The Fake Line Between Obesity and Other Metabolic Disease

Nestled in the midst of a lot of good news last week was a nasty reminder of a persistent problem. It’s the fake line that people persist in drawing between obesity and other metabolic disease. Lilly did it (with consent from FDA) when they decided to put a different brand name on tirzepatide for obesity. If it’s for diabetes, the name is Mounjaro. For obesity, it will be Zepbound.

This prompts an obvious question. What shall we call tirzepatide for the many people who have both obesity and diabetes?

Moonbound?

Who Are We Fooling?

Honestly, this is a silly tactic that fools no one. Zepbound is exactly the same drug substance as Mounjaro, supplied in the same dosage forms and strengths. The only difference is the brand name on the label and the details in the prescribing information. Are we supposed to believe that FDA and Lilly were not capable of coming up with a package insert that covers both indications?

Nope. Not a chance. In fact, more complete labeling for a single product could be even better – simply because these two indications overlap. Treating diabetes requires treating obesity in the many people where the two diseases occur together.

This is not hard. The people developing these drugs are very smart. This fake line between obesity and other metabolic disease does not benefit people living with obesity. In fact, it sets them apart and perpetuates the second-class status for people with this disease. A disease that, in fact, they want no part of.

All About the Money?

Beyond saying that executives really like the name and it “tested well,” Lilly isn’t really saying why they chose to set up the fake distinction line between using tirzepatide for obesity versus other metabolic disease.

But the most likely explanation is likely money. No surprise. Perhaps they figured that two brands would generate more sales than one. Or maybe they thought that the stigma associated with obesity would tarnish their diabetes brand. A similar rationale led Lilly to market two separate brand names for fluoxetine – Prozac for depression and Sarafem for PMDD. The second brand, Sarafem, never took off and Lilly discontinued it.

Dual branding is a stupid trick that seldom fools anyone. Even in obesity, the public is talking about Ozempic. Not Wegovy.

An Ongoing Charade

This charade may make no sense for patients or prescribers, but so long as Lilly and Novo Nordisk believe it creates a financial advantage for them, it will continue. Novo even went so far as to slap a huge list price premium on Wegovy versus Ozempic. So PBMs can angle for bigger rebates and thus bigger profits.

We give Lilly credit for not repeating that mistake.

But the dual branding game serves to reinforce the utterly false perception of stigma attached to obesity. Oh, you’re taking it for obesity? Tsk, tsk.

In truth, the stigma should belong only to business tactics that don’t put patients first.

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Lineare Composition, painting by Lyubov Popova / WikiArt

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November 13, 2023