Tirzepatide Data Signal a New Era in Obesity Treatment

White Bear King Valemon,This is what you might call a clean sweep. At the Scientific Sessions of the ADA and in NEJM yesterday, researchers unveiled detailed data on tirzepatide for obesity. When Lilly gave us a peek at these data a month ago, “Wow!” was our response. With the full details in view and peer reviewed, we tend to agree with people who are saying these data on tirzepatide point to a new era in obesity treatment.

No Magic, but a New Era

Lest we get too carried away with these impressive results, let’s be clear. Though we believe that tirzepatide may indeed mark the beginning of a new era in obesity treatment, there’s no magic here. Not everyone will tolerate this drug or get good results. In a press conference at the ADA meeting, Lee Kaplan summed it up quite well:

“We are in a new era of treating obesity. That is one of the most important conclusions from what we have seen today. There are now three strikingly effective and adequately safe therapies for obesity. First is bariatric surgery, second is semaglutide and now the third is tirzepatide.”

“Two-thirds of patients lost more than 20% of their body weight and 23% lost as much weight as seen with bariatric surgery – 30%. However, at the other extreme, about 3.7% lost less than 5% of their body weight. This variability becomes important. We will not solve everyone’s obesity by treating them all with tirzepatide, even if we could.”

A new era? Yes. Magic? No.

Coming to Terms with the Chronic Disease of Obesity

The lead author and presenter of this research was Ania Jastreboff. Emphasizing the unprecedented results in this 72-week study, she pointed out that 40 percent of the people receiving the top dose of tirzepatide lost at least a quarter of their initial body weight.

But still, she cautioned people to remember that not everyone will respond to this medicine. And she stressed that, even for people who respond well to tirzepatide, this is still a chronic disease:

“If you stop the anti-obesity medication then the body fat mass setpoint will go back up so this necessitates long-term treatment.”

Clifford Rosen and Julie Ingelfinger, a bone metabolism researcher and a pediatric nephrologist, wrote a generally positive editorial for the NEJM to go with this stunning research report. They, too, seem to think tirzepatide marks the beginning of a new era. “The tides are shifting,” they wrote as they called these results “remarkable” and compared the outcomes to bariatric surgery.

Curiously though, they added speculation to their commentary about “holidays” from the drug and using it intermittently, which makes us wonder if they really understand the chronic disease of obesity. It was an odd tangent, untethered from the science of obesity or the research at hand.

(Mis)Understanding Obesity

Perhaps this was a useful reminder. Most healthcare providers do not devote themselves to understanding obesity and caring for the people who live with it. And thus, even though this is the most prevalent chronic disease in America, many healthcare professionals carry a lot of biases and misunderstandings about obesity. A prominent example is the presumption (possibly a wish) that obesity should be a transient condition – preventable and reversible with the right behaviors and discipline.

It’s an utterly false presumption, but it’s a common one that fuels a lot of implicit bias. Maybe this is why Rosen and Ingelfinger imagined that people with obesity might take drug “holidays” from a regimen that’s working.

In any event, we remain confident that with new drugs that can treat this challenging chronic disease, people will come to understand it better. With better understanding and better options, as we have seen with other difficult diseases, we hope that biases will fade, and barriers to better care will diminish. That is our hope.

Click here for the full results in NEJM and here for the editorial to go with it. For further reporting, click here, here, and here.

White Bear King Valemon, painting by Theodor Severin Kittelsen / WikiArt

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June 5, 2022

3 Responses to “Tirzepatide Data Signal a New Era in Obesity Treatment”

  1. June 05, 2022 at 6:19 am, Joe Gitchell said:

    Thanks, Ted–this is encouraging, not the least of which how important it is to have options and new reasons for both patients and providers to re-engage with a stubborn challenge.

    I don’t pay enough attention to NEJM commentaries across domains, but I wonder if they’ve adopted a “this is a really promising treatment but how do we make sure that it doesn’t work too well/have too big in impact” posture? I can understand not wanting to seem like overly enthusiastic cheerleaders, but this one from 2019 after the publication of a study comparing e-cigarettes to NRT in English Stop-Smoking Services is noteworthy for the tepidness of its recommendations, IMO.


    Fingers crossed that more people who confront obesity can get the help they need.


    My employer, PinneyAssociates, provides consulting services regarding tobacco harm minimization and vaping products to JUUL Labs, Inc, on an exclusive basis. I also own an interest in a nicotine gum that has not been developed nor commercialized.

    • June 05, 2022 at 7:20 am, Ted said:

      You raise a good question, Joe. I note that in the editorial you are referencing, the authors are a psychologist with expertise in tobacco dependence and a physician whose expertise is asthma. In the obesity medicine editorial, neither author practices in obesity care. Another common thread in both obesity and tobacco dependence is bias that favors thinking about these conditions in simplistic behavioral terms. It’s impossible to say that implicit bias influences a specific opinion piece, but the possibility merits our attention.

      Expertise can come through scientific and clinical work. It can also come from lived experiences. But it should be reflected in such a distinguished journal as NEJM.

  2. June 05, 2022 at 7:50 am, Angie Golden said:

    Great news indeed of a possible new treatment several years in the future. I wonder if the esteemed Rosen and Ingelfinger might suggest drug holidays for HTN, DM, and every other chronic disease! This example of bias and lack of knowledge in obesity will become my ‘go to’ example in upcoming presentations perhaps making them well known for their lack of education. I hope there is a commentary by obesity physicians to educate this audience in NEJM the obesity is chronic and those of us living with it don’t get to take a “holiday” from the disease.