23 Apr 2023 How a diabetes drug became a blockbuster diet drug
“New” and very effective weight loss drugs are creating headlines everywhere…. so what’s all the fuss and interest about?
In the summer of 2018, Lisa Robillard left her doctor’s office and walked down the long corridor of a medical complex in suburban Virginia. She’d just had an appointment with yet another physician who could only recommend “diet and exercise” when she brought up her life-long struggle with her weight.
Robillard was 11 when she attended her first Weight Watchers meeting with her family, who celebrated hitting their dieting goals by going out for ice cream.
Later, when her first fiancé proposed, the ring was conditional on dropping several dress sizes. She lost the weight but, when they split, it piled back on. Now, after 40 years of yo-yoing, she was dispirited. Then Robillard glimpsed a sign hanging on one of the doors along the corridor: “Struggling to lose weight? You don’t have to do it alone.”
Inside, she found a somewhat grim clinic of aged vinyl chairs and wall-to-wall beige that didn’t much look like the birthplace of a wonder drug. But she also learnt that more and more scientists believe obesity is a disease rather than simply resulting from unhealthy habits and that, for the seriously overweight, lifestyle changes will never be entirely effective.
Eventually, she joined a trial the clinic was running for a new drug called Wegovy. “I wish I had known sooner that it wasn’t just a lack of willpower,” says Robillard, who is now 55. “The many dollars spent on going to weight-loss [meetings], the years of beating myself up, the years of self-hate. I wish I had known that it wasn’t my fault.”
Wegovy, made by Danish drugmaker Novo Nordisk, is the first in what is shaping up to be a new generation of obesity treatments, which use a hormone to regulate appetite. (The name is the result of a nebulous bureaucratic process involving pharmaceutical regulators and the company’s marketers.)
The average patient in the study in which Robillard participated lost 15 per cent of their body weight, about three times more than on previous drugs. Nearly a third of them lost almost as much as they would after weight-loss surgery. Robillard lost 57 pounds. (See the study report in the BMJ here)
The obesity crisis
The US FDA approved Wegovy for general use in June 2021. Wegovy arrived on the market amid a global obesity crisis. Almost half of Americans are expected to be obese by 2030, a Harvard study found, and that could account for up to 18 per cent of healthcare spending on related conditions, ranging from heart disease and stroke to osteoarthritis.
Worldwide obesity rates have tripled since 1975, with 650 million adults obese in 2016, according to the WHO. In 2019, the OECD declared that developed countries’ plans to tackle the problem were largely failing. And the Covid-19 pandemic only underscored that obesity puts people at greater risk for infectious disease.
Despite the vast need, many major pharmaceutical companies have held back from developing weight-loss drugs, in part because the category is marred by a long history of quackery and safety scares.
From the 1930s to the 1960s, the industry poured money into diet pills based on amphetamines. These eventually fell out of favour because they were highly addictive and had harmful side effects. In the 1990s, fen-phen — a combination of fenfluramine and phentermine — became so popular that weight-loss clinics sprung up across the US just to prescribe it, even though some patients on the drug experienced manic episodes.
It was later taken off the market after a study showed up to a third of patients could suffer from heart valve defects. As recently as 2020, US regulators forced the withdrawal of weight-loss drug Belviq because of concerns it increased the risk of cancer. For the most desperate, surgery has become popular, though it is expensive and comes with its own risks and restrictions.
Perhaps unsurprisingly, Wegovy — a weekly injection patients self-administer using a small device that looks a bit like an EpiPen — has plenty of fans.
Patients like Robillard, for one. While her day job is still working for a union, she now works part-time as a Novo Nordisk spokesperson, giving motivational speeches to staff. Unpaid celebrity endorsements include venture capitalist Marc Andreessen, who says the drug completely changed his relationship with food, and Elon Musk, who has cited it on Twitter.
Novo Nordisk recently more than doubled its sales targets for obesity drugs to $3.7bn by 2025. But before the company can make Wegovy mainstream, it has to convince doctors to prescribe it and insurers and governments to pay for it. It has to persuade patients to sign up for some heinous side effects.
Seeing obesity as disease
And then there’s the small matter of overturning centuries of, as it turns out inaccurate, assumptions embedded in the Latin root of the word obesity: “having eaten until fat”.
Since the second half of the 20th century, the wealthy have tended to stay thin, a benefit of having access to medical care, healthy food and free time to exercise. But for most of human history, scarcity reigned, and the rich flaunted their fat. Corporal excess was proof of a bountiful table and perhaps even genes that would protect offspring in times of famine.
But the story of obesity has always been complicated. The toll it takes was clear to the ancient Greeks, Hippocrates noting that “corpulence is not only a disease itself, but the harbinger of others”. Then Christianity came along and yoked appetite to deadly sins such as gluttony and sloth. In Dante’s inferno, the souls of food addicts are punished by icy rain, representing the damage their overindulgence does to themselves and others.
Novo Nordisk scientists have viewed obesity as a disease for 25 years. It is an unusual pharmaceutical company. Based just outside Copenhagen and almost a century old, it is controlled and part-owned by a charitable foundation that invests in scientific research, start-ups and humanitarian projects. The world’s 17th largest pharmaceutical company by revenue, it generated sales of about $20bn in 2021.
The company’s staff likes to say Novo Nordisk was born from a love story, because its founder sought out insulin for his diabetic wife, bringing it back to Denmark for her from Canada before building his business. So its scientists paid attention in 1987 when three separate teams of academic researchers — in Copenhagen, Boston and London — simultaneously discovered the effect of a hormone known as GLP-1 on insulin…..
The Financial Times: Read the full article
Additional reading:
‘You forget to eat’: How Ozempic went from diabetes medicine to blockbuster diet drug: In the last several months, Ozempic has exploded onto the scene, with everyone from Elon Musk to Chelsea Handler talking about taking versions of the drug. But Ozempic’s rise to superstardom status was not something most people predicted…… Read more here
What is Ozempic and why is it getting so much attention? More people are turning to a diabetes medication to induce weight loss — but experts say it’s not a miracle drug….. Read more here
The obesity jab may save the food industry’s bacon, but should it?: Semaglutide has reignited the debate over who is responsible for weight, and how as a society we tackle it….. Read more here
How diabetes med Ozempic became a fad weight-loss drug: TikTok, a Kim Kardashian rumour, and a handful of telehealth companies have helped turn Ozempic and its sister drug Wegovy from essential medicines to weight loss drugs du jour….. Read more here