Imagine it’s lunchtime and instead of craving this giant bacon double
cheeseburger to feel full, all you needed was this little slider.
That’s the reality for many patients taking a brand-new kind of obesity treatment.
When I took my first dose, the next two days,
I felt this satisfied-hunger feeling that I don't think I'd ever felt for years.
Wow!
Was this how a normal person maybe can feel around food?
The secret behind Wegovy and its predecessor Ozempic is an active
ingredient called semaglutide, which belongs to a group of drugs called GLP-1 receptor agonists.
They work by imitating a naturally occurring gut hormone that helps regulate appetite in the brain.
Originally developed to treat diabetes,
this class of drugs has taken the pharmaceutical world by storm.
They're much more effective than drugs we've had before.
They're even more effective than lifestyle modifications on their own.
We are getting lots of inquiries, lots of people are desperate to try.
Celebrities like Elon Musk and Jeremy Clarkson have helped fuel the excitement, with Hollywood
stars and social media influencers touting the effectiveness of these ‘miracle drugs.’
I lost so much weight so fast that I was like, OMG this is magic, this is amazing!
I’m going to start Wegovy because I’m a plus-size individual and I don’t want
to be plus-size anymore and I want to be healthier.
I lost 75lbs in 7 months and I’ve had a lot of people asking me, how did I do it?
So, is there a catch?
Well, the long-term consequences of these drugs are not yet known. And they’re expensive.
Plus, there are concerns about them getting into the wrong hands. But despite these issues,
GLP1s could transform the diet market.
And experts argue the revolution has only just begun.
The latest report by the World Health Organisation showed that
obesity has nearly tripled since 1975 and continues to rise.
There are more than 1 billion people clinically obese globally,
of whom 650 million are adults, 340 million are adolescents
and 39 million are children.
This is why analysts believe the obesity treatment market could reach
more than $50 billion by the end of the decade.
Peter Verdult is a pharmaceuticals analyst at Citi.
Could you see obesity becoming a $50 billion plus market without making ridiculous assumptions?
That is a feasible scenario.
These medicines are so powerful they are already displacing traditional weight loss programs.
In March 2023, shares in WW International, formerly known as Weight Watchers, surged over
70% in one day after the diet company announced a $132 million acquisition of Sequence, a subscription
service connecting patients with providers which can prescribe these new weight loss drugs.
This relatively new drug class was originally developed by Danish pharmaceuticals giant Novo Nordisk
to treat diabetes, and it’s been a monumental achievement in diabetes care.
But researchers also noticed that patients
taking these drugs were losing significant amounts of weight.
GLP-1 is a gut hormone that you and myself produce.
And it has multiple effects around the body,
So it signals to the pancreas to produce insulin when glucose or blood sugars are high.
It sends signals to GLP receptors in certain parts of your brain
that almost acts as an appetite suppressant.
It slows down the emptying of your stomach, so it makes you feel full, so you eat less.
Novo Nordisk originally won approval for Ozempic to treat diabetes,
then went back to the regulators with more data and got approval
for WeGovy, a higher dosage version, to treat obesity.
Studies have shown that patients taking a weekly injection of WeGovy achieved
15% weight loss over a 2-year period compared to just 2.6% with a placebo.
U.S. pharma giant Eli Lilly is hoping for even better results with its own
version in 2023, sold under the brand Mounjaro.
WeGovy really sort of changed the paradigm because this is a high dose GLP-1.
It is the same molecule that’s in Novo’s best-selling diabetes product
called Ozempic but it is at a higher dose.
And this drug really is now really changing the paradigm of obesity treatment.
You’re getting 15 to 17 approaching 20% weight loss with a weekly injection.
Jackie Bannister has struggled with weight for years, and she isn’t alone.
The prevalence of obesity in adults from high-income
countries is the highest of any income group.
After reading reports about celebrities losing weight with these new drugs,
she decided it was worth a shot.
I do think a lot of people just will say you're not
disciplined enough. Which, you know, fair enough.
But when you are genuinely feeling hungry, and that's all your brain can focus on,
even though you know you've eaten what should be for the day.
Like it's hard to ignore.
As with any new drug, patients worry about safety and side effects.
Dr. Babak Ashrafi is a general practitioner and clinical lead
for service expansion at ZAVA, a digital healthcare service.
What about side effects, are there any of concern to you?
The main ones with this group of drugs are gut related, and a few sent what we call centrally
associated side effects.
