- Obesity is a rising health concern in the United States.
- New medical breakthroughs have delivered new tools that can help treat obesity.
- Among the year’s most impactful breakthrough’s is the approval of new GLP-1 medications like Zepbound that can aid with weight loss.
One of the most prevalent chronic health issues in the United States is obesity and it’s linked to higher risks of other serious chronic diseases like type 2 diabetes and heart disease.
Recent figures from the Centers for Disease Control and Prevention (CDC) reports that 41.9% of Americans are living with obesity, and medical costs associated with the condition totaled nearly $173 billion in 2019.
It’s an issue that is only continuing to grow in national impact. Population data from 2022 reveals an adult obesity prevalence of 35% in 22 states — a number that has shot up from 19 states just the year before.
However, new innovations and breakthroughs in 2023 have resulted in new tools that can help effectively treat obesity.
Here’s an overview of how those breakthroughs have changed obesity treatment this year and a look ahead at what’s to come in 2024 and beyond.
The approval of Zepbound for weight loss
In 2014, liraglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist drug for diabetes was approved by the Food and Drug Administration (FDA) for weight management in people living with obesity who don’t have diabetes.
It was the first drug of its kind to be approved for this purpose, according to the NEJM Journal Watch.
That was followed by semaglutide (sold under the brand names Ozempic and Wegovy) in 2021, reports Harvard Health Publishing.
This paradigm shift in how these drugs were being used came to a head this year, when it seemed like every major health news headline revolved around GLP-1 medications and their implications for tackling the nation’s obesity epidemic.
In November, the FDA approved the Eli Lily and Co. diabetes medication Zepbound (tirzepatide) — which was originally approved and marketed as Mounjaro to help treat diabetes — for chronic weight management in people with obesity who don’t have diabetes.
How Zepbound works
The medication essentially turns on the hormones GLP-1 and GIP (glucose-dependent insulinotropic polypeptide).
These hormones work in concert to essentially cut down on one’s appetite and food consumption.
The drug spurs insulin production, which is effective for people with type 2 diabetes.
However, it’s that key element of cutting down on food intake that makes it particularly effective for people who are attempting to lose weight.
Why Zepbound is being hailed as a significant breakthrough
Dr. Angela Fitch, FACP, FOMA, chief medical officer at knownwell, president of the Obesity Medicine Association, and an Assistant Professor of Medicine at Harvard University, told Healthline that the approval of these newer, more effective weight loss medications like Zepbound are “the biggest breakthrough we’ve had in the past five years.”
Others agree. This year, Science named these drugs the single biggest scientific breakthrough of 2023.
“We’ve had semaglutide on the market for a significant period of time — that was a huge advancement scientifically in the treatment of weight — and most recently, you had tirzepatide advancing, which is also a significant,” Fitch said. “We are just getting better and better scientifically in figuring out the chemistry behind metabolism, which is what we are ultimately talking about.”
Dr. Steven Nissen, a cardiologist at Cleveland Clinic, pointed out that tirzepatide has been revealed to result in a 20% reduction in body weight for people who are living with overweight or obesity.
Nissen, who has been leading an ongoing 15,000 patient study on tirzepatide, calls the drug “a turning point in the battle against obesity.”
2023: The year of reframing how we see and treat obesity
Fitch said the rise of these drugs as effective tools for treating obesity has helped refocus how we approach treatment.
“Another thing we have accomplished in the past year, this highlight that obesity is not about your character, it’s not because you are lazy and can’t do the work yourself — it’s because this is a medical problem that has real needs for medical treatments that are much more effective than they were in the past,” Fitch explained.
The growing popularity of these drugs is as much a cultural advancement as it is a scientific one.
She said other chronic conditions like diabetes and heart disease are viewed from a holistic standpoint.
While lifestyle modifications, like diet and exercise, are needed to help manage those conditions, we also have widely adopted medications that complement those behavioral changes.
Fitch explained that you wouldn’t tell someone with heart disease to solely eat salads and work out, and then not take medication that might save their life.
With obesity, the focus in society at large falls squarely on people needing to make these lifestyle shifts, while people look suspiciously on those who might opt for a medical solution.
“In the 1800s we didn’t have blood pressure medicine. We didn’t live so long. We didn’t live so healthily and we ended up dying earlier from all of these other diseases,” she said. “Today, we do have to focus on the combination of taking care of our lifestyle, improving our lifestyle, because the environment we are living in today is not promoting health in any way.”
Fitch said the new awareness that has been generated around these medications is having a concrete, positive effect on people who are seeking treatment for obesity.
Dr. Sarah Kim, professor of medicine, UCSF ZSFG Division of Endocrinology, Diabetes and Metabolism, director of ZSFG Adult Diabetes Clinic and ZSFG Adult Weight Management Clinic, and director of the UCSF Diabetes Teaching Center, told Healthline that it’s crucial we understand that obesity is often the “core reason why people are getting type 2 diabetes, getting coronary disease.”
She stressed that if you can treat this root cause of other serious, life threatening chronic illnesses with this type of medication, then you will start to see all of the wider “collateral benefits.” Tackling obesity can go a long way to promoting greater overall health.
“The data suggests that if you don’t lose weight on these medications, you don’t get as much cardiovascular benefit. So, is it the weight loss that is mediating all of it? Probably, as opposed to some sort of direct effect on the hormone on your heart, on the vessels. It’s really lowering weight, which is the core problem that has led to all of these metabolic conditions,” Kim explained. “We have gotten better at medication-assisted weight loss.”
New obesity treatments on the horizon
Zepbound isn’t the only drug on the block.
Right now, another medication from Eli Lily and Co. — retatrutide — is in clinical trials.
The triple-hormone-receptor agonist has been showing signs of spurring significant weight loss in study participants.
Kim said that is is “showing even more weight loss and stronger and stronger weight loss [than other related drugs] by manipulating all these hormones.”
She added that it will be completing it’s phase III clinical trial in 2024 and it’s assumed to go up for FDA approval similar to Zepbound.
Fitch said the biggest challenge moving forward is “supply, access, and cost.”
How insurance coverage of obesity treatments needs to evolve
Fitch also pointed out that one of the big challenges with obesity treatment is that the condition isn’t considered a “standard benefit” in the health insurance arena.
That means there needs to be a special “carve out” in most employers’ health plans to provide treatment coverage to their workers.
The big obstacle is that most people will likely be employed at a given company for just a year or two. Because of this, many businesses are often unmotivated to make an investment in treatment that will likely be costly for them over such a short period of time.
Fitch said her hope is that 2024 will see obesity transition to being a “standard benefit” and people seeking these treatments won’t have to deal with these complexities and insurance hurdles.
“The goal is to develop these comprehensive, longitudinal care paths that are covered like other diseases are — like diabetes, like cancer,” she said. “If you get a new job, you don’t wonder ‘is my insurance going to cover my cancer treatment?’ You don’t question that because it covers your cancer. So, we need that to be the same for obesity.”
