I Was Right (and Wrong) About the Weight Management Space

I made some predictions on the weight management space on June 5th, 2022, and I think it’s only fitting to reflect on those predictions a year later.

So, in this Huddle, I’ll revisit the predictions I made a year ago, catch you up to speed on the latest developments in the weight management space since then, and then I’ll provide critical feedback on my past predictions plus share some fresh predictions.

June 5th 2022: “The Future of Weight Management”

A year ago, I recapped Eli Lilly’s Phase III clinical trial (SURMOUNT-1) results for their anti-obesity drug, tirzepatide, which showed significant percentage decreases in body weight with tirzepatide at 72 weeks compared to baseline.

I noted these final results were “a huge deal that have implications for solving the metabolic health crisis in the U.S. (and much of the world).” Here were my other predictions:

• Anti-obesity medications like tirzepatide will be as common as high blood pressure medication (main obstacle to access will be the drugs’ prices)

• More startups like digital metabolic health company Calibrate will launch.

• Gastric bypass surgery will be considered an ancient procedure within 10 years.

June 5th 2023: A Year Later…

The weight management space looks much different now than it did when I wrote up my predictions in June of last year.

Here’s a quick highlight of clinical trials testing novel anti-obesity medications:

Tirzepatide (Eli Lilly)

Last October, the FDA granted tirzepatide fast-track designation based on promising results from the SURMOUNT-1 trial mentioned above. The fast-track pathway aims to expedite the development and review of novel drugs to treat serious conditions (e.g., Alzheimer’s and ALS) and fill an unmet medical need.

This April, Eli Lilly announced results from their Phase III clinical trial SURMOUNT-2, showing an average 35 pound (16%) weight-loss over 18 months compared to baseline in patients with obesity/overweight and type 2 diabetes. The latest phase III clinical trial results increase the likelihood of tirzepatide’s FDA approval as obesity treatment.

Retatrutide (Eli Lilly)

Last December, Lilly announced their Phase II clinical trial of retatrutide showed participants with obesity receiving the drug had a 24% decrease in weight after 48 weeks. Official results will be discussed next week at the 2023 American Diabetes Association Scientific Sessions conference.

Semaglutide (Novo Nordisk)

Last December, the STEP TEENS Phase III clinical trial found adolescents with a BMI greater than or equal to the 95th percentile or 85th percentile with at least one weight-related comorbidity receiving semaglutide had a significant 16% decrease in BMI compared to baseline. These results led to the FDA approving the medication for adolescents with obesity back in January. It also prompted the American Academy of Pediatrics to include semagltuide in their guidelines for managing childhood obesity.

This May, Novo Nordisk recently announced that their Phase III clinical trial (OASIS 1) for oral semaglutide led to a superior 15% decrease in bodyweight compared to baseline at 68 weeks.

AMG133 (Amgen)

Last December, Amgen announced their Phase I clinical trial of AMG133 resulted in significant weight-loss compared to placebo participants. The trial enrolled 110 participants to test the safety and optimal dosage of the drug. After 85 days, those in the high-dose group lost 15% of their body weight, those in the low-dose group lost 7%, and those in the placebo group gained 1%. Amgen will start Phase II trials as soon as possible. We’re still waiting for official results in a peer-reviewed journal.

The advancements of anti-obesity medication and their high efficacy has sparked dozens of new and established startups to launch weight management services that incorporate anti-obesity medication semaglutide. I covered it all here.

Dash’s Dissection

Looking back at my original predictions, I wasn’t far off on what’s been happening in the weight management space.

Foremost, it’s still too early to tell if anti-obesity medications will be as common as anti-hypertension medications. But looking at the cost of semaglutide and what the cost of tirzepatide will be, it’s unlikely these anti-obesity medications will achieve the same market penetration as anti-hypertension meds. Many insurance companies still don’t have semaglutide on their formularies for obesity or overweight, meaning patients must pay out of pocket.

Will insurers ever include these novel anti-obesity meds are their formularies? I don’t really know.

But, once competition increases and the anti-obesity market sees new entrants (there’s a bunch of GLP-1-type medications in clinical trials pipeline), the costs should decrease, meaning OOP costs will, too. However, we’re likely half a decade to a decade away from this point.

Second, over the past year we’ve seen a flood of new digital health companies and existing ones launch services using anti-obesity medication semaglutide. I was right about this! I have more predictions on startups in the $100+ billion weight management space, which I covered here.

Basically, the weight-management space will become flooded with companies and the ones that thrive will be those B2B companies focusing on integrated, sustainable obesity care targeted at the populations who need it most. As long as new companies don’t emerge to cater to specific populations affected by obesity and overweight, racial and ethnic disparities will persist. This will result in medications like semaglutide being considered “privileged” drugs, accessible only to those with private insurance, while individuals with public insurance are left without effective treatment.

Lastly, I retract my statement that gastric surgery (bypass and sleeves) will be a thing of the past and certainly don’t want to lose my future attending salary, knowing what I know now.

Above, I mentioned that the startups or companies that survive are those offering integrated and sustainable obesity care. This includes nutritional counseling, behavioral therapy, lifestyle coaching, medical treatment, and surgical treatment. Gastric bypass and sleeve surgery are two extremely effective modes for sustainable obesity treatment. I envision gastric surgeries and anti-obesity medications like semaglutide or tirzepatide being used together in patients with obesity especially those with severe obesity. Dr. Raj Aggarwal‘s Twenty30 Health is a great example of a new company taking this integrated and sustainable approach.

In summary, the weight management space has advanced tremendously over the past year. I was right (and wrong) about a few of my predictions. Advancements in anti-obesity medications and the emergence of startups incorporating these medications have been notable. However, disparities in medication access persist, and the prediction of gastric bypass surgery becoming obsolete was incorrect. Moving forward, a combination of approaches will shape the future of weight management.