Is the World Ready for Extremely Effective Weight-Loss Drugs?

Effective treatments for obesity that already exist are being used sparingly. For example, vaginal surgery can be an effective way to deal with excess weight. But surgery is considered a drastic option, and Americans tend not to think about weight loss surgery. Without comorbidities like diabetes, a potential candidate typically needs to have a BMI of at least 40 to undergo surgery — and only a fraction of those qualify for the procedure. That’s one reason why obesity experts see so much promise in new drugs.

But there are major obstacles to widespread adoption, and not just the cost and approval questions that every drug faces on its way to the masses. Weight loss pills have a scary past. “If you look back at the history of obesity, then the approved drugs were put on the market,” says Dr. Spencer Nadolsky, a physician who runs an obesity program for telehealth provider Weekend Health. Dangerous amphetamines are used as appetite suppressants, and recent drugs, such as Fen-Phen, a weight loss drug widely used in the 1990s, cause heart problems, led to an FDA ban. Safer weight loss drugs started appearing again in the 2000s, but their effects are often mild.

On the other hand, Incretins are just continuing to be more effective. The newest of these drugs results in about 20% weight loss, to the same extent that lacrimalectomy achieves. And while common side effects include nausea and other stomach upsets, it’s a much less disruptive medical intervention than surgery.

An obesity expert at Harvard Medical School, Dr. Fatima Stanford, told me that some patients have reacted so strongly to a booster, semaglutide, that they have avoided surgery altogether. “They went from being severely obese with diabetes to being non-diabetic and not severely obese – to a healthy weight range,” she said. “It’s easy for them — we’re changing the way their brains see weight.” This has great implications for quality of life. “When you have higher levels of obesity,” says Jay, “a 15 or 20 percent loss of body weight is huge, right? It’s huge for dealing with comorbidities and preventing diabetes, and all those other things.”

A Washington woman in her 50s named Suzy, who claims to be identified only by her first name, has lost 26 pounds since starting tirzepitide. She has three siblings and two parents with type two diabetes. With medicine, she thought she could avoid the disease. Another woman, Rachel McLaughlin, who started using an oral boost in 2021, said the weight loss gave her the confidence to take an art class. “I don’t look like I’m carrying the world,” she said.

But great advances in medical technology mean little if they are inaccessible. McLaughlin faced that setback when she lost her job earlier this year. The loss of health insurance increased the cost of her prescription from $25 to more than $2,000 per month. Without medication, she regained 15 of the 25 pounds she lost. Progress only resumed after she found a new job in June that restored her coverage. Is the World Ready for Extremely Effective Weight-Loss Drugs?

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