Wegovy Approved: Radical or Incremental Progress?

TramExperts labeled it as a gamechanger months ago. So it is certainly good news to see semaglutide approved by FDA, now with a brand name, Wegovy. With good reason, people see this new drug as something that can bring radical progress to treating obesity. On average, it’s more effective than other drugs for obesity. Compared to diet and exercise alone, it is much more effective. For a few patients, it will even bring effectiveness that approaches level of effectiveness seen with bariatric surgery.

But we have to ask. Is this really radical progress? Or is this more of an important increment of progress, with more yet to come?

Subtle Progress Beyond Headlines

People will write volumes about the efficacy of this product. We’ve certainly written plenty about it. JAMA, NEJM, and Lancet all have published papers about it. Anyone who tries to tell you this is not a big deal is not being honest with you or with themselves. This drug simply works better for treating the chronic disease of obesity than any other drug before.

But while the efficacy is a big improvement, it’s still just a big increment of improvement. Not everyone will benefit and the average of 15 percent weight loss will not be fully satisfying to every person seeking treatment for obesity.

Plus, we see other, more subtle marks of progress that are important. One big thing to note is that the initial wave of stories about this approval all describe it as a drug for obesity. Not for weight loss. This is big progress.

Getting Over the Preoccupation with Weight Loss

Years ago, we wrote that losing weight – a little or a lot – has limited value. Yes, it has value, but it’s not even close to being the end of the story for living with obesity. Obesity is a chronic disease. So that means that neither Wegovy, nor bariatric surgery, nor anything else cures it. The goal of treating obesity is to keep it under control. To manage the effects on health and quality of life. It takes patience, persistence, and a long-term focus. There will be ups and downs.

But it is doable. It’s more doable when you go into it with realistic expectations. Not chasing some sort of “dream” weight. Life gets better when obesity is under control. The definition of “under control” will vary from person to person, anchored by the reality of individual physiology.

Getting Serious About Obesity Care

The consistent framing of Wegovy as a treatment for obesity is a step along the way to dealing with obesity just like any other medical condition. Strip away the stigma and help people achieve their personal best health. We’re making progress. However, for radical progress, we have our eyes on the SELECT study, which will be done in 2023. This is a huge cardiovascular outcomes study with semaglutide.

If successful, it will offer strong evidence that treating obesity can extend lives and prevent heart attacks. That will bring radical progress.

Click here, here, here, and here for more on the Wegovy approval. For the full prescribing information, click here.

Tram, painting by Oleksandr Bogomazov / WikiArt

Subscribe by email to follow the accumulating evidence and observations that shape our view of health, obesity, and policy.


June 5, 2021