The FDA recently approved a new weight-loss drug, called Wegovy, intended for those who are either obese or overweight with at least one weight-related medical condition. And while we enthusiastically welcome any new tools in the fight against devastating obesity and type 2 diabetes, we do have a word of caution about “revolutionary” weight-loss medications.
A Reason for Skepticism
Wegovy is a “me-too” drug and another GLP-1 agonist, like the drug Saxenda. The current GLP-1 agonist Saxenda in clinical use is helpful, but participants in the drug industry-funded studies lost 7-8% of body weight if they injected themselves with it every day. It is brutally expensive. Most insurance plans do not cover it. Time will tell if the weight loss is meaningfully durable; we don’t know. Wegovy somehow resulted in a much larger magnitude weight loss in its own drug company-sponsored trial, despite the fact that it has the same mechanism of action as Saxenda. What explains this difference? Is it something important about the drug molecule that makes it more effective, or is it the random finding of a single study of the same mechanism, which – if enough studies are properly done – will show that the results are the same? Time will tell.
However, there is reason for skepticism. Plans involving diet, exercise, counseling, drugs, and expert medical support tend to result in weight loss over about a two-year period before the participants regain the weight. Look up the LOOK AHEAD Trial, the NIH study of The Biggest Loser, and countless other published analyses for evidence. This is no fault of the participants or the programs, it is just biology. Humans have a powerful set-point of body weight, determined by a complex set of hormone levels. To date, only surgery, which directly and permanently affects the tissues producing those very hormones, changes the set point and results in long term improvements in health, longevity and body weight.
Hopefully the surprising amount of weight loss with Wegovy proves to be true. And more durable. And not associated with severe side effects such as those the FDA required mention of on the label. Drug company studies for decades have notoriously under-reported side effects and complications while producing gleeful and optimistic outcomes. And while surgeons, too, have reported overly rosy results of surgery at times, 40 years of data has validated the main findings of metabolic surgery. So, we should be cautious in our assessment, demand better, longer-term studies, and continue to seek answers to obesity epidemic that focus on the root causes in the environment which hijack our metabolic machinery.
I hope this drug works as well as the drug company says. I hope that the cost comes down so our patients might actually enjoy access to it. I hope insurance companies cover it and all proven treatments for obesity and diabetes, including surgery.