Can Obesity Drugs Match Surgery’s Effectiveness?

Novo Nordisk is feeling bold. The company has long been a leader in diabetes care. But now, it aims to create obesity drugs that will match the effectiveness of bariatric surgery. CEO Lars Fruergaard Jorgensen told investors this week:

We are making a bet on obesity, and we believe we can ride it based on lifting efficacy. And that will create the market.

Raising the Expectation for Outcomes

Right now, success for a new obesity drug is defined by helping a person achieve and maintain a lower body weight. And at the same time, markers of heart and metabolic health should improve. The benchmark for weight loss right now is about five to ten percent of a person’s initial weight. Novo’s Senior VP for global research says they are aiming higher:

Maybe 25 percent (weight loss) or beyond, but we start by setting the bar at 15 percent or beyond.

Comparisons to bariatric surgery are tricky because of the way that surgeons typically talk about outcomes. They use a number called %EWL – percent excess weight loss. It’s a calculation based on a theoretically healthy weight for a patient. So, if a patient starts out 100 pounds over a healthy weight and they lose 50 pounds, that’s 50% EWL. And a minimum of 50% EWL is a crude benchmark for a successful bariatric surgery.

But %EWL has lots of critics. It’s a somewhat squishy number because the definition of a theoretically healthy weight varies. So in obesity medicine, clinicians simply use the percent of a person’s total baseline weight. And that 50% EWL benchmark translates to something more like 25% total weight loss.

That’s more or less why Novo Nordisk is aiming for drugs that can deliver durable 25% weight loss for people with obesity.

First Up: Semaglutide

The first test of whether Novo is making progress will come in an ambitious Phase III clinical research program Novo unveiled this week. The company will begin this final phase of testing semaglutide in about 4,500 patients with obesity early next year. Early results with this once-weekly injection point to the possibility of achieving a sustainable 15% weight loss.

Semaglutide will likely be approved for diabetes before the end of the year. Approval for obesity will come only after completion of these pivotal studies and only if the studies are successful.

But sustainable weight loss of 15% without surgery will indeed be a step forward. And a pipeline of even more promising possibilities is lined up after that.

This is a high risk enterprise. Many people have tried and failed before. We hope that Novo Nordisk will succeed and point the way for many competitors to follow. People living with obesity need better options.

Click here, here, and here for further perspective.

Illustration from A Text Book of Operative Surgery by Bernard, Huett, and Norton / Wikimedia commons

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November 24, 2017