Medical Innovations Update: Have We Found the Cure to End Obesity?
Technological advances in pharmacology, genetic engineering, genomics, and artificial intelligence are increasing the speed at which medical breakthroughs occur. These advances are creating fundamental changes to our understanding of health and medical treatment, and could produce a lasting positive mortality and morbidity impact.
In this article series, the Munich Re medical team examines recent innovations in the field of medicine that are of particular interest to life and disability insurance carriers. Our first topic is the new drugs capturing headlines for their promise in the treatment of obesity.
New Obesity Drugs
Obesity has long been a global health issue. The World Health Organization estimates that global obesity has tripled since 1975, and Statistics Canada estimates that almost 30% of Canadians are obese.1 While a low percentage of people with obesity are considered metabolically healthy,2 the majority are considered metabolically unhealthy, with unfavorable obesity-related cardiovascular co-morbidities such as high blood pressure, high cholesterol, and type 2 diabetes. Obesity is also correlated with a host of health risks including heart disease, stroke, and some cancers. Despite a multi-million3 weight and diet management industry in Canada that offers everything from medications and supplements to weight loss apps, true success in treating obesity has been limited.
One promising – and well-publicized – area in the treatment of obesity is through the use of a new class of drugs, glucagon-like peptide-1 (GLP-1) agonists, a class of drugs originally approved for the treatment of type 2 diabetes. Studies have shown dramatic weight loss effects compared to other obesity medications.4 This class of drugs mimic the hormone that stimulates insulin production, which prompts the body to produce more insulin which lowers blood sugar levels. They also slow the movement of food from the stomach, causing early satiety and decreasing appetite.
Many are familiar with the GLP-1 agonist, semaglutide, sold under the brand name Ozempic for type 2 diabetes. Despite frequent headlines about Ozempic as a weight loss drug, Health Canada has not yet approved it for weight loss. Currently in the U.S. and Canada, only two GLP-1 agonists are approved for obesity treatment. These are Wegovy (semaglutide) and Saxenda (liraglutide).
Wegovy is made by Denmark-based Novo Nordisk, the same company that makes the diabetes drug Ozempic. Both contain semaglutide, but Wegovy is marketed specifically for weight loss and comes in higher doses. Patients taking the higher 2.4 mg semaglutide injection showed dramatic ~15% (~35 pound) weight loss at 68 weeks in a recent study, results not seen in any other Health Canada-approved weight loss medication. Additional metabolic benefits, including lower blood pressure, improved cholesterol, and reduced waist circumference – all of which are risk factors for heart disease – were also evident.5
In other promising news, another new type of type 2 diabetes medication, dual-action GLP-1 and GIP receptor agonists, may be even more effective than GLP-1 inhibitors alone at inducing weight loss.6 The Eli Lilly drug tirzepatide, sold under the brand name Mounjaro, was approved for diabetes treatment in 2022 and should arrive in Canada in 2023.
It’s not surprising, given these results, that word is spreading rapidly. Social media has exploded with weight loss success stories, such that some diabetic patients are now finding it hard to get their prescribed medications.
A Magic Bullet?
It’s important to stress that these drugs are not magic bullets to be used on their own. They are meant for chronic weight management as an adjunct to diet and exercise lifestyle modification. Similar to other weight loss treatments, the most important aspect for weight loss success is a consistent and sustainable healthy lifestyle change!
We also must remember that these drugs are not without concerns. They must be given by injection and have potential side effects that include nausea, vomiting, diarrhea, pancreatitis, and kidney and/or liver damage. Further, treatment is expensive, costing approximately $5000/year in Canada, and may not be covered by provincial plans if prescribed for weight loss management. Weight rebound can also occur if the drug is stopped, so it remains unclear if lifelong treatment is necessary.
From a life insurance underwriting perspective, GLP-1 drugs and future combination drugs could make a significant impact on the ever-worsening prevalence of obesity. The mortality and morbidity impact could be huge if this new class of drugs could end obesity entirely! Not only would we see decreased heart disease, the leading cause of death in the U.S. and the second leading cause of death in Canada,7 but obesity-related cancers and all other obesity comorbidities such as obstructive sleep apnea and fatty liver disease would also decrease. That would be amazing.
The next article in this series will focus on advances in HIV treatment.
4 Khera R, Murad MH, Chandar AK, et al. Association of pharmacological treatments for obesity with weight loss and adverse events: A systematic review and meta-analysis. JAMA 2016; 315:2424.
Rubino DM, Greenway FL, Khalid U, et al. Effect of weekly subcutaneous semaglutide vs daily liraglutide on body weight in adults with overweight or obesity without diabetes: The STEP 8 randomized clinical trial. JAMA 2022; 327:138.
Wilding JPH, Batterham RL, Calanna S, et al. Once-weekly semaglutide in adults with overweight or obesity. N Engl J Med 2021; 384:989.
N Engl J Med 2015; 373:11-22 ; DOI: 10.1056/NEJMoa1411892. 5 Rubino D, Abrahamsson N, Davies M, et al. Effect of continued weekly subcutaneous semaglutide vs placebo on weight loss maintenance in adults with overweight or obesity. The STEP 4 randomized clinical trial. JAMA. 2021;325(14):1414-1425. 6 Jastreboff AM, et al. Tirzepatide Once Weekly for the Treatment of Obesity. N Engl J Med 2022;387:205-216. 7 Heron M. Deaths: Leading causes for 2019. National Vital Statistics Reports; vol 70 no 9. Hyattsville, MD: National Center for Health Statistics. 2021. DOI: https://dx.doi. org/10.15620/cdc:107021; Death rate Canada all causes 2000-2020 | Statista