The effective treatment options for obesity that already exist are under-used. Bariatric surgery, for example, can be an effective way to address extra weight. But surgery is seen as a drastic option, and Americans tend to think poorly of weight loss surgery. Without a comorbidity like diabetes, a prospective candidate typically needs a BMI of at least 40 to undergo the surgery—and only a small sliver of those who qualify get the procedure. That’s one reason why obesity experts see so much promise in the new drugs.
But there are big hurdles to widespread adoption, and not just questions of cost and approval that every drug faces on its way to the public. Weight loss drugs have a checkered past. “If you look back in the history of obesity, drugs that have been approved have then been taken off the market,” says Dr. Spencer Nadolsky, a physician who runs the obesity program for telehealth provider Weekend Health. Dangerous amphetamines were used as appetite suppressants, and more recent drugs, like Fen-Phen, a weight loss drug widely used in the 1990s, caused heart problems, leading to an FDA ban. Safer weight loss drugs began to reappear in the 2000s, but their efficacy was often mild.
Incretins, on the other hand, are only continuing to get more effective. The newest of these medications cause around 20 percent weight loss, within the same range that bariatric surgery achieves. And while common side effects include nausea and other gastrointestinal distress, it’s a much less disruptive medical intervention than surgery.
One obesity expert at Harvard Medical School, Dr. Fatima Stanford, told me that some patients have reacted so strongly to one incretin, semaglutide, that they’ve avoided surgery completely. “They went from severe obesity with diabetes to no diabetes and no severe obesity—into a healthy weight range,” she said. “It’s effortless for them—we’re changing the way their brains see weight.” This has major quality of life implications. “When you have higher levels of obesity,” said Jay, “losing 15 or 20% of your body weight is huge, right? It’s huge for resolving comorbidities and preventing diabetes, and all sorts of things.”
One Washington woman in her 50s named Suzy, who asked to only be identified by her first name, has lost 26 pounds since starting tirzepitide. She has three siblings and two parents with type two diabetes. With the drug, she thinks she can avoid that disease. Another woman, Rachel McLaughlin, who started an oral incretin in 2021, said weight loss gave her the confidence to join an art class. “I don’t look like I’m carrying the weight of the world around,” she said.
But remarkable advances in medical technology don’t mean much if they’re impossible to access. McLaughlin faced that setback when she lost her job earlier this year. Losing health insurance increased the cost of her prescription from $25 to more than $2,000 per month. Off the medication, she regained 15 of the 25 pounds she’d lost. Progress only resumed once she found a new job in June that restored her coverage.
This content was originally published here.