Tirzepatide Is 99% Effective in Preventing Diabetes. Who Cares?

In the New England Journal of Medicine yesterday, detailed results of a three-year study showed that tirzepatide was 99% effective in preventing diabetes in people with prediabetes and obesity. This was a placebo-controlled trial. Every person in the study, whether they received tirzepatide or not, received regular lifestyle counseling. Compared to the control group getting only that counseling, tirzepatide was 94% better for preventing diabetes.

By comparison, the Diabetes Prevention Program achieved a 58% reduction in that risk. At the time, that study was hailed as major milestone.

A Puzzling Response

So we are puzzled (but not surprised) when some doctors tell the New York Times they prefer to just counsel patents with obesity and prediabetes. Eat less and move more. Stephen Mohring, a primary care physician in Nebraska, said he always starts with discussing nutrition and physical activity:

“I know it’s not exciting, but nutritional approaches and exercise really go a long, long way.”

Kristina Lewis at the Wake Forest University School of Medicine added:

“Potentially a lot of those same people [who received tirzepatide] could have had a great outcome with lifestyle intervention or with a much less expensive, much more accessible medication. Just because something works, is the most potent possible thing, doesn’t mean that everybody needs it, wants it, should have it.”

Persistent Denial of Care

We say that this response is not surprising because it is part of a persistent pattern of denying care to people who want to overcome obesity and its complications. This is on our mind because we are in the midst of discussions at the National Academy of Sciences on the journey of people seeking care for obesity. It is a frustrating, stigmatizing journey. Weight bias is all too common, with many health professionals telling people that they simply need to try harder. Do-it-yourself is the dominant paradigm for obesity care, as we explained in our opening presentation for this meeting.

Liz Paul, a member of the OAC Board of Directors, told us just how wrong this is:

“Whenever you see a person with obesity in a healthcare setting, you can be sure they are there because they care about their heath. Despite knowing that they will face stigma in that setting. We are going into a lion’s den, never knowing if we will meet up with a lion or a lamb.”

A Serious Mistake

Not only is this situation cruel and unjust, it is harming the health of the nation. Over the last two decades, while doctors have relied on the eat-less-move-more strategy, the prevalence of obesity has risen dramatically. Obesity-related cardiovascular deaths have nearly tripled.

Access to more effective obesity treatment can prevent both of these bad outcomes. So who cares if tirzepatide can prevent progression of prediabetes in 99% of people with obesity? We do. We care very much.

Click here for the new study in NEJM, here and here for further perspective, and here for our presentation at the National Academies. For the story in the Times, click here.

Seated Woman, painting by Pablo Picasso / WikiArt

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November 14, 2024