth start-ups that now prescribe it. A highly public ad campaign from one start-up, Ro, banks on the drug’s simple premise: “A weekly shot to lose weight.”
Never before has a weight-loss treatment been hyped this way and been able to deliver on its promise. Ozempic itself is technically a diabetes drug, but its active ingredient, semaglutide, has been approved by the FDA for weight loss under the brand name Wegovy, and can reduce a person’s body weight by up to 20 percent through a weekly injection. An even more powerful drug, known as tirzepatide, or Mounjaro, may soon be approved for weight loss, and a host of new medications are coming down the pipeline. All signs suggest that America is on the verge of a weight-loss revolution.
But for people with obesity, semaglutide isn’t even the most effective weight-loss treatment around—not even close. Bariatric surgery, which has existed for many decades, is still significantly more potent. This class of procedures, which, broadly speaking, reconfigure the digestive system so people feel less hungry and more full, is considered to be the “gold standard” for treating obesity, Holly Lofton, an obesity-medicine physician at NYU, told me. Most people experience weight loss of 50 percent and, with one procedure, up to 80 percent, according to the Cleveland Clinic.
Despite the impressive abilities of the new crop of weight-loss drugs—and bold assertions that such drugs could someday replace surgery outright—several doctors told me that surgery will likely continue to be the top-line treatment for obesity, even as the medications improve. People may seek out treatment with the new drugs because they’re so popular, but “long term, there will be an increase in surgery,” Shauna Levy, a professor specializing in bariatric surgery at Tulane University School of Medicine, told me. The new drugs, however potent, may be less a revolutionary fix for obesity and more a powerful tool for treating it—one of many that already exist.
Unlike semaglutide, bariatric surgery, first introduced in the 1950s, took several decades to become accepted by the medical community. Initial attempts made people so sick that, at times, the surgery had to be reversed. The term bariatric surgery refers to several different procedures that reshape the gastrointestinal tract so that it absorbs fewer nutrients, holds less food, or both. These days, the most commonly performed surgery is called a Roux-en-Y, which shrinks the stomach to the size of a walnut—so people need less food to feel satisfied—and then reconnects it to the small intestine in a Y shape, rather than linearly. This gastric bypass lets food circumvent most of the stomach, leaving fewer opportunities for the body to harvest nutrients. In another common procedure, surgeons sculpt the stomach into a banana-size “sleeve” and toss the rest; another common type involves rerouting the intestines in a way that minimizes the area where calories can be absorbed.
But bariatric surgery does more than shrink gastrointestinal real estate. It exerts a less visible but equally powerful effect on the many different hormones that control hunger. Some procedures remove the part of the gut that produces the “hunger hormone,” ghrelin, while the rerouting of food through a Roux-en-Y ramps up the release of “incretin” hormones that create the feeling of fullness after eating.
In a sense, the new weight-loss drugs are essentially trying to re-create the effects of bariatric surgery: The success of these drugs is due to their ability to mimic the incretin hormones and get people to feel satisfied with less food. Semaglutide masquerades as the hormone GLP-1, whereas Mounjaro poses as both GLP-1 and GIP. But these are just two hormones; bariatric surgery “touches on multiple different hormones and different pathways” and, as such, is “more comprehensive,” Levy said. In one study, Mounjaro, considered the most powerful of the current crop of medications, led to 20 percent or more weight loss in 57 percent of people who took the highest dose—an impressive feat, but still a far cry from what is possible with surgery. Similarly, Ozempic and Mounjaro, both technically diabetes drugs, have powerful effects on blood-sugar levels over time, but many surgery patients “leave the hospital already in remission from their diabetes,” Levy said.
In addition to sheer potency, surgery is also much more affordable than these weight-loss drugs. Unlike the drugs, bariatric surgery is covered by Medicare if the patient meets certain criteria, including having a BMI equal to or greater than 35 and at least one comorbidity related to obesity. Many private insurers cover it too, albeit to varying degrees. Out of pocket, surgery costs $15,000 to $25,000—not cheap, but still cheaper than shelling out more than $1,000 a month indefinitely. “The patient must understand that they have to continue taking medication forever,” Lofton said. People who stop taking semaglutide generally regain the weight they lost. Lofton told me about one patient who had to forgo rent just to pay for the drugs: Factoring in insurance, “you can pay for three months of medicine and then have surgery at the same price.”
