The real toll of weight-loss injections: Semaglutides, the economy & you
Semaglutides, Tirzepatides, Liraglutides & The Fortnight in Resources
Dear Friend of Global Health Conversations,
With an epidemic of obesity in the United States and beyond, airlines had projected a need for more expenditure on aviation fuel in the future. That was until recently. Famously, in 2018, United calculated that by printing their in-flight magazine on lighter weight paper, they would save 170k gallons of fuel or over $200k annually.
Today, American airlines have projected a new reason to save gallons of aviation fuel: Skinnier humans. The widespread use of semaglutides and similar drugs, such as Ozempic, Wegovy and others means that passengers can be expected to be up to 10lbs (4.5kg) lighter on average. This spells good news for the aviation sector. But what does it mean for patients.
I write to you this evening from London where I have been spending my free time largely indulging in things I love: art and culture, having interesting conversations, spending time at church, painting pottery, reading Maid by Stephanie Land, watching the spectacular (TW:DV) Netflix series by the same name and scoping office spaces with Loredana, from last fortnight’s discussion on Alzheimer’s. I took time for myself.
But first, I was invited to speak on a healthcare careers panel at my alma mater where I was privileged to share the stage with some incredible business owners and professionals; and later met intelligents from across the broader sector from healthtech & innovation to biopharma and public health.
I proceeded to spend the weekend in art & literature. Both at London Frieze Masters and the 1:54 African Art Fair. It was a beautiful and enriching time. At Frieze, I was privileged to breathe art all around me and saw more Chagalls in one spot than I ever have (bar once). And at 1:54 I had the opportunity to listen to a panel of African visual artists and academics discussing the historical and personal experiential journeys that influenced their work. Breaking down meaning through the tiniest details, as I tend to do myself when observing art or reading literature. But it’s always a little different hearing what the artists truly intended, such as how the early use of certain media was influenced by geopolitics & oil; or how an innocuous Nestlé product in the foreground served as a nod to a colonial history.
Back in the real world, the annual World Health Summit is commencing in Berlin. I am not there but will read up remotely. One thing that really struck me this week was an insightful discussion I had with my good friend, Mary. Over some fantastic tempura and sushi we discussed some the evolving trends around GLP-1 agonists like the semaglutides I mentioned above. The subsequent rabbit hole is the basis for my summary article below - the first in the FiRs.
I hope your fortnight has been as lovely as you might have hoped for. I always love feedback - I am always looking to improve and above all, always grateful to you for reading and sharing your ideas.
Cozy greetings,
Christiana
1. GLP-1 Agonists: Semaglutides, Tirzepatides, Liraglutides for weight loss
The rise of GLP-1 agonists, particularly semaglutide, tirzepatide, and liraglutide, marks a new era in weight management and diabetes care. Initially designed to treat type 2 diabetes, these drugs have gained widespread attention for their powerful weight-loss effects, leading to a significant shift in their clinical and consumer use. Indeed, Novo Nordisk, holding the patents to both Ozempic and Wegovy, attained authorisation for Wegovy for weight loss not only for Type II Diabetes Mellitus; as was the case for Ozempic which came to market in 2017 ahead of Wegovy in 2022. And this leads the trend in all the similar
Mechanisms and Indications
Semaglutide, marketed by Novo Nordisk under the brand names Ozempic and Wegovy, is a GLP-1 receptor agonist. It enhances insulin secretion, reduces glucagon release, slows gastric emptying, and promotes satiety. Approved in 2017 for type 2 diabetes (Ozempic) and in 2021 for chronic weight management (Wegovy), semaglutide’s efficacy in reducing both A1c levels and body weight has been well-documented. Clinical trials demonstrate an average weight loss of 15% over 68 weeks for patients using Wegovy.
Recently, as first introduced to me by Mary, a new term has been introduced into our lexicon. ‘Ozempic babies’. There is evidence to show that the babies born to women using GLP-1 agonists are significantly lower weight at birth compared to the mean. This particular area - fertility and GLP-1 agonists is an essay of its own - but there isn’t enough data available at present for me to say much more on this subject.
Tirzepatide, developed by Eli Lilly and marketed as Mounjaro, takes a more advanced approach by acting as a dual agonist of both GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) receptors. This dual mechanism allows for more potent effects on blood sugar regulation and weight loss. Approved in 2022 for diabetes management, tirzepatide shows promise for weight loss, with ongoing clinical trials.
