OW2023: A Tantalizing Future, Inadequate in the Present

Forgive us a bit of skepticism please. We are facing a jarring disconnect at ObesityWeek from the reality of medical care that simply can’t keep up with stunning progress in obesity science. Scientists and obesity medicine experts are promising us a tantalizing future for obesity care while the present circumstances facing real people living with obesity is utterly inadequate.

It feels a lot like the promise of flying electric cars meets the reality of earthbound vehicles burning up the planet. Is a bit of skepticism warranted?

Stunningly Good Results with Tirzepatide in Obesity

First of all, we should say that yet again tirzepatide is delivering effectiveness for obesity that impresses. Yesterday, Thomas Wadden and colleagues published results from the SURMOUNT-3 study in Nature Medicine and then five consecutive presentations delivered all the details at ObesityWeek. Speaking with the Associated Press, Caroline Apovian summarized it succinctly:

“Any way you slice it, it’s a quarter of your total body weight. We’re doing a medical gastric bypass.”

People took tizepatide for 72 weeks after an intensive lifestyle change program for 12 weeks. Their weight was 25% less at the end of those 84 weeks than it was when they started. In the control group, people got 12 weeks of behavioral therapy and a placebo for 72 weeks. Their total weight loss was only five percent of their starting weight.

This indeed is a result that approaches what many people see with gastric bypass surgery. Even more impressive is the picture presented by Ania Jastreboff and Lee Kaplan, describing the future that lies ahead. Many more options for medical therapies that improve upon tirzepatide and semaglutide are coming.

Back to Reality

But back in the real world, the picture is not so glowing. Surprised by the unmet need for obesity care, Novo Nordisk is unable to keep up with the demand for semaglutide. They’re keeping the supply constrained and the price high. The same is true for tirzepatide, which is only approved right now for treating type 2 diabetes. Even with this limited indication Lilly cannot keep up with demand.

Likewise, the capacity of health systems to deliver skilled medical care for people living with obesity is dismally poor. The waiting lists to see obesity medicine specialists are thousands of patients long. Health insurance plans are jerking their customers around, pleading poverty and cutting off patients whose lives have been transformed by these medicines. So some of these patients are suing their health insurance provider.

It is a bloody mess. We have a long way to go before a tantalizing future of flying electric cars replaces the inadequate present.

Click here for the new study in Nature Medicine, here and here for further reporting on it.

Flying Electric Car, illustration by unknown artist / Wikimedia Commons

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October 16, 2023