Neither treatment, of course, is without its potential downsides. Semaglutide can cause temporary but nasty side effects such as nausea, vomiting, and diarrhea—and though it is considered safe for treating obesity, long-term data on this usage span just two years. Because many surgeries are done laparoscopically—using only tiny incisions—mortality is vanishingly low, and many patients go home after two or three days; full recovery usually takes four to six weeks. In the long term, complications such as hernias, gallstones, and low blood sugar can develop.
But there’s a reason bariatric surgery has not led to a weight-loss revolution of the kind that now gets associated with semaglutide. Despite its dramatic effects, and obesity’s prevalence across America, only 1 percent of people eligible for surgery actually get it. People hesitate for many reasons, medical and otherwise, but the most pervasive issue is a lack of awareness that surgery is even a safe or realistic option for weight loss. Bariatric surgery is plagued by stigma even within the medical community: In the 1990s, it was dismissed as a “barbaric” way to address an issue that, many believed, could be treated with diet and exercise. “There are a lot of primary-care doctors who are not talking enough about surgery” because they were trained with that old mindset, Levy said. It doesn’t help that bariatric surgery hasn’t exactly been a media sensation, with few high-profile patient advocates beyond Al Roker and Mariah Carey. In contrast, stories of celebrities on weight-loss drugs abound. Unlike surgery, semaglutide has the potential to be taken recreationally.
The advantages that surgery has over weight-loss drugs may change as the drugs become more potent and eventually cheaper. But for now, semaglutide won’t dramatically shift the way obesity is treated, doctors told me—in fact, these new drugs may act as a conduit to surgery itself. Levy predicts that their sheer popularity will trigger a brief dip in the bariatric-surgery rate, but as price remains an issue, and people with obesity are unable to reach their weight-loss goals on the drugs alone, “they may start opening their mind to surgery.”
Certainly, in some patients, weight-loss drugs alone could lead to lasting weight loss. And they can benefit those who are overweight but don’t qualify for surgery. But more widely, these drugs will likely be used in tandem with bariatric surgery to produce more dramatic, longer-lasting results, experts told me. “I don’t see this as an either/or,” Fatima Cody Stanford, an obesity-medicine physician at Massachusetts General Hospital and Harvard Medical School, told me. “I see it as surgery plus medicine.”
Drugs can help fill in any gaps that surgery leaves behind. Weight can rebound after a procedure, because the body has a way of rebalancing itself; hormones that were tamped down due to bariatric surgery, Stanford said, can “start to reemerge with a vengeance.” About a fifth of people, and perhaps even more, regain a significant amount of weight—15 percent or more—two to five years after surgery. All of the doctors I spoke with said that medication could be a powerful tool to prevent post-surgery weight rebounds—though to keep that weight off, the medication would still have to be taken in perpetuity. Stanford estimated that more than 90 percent of her patients are on weight-loss drugs after surgery—and not necessarily semaglutide; older medications often suffice. Drugs could also be used to help people prepare for surgery, Lofton said. Some doctors encourage patients to lose weight beforehand to decrease the risk of complications such as blood clots, heart attack, and infection.
Despite the hype, weight-loss drugs were never a perfect treatment for obesity. Neither is bariatric surgery, for that matter. “It is not a cure,” Lofton told me. A cure, she explained, would ensure that hunger doesn’t return and that fat cells don’t get bigger, a hallmark of obesity: “We have nothing that does that”—not even more potent next-gen drugs will provide a permanent fix. But the effect of combining surgery and medication could come close, she said.
That no cure for obesity exists is evidence of its complexity. All of the experts I spoke with pointed out that obesity has long been misunderstood as a failure of personal will, as laziness or gluttony. That misunderstanding has led to inadequate care: Many people who regain weight after a bariatric procedure are made to feel by their doctors like they “wasted the surgery,” even if human biology is to blame, Stanford said. Ozempic and other weight-loss medications frame obesity as a condition that can be treated with drugs—in other words, a disease. Patients on those medications may realize, “Hey, maybe it’s not just me being lazy this whole time—maybe there is science to it and an actual disease here,” said Levy. Collectively understanding obesity as an illness that exists alongside heart disease and cancer—diseases routinely treated with medication and surgery—instead of as a matter of personal inadequacy will have far more profound impacts on people with obesity than any drug alone.
Newswise — A research model of dietary intake in 184 countries, developed by researchers at the Friedman School of Nutrition Science and Policy at Tufts University, estimates that poor diet contributed to over 14.1 million cases of type 2 diabetes in 2018, representing over 70% of new diagnoses globally. The analysis, which looked at data from 1990 and 2018, provides valuable insight into which dietary factors are driving type 2 diabetes burden by world region. The study was published April 17 in the journal NatureMedicine.
