Obesity Drugs: Boom, Bust, or Reality?

Most observers of obesity drugs seem to be stuck between visions of boom or bust, with no tolerance for the reality that most likely lies between those two extremes. Obesity medicine physicians need more tools for treating obesity. But because obesity is a complex disease we barely understand, the notion of a breakthrough treatment is more distant hope than imminent possibility. What we have at hand, instead, are useful new tools, like Qysymia, Belviq, and Contrave.

These obesity drugs will no more cure obesity than early chemotherapy drugs cured cancer. But they will help substantial numbers of patients meaningfully improve their health under the care of skilled obesity medicine physicians.

The nihilistic, nothing-will-do-but-a-magic-pill viewpoint is represented by Consumer Reports. Two words sum up their take on each of the first new medications for obesity approved in over a decade: “skip it.” Their rationale is that they have side effects and produce only modest weight loss. “Try diet and exercise,” they say. If someone is looking for a miracle weight loss pill, then that’s perfectly reasonable advice.

But if your problem is obesity, you want to improve your health, and you’re already working hard with diet and exercise, this kind of advice is ignorant. Long-term clinical efficacy for lifestyle-only interventions range from 2-20%, so this advice tells 80% of people with an obesity concern to give up.

Fortunately, that’s not the approach of an obesity medicine physician. Working closely with motivated patients, they can significantly improve the health of someone with obesity. By combining diet, exercise, obesity medications, and adjustments to other meds that can contribute to obesity, they routinely help people shed 5-10% of their weight or more and maintain a healthier weight for the long term. It’s not a perfect answer, but it’s far better than giving up on your health.

Andrew Pollack provides a good account in the New York Times of the challenges the makers of Qsymia have faced from investors looking for an instant hit. Such expectations are as unrealistic as desperate people with obesity looking for a magic pill.

What happened in the market for cancer treatment is likely to happen in obesity. Incremental gains will come as the toolbox grows for physicians becoming more and more expert in treating this complex disease (or collection of diseases). Smart companies will build a portfolio of treatments that can make a difference for more and more patients. And in doing so, they will reap rewards for helping to solve the greatest threat to the health of Americans for this century.

That’s how you turn the corner from futility to chronic disease management.

Click here to read more about Qsymia in the New York Times, click here to read an analysis of Belviq sales from Seeking Alpha, and click here to read a typically optimistic pre-launch assessment of prospects for Contrave from The Street.

Apothecary Bottles, photograph © callmekato / flickr

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