An unhealthy bias to medicinal fixes?

Wegovy is a brand getting a lot of attention. It is one of a new generation of obesity treatments which employ a hormone to regulate appetite and based on their clinical trials claims to contribute to a weight loss of c15%. Owner Novo Nordisk gained FDA approval only a year ago (June 2021) and is now struggling to meet fast growing demand.

The potential for Novo Nordisk (and competitors) is undeniably huge. Obesity is forecast to affect 1 billion people by 2030 – which shockingly could include almost 1 in 2 of those living in the US. What’s more to sustain weight loss benefits the treatment requires continued use – in effect, a lifetime subscription.

With an annual cost of more than $1,000 Novo Nordisk will need to unlock health authority and / or insurance company funding to make it a mainstream blockbuster. In the meantime, the market will orientate to those with the finances to pay for personal consultations and product. With Americans spending around $70bn annually on weight loss solutions Wegovy’s appeal will be more than niche. The company has ramped up sales and marketing to ‘educate’ medical professionals, has enlisted Queen Latifia as a brand spokesperson and recently doubled its revenue target for obesity drugs to $3.7bn by 2025.

In isolation the investment case for hormone-based treatments looks compelling. US consumers are already spending billions on products that can’t match Wegovy’s claims and the societal / healthcare burden attributable to obesity is a growing concern. But, as Hannah Kuchler’s article in the FT highlights the net impact of such treatments on tackling obesity is more difficult to predict and may not be entirely positive. Much depends on human behaviour.

Firstly, new treatments could embed a narrative of obesity as a disease that can be primarily addressed by medicine to the detriment of individual motivation to change dietary and lifestyle choices. Assuming a lifetime of continued commitment to these treatments is also problematic – will efficacy be sustained over time and what happens if patients have stop and start cycles? History also warns us that the impact of medical professional behaviour will be instrumental. As the remarkable growth in antidepressants use demonstrates, doctors have found it much easier to prescribe medicine than introduce alternative therapies that may be more effective.

Attention, availability and research for cognitive therapies has lagged behind antidepressants despite indications of comparable effectiveness.

Wegovy (and competitors) may well prove to be life-enhancing for millions and a huge commercial success. Early indications are clearly encouraging. At the same time success is likely to reflect a behavioural and system bias that favours converting consumers to medical treatment. That bias starts with the potential rewards to investors, encompasses the convenience for busy medical professionals and includes the simplicity / appeal for patients. Solving obesity, however requires action on prevention and so changing behaviour on a massive scale. Widening access to affordable healthy food and increasing levels of physical activity are complex challenges, requiring collaborative and diverse solutions that will be less able to attract funding.

Hopefully, the likes of Wegovy will make a significant contribution to the obesity issue without any opportunity cost in investment, urgency or individual agency for the difficult changes needed. Arguably the potential for more dramatic weigh-loss could be an amplifier for government driven interventions. That said, I wouldn’t be surprised if a new category of billion dollar weight loss brands emerge to coexist with growing fast food consumption and no significant reversal in the activity / dietary trends creating the obesity problem. Ultimately, it all depends on achieving system and behaviour change.

This article was informed and inspired by a fantastic article in the FT by Hannah Kuchler – do read it!

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