Of the 11 dietary factors considered, three had an outsized contribution to the rising global incidence of type 2 diabetes: Insufficient intake of whole grains, excesses of refined rice and wheat, and the overconsumption of processed meat. Factors such as drinking too much fruit juice and not eating enough non-starchy vegetables, nuts, or seeds, had less of an impact on new cases of the disease.
“Our study suggests poor carbohydrate quality is a leading driver of diet-attributable type 2 diabetes globally, and with important variation by nation and over time,” says senior author Dariush Mozaffarian, Jean Mayer Professor of Nutrition and dean for policy at the Friedman School. “These new findings reveal critical areas for national and global focus to improve nutrition and reduce devastating burdens of diabetes.”
Type 2 diabetes is characterized by the resistance of the body’s cells to insulin. Of the 184 countries included in the Nature Medicine study, all saw an increase in type 2 diabetes cases between 1990 and 2018, representing a growing burden on individuals, families, and healthcare systems.
The research team based their model on information from the Global Dietary Database, along with population demographics from multiple sources, global type 2 diabetes incidence estimates, and data on how food choices impact people living with obesity and type 2 diabetes from multiple published papers.
The analysis revealed that poor diet is causing a larger proportion of total type 2 diabetes incidence in men versus women, in younger versus older adults, and in urban versus rural residents at the global level.
Regionally, Central and Eastern Europe and Central Asia —particularly in Poland and Russia, where diets tend to be rich in red meat, processed meat, and potatoes —had the greatest number of type 2 diabetes cases linked to diet. Incidence was also high in Latin America and the Caribbean, especially in Colombia and Mexico, which was credited to high consumption of sugary drinks, processed meat, and low intake of whole grains.
Regions where diet had less of an impact on type 2 diabetes cases included South Asia and Sub-Sharan Africa —though the largest increases in type 2 diabetes due to poor diet between 1990 and 2018 were observed in Sub-Saharan Africa. Of the 30 most populated countries studied, India, Nigeria, and Ethiopia had the fewest case of type 2 diabetes related to unhealthy eating.
“Left unchecked and with incidence only projected to rise, type 2 diabetes will continue to impact population health, economic productivity, health care system capacity, and drive heath inequities worldwide,” says first author Meghan O’Hearn. She conducted this research while a PhD candidate at the Friedman School and currently works as Impact Director for Food Systems for the Future, a non-profit institute and for-profit fund that enables innovative food and agriculture enterprises to measurably improve nutrition outcomes for underserved and low-income communities. “These findings can help inform nutritional priorities for clinicians, policymakers, and private sector actors as they encourage healthier dietary choices that address this global epidemic.”
Other recent studies have estimated that 40% of type 2 diabetes cases globally are attributed to suboptimal diet, lower than the 70% reported in the Nature Medicine paper. The research team attributes this to the new information in their analysis, such as the first ever inclusion of refined grains, which was one of the top contributors to diabetes burdens; and updated data on dietary habits based on national individual-level dietary surveys, rather than agricultural estimates. The investigators also note that they presented the uncertainty of these new estimates, which can continue to be refined as new data emerges.
Research reported in this article was supported by the Bill and Melinda Gates Foundation. Complete information on authors, funders, methodology, and conflicts of interest is available in the published paper. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders.
All of a sudden, Ozempic is everywhere. The weight-loss drug that it contains, semaglutide, is a potent treatment for obesity, and Hollywood and TikTok celebrities have turned it into a sensation. In just a few months, the medication has been branded as “revolutionary” and “game-changing,” with the power to permanently alter society’s conceptions of fatness and thinness. Certainly, a drug like semaglutide could be all of those things: Never in the history of medicine has one so safely led to such dramatic weight loss in so many people.
But let’s not get ahead of ourselves. As weight-loss medications go, Ozempic is far from perfect. Though the drug has profound impacts, it requires weekly injections, a tolerance for uncomfortable side effects, and the stamina—not to mention the budget—for long-term treatment. (Ozempic has somehow become a catchall term for semaglutide but technically that product has gotten FDA sign-off only as a diabetes medication. A larger dose of semaglutide, marketed as Wegovy, has been approved for weight loss.)
Made by the Danish drugmaker Novo Nordisk, semaglutide dominates the U.S. weight-loss market right now, but its reign might be short-lived. The colossal demand for these drugs has spurred a competition in the pharmaceutical industry to develop even more potent and powerful medications. The first of them could become available as soon as this summer. For all its hype, semaglutide is the stepping stone and not the final destination of a new class of obesity drugs. Just how good they get, and how quickly, will go a long way in determining whether this pharmaceutical revolution actually meets its full promise.