Liraglutide, another product from Novo Nordisk, is marketed under the names Victoza for diabetes and Saxenda for weight management. Although less potent than semaglutide or tirzepatide, liraglutide remains a daily injectable option for patients requiring weight control (for health reasons).
Long-term implications, Recent Developments and Usage Trends
The growing popularity of GLP-1 agonists for weight loss has had profound effects on healthcare systems, the pharmaceutical industry and as we saw earlier, other industries too. Novo Nordisk reported a significant surge in sales, with semaglutide-based products generating billions in revenue during the first quarter of 2024. Similarly, Eli Lilly’s tirzepatide has been a major driver of its financial success, particularly with the introduction of Zepbound, a weight-loss-focused version of the drug.
Despite these successes, supply chain challenges persist for some of these drugs due to overwhelming demand, causing shortages for patients requiring these drugs for diabetes, although it seems that these are being swiftly resolved by the innovative companies at the helm of this new dawn. Demand here is driven not only by clinical needs but by the cultural phenomenon around weight loss, with celebrities and public figures endorsing these medications.
While GLP-1 agonists such as semaglutide, tirzepatide, and liraglutide have shown great promise in weight loss and diabetes management, their long-term implications raise significant concerns. These drugs are all fairly new. As such, we have no longitudinal studies or specific studies to provide real insight into their long term effects on patients, populations and society. These drugs are an exciting development, in my opinion. Nevertheless, it is hard not to parallel and compare their swift rise in popularity to other blockbuster drugs.
One of the most pressing issues involves the possibility of weight regain after discontinuation. Novo Nordisk, the manufacturer of both Ozempic and Wegovy, confirmed that patients regain up to two-thirds of their lost weight within a year of stopping treatment - even with steady exercise and diet.
As Novo Nordisk stated, “The treatment is chronic, and discontinuation leads to significant weight regain in most patients.” The company highlighted the necessity for ongoing, long-term use of these medications. And this has broader implications for both patient care and long term healthcare costs.
Cost remains a substantial barrier for many patients. With prices for Wegovy and Ozempic exceeding $1,000 per month, affordability and long-term care sustainability are growing concerns. The necessity for extended use to maintain benefits places financial strain not only on individuals but also on insurance systems and government programs. According to an analysis, only 24% of patients continue using Wegovy after two years, largely due to cost and side effects. The high price tags and ongoing treatment requirements have also drawn political attention, with public officials in the United States expressing concerns about the potential financial burden on public health programs.
Another significant issue is the rising concern around cancer risks associated with GLP-1 agonists. Early studies indicated potential links between GLP-1 receptor agonists and cancers, particularly pancreatic and thyroid cancer. However, more recent meta-analyses, including one published in 2023, found no significant correlation between semaglutide use and an increased risk of pancreatic cancer, thyroid cancer, or other malignancies. The FDA has also monitored reports of adverse events linked to compounded GLP-1 drugs, reinforcing the need for vigilance when using versions of these medications outside of FDA-approved products.
As GLP-1 drugs evolve, newer entrants like retatrutide are showing promise, potentially offering even greater efficacy for both diabetes and obesity management. However, retatrutide is still in development and is not yet approved for clinical use, and this was highlighted by the FDA. Looking forward, while these medications represent a transformative shift in obesity treatment, addressing their affordability, managing side effects, and ensuring long-term efficacy without significant weight regain remain critical challenges for the healthcare system.
So will patients on these blockbuster weight loss drugs lead to the ‘slightly’ skinnier passenger load that airlines and some other industries are hoping for? We’ll have to wait and see.
(For background, you can refer to my May 2024 (Q1 Pharma Financials) and August 2023 (Skinny at all costs) editions of GHC Newsletter as well as the June 2024 Profitability of Skinny GHC Podcast Episode! :))
P.s. I have a long list of sources for this one so I haven’t added them in the e-mail version, but if you return to the web version later in the week, this text will be replaced by those links.
2. Marburg Virus in Rwanda
On 27 September 2024, incidentally the last day of the 79th session of the UN General Assembly, an outbreak of Marburg virus was declared in Rwanda. Marburg virus disease causes a severe hemorrhagic fever that can lead to serious illness and death. Its symptoms often resemble other tropical diseases, complicating diagnosis. It is very similar to Ebola virus, for instance. There are currently no treatments or vaccines available. The virus spreads through contact with infected animals or individuals.