So, the gut related ones are things like nausea, vomiting, occasional abdominal pain,
and the centrally acting side effects are things like headache and fatigue.
Some of the rarer ones that we ask people to look out for include things like pancreatitis.
But, on the whole, these drugs are relatively safe,
they don’t tend interact with a lot of other drugs. And that’s part of the appeal.
The GLP 1 drug class has been on the market for 15 years so there is a well-established
safety database, so I think it’s a pretty safe drug class for sure.
So far, Jackie’s tolerated the injections well.
I've had no negative side effects,
which was something that really scared me to begin with. It seems to be doing the job.
I'm not quite on the full dose yet, that's to come in the future,
but so far I seems to be tolerating it really well.
So how are social media influencers and celebrities getting their hands on these drugs
if they’re intended for those with diabetes or struggling with obesity?
The answer lies in a practice called ‘off label’ prescriptions.
This is when a drug is used for a medical condition that it is not
approved to treat or given in a different way or in a different dose than intended.
The practice is commonly used in cancer treatment.
Jackie has been taking Ozempic, off-label,
as Wegovy was only approved for use in the UK’s free health care system in 2023.
I have yo-yo-ed so much. And ever since taking this, I've been consistent.
Which has been awesome, mentally and physically.
And it's been working. I've lost. I've lost weight.
As the drugs become more popular, concerns about off-label prescriptions are on the rise too.
Novo, understandably, can’t stop Elon Musk from sending a Tweet out to his followers.
It’s out of their control. What they can do is control their sales force to
make sure that the messaging is all as per label.
And I think it’s worth noting that Novo have yet to actually
do any direct-to-consumer advertising in the US.
Anyone who brings up TikTok, Instagram and puts WeGovy and sees what’s going on there,
I don’t think Novo would condone what’s going on in terms of off-label promotion.
I think there's a fine line between prescribing off label and prescribing totally against the
advice of the manufacturer and of all the other organizations that create guidelines.
I don't think there'll be a huge issue in terms of
people taking it outside of the recommended BMI ranges, at least not legitimately.
CNBC’s Meg Tirrell asked Novo Nordisk CEO about the ‘off label’ use of its drugs.
We’re always concerned about, you know, the safety of our medicines
and that’s why we really focus on promoting it the right way,
getting it to a physician and describing how our products should be used.
There is also one big known catch: if a patient stops taking the drugs,
they are likely to regain most of the weight lost.
This means a patient might end up injecting for life if they want to keep the weight off.
How do you feel about the fact that you know, there's a possibility that if you stop taking
the treatment that you might put some of the weight or all of the weight back on? Yeah.
Oh, I mean, that scares me, and it’s somewhere I've been as well. I’ve sat here lighter.
I think this drug is so new, that perhaps maybe down the line,
it might be something where they say it's something you need to take long term.
WeGovy can cost over $1,000 a month in the U.S. out of pocket,
so affordability is a big barrier for these drugs.
Analysts do expect these costs to come down over time as more versions enter the market.
If insurers and public health institutions can be convinced that the
drugs reduce the risk of long-term weight-related complications like
cardiovascular disease, they might be inclined to help foot the bill.
There’s a very strong or very important study looking at WeGovy
in 17,000 non-diabetics, but obese patients.
Its primary aim is to look at the cardiovascular benefit of WeGovy,
so does it reduce the number of strokes and heart attacks.
Now if that trial is positive, I think that would add fuel to the fire.
It also opens the door to what’s going to happen in Medicare.
Beyond safety and cost, there is concern that if drugs like these are used by individuals with
more modest weight loss goals, it could take the body positivity movement in the wrong direction.
The finance community is exuberant about the potential of these drugs.
Novo Nordisk’s share price has doubled over the last two years and still,
healthcare analysts think it could go higher from here.
There’s no reason why the GLP-1 market in diabetes alone couldn’t be worth $40bn+ over time.
Then we move to GLP-1 in obesity. Novo is the only show in town today.
They generated over $2 billion of sales in 2022.
Ultimately, this isn’t just about one company.
While Novo Nordisk has been the leader, Eli Lilly, Pfizer and more are all hoping
to get a piece of the pie with a whole host of promising obesity drugs in the pipeline.
Around the world, it doesn't matter whether it's North America, Europe,
Asia, you're seeing phenomenal growth.
The current script trends are ridiculous.
I absolutely think this is a unique drug class, and that Lilly and Novo will probably
have two of the biggest selling drugs that we've ever seen across diabetes, obesity.
I’ve never seen anything like this, no, in my 20 years.