In a sense, semaglutide hardly represents a major step forward in science. Diet drugs are nothing new, and even the category of pharmaceuticals that these new products belong to, called “GLP-1 agonists,” has been around for several years. These drugs mimic the hormone GLP-1 (glucagon-like peptide one) and bind to its receptor in the body. This triggers a sense of fullness associated with having just eaten, and also slows the release of food from the stomach. (It also increases insulin secretion, keeping blood sugar in check, which is why Ozempic is still intended as a diabetes drug.) Already, these pharmaceuticals have gotten better over time: A daily injection called liraglutide and sold as Saxenda, which was approved by the FDA in 2014 for obesity, leads to the loss of 5 to 10 percent of a person’s body weight in most cases. But one reason semaglutide took off in a way that liraglutide didn’t is that it can lead to weight loss of up to 20 percent. “Now you have a shot that’s once a week instead of every day, you’re making dramatic improvements, and people notice more,” Angela Fitch, the president of the Obesity Medicine Association and the chief medical officer of the obesity-care start-up Knownwell, told me.
But not everyone who takes these drugs can achieve that level of weight loss. More than 60 percent of those on Wegovy experience smaller changes, in part because the drug can’t account for the complex drivers of obesity that aren’t related to food. The next generation of drugs is reaching for more. The first leap forward is Mounjaro, known generically as tirzepatide, a diabetes drug from Eli Lilly that the FDA is expected to approve for weight loss this year. In one study, it led to 20 percent or more weight loss in up to 57 percent of people who took the highest dose; TheWall Street Journal recently called it the “King Kong” of weight-loss drugs. People on Mounjaro tend to lose more weight more quickly and generally have a “better experience” than those on Wegovy, Keith Tapper, a biotech analyst at BMO Capital Markets, told me. It’s also cheaper, though by no means cheap, at roughly $980 for the highest-dose option, he said; a dose of Wegovy costs about $1,350.
These leaps in potency are happening on the molecular level. Like semaglutide, Mounjaro mimics the effects of GLP-1, but it also hits receptors for another hormone—GIP. That leads to even more weight loss by further attenuating focus on food and potentially also increasing the activity of a fat-burning enzyme, said Tapper. So-called dual-agonist drugs “offer a step change” in both weight loss and blood-sugar control, he added.
And why stop at two receptors when so many others are involved in regulating hunger? “This area is exploding in terms of research and testing different combinations of hormones,” which are still poorly understood, Shauna Levy, a professor specializing in bariatric surgery at Tulane University School of Medicine, told me. Eli Lilly has another drug in the works that targets three receptors; one from the drugmaker Amgen works by “putting the brakes” on the GIP receptor and “putting the gas” on GLP-1’s, a company spokesperson told me. Several other companies have already joined what some havedubbed a “race” to develop the next great obesity drug, in which Lilly, Pfizer, Amgen, Structure Therapeutics, and Viking Therapeutics are expected to be the front-runners, said Tapper.
The potency of weight-less drugs is not the only factor that will determine the shape of their future trajectory. Wegovy and Mounjaro injections are tolerable for most people, but they are less convenient than a pill. Making oral versions of these drugs isn’t as easy as packing everything into a capsule, though. Semaglutide is a molecule that gets chewed up in the stomach. For this reason, the semaglutide pill Rybelsus, which is already approved for diabetes, leads to far less dramatic weight loss than its injectable kin. But drugmakers are undeterred by this complication, because a pill even more powerful than semaglutide would no doubt have many customers. In January, Pfizer’s CEO Albert Bourla said that an oral weight-loss drug “unlocks the market,” which he estimated could eventually be worth $90 billion. Pfizer doesn’t have any weight-loss drugs yet but is developing a twice-daily GLP-1 agonist pill; Eli Lilly also has an oral version in the works. Tapper expects those drugs to become available in 2026, and a similar offering from Structure Therapeutics is likely to follow the next year.
Drugmakers will also likely vie to create drugs with fewer side effects. Novo Nordisk notes that gastrointestinal issues are common with semaglutide; accounts of horrible nausea, constipation, and vomiting have proliferated online. As one actor put it toNew York Magazine, people on Ozempic are “shitting their brains out.” With Wegovy, more serious issues, such as pancreatitis, thyroid cancer, and kidney failure, are also possible but are considered rare. Although nothing to scoff at, side effects tend to subside with prolonged treatment and can usually be managed with help from a doctor, said both Fitch and Levy, who regularly prescribe semaglutide to patients with obesity. It’s possible, Levy added, that people experiencing really terrible effects may be getting their drugs from shady compounding pharmacies or even from other countries.
