Two years ago, I found myself sitting in an endocrinologist’s office, holding a color-coded portion plate and wondering if I was supposed to put the tomatoes in the ‘fruit’ section or the ‘vegetable’ section.
It took me close to a year to get the coveted appointment slot and I thought I was going to walk away with some answers as to why I couldn’t lose any of the weight I had gained. Instead, I was being lectured about eating too much. Even though I was seeing a nutritionist, tracking my food and working out daily, I left the office convinced my excess weight was entirely due to my own personal failing.
For better or for worse, weight has always carried meaning.
History offers a capricious narrative about body size. In the 19th century, ‘plumpness’ was not only fashionable but also associated with power, good health and prosperity. Yet the tables turned with the century, and people suddenly began to equate excess weight with being inconsiderate, unintelligent, lazy and even promiscuous.
While social stigmas can be bitter pills to swallow, medically, stigmas can be dangerous. With obesity widely perceived as something that can be controlled with diet and exercise alone, patients are less inclined to seek treatment and doctors are less inclined to prescribe medication.
But the problem isn’t going away. Obesity rates are expanding with our waistlines and currently, two thirds of America is overweight or obese.
Up until recently, the issue was compounded by a lack of long-term, effective pharmacologic treatment options. This can be partially attributed to an obesity space that’s never been overly fruitful for the pharma industry. Phentermine has been the most commonly prescribed anti-obesity treatment for decades, and yet the entire U.S. phentermine industry, brand and generics combined, is estimated to generate just over $200 million annually.
For comparison, Novo Nordisk’s GLP-1 receptor agonist, Wegovy, brought in $1.1 billion in the second quarter of 2023 alone.
But to be sustainable, weight loss gains need to go further than the bank. The rise of incretin mimetics in chronic weight management has the potential to change the look of obesity care. Not only can the drugs help people lose upwards of 20% of body weight when used in conjunction with diet and exercise, but the public buzz has given drugmakers a platform to educate on the multiple health risks that come with obesity.
In short, it’s time for obesity care to shape up — and pharma holds the key to shedding stubborn stigmas.
Of course, some very big issues loom large for the pharma industry. Chief among them, a demand that is massively outstripping supplies, and a U.S. price point that much of the country can’t afford. But as you will read in this month’s cover story, drugmakers are advancing new drugs through pipelines and pouring billions into manufacturing capacity for existing drugs. Further clinical evidence in indications like cardiovascular health is making a strong case for incretins with payers.
Obesity has been viewed as many things throughout history but perhaps with modern-day medications, it can simply be viewed as treatable. We aren’t there yet, but for those of us who have exhausted all options only to be fat-shamed while wondering why paper gowns only come in one size, the weight may be close to over.