‘Robbing Peter to pay Paul’: Obesity experts debate risks of new weight loss drugs

Amid rising demand for drugs like Wegovy, Ozempic, and Mounjaro that can lead to significant weight loss, some obesity experts are concerned about the drugs’ costs — both to patients’ finances and to their health.

Speaking at a panel on new obesity treatments at the STAT Breakthrough Summit in San Francisco on Thursday, one expert cited a large clinical trial for Wegovy that showed that about 40% of the weight participants lost was lean mass. Side effects like nausea, vomiting, and a possible link to rare cases of pancreatitis also still plague this newest class of drugs, which imitate the effects of a hormone called glucagon-like peptide 1 (GLP) that helps people feel full.

“That’s what starvation does. You lose equal amounts of muscle and fat,” said Robert Lustig, emeritus professor of pediatrics at the University of California, San Francisco. “If you’re a person 60 years old or over and you’re losing muscle, your risk of dying just went up exponentially. So we may be … robbing Peter to pay Paul.”


Jamy Ard, professor of epidemiology and prevention at Wake Forest School of Medicine, was more open to using the drugs to treat some people with obesity. For patients who don’t feel full because their bodies have a weaker GLP-1 response after eating, Ard — also the co-director of a weight management center at Wake Forest — might recommend an incretin.

“It’s like I’ve given you a remote control that allows you to turn up the volume on the television,” he said.


That said, the drugs are costly, as Ard acknowledged; Wegovy, for example, has an average net price of $13,600 per year. That means they have the potential to make existing health disparities even worse. People most affected by social determinants of obesity, such as poverty and reduced access to healthy food and spaces for physical activity, are also those least likely to have access to these treatments through health insurance or the ability to pay out of pocket.

At the same time, public discourse around these newest drugs is helping break down another major barrier to tackling obesity, Ard said — a longstanding view that “if you just think hard enough, if you try hard enough, then you can stay thin or you can lose weight and keep it off.”

The pharmaceutical companies behind the new weight loss drugs, including Novo Nordisk and Eli Lilly, have launched campaigns to get the public to see obesity as a disease. Ard pointed to research that shows that weight issues aren’t a matter of lack of willpower.

The drugs “represent the evolution of our learning and understanding of the physiology related to body weight regulation,” said Ard, who has consulted for companies like Novo and Eli Lilly.

But Ard cautioned against over-prescribing the drugs, noting that the current frenzy over them risks being “driven not by provider discretion and input but really on the social media side [by] … issues that are not related to disease.”

Lustig, who is also the chief medical officer of fiber supplement startup BioLumen, said that solving access issues to healthy food should be prioritized before turning to drugs as a solution. He noted that in clinical trials for drugs like Mounjaro, patient responses were compared against a placebo, but not to a group that ate different food. Reducing the amount of sugar in food, he said, could have a big impact on obesity.

“Fix the food first,” Lustig said. “Let’s see if these drugs are actually better than real food.”

Read more of STAT’s series on The Obesity Revolution. Other parts of this series examine how pharmaceutical makers are promoting a new message about obesity; assess attempts to personalize obesity treatment; explain the origins of a flawed weight metric, the body mass index; and delve into the debate over new childhood obesity guidelines.

Source: STAT