The fact that people are turning to sketchy outlets to get weight-loss drugs underscores the biggest issue with them: access. Medicare and most private insurance companies don’t cover anti-obesity drugs. (Such drugs are classified as “cosmetic” by the Centers for Medicare and Medicaid Services, and thus don’t qualify for coverage.) “I am hopeful that the price will come down with more competition,” Fitch told me. But there’s no guarantee that will happen: Competition typically makes a product cheaper over time, but research suggests that isn’t always the case in pharmaceuticals. Even if the drugs do become cheaper, they may not become cheap enough. The oral forms of these drugs, some of which could be available by 2026, are expected to cost about $500 a month, Tapper said. By 2030, the cost of obesity drugs could come down to about $350 a month, according to a recent Morgan Stanley analysis, which would still be out of reach for many Americans.
Levy estimates that the next five years will bring about a “huge explosion” of next-gen obesity drugs. In that case, the market will likely expand to accommodate a variety of drugs with different price points and efficacies. Some people may aim to lose 20 or more percent of their body weight; some may be content with less. The market is so diverse that it will likely “support a broad range of options,” said Tapper, such as cheaper, lower-dose oral drugs for people who have milder medical issues, and more expensive injectables for those with more severe medical concerns. That opens up the possibility that medically mediated weight loss could soon be an option for a far greater proportion of people.
Regardless of how much these drugs’ costs may decrease, they will always add up if people are paying out of pocket for them. They are meant to be taken long term: Once a person stops taking Wegovy, the weight tends to come right back. The current crop of weight-loss medications are essentially maintenance drugs, much like the cholesterol-busting drug Lipitor, which is taken daily to treat long-term disease. But Lipitor, unlike obesity drugs, is generally covered by insurance. Unless obesity drugs receive the same kind of coverage, no level of improvement will lead them to deliver on what Ozempic is promising us now.
After gaining 30 pounds during the COVID-19 pandemic, U.S. Army Staff Sgt. Daniel Murillo is finally getting back into fighting shape.
Early pandemic lockdowns, endless hours on his laptop and heightened stress led Murillo, 27, to reach for cookies and chips in the barracks at Fort Bragg in North Carolina. Gyms were closed, organized exercise was out and Murillo’s motivation to work out on his own was low.
“I could notice it,” said Murillo, who is 5 feet, 5 inches tall and weighed as much as 192 pounds. “The uniform was tighter.”
Murillo wasn’t the only service member dealing with extra weight. New research found that obesity in the U.S. military surged during the pandemic. In the Army alone, nearly 10,000 active duty soldiers developed obesity between February 2019 and June 2021, pushing the rate to nearly a quarter of the troops studied. Increases were seen in the U.S. Navy and Marines, as well.
“The Army and the other services need to focus on how to bring the forces back to fitness,” said Tracey Perez Koehlmoos, director of the Center for Health Services Research at the Uniformed Services University in Bethesda, Maryland, who led the research.
Overweight and obese troops are more likely to be injured and less likely to endure the physical demands of their profession. The military loses more than 650,000 workdays each year because of extra weight and obesity-related health costs exceed $1.5 billion annually for current and former service members and their families, federal research shows.
More recent data won’t be available until later this year, said Koehlmoos. But there’s no sign that the trend is ending, underscoring longstanding concerns about the readiness of America’s fighting forces.
Military leaders have been warning about the impact of obesity on the U.S. military for more than a decade, but the lingering pandemic effects highlight the need for urgent action, said retired Marine Corps Brigadier General Stephen Cheney, who co-authored a recent report on the problem.
“The numbers have not gotten better,” Cheney said in a November webinar held by the American Security Project, a nonprofit think tank. “They are just getting worse and worse and worse.”
In fiscal year 2022, the Army failed to make its recruiting goal for the first time, falling short by 15,000 recruits, or a quarter of the requirement. That’s largely because three-quarters of Americans aged 17 to 24 aren’ot eligible for military service for several reasons, including extra weight. Being overweight is the biggest individual disqualifier, affecting more than 1 in 10 potential recruits, according to the report.
“It is devastating. We have a dramatic national security problem,” Cheney said.
Extra weight can make it difficult for service members to meet core fitness requirements, which differ depending on the military branch. In the Army, for instance, if soldiers can’t pass the Army Combat Fitness Test, a recently updated measure of ability, it could result in probation or end their military careers.
