Water Album - The Waving Surface of the Autumn Flood

Scratching the Surface with New Obesity Meds

With all the sensational reporting about semaglutide and tirzepatide for obesity – often with the emphasis on weight loss – you might think a revolution is underway. Yes, it is coming. But the truth is that it hasn’t even started yet. At present, for a number of reasons, we are barely scratching the surface of the potential of these new obesity meds to transform obesity care and thus long-term health outcomes for people living with obesity.

With a new paper in Expert Review of Endocrinology & Metabolism, Kevin Maki, Carol Kirkpatrick, David Allison, and Kishore Gadde explain.

Unexplored Potential

Even with the recent sensational buzz about improved short-term efficacy for weight loss, the implications for long-term health get scant consideration – apart from speculation about hidden dangers. Maki et al explain that these medicines presently receive limited use for promoting better long-term health outcomes:

“The use of medications to treat obesity is relatively rare. In part, this reflects concerns about long-term safety and weight loss effectiveness, possible provider bias, as well as lack of clear evidence of MACE risk reduction. If ongoing outcomes trials demonstrate the efficacy of newer agents in reducing MACE risk, this will likely lead to expanded use in obesity management.”

Two Major Trials in Progress

In their paper, Maki et al review the clinical outcomes from various treatments of obesity, ranging from modestly effective lifestyle changes to highly effective bariatric surgery. With the effectiveness of surgery, available evidence points to a substantial improvement in long-term outcomes:

“Bariatric surgery is associated with substantial weight reduction (20–30%) and markedly lower subsequent risk for MACE.”

Semaglutide and Tirzepatide represent successive leaps toward matching the effectiveness of surgery with advanced medicines for obesity. For each of these drugs, major trials of their effectiveness for reducing MACE outcomes are underway.

The SELECT study with semaglutide in obesity will report final results this fall. The SURMOUNT-MMO study started last fall and will not be complete until 2027. With hypertension, cholesterol, and now diabetes medicines, we have seen how favorable data on MACE outcomes can bring huge shifts in clinical care.

We have every reason to expect that – if these obesity outcome studies are favorable – we will see a similar transformation in obesity care.

More to Come

Clearly, other pharmaceutical companies see this potential for great progress beneath the surface of news about new obesity meds like semaglutide and tirzepatide. Maki et al mention cagrilinitide, cotadutide, and bimagrumab – all of which are progressing in clinical development. Other big pharma companies, such as Pfizer, Amgen, and Boehringer Ingelheim, are investing in clinical development of obesity drugs in their pipeline.

On top of that, STAT News points out that biotech startups are looking to leap past big pharma with even more advanced medicines.

So yes, we have plenty of reasons to believe that the present interest in using better medicines to treat obesity is barely scratching the surface of what might lie ahead.

Click here for the paper by Maki et al, here and here for further insights on new obesity medicines in development.

Water Album – The Waving Surface of the Autumn Flood, painting by Ma Yuan / WikiArt

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May 9, 2023