Rwanda has made swift efforts to contain the spread and protect high-risk populations, particularly healthcare workers. The virus, a close relative of Ebola, has a high mortality rate, with outbreaks often resulting in death rates of up to 88%. As of early October, the virus had infected 56 people and claimed 12 lives, with a significant portion of the infected being healthcare workers.
(Rwandan Health Minister Nsanzimana who explained that, health workers would receive the vaccine first. Source: BBC)
The Rwandan government, with support from international partners, has implemented rigorous testing, contact tracing, and quarantine measures to limit further spread. Approximately 700 doses of an investigational Marburg vaccine developed by the Sabin Vaccine Institute have been delivered to Rwanda, where a Phase 2 clinical trial has begun. This trial prioritizes healthcare workers and other high-risk individuals across six sites. Early reports from similar trials in Kenya and Uganda indicate no significant safety concerns.
In parallel, Gilead has donated 5,000 vials of remdesivir to Rwanda for emergency use, although the drug's efficacy against Marburg has not been established. Rwanda has also ramped up community surveillance, temperature checks at entry and exit points, and public health awareness campaigns. These interventions, combined with global collaboration, aim to control the outbreak and prevent its spread within the region. Marburg has currently been declared controlled by the Africa CDC.
The Africa CDC also recently criticised the U.S. government’s recent Level 3 travel advisory for Rwanda as unfair and baseless, arguing it undermines Rwanda’s proactive efforts to contain a Marburg outbreak. This element creates a lot more to think about: especially in economies that rely strongly on tourism and are also vigilant in reporting their genomic sequencing and clinical data - which might be a conversation for a different day.
(Read more: here (Health Policy Watch), here (BBC), here (also BBC), here (Scientific American), here (Sabin Vx Institute) & here (Gilead))
3. Vice President Kamala Harris talks Women’s Rights
This Fortnight, US VP and presidential candidate, Kamala Harris went on a popular, non-political podcast that I am aware of. It is not to my taste so I have to say that while I am not a listener, I listened to this one. It was a strong interview. It focussed on women’s health and some important issues to consider around women’s health in the upcoming US elections. Alex Cooper, podcast host, asked the tough questions and vice-president Harris gave candid and honest explanations of her parties policies and also touched on the Republican parties plans in the same areas.
A couple of months ago, I recorded a podcast episode entitled Project 2025’s Impact on Healthcare, Women's Health and Regulation. I broke down the comprehensive document prepared by the Heritage foundation for the next Republican presidency in detail. I encourage you to engage in this discussion, no matter where you are or where you stand. I strongly believe that our engagement, commentaries and conversations can make a difference.
Behind the scenes:
Rest, fun, intellectual stimulation at Imperial and beyond & a little bit of self care. :)
Recent Episodes: In case you missed them! 💃🏾
Episode 24: What is the Pandemic Accord, really?
This episode takes a high level overview of the Pandemic Accord, its purpose and a walkthrough of some of its most pertinent Articles. A walkthrough. The Pandemic Accord is a proposed global agreement aimed at strengthening pandemic prevention, preparedness, and response. Emerging in the aftermath of COVID-19, the accord aims to address gaps in international coordination, surveillance, and equitable access to medical countermeasures, globally.
Episode 23: Mpox Update 18/08/2024
On August 14, 2024, WHO DG Dr Tedros Adhanom Ghebreyesus declared the Mpox outbreak a PHEIC, the second such declaration in two years. The Africa CDC declared Mpox a Public Health Emergency of Continental Security a day earlier. The current outbreak, driven by the more severe Mpox clade Ib, first identified in South Kivu, DRC, has rapidly spread across Central, East Africa and even as far as South Africa, with the first European case detected in Sweden.
Episode 22: Project 2025’s Impact on Healthcare, Women's Health and Regulation
In this fortnight's episode we explore and discuss Project 2025's proposed policies, which could dramatically impact health, women’s health and safety. The plan includes lifetime caps on Medicaid, reducing coverage for millions, and increased out-of-pocket costs for Medicare recipients. It threatens reproductive rights and seeks to curtail the CDC's public health role, potentially weakening responses to health crises. Basically, an anti-epidemic preparedness vision and plan.