Koehlmoos and her team analyzed medical records for all active duty Army soldiers in the Military Health System Data Repository, a comprehensive archive. They looked at two periods: before the pandemic, from February 2019 to January 2020, and during the crisis, from September 2020 to June 2021. They excluded soldiers without complete records in both periods and those who were pregnant in the year before or during the study.
Of the cohort of nearly 200,000 soldiers who remained, the researchers found that nearly 27% who were healthy before the pandemic became overweight. And nearly 16% of those who were previously overweight became obese. Before the pandemic, about 18% of the soldiers were obese; by 2021, it grew to 23%.
The researchers relied on standard BMI, or body mass index, a calculation of weight and height used to categorize weight status. A person with a BMI of 18.5 to 25 is considered healthy, while a BMI of 25 to less than 30 is considered overweight. A BMI of 30 or higher is categorized as obese. Some experts claim that the BMI is a flawed measure that fails to account for muscle mass or underlying health status, though it remains a widely used tool.
In Murillo’s case, his BMI during the pandemic reached nearly 32. The North Carolina Army soldier knew he needed help, so he turned to a military dietician and started a strict exercise routine through the Army’s Holistic Health and Fitness, or H2F, program.
“We do two runs a week, 4 to 5 miles,” Murillo said. “Some mornings I wanted to quit, but I hung in there.”
Slowly, over months, Murillo has been able to reverse the trajectory. Now, his BMI is just over 27, which falls within the Defense Department’s standard, Koehlmoos said.
She found increases in other service branches, but focused first on the Army. The research squares with trends noted by the Centers for Disease Control and Prevention, which warned that in 2020, nearly 1 in 5 of all service members were obese.
The steady creep of obesity among service members is “alarming,” said Cheney. “The country has not approached obesity as the problem it really is,” he added.
Putting on extra pounds during the pandemic wasn’t just a military problem. A survey last year of American adults found that nearly half reported gaining weight after the first year of the COVID-19 emergency. Another study found a sharp rise in obesity among kids during the pandemic. The gains came in a country where more than 40% of American adults and nearly 20% of children struggle with obesity, according to the CDC.
“Why would we think the military is any different than a person who is not in the military?” said Dr. Amy Rothberg, an endocrinologist at the University of Michigan who directs a weight-loss program. “Under stress, we want to store calories.”
It will take broad measures to address the problem, including looking at the food offered in military cafeterias, understanding sleep patterns and treating service members with issues such as PTSD, or post-traumatic stress disorder, Rothberg said. Regarding obesity as a chronic disease that requires comprehensive care, not just willpower, is key. “We need to meet military members where they are,” she said.
A new category of effective anti-obesity drugs, including semaglutide, marketed as Wegovy, could be a powerful aid, Rothberg said. TRICARE, the Defense Department’s health plan, covers such drugs, but uptake remains low. Since June 2021, when Wegovy was approved, just 174 service members have received prescriptions, TRICARE officials said. Novo Nordisk, which makes Wegovy, funded the security group’s report, but didn’t influence the research, Rothberg said.
“People are working hard at their weight and we have to give them whatever tools we have,” Rothberg said.
Advisers to the World Health Organization will consider next month whether to add liraglutide, the active ingredient in certain diabetes and obesity medications, to its list of essential medicines.
The list, which is updated every two years, includes medicines “that satisfy the priority health needs of the population,” WHO says. “They are intended to be available within the context of function health systems at all times, in adequate amounts in the appropriate dosage forms, of assured quality and at prices that individuals and the community can afford.”
The list is “a guide for the development and updating of national and institutional essential medicine lists to support the procurement and supply of medicines in the public sector, medicines reimbursement schemes, medicine donations, and local medicine production.”
The WHO Expert Committee on the Selection and Use of Essential Medicines is scheduled to meet April 24-28 to discuss revisions and updates involving dozens of medications. The request to add GLP-1 receptor agonists such as liraglutide came from four researchers at US institutions including Yale University and Brigham and Women’s Hospital.
These drugs mimic the effects of an appetite-regulating hormone, GLP-1, and stimulate the release of insulin. This helps lower blood sugar and slows the passage of food through the gut. Liraglutide was developed to treat diabetes but approved in the US as a weight-loss treatment in 2014; its more potent cousin, semaglutide, has been approved for diabetes since 2017 and as an obesity treatment in 2021.
The latter use has become well-known thanks to promotions from celebrities and on social media. It’s sold under the name Ozempic for diabetes and Wegovy for weight loss. Studies suggest that semaglutide may help people lose an average of 10% to 15% of their starting weight – significantly more than with other medications. But because of this high demand, some versions of the medication have been in shortage in the US since the middle of last year.
