From Weight Loss to Obesity to Cardiorenal Metabolic Health

A profound shift in the understanding of medicines that help with excessive or abnormal fat is underway. A few years ago, everybody thought of these in only one frame of reference – weight loss drugs. But that is changing now. Discourse about them is moving from weight loss to obesity treatment and even further, to cardio, renal, and metabolic health.

This change is moving on several fronts. But the biggest milestone in this progression came this month when FDA granted an indication for semaglutide in obesity to prevent heart attacks, strokes, and deaths. Very quickly after that, CMS announced that this means Medicare drug plans can start covering semaglutide prescriptions for obesity in persons who also have heart disease.

Opening the Door to More Than Weight Loss

Two aspects of this are important. First and foremost, it does away with an absolute prohibition on paying for obesity medicines. Medicare has always used the excuse that these are merely weight loss drugs and refused to cover them. No more.

Second, the agency seems to be looking further down the road, toward other health benefits that obesity medicines might offer beyond weight loss. In updating its guidance, CMS said that Medicare plans can cover obesity medicines that receive “an additional indication” beyond weight management. So they might be anticipating more than just heart health indications.

Moving Beyond Weight

Along with thought leaders in obesity, we have been saying for some time that obesity care involves much more than weight loss. So now we see drug development programs moving beyond weight loss toward establishing benefits in cardiovascular health, liver function, renal function, and more.

For example, Lilly plans regulatory submissions for tirzepatide in obstructive sleep apnea and heart failure this year. Lilly, Novo, and Boehringer are studying applications for their obesity medicines in MASH. Furthermore, nephrologists see promise for new obesity medicines to benefit patients with both kidney disease and obesity:

“A wave of new, highly effective, and more tolerable anti-obesity agents is revolutionizing the management of obesity, with additional drugs expected on the horizon. This has major positive implications for the population with CKD because obesity is a central mediator of kidney disease as well as a major obstacle to the optimal care of such patients.”

Public Understanding?

Perhaps the biggest question is how the public understanding of obesity medicines will change. Relying on People magazine or the Daily Mail might lead one to think that the public only cares about these drugs for weight loss.

But a more careful look at this by Pew Research, suggests the public understands more than one might assume. Most people (53%) regard these new medicines as useful for persons with obesity or a weight-related medical condition. They are not such a good idea for people who do not have a weight-related medical condition, according to 62% of U.S. adults.

So yes, we are on our way toward understanding obesity medicines as tools for gaining health in serious ways, not just for weight loss.

For further perspective on obesity and cardiorenal metabolic diseases, click here and here.

Ivory Male Anatomical Figure, France, photograph from Wellcome Images, licensed under CC BY 4.0

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March 23, 2024