Brands That Keep Obesity Separate and Unequal

Fed up. That’s where we are with stories about how people taking semaglutide for obesity are keeping people with diabetes from getting an adequate supply of the drug they need. Fed up, because it’s a stealthy way of expressing implicit bias against people living with obesity. The subtext is that those people don’t really need or deserve the drug. And part of what fuels this bias is an apartheid system of separate brands for obesity and diabetes for both semaglutide (Wegovy vs. Ozempic) and liraglutide (Saxenda vs. Victoza).

Now we hear that Lilly is considering assigning a different brand for obesity to tirzepatide when the company gains approval for it.

Let’s be clear. This is a bad idea – because it will perpetuate a separate and unequal status for the complex, chronic disease of obesity.

Anatomy of the Narrative

The stories about this situation, as we’ve noted before, rely on sensationalism, complemented by a deep misunderstanding of obesity. In fact, folks promoting this narrative leave the word obesity out of their stories. They simply talk about weight loss. That’s because weight loss sounds more trivial than obesity treatment. Easier to link to Hollywood and superficial, cosmetic concerns about body weight.

So it becomes a story about stupid, shallow people hogging a tight supply of a drug that more deserving people with diabetes really need. In a very tidy, implicit way, it plays on all the stereotypes about people with obesity and their greedy appetites.

But the truth of the matter is that people living with obesity who need semaglutide need it for sound medical reasons. Much has been made in the press about Elon Musk taking it. We get it. Right now it’s fun to make fun of the guy who seems to be burning Twitter to the ground. But the fact is that the folks writing these stories and linking his use of semaglutide to “Hollywood’s harmful weight-loss obsession” know absolutely nothing about Musk’s medical history or his metabolic health. Mocking him for taking a drug that treats obesity is wrong.

Obesity can have consequences for health that are every bit as serious as diabetes. In fact, diabetes can be the result of untreated obesity, along with many other complications.

Dual Branding of Drugs

When a drug has two uses – one for a serious medical condition and one for something more cosmetic – pharma will sometimes assign different brand names for the different uses. An example is Proscar (finasteride) for an enlarged prostate. The same drug works for male pattern hair loss and carries the brand name Propecia. But separate branding seldom happens when a drug has two serious medical indications – like hypertension and heart failure.

In the case of semaglutide and liraglutide, one excuse was that the doses were very different (much higher) for obesity. That made it easier to rationalize putting a different brand name on these drugs for the obesity indication. But some people with obesity get adequate benefit from these drugs at the lower doses typically used for diabetes. Plus some people with diabetes require doses of semaglutide (2.0 mg) that are almost as high as the obesity dose.

Having a separate brand for semaglutide in obesity has also made it possible for Novo Nordisk to charge a higher price for this indication. Not something we favor.

Separate, Unequal Brands Hard to Justify Today

In sum, things are changing fast in obesity care. Though many people perpetuate the stigma and misunderstanding attached to obesity, thought leaders in health know better and the world is catching on. Separate and unequal branding is simply wrong. It’s a subtle way to dismiss the importance of treating obesity in contrast to diabetes.

We hope Lilly will not take this path.

Click here and here for more on double-branding deliberations at Lilly. For perspective on confusion with multiple brand names, click here.

Separation in the Evening, painting by Paul Klee / WikiArt

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November 20, 2022