What you need to know about the obesity and weight loss drug market

More than 70% of adults in the United States are overweight or considered obese.

"It's important not to advise a patient to just 'eat less and exercise more,'" said workshop presenter Irene W. Bean, DNP, APRN, PMHNP, PNAP, FAANP, FAAN, executive director and founder of the Tennessee Association of Nurse Practitioners.

According to Bean, obesity is a chronic disease and a global health problem, and doctors know that if left untreated, obesity can lead to insulin resistance, hypertension and dyslipidemia and cause further complications such as type 2 diabetes, cardiovascular disease, nonalcoholic fatty liver disease and in some cases death.

It's important to know what your options are as a physician and to understand what treatments may work best for your patients. According to Bean, it is important to be familiar with the proper dosages of obesity and weight-loss medications. She said some doctors may be unfamiliar with prescribing medications and start with doses that are too high or increase the dosage too quickly, which can cause indigestion, nausea and vomiting.

Bean began her talk by describing the mechanisms of action of glucagon-like peptide-1 (GLP-1) receptor agonists, which she said are preferable to amphetamine-based therapies such as phentermine, which can worsen blood pressure, heart rate, anxiety and insomnia.

There are several options for treating obesity and weight loss, including oral medications, but Bina directed her presentation to injectable GLP-1 receptor agonist drugs.

First approved by the U.S. Food and Drug Administration (FDA) on June 4, 2021, semaglutide 2.4 mg injectable (Wegovy) was the first and only once-weekly prescription weight loss drug. The approval was based on the results of a clinical trial program, The Treatment Effect of Semaglutide in Obese People (STEP), which ran four phase 3a trials and included about 4,500 participants. In the STEP 1 trial, Bean noted, 83.5% of patients achieved a 5% or greater reduction in body weight compared with placebo (3.1%). Patients also had an average weight loss of 15.6% after 68 weeks, according to the study.

A once-weekly injection of semaglutide has previously been approved for the treatment of type 2 diabetes under the trade name Ozempic. When used together with diet and exercise, it improves glycemic control in adults with type 2 diabetes, Bean said. It has been shown to reduce the risk of major adverse cardiovascular events such as death, nonfatal myocardial infarction or nonfatal stroke in adults with type 2 diabetes and pre-existing cardiovascular disease.

The next drug is tirzepatide (Munjaro), a once-weekly glucose-dependent insulinotropic polypeptide (GIP) and GLP-1 receptor agonist. The first and only FDA-approved dual-acting GIP and GLP-1 receptor agonist for the treatment of diabetes, tirzepatide is also being studied as a potential treatment for nonalcoholic steatohepatitis.

Another option is to inject 3 mg of liraglutide (Saxenda), Bean noted. This GLP-1 receptor agonist acts on certain brain receptors that control appetite and induces a feeling of satiety and decreased hunger, which can lead to reduced caloric intake. It is the first and only GLP-1 receptor for weight control in adolescents (ages 12 to 17) to be combined with exercise and a low-calorie diet. Weight loss with liraglutide can start within 2 weeks and last from 9 months to a year, Bean said.

This dosage of liraglutide showed significant results in reducing BMI for age at clinical stages, Bean said, referring to a study that looked at adolescents aged 12 to 17 years with obesity. Adolescents who received liraglutide for 1 year had a 0.23% reduction in BMI for age, whereas BMI for age in adolescents who did not receive liraglutide did not change at all.

Although GLP-1 agonist receptors can produce weight loss results, it is important for physicians to be aware of possible side effects, especially when counseling patients. These include nausea, vomiting, abdominal pain, headache, dizziness, fatigue, constipation or diarrhea, heartburn or gastroesophageal reflux disease, low blood sugar in people with type 2 diabetes, mood changes, and drug interactions. Less common side effects include allergic reactions, acute pancreatitis, acute cholelithiasis, suicidal thoughts or behavior, and risk of developing C-cell thyroid tumors.

It is important that physicians evaluate patients for contraindications, including heart disease, sleep apnea, hypertension, hyperlipidemia, nonalcoholic fatty liver disease, nonalcoholic steatohepatitis, cholelithiasis and cancer.

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