The US patent on liraglutide is set to expire this year, and drugmaker Novo Nordisk says generic versions could be available in June 2024.
The company has not been involved in the application to WHO, it said in a statement, but “we welcome the WHO review and look forward to the readout and decision.”
“At present, there are no medications included in the [Essential Medicines List] that specifically target weight loss for the global burden of obesity,” the researchers wrote in their request to WHO. “At this time, the EML includes mineral supplements for nutritional deficiencies yet it is also described that most of the population live in ‘countries where overweight and obesity kills more people than underweight.’ “
WHO’s advisers will make recommendations on which drugs should be included in this year’s list, expected to come in September.
“This particular drug has a certain history, but the use of it probably has not been long enough to be able to see it on the Essential Medicines List,” Dr. Francesco Blanca, WHO director for nutrition and food safety, said at a briefing Wednesday. “There’s also issues related to the cost of the treatment. At the same time, WHO is looking at the use of drugs to reduce weight excess in the context of a systematic review for guidelines for children and adolescents. So we believe that it is a work in progress, but we’ll see what the Essential Medicines List committee is going to conclude.”
March 28, 2023 – A new analysis gives a promising answer to the weight loss question: Is it better to have lost and gained, than never to have lost at all?
People who lost weight but regained some of it experienced sustained health improvements for at least 5 years after the initial weight loss, a new study says. The prolonged benefits included lowered risks of heart disease and type 2 diabetes, as well as improved blood pressure and cholesterol levels.
“Many doctors and patients recognize that weight loss is often followed by weight regain, and they fear that this renders an attempt to lose weight pointless,” said University of Oxford professor and researcher Susan A. Jebb, PhD, in a statement. “This concept has become a barrier to offering support to people to lose weight. For people with overweight or obesity issues, losing weight is an effective way to reduce the risk of Type 2 diabetes and cardiovascular disease.”
The results were published on Tuesday in Circulation: Cardiovascular Quality and Outcomes. The researchers analyzed data from 124 previously published studies in which people lost weight in what are called “behavioral weight loss programs.” Those programs focus on lifestyle and behavior changes such as eating healthy foods and increasing physical activity.
The average participant was 51 years old and considered obese based on body mass index (a measure that combines weight and height). On average, people lost between 5 and 10 pounds and typically regained less than 1 pound per year.
People who participated in the most intensive programs had significant long-lasting benefits, compared to people in less intensive programs or who followed no formal weight loss program at all. Programs that were considered intensive had features such as partial or total meal replacement, intermittent fasting, or financial incentives contingent on weight loss.
Specific average benefits included:
Systolic blood pressure was decreased by 1.5 points one year after program participation, and by 0.4 points lower at 5 years.
The level of HbA1c, a protein in red blood cells used to test for diabetes, saw a sustained 5-year reduction.
A cholesterol measure that compares total cholesterol to “good” or HDL cholesterol was 1.5 points lower at the 1-year and 5-year marks after participation in an intensive program.
The benefits of weight loss did diminish as people regained more and more weight, the researchers found.
Obesity affects 42% of U.S. adults, according to the CDC, and is known to increase the risk of many dangerous health conditions, including heart disease, which is the leading cause of death in the U.S. Obesity is defined as a body mass index of 30 or higher.
The new findings could play a particularly important role in addressing weight gain that often happens after people stop taking weight loss medications, wrote Vishal N. Rao, MD, MPH, and Neha J. Pagidipati, MD, MPH, both of the Duke University School of Medicine, in a letter published alongside the new study. They called the reported risk reductions “favorable, although modest,” and said data showing longer-term results are needed.
March 28, 2023 – A new analysis gives a promising answer to the weight loss question: Is it better to have lost and gained, than never to have lost at all?
People who lost weight but regained some of it experienced sustained health improvements for at least 5 years after the initial weight loss, a new study says. The prolonged benefits included lowered risks of heart disease and type 2 diabetes, as well as improved blood pressure and cholesterol levels.
“Many doctors and patients recognize that weight loss is often followed by weight regain, and they fear that this renders an attempt to lose weight pointless,” said University of Oxford professor and researcher Susan A. Jebb, PhD, in a statement. “This concept has become a barrier to offering support to people to lose weight. For people with overweight or obesity issues, losing weight is an effective way to reduce the risk of Type 2 diabetes and cardiovascular disease.”
