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Weight loss drugs: the promise and pitfalls

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For decades, scientists have searched for a magic pill to help people shed excess pounds. Yet, along the way, weight loss medications have also been marred by challenges.

Daniel Chancellor, Director, Thought Leadership and Consulting, Citeline 

Permission granted by Citeline


Abuse-prone amphetamine or amphetamine-like appetite suppressants were often used in the ‘50s and ‘60s. Then, the early ‘90s gave rise to the “Fen-Phen” — a two-drug combination (fenfluramine–phentermine) that helped people slim down but was also linked to heart valve damage and pulmonary hypertension. By 1996, doctors had written millions of prescriptions for the drug and subsequent lawsuits related to its side effects led to more than $18 million in legal settlements.

Now, a new crop of meds in a category called glucagon-like peptide-1 (GLP-1) agonists is dominating the weight loss scene.

“The obesity market has had several false starts going back a couple of decades, with drugs that have safety concerns and limited efficacy,” said Daniel Chancellor, director of Thought Leadership and Consulting at Citeline. “It is finally set to realize its potential with the remarkable weight loss that high-dose GLP-1 agonists have produced in clinical trials.”

There are 13 anti-obesity drugs on the market worldwide and some 174 more in the pipeline, according to Citeline’s Pharmaprojects. Overall, the global market for weight loss drugs is projected to grow dramatically from a $2.82 billion industry figure in 2022 to more than $13 billion in 2029.

While this newer class of drugs have been shown to be highly effective, hurdles to their uptake remain.

A promising class of drugs

Although GLP-1 agonists were originally developed to help manage diabetes, they were also found to help patients feel full while controlling their appetite — contributing to an average drop of 10 to 15 pounds.

Novo Nordisk’s drug Saxenda was the first drug approved in this class specifically approved for weight loss in 2014, but doctors have also prescribed other GLP-1 agonists off-label to help people lose weight.

Then in 2021, another Novo Nordisk’s drug called Wegovy hit the scene with an FDA approval — and quickly skyrocketed in popularity. Wegovy is a high-dose formulation of semaglutide, which is also used in Ozempic, the version of the drug approved for diabetes. And another option from Eli Lilly could hit the market soon.

“In terms of competitive landscape, this is definitely an area with growing interest, albeit heavily dominated by Novo Nordisk and Eli Lilly,” Chancellor said. “Far and away, the most notable approved drug is Novo Nordisk’s Wegovy, which is overcoming its supply chain constraints at the start of its launch, with Eli Lilly’s rival drug Mounjaro expected to enter the market imminently too.”

Mounjaro (tirzepatide) is already approved for diabetes, and is now in late-stage clinical trials in a new formulation to gain FDA approval for weight loss.

“If tirzepatide is approved for this indication, our goal will be to make our medicines available and accessible to as many people as possible,” said a spokesperson from Eli Lilly. “More than 650 million people around the world face the difficult challenges of living with obesity every day.”

In a country where some 69% of adults are overweight or obese, there is strong demand for a better solution. Adults are not the only patients fueling demand.

“The obesity market has had several false starts going back a couple of decades. It is finally set to realize its potential.”

Daniel Chancellor

Director of Thought Leadership and Consulting, Citeline

As part of broader recommendations to help control childhood obesity, the American Academy of Pediatrics issued guidance earlier this month encouraging doctors to consider GLP-1 agonists or other medications for obese adolescents over age 12.

However, while there is great potential for these drugs, the road ahead may not be completely smooth.

“The hurdle is now an educational one as prescribers need to see the benefits of treatment and payers,” Chancellor said.

Demand for better options

Because demand for these medications has, at times, outstripped supply, many people who need these drugs to treat their diabetes have reported trouble filling prescriptions.

It’s not difficult to understand why these drugs are so popular. GLP-1 agonist drugs, most often taken through weekly injections, can spur significant weight loss when used in conjunction with diet and exercise. Studies found that Wegovy helped people to lose, on average, 15% of their body weight over 16 months. And 89% to 91% of people who took tirzepatide lost at least 5% of their body weight when taking a 10 mg or 15 mg dose. Some people lost far more — even up to 20% of their body weight.

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