A new generation of anti-obesity drugs promises to significantly reduce weight, but there is still a long way to go before they are available to those who need them.
Obesity is the last major untapped disease — afflicting more than 100 million Americans — and pharmaceutical companies have struggled for decades to develop a cure.
After all, there are drugs on the market that promise more than 15% to 20% of body weight loss, more than drugs can achieve, and such weight loss is rarely seen outside of surgery.
But until now, only the wealthiest and luckiest have had access to the first new drugs. The drug, called Wegovy, costs $1,349 for four monthly injections.
Insurance usually doesn’t cover obesity drugs, even though obesity has been linked to 200 diseasesThese include diabetes, heart disease, and certain cancers. As a result, Wegovy is often not available to patients in dire need. For some who can, they suffer horrific side effects.
Just ask Elise Davenport.
Davenport, 40, decided to stop taking his meds one night in late spring while sobbing on the bathroom floor.
She had been suffering from dry mouth and severe vomiting. Even the water made her vomit. The food was so disgusting she couldn’t imagine eating it. “Nothing worth it,” she thought.
Davenport lost more than a quarter of her body weight in seven months thanks to medication and cutting back on processed foods.
Lying on the bathroom floor, she decides to shelve Wegovy, even if it means regaining the weight she’s worked so hard to lose for a decade. She decided the drug was more than her lean body could handle, and that better monitoring through her weight loss program might have saved her from dreaded nausea and acid reflux, trouble sleeping, and depression.
“It just got too much for me,” she said.
Inside America’s obesity epidemic:
Wegovy side effects, supply challenges and unfair distribution
In a way, Davenport was lucky. Most people haven’t been able to get Wegovy because it’s been in short supply for more than a year. Novo Nordisk, which makes the drug, says it will resolve its production issues this month and will relaunch the drug commercially in the first quarter of next year.
Earlier this year, to reduce the number of new patients who started taking Wegovy, Novo Nordisk took the three lowest, ramp-up doses off the market while filling orders for the higher doses, in an effort to target those who were already taking the drug, said Dr. Jason Brett, executive director of medical affairs, via email.
But instead of deterring all new patients, some were started immediately at one of the two highest doses. The ramp-up doses were created to avoid severe side effects.
Davenport was in a medically monitored weight-loss program that diagnosed her as at-risk for diabetes, though her insulin resistance levels were just below the threshold for pre-diabetes. Starting in October 2021, she cut back on processed foods, was prescribed the diabetes drug metformin and ramped up slowly on Wegovy before the shortage really took hold.
She had no issues on the two lowest doses, but problems started as she moved up to the 1 mg dose early in 2022. She had constant nausea, terrible reflux, a sour stomach.
“I was so nauseated, I couldn’t imagine eating anything,” Davenport said.
Her lifelong sleep struggles got far worse and she stopped taking pleasure in food or anything else. In late spring, after shedding about 50 of her 199 pounds, she found herself on the bathroom floor.
“Because I was losing so much weight between the drug and the program, I think that’s what did it to me,” Davenport said.
Dr. Fatima Cody Stanford, an obesity medicine specialist at Massachusetts General Hospital, blames most of Wegovy’s severe side effects on such over-dosing. In her busy practice, she’s found that some people, particularly those over 60, are extremely sensitive to the drugs and may not need the full 2.4 mg dose.
“The side effects, I think, are secondary to people not prescribing them correctly,” Stanford said. “You have to listen to the patient.”
She makes sure her patients are symptom-free before advancing them to the next dose.
People who are immediately started on 1.7 mg or 2.4 mg, as some have been during the shortage, are “a disaster waiting to happen,” Stanford said. “It’s like me throwing a hurricane at your body and you’re not even prepared for light rain.”
Novo Nordisk’s Brett agrees that dosage should be ramped up slowly from .25 mg to the maintenance dose of 2.4 mg.
“Titrating the dose strengths up too quickly or starting at any unapproved dose strength may result in increased rates of adverse events,” he said. “This is why the dose strength of the medicine should be increased gradually, as directed by a health care provider and in accordance with the package insert.”
In clinical trials, 73% of patients treated with full-dose Wegovy and 47% of those receiving a placebo reported gastrointestinal disorders. The most frequently reported reactions were nausea (44% vs. 16%), vomiting (25% vs. 6%), and diarrhea (30% vs. 16%). Just over 4% of those who received Wegovy quit the treatment because of these side effects, compared to less than 1% of those on placebo.
Obesity medicine specialist Dr. Katherine Saunders said her patients typically do well on Wegovy but that it and other medications should be “part of a comprehensive, individualized and long-term approach.”
“We tailor our treatment strategy and we recommend adjustments to diet and behavior in order to minimize side effects,” said Saunders, an assistant attending physician at NewYork-Presbyterian Hospital and co-founder of Intellihealth, a medical obesity treatment platform.
Demand for Wegovy has been unprecedented, said Stanford, who is resentful that celebrities and rich people have been getting access to Wegovy to look better, while her patients in real medical need haven’t been able to access the drug.
“I should not be getting this to look cuter in my bathing suit. That is not the goal,” she said. “I’m really frustrated with the celebrity group taking medications from people I think actually need the medications. I think it’s not right.”
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Not everyone will benefit from Wegovy or any anti-obesity medication, Stanford warned.
And she’s worried about what will happen when these drugs become more widely available. Doctors are not used to prescribing these medications. “We need to be prepared and change our strategy,” she said.
The industry is far more enthusiastic than anxious.
Analysts estimate the weight loss medication field could generate $50 billion annually by 2030, with more than 40% of Americans meeting the definition for having obesity and 70% considered overweight.
“This may be the last 100-million-plus type marketplace left untreated in the United States,” said George Hampton, CEO of Currax Pharmaceuticals, which sells the weight-loss medication Contrave. Contrave, made up of two drugs with a 30-year-old history, targets hunger and cravings and has been shown to reduce weight as much as 11%.