The results were published on Tuesday in Circulation: Cardiovascular Quality and Outcomes. The researchers analyzed data from 124 previously published studies in which people lost weight in what are called “behavioral weight loss programs.” Those programs focus on lifestyle and behavior changes such as eating healthy foods and increasing physical activity.
The average participant was 51 years old and considered obese based on body mass index (a measure that combines weight and height). On average, people lost between 5 and 10 pounds and typically regained less than 1 pound per year.
People who participated in the most intensive programs had significant long-lasting benefits, compared to people in less intensive programs or who followed no formal weight loss program at all. Programs that were considered intensive had features such as partial or total meal replacement, intermittent fasting, or financial incentives contingent on weight loss.
Specific average benefits included:
Systolic blood pressure was decreased by 1.5 points one year after program participation, and by 0.4 points lower at 5 years.
The level of HbA1c, a protein in red blood cells used to test for diabetes, saw a sustained 5-year reduction.
A cholesterol measure that compares total cholesterol to “good” or HDL cholesterol was 1.5 points lower at the 1-year and 5-year marks after participation in an intensive program.
The benefits of weight loss did diminish as people regained more and more weight, the researchers found.
Obesity affects 42% of U.S. adults, according to the CDC, and is known to increase the risk of many dangerous health conditions, including heart disease, which is the leading cause of death in the U.S. Obesity is defined as a body mass index of 30 or higher.
The new findings could play a particularly important role in addressing weight gain that often happens after people stop taking weight loss medications, wrote Vishal N. Rao, MD, MPH, and Neha J. Pagidipati, MD, MPH, both of the Duke University School of Medicine, in a letter published alongside the new study. They called the reported risk reductions “favorable, although modest,” and said data showing longer-term results are needed.
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Americans took fewer steps during the height of the Covid-19 pandemic, and they still haven’t gotten their mojo back, a new study found.
“On average, people are taking about 600 fewer steps per day than before the pandemic began,” said study author Dr. Evan Brittain, associate professor of cardiovascular medicine at Vanderbilt University Medical Center in Nashville.
“To me, the main message is really a public health message — raising awareness that Covid-19 appears to have had a lasting impact on people’s behavioral choices when it comes to activity,” he said.
The study used data from the National Institutes of Health’s All of Us Research Program, which is focused on identifying ways to develop individualized health care. Many of the 6,000 participants in the program wore activity trackers for at least 10 hours a day over multiple years and allowed researchers access to their electronic health records.
In the new study, published Monday in JAMA Network Open, researchers compared steps taken by nearly 5,500 people who wore the program’s activity trackers. Most were White women, with an average age of 53.
Step counts collected between January 1, 2018, and January 31, 2020, were considered pre-Covid. Steps tracked after that date until the end of 2021, which is when the study ended, were considered post-Covid.
Results showed no difference in identified step activity based on sex, obesity, diabetes and other illnesses or conditions such as coronary artery disease, hypertension or cancer.
People who took the fewest steps were socioeconomically disadvantaged, under psychological stress and not vaccinated, the study said.
Age made a difference as well, but in an unexpected manner: People over 60 were not impacted by the pandemic, the study found — they continued to keep their steps up.
Oddly, it was younger people between 18 and 30 whose step counts were most impacted, Brittain said. “In fact, we found every 10-year decrease in age was associated with a 243 step reduction per day.”
“If this persists over time, it could certainly raise the risk of cardiovascular disease, obesity, hypertension, diabetes and other conditions strongly linked to being sedentary,” Brittian said. “However, it’s too soon to know whether this trend will last.”
Why would a younger generations lose steps while older people did not?
“I think it’s difficult to interpret because it’s only 600 steps, which you could argue is what some people would get simply walking into work and through their day,” said Dr. Andrew Freeman, director of cardiovascular prevention and wellness at National Jewish Health, a hospital in Denver, who was not involved in the research. “I think the question is who is more likely to work from home?”
Younger generations make up the majority of workers in technology, software and other professions that are able to work from anywhere, “whereas older people may have less of those jobs,” Freeman said.
Whatever the reason, the study data shows that people were not moving as much during the pandemic as they used to. That is worrisome, Freeman added.
“If this trend remains, we should really be cognizant that if you’re going to work from home, use either a standing, treadmill or bike desk,” he said, adding that managers of remote employees should “insist people take periodic breaks for people to do exercise, which also is proven to improve mental clarity and acuity,” he said.
Health professionals should always be talking to their patients about activity levels, but “the impact of Covid-19 might make those kinds of messages all the more important to discuss with patients,” Brittain said.
