Peter's Memo: The skinny on the new obesity drugs

I’ve spent a good part of my career arguing that anti-obesity drugs like Meridia and fenphen have serious side effects, are not terribly effective, and should be taken off the market. Several have been.

But now, for the first time, we have a class of drugs that seem to truly help many people lose weight. Those medications—sold as Wegovy and Zepbound for weight loss or as Ozempic and Mounjaro to treat type 2 diabetes—look like great news for the more than 100 million U.S. adults with obesity.

Never before has there been a way, short of surgery, for people with obesity to lose so much: an average of 12 to 18 percent of their body weight. The drugs may also lower the risk of heart attacks and strokes.

Still, it’s not clear that the new drugs will improve the public’s health overall. As I argued recently in a Washington Post op-ed that I co-authored with Joshua Sharfstein, Vice Dean at the Johns Hopkins Bloomberg School of Public Health, that depends on several factors:

Long-term research

How much weight do people regain if they stop taking the drugs? Will adverse effects emerge with longer-term use in larger numbers of patients? Do people taking the drugs live longer? How do the drugs affect patients’ diets and overall health?

To find out, the National Institutes of Health and the nonprofit Patient-Centered Outcomes Research Institute need to fund studies looking into those questions, because companies have little incentive to do so.

Availability

Most people can’t afford to pay the monthly retail price (up to $1,300) of the drugs. Medicare, most state Medicaid programs, and many employers don’t cover them...or the older drugs for obesity. (Stigma that treats obesity as a cosmetic or self-control issue may be at play.)

That inconsistent access to the new medications threatens to worsen health care disparities across economic, regional, racial, and ethnic groups.

But what if manufacturers sold the drugs to federal and state governments and insurance companies in bulk at affordable prices? Insurers could then reduce costs for patients and expand coverage.

Food & exercise still matter

While treating obesity is critical, so is preventing it. So we still need taxes on sugary drinks, front-of-package labels disclosing key nutrients, and foods that are lower in added sugars and unhealthy fats.

Healthier school meals could accustom children to eating vegetables and fruits. Bike lanes, parks, and sidewalks could make it easier to exercise safely.

We need an “all of the above” solution: policies to improve diet and exercise, more research on the new drugs, and greater access to effective care for people with obesity.