Diabetes drugs may soon change the treatment of obesity

Kunal Shah, an assistant professor of endocrinology at Rutgers University's Robert Wood Johnson School of Medicine who has specialized in the treatment of obesity for more than a decade, sees reason for hope in newly approved diabetes drugs coming to market.

Obesity rates have been rising steadily for years: According to the Centers for Disease Control, about 42 percent of American adults are obese. Shah talks about Victoza (liraglutide) and Wegovy (semaglutide), two drugs developed to treat type 2 diabetes that have recently been approved to treat obesity. He also discusses a third diabetes drug, Mounjaro (tirzepatide), which has had positive results in trials against obesity.

What constitutes an effective treatment for obesity?
Getting rid of excess weight is certainly ideal, but any weight loss of more than 5 percent provides clinically meaningful benefits, such as reduced risk of heart attack and other cardiovascular problems.

Were there effective treatments before the advent of diabetes medications?
Yes, both Qsymia, which helps people control food cravings, and Contrave, which speeds up the metabolism, usually reduce weight by about 7 percent, but various drawbacks make them unsuitable for many patients.

What diabetes medications are currently available for the treatment of obesity?
Two drugs are currently approved: Victoza (liraglutide) and Wegovy (semaglutide). Both are more effective and better tolerated than the older drugs, but semaglutide is probably the best drug for most people. It causes more weight loss - up to 15 percent of body weight - and is administered weekly rather than daily.

What new drugs might be approved soon?
Final trial results published in the New England Journal of Medicine showed that weekly injections of tirzepatide, containing 15 milligrams of the diabetic drug, resulted in an average weight loss of 20 percent in patients.

How important is that?
It makes a difference. This weight loss is usually associated with surgery. It is not enough to get rid of excess weight, but it is enough to move most obese people into the category of simply being overweight and to eliminate most of the health risks associated with weight.

What side effects do these medications cause?
Many people experience gastrointestinal upset at the beginning of treatment, but these usually go away.

Will most obese people be on one of these medications in a few years?
Perhaps they should already be taking it.

Why?
For two reasons: First, primary care physicians, who treat most patients for obesity and everything else, are not yet comfortable prescribing them. Professionals like me need to do a better job of explaining to primary care physicians how safe and effective they are.

Second, these drugs are expensive, and although most insurers seem to cover them for diabetes, they refuse to cover them only for obesity. Most insurance companies will not cover medications for obesity unless patients can prove that they have been following a diet and exercise program for at least three months.

So these therapies supplement - not replace - diet and exercise?
Unfortunately, yes. There are no magic drugs for weight loss yet. You can still beat any treatment, including gastric bypass. But these drugs help significantly, so much so that they can significantly reduce obesity.

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