Obese people are prone to type-2 diabetes, to coronary heart disease, circulatory problems, joint problems and a plethora of conditions that both shorten their lives and decrease their quality of life. Given that obesity has grown to epidemic proportions according to the World Health Organisation (WHO), mainly across developed countries – and increasingly in the developing world too – that represents a crisis for healthcare systems.1
Until recently, there were two main approaches to tackling obesity: lifestyle change – exercise and dieting – and surgery. The former hasn’t worked – most weight-reduction diets are little more than fads. Meanwhile, bariatric surgery isn’t for everyone, it’s expensive and invasive, which carries significant dangers and side-effects. Which is why the advent of apparently effective new drug treatment has stirred up such enormous interest, according to the Pictet Health Thematic Advisory Board (TAB), which devoted its most recent meeting to the topic.
A healthcare revolution
The latest obesity drugs suppress the appetite by mimicking a hormone known as GLP-1. Studies have reported significant weight loss – 15 per cent of body weight on average when coupled with lifestyle changes, compared with just 5 per cent when only lifestyle changes are made.2 That’s already having an impact on diabetes. Evidence shows that 15 per cent of weight loss soon after diagnosis can put type 2 diabetes into remission.3
The latest research shows that GLP-1 drugs cut cardiovascular events – primarily heart attacks and strokes – by 20 per cent in non-diabetic obese adults with pre-existing cardiovascular disease in the 40 months following the start of treatment.4 They are also being studied as a treatment for chronic kidney diseases, severe fatty liver disease and heart failure. Anecdotal reports also point to possible effectiveness in reducing various types of addiction, including alcohol and gambling.
While the side effects are generally limited to gastro-intestinal discomfort – including diarrhea and vomiting – there are concerns about rarer but significant dangers, including higher incidence of pancreatitis and serious stomach disorders, according to the Journal of the American Medical Association.5
According to the Pictet Health TAB, it’s impact is likely to be at least as significant as the introduction of statins, the anti-cholesterol drugs that reduce heart attacks and strokes by a quarter according to various studies, and that are now some of the most prevalent prescription medication used in preventing coronary events.
Much analysis is now focusing on the ultimate impact of the drugs on the medical industry in particular and on consumption of food more generally.
Walmart and beyond
The US Food and Drug Administration approved the popular GLP-1 obesity drug, Novo Nordisk’s Wegovy, in June 2023. By October, the US retailer Walmart reported that it was already beginning to see an impact on food shopping behaviour, with consumers buying slightly less volume and slightly fewer calories. Walmart’s observations are very preliminary. Members of Pictet Health TAB cautioned against jumping to conclusions about the effects of anti-obesity drugs on consumer behaviour, stressing that the effects on general food retail are likely to be relatively modest. Even so, Walmart's early findings show the extent to which such drugs have filtered through to the wider consciousness.
Walmart's comments sent a shock wave through the financial markets, as investors tried to figure out the ultimate impact of people eating less. Shares in makers of salty snacks wobbled. Some analysts believe that the emergence of anti-obesity drugs will cause a 2 percent dip in growth of processed food – though with signs that growth in this segment is slowing, that could be sufficient to have a modest impact on corporate earnings in the food sector. Specialist producers, like manufacturers of some food ingredients could have more of an impact.
Although there are expectations that the drug will prompt a shift away from fattening foods, early evidence suggests that people on GLP-1 drugs eat a little less of everything, rather than of less healthy foods. That might change if losing weight encourages a healthier lifestyle – after all, losing weight increases mobility, making it easier for people on the treatment to exercise, even if that is only walking more.
The impact of anti-obesity drugs on the healthcare industry is less clear cut as opposing effects may be at work. There are anecdotal reports that demand for specialist orthopedic equipment is declining. As people lose weight, strain on their joints decreases and, at the margin, they need fewer knee replacements, for instance. On the other hand, as seriously obese people lose weight, they become better candidates for surgery, so in those instances there might be more demand for knee replacements and the like.
At the same time, if anti-obesity drugs end up increasing life expectancy by reducing incidence of diabetes, kidney disease and coronary diseases, then people will probably need other medical interventions as they get older. So while they might not need knee replacements because they’re too heavy, they might need them later on because the joints have worn out with age.
Insurers and state providers of healthcare will have to weigh the high cost of GLP-1 drugs and the fact that they need to be taken forever – evidence suggests people revert to their old eating habits and weight once they stop taking the drug – against their undeniable benefits.
What seems certain is that this new drug will have a dramatic effect on quantity and quality of life. And so notwithstanding the debate about its expense, it is poised to be an important treatment for a modern scourge.
