Is the world prepared for very efficient weight reduction medication?

This is partly because the effective treatments for obesity that already exist are underutilized. Bariatric surgery, for example, can be an effective way to treat extra weight. But surgery is seen as a drastic option, and Americans tend to think badly about weight loss surgery. Without a comorbidity like diabetes, a potential candidate typically needs a BMI of at least 40 to undergo the surgery — and only a small fraction of those who qualify get the procedure. That’s one of the reasons obesity experts see so much promise in the new drugs.

But there are major hurdles to widespread adoption, and not just cost and regulatory issues that each drug faces on its way to the public. Weight loss drugs have a turbulent past. “If you look back in the history of obesity, approved drugs were then withdrawn from the market,” says Dr. Spencer Nadolsky, a physician who directs telemedicine provider Weekend Health’s obesity program. Dangerous amphetamines were used as appetite suppressants, and newer drugs, like fen-phen, a weight-loss drug widely used in the 1990s, caused heart problems, leading to an FDA ban. Safer weight-loss drugs reappeared in the 2000s, but their effectiveness was often low.

Incretins, on the other hand, are becoming more and more effective. The latest of these drugs result in weight loss of about 20 percent, which is in the same range as bariatric surgery. An obesity expert at Harvard Medical School, Dr. Fatima Stanford told me that some patients have responded so severely to an incretin, semaglutide, that they have avoided surgery altogether. “They went from severe obesity with diabetes to no diabetes and no severe obesity — into a healthy weight range,” she said. “It’s effortless for them — we’re changing the way their brain sees weight.” This has significant implications for quality of life. “If you have a higher level of obesity,” Jay said, “losing 15 or 20 percent of your body weight is huge, isn’t it? It’s tremendous for solving comorbidities and preventing diabetes and all kinds of things.”

A Washington woman in her 50s named Suzy, who asked to be identified by her first name only, has lost 26 pounds since starting Tirzepitide. She has three siblings and two parents with type 2 diabetes. With the drug, she believes she can prevent this disease. Another woman, Rachel McLaughlin, who started an oral incretin in 2021, said the weight loss gave her the confidence to take an art class. “I don’t look like I’m carrying the weight of the world around,” she said.

But remarkable advances in medical technology don’t mean much if they’re not accessible. McLaughlin experienced that setback when she lost her job earlier this year. Losing health insurance increased the cost of her prescription from $25 to more than $2,000 a month. Without the medication, she regained 15 of the 25 pounds she had lost. Progress only resumed when she found a new job in June, which restored her cover.

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