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Weighing the options


WORLD Radio - Weighing the options

Weight-loss drugs raise compelling questions about the balance between lifestyle and medication in combating obesity

The injectable drug Ozempic Associated Press/Photo by David J. Phillip

PAUL BUTLER, HOST: Coming up next on The World and Everything in It:

Weight-loss drugs.

AUDIO: We’re learning more about the first weight loss drug approved by the FDA in seven years.

AUDIO: Today I am doing a video follow up about Ozempic.

AUDIO: Could a diabetes drug be a game changer for weight loss?

MYRNA BROWN, HOST: Wegovy and Ozempic have caught the attention of influencers and news outlets in recent months, leading to viral stories about the success and sometimes the abuse of these drugs.

The weight-loss drug category is now so hot that analysts at Morgan Stanley are seeing investments soar in companies developing similar drugs. At the same time, investments in other health treatments—like drugs for heart disease or sleep apnea machines—are dropping.

BUTLER: Are these drugs just the latest weight-loss fad, or are they a breakthrough in treating obesity?

WORLD’s Mary Muncy reports.

SOUND: [Gym activity]

MARY MUNCY, REPORTER: Diet and exercise are the traditional ways to lose weight, but that wasn’t working for Sabra Smith.

SABRA SMITH: I have been a yo-yo dieter, all my life since basically, I was 12 years old.

By New Year’s Eve of 2021, she was the heaviest she’d ever been. She knew she knew something needed to change.

She considered bariatric surgery, but she was scared of it. Then she found a program where doctors combine genetic testing with exercise, dieting, and medication if it’s necessary.

SMITH: But one of the things that I learned was that I was not imagining it.

Smith discovered she had a genetic disorder where her body isn’t good at telling her when she’s satisfied and not hungry anymore. And that line between hungry and satisfied matters a lot when navigating obesity versus malnutrition.

Smith typically avoids pharmaceutical treatments unless it’s absolutely necessary, but she decided this was one of those times.

So, her doctors prescribed a drug to help her feel full longer.

That drug is called Wegovy, the brand name form of an injectable medication known as semaglutide. This medication was originally created to help people with Type 2 diabetes by stimulating the pancreas to produce insulin.

At that time, semaglutide was sold under the name Ozempic. But when its creator Novo Nordisk realized that the medication also helped people lose weight, they applied for FDA approval to market it as an obesity drug.

Dr. Lydia Alexander specializes in obesity and lifestyle medicine. She’s also the incoming president of the Obesity Medicine Association.

She explains that the drug works by mimicking a hormone called GLP-1.

LYDIA ALEXANDER: And when they do that, they increase satiety. So that person is receiving the signaling that they are full and-and the food noise is going away.

The hormone also stimulates the pancreas to produce insulin and slows down digestion so people stay full longer.

There have been various versions of these drugs since 2005, but none have been this effective or convenient. And rival drug makers have taken notice.

Eli Lilly is developing a new drug called tirzepatide under the brand name Mounjaro. Studies show it could help people lose about 26 percent of their weight by adding another hormone to GLP-1. That hormone further suppresses appetite and helps burn fat. The results are about the same as bariatric surgery.

ALEXANDER: These medications are powerful. And it's not just because you want to look good, it's because they're saving lives.

When someone is at an unhealthy weight, they could end up with conditions like insulin resistance, high blood pressure, or high cholesterol, just to name a few.

ALEXANDER: So if we treat the roots instead of the fruits of all the chronic conditions that we're trying to manage, over time, heart disease, and so forth, that instead of playing Whack a Mole with each one of these, we're able to, you know, to treat the root cause and improve people's health.

But these drugs are likely not the cure for obesity.

GILES YEO: My name is Giles Yeo, and I am a professor of Molecular neuroendocrinology at the University of Cambridge.

Yeo says these drugs help bridge the gap between what diet and exercise can do, and what bariatric surgery can do.

YEO: So I do think we are at a an inflection point in in, you know, the history of obesity research, so to speak, in being able to treat obesity and I say the word treat as opposed to prevent because these drugs are not going to prevent obesity.

There are several reasons for this. For one, these drugs don’t fix a hormone imbalance, so once someone is on them, they have to keep taking them to maintain the effect. And even though semaglutide has been around for a while, this particular formulation of it hasn’t. So doctors don’t know what all of the long-term side effects could be.

Right now, one of the most common side effects is nausea, but other rarer ones are popping up as millions of people take the drug.

Another problem is that the market can’t handle the demand of those millions of people right now, pushing the drug out of some people’s price range.

Yeo says there is plenty of semaglutide, but the manufacturers creating the delivery system can’t keep up with demand.

YEO: But as more and more of these drugs hit the market, then I think the price will begin to drop, and then we will get people who really need it getting it.

Even as these drugs become more widely available, Yeo adds that this isn’t the end of obesity.

YEO: These drugs are wonderful for treating obesity. We still need to tackle our diet, our health, our exercise, our poverty, and educating our kids.

Sabra Smith has lost another 100 pounds while on Wegovy. And with the drug’s help, she plans to keep the weight off. But she says she’s still exercising and dieting. She wants the drug to help her maintain a healthy weight, not enable an unhealthy lifestyle.

SMITH: It helps, it can help. It's just like any other medication it has to be really well thought out. It has to be needed and it has to be respected.

Reporting for WORLD, I’m Mary Muncy.

WORLD Radio transcripts are created on a rush deadline. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of WORLD Radio programming is the audio record.


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