New weight loss drugs are “miraculous,” but who needs them?

Obesity is undergoing a paradigm shift: no longer framed as a consequence of poor lifestyle choices, but a chronic biological disease — one that is treatable with a new class of miracle drugs.

Novo Nordisk’s once-a-week injection promised 15 percent weight loss on average. Patients who took Eli Lilly’s experimental drug lost an average of 58 pounds or 24 percent of their body weight.

A breakthrough treatment after decades of failed medications seemed too good to be true — bridging the gap between dieting and bariatric surgery. What followed was a continual soar in prescriptions, leading to supply and insurance problems making the treatment evasive.

How much weight do people lose on these drugs?

• Novo Nordisk drugs Ozempic and Wegovy (semaglutide) showed a minimum of 5 percent reduction in body weight, with an average of 15 percent of body weight lost with a once-a-week injection over 68 weeks.
• Eli Lilly’s trizepatide (Mounjaro) demonstrated an average of 15 percent reduction in body weight. The drugmaker reports a 26 percent average weight reduction over 88 weeks.
• Orforglipron, Eli Lilly’s experimental drug available as a pill, reports a 9.4 to 14.7 percent average weight reduction when taken as a once-daily pill.
• Another experimental drug, retatrutide is a triple-hormone receptor agonist — with clinical trials showing participants losing 24 percent of their body weight on average.

Who should be using these weight loss drugs?

• Nearly 2 billion adults worldwide are considered overweight, of which an estimated 650 million are affected by obesity. While the incentive to use these anti-obesity drugs can be significant, losing sight of generic lifestyle interventions becomes more convenient.
• The Food and Drug Administration suggests the use of a weight-loss drug in adults with at least one weight-related condition (such as type 2 diabetes or high cholesterol), used in conjunction with a reduced calorie diet and increased physical activity.
• Almost half of US adults (45 percent) say they would be interested in taking a safe prescription weight loss drug, a recent survey from KFF found. However, interest decreased substantially once they were informed of the drawbacks.

Potential risks

• The new class of weight loss drugs helps regulate appetite and reduce hunger — but has a potential side effect of gastrointestinal issues and even a potentially increased risk of intestinal obstruction.
• Experts have flagged concerns such as excessive loss of muscle mass, while other patients experience heart palpitations, nausea, and the emotional trauma of a weekly injection.
• These drugs have also been under watch for their safety data after some patients reported suicidal or self-harming thoughts.

The “second generation” of anti-obesity drugs is resetting expectations: with an oral pill promising wider availability, and experimental injectables demonstrating unprecedented levels of weight loss.

However, several patients remain uninterested due to absurd costs, a lack of insurance coverage, the risk of regaining weight, and the requirement for routine injections.