Early use of anti-obesity medication more than doubles weight loss
Incorporating an anti-obesity medication just one month after beginning behavioural therapy—rather than the current guideline of waiting six months—can more than double weight loss for individuals who initially struggle with lifestyle changes alone. This is the key finding of a new study from researchers at the Perelman School of Medicine at the University of Pennsylvania, published in Nature Medicine.
Obesity and Its Health Implications
Obesity affects over 40 percent of adults in the United States and is associated with a heightened risk of heart disease, stroke, type 2 diabetes, and certain cancers. Behavioural therapy—also referred to as lifestyle intervention—along with anti-obesity medication, are recognised as effective strategies to support individuals in achieving their weight and health-related goals. However, the effectiveness of these approaches can vary widely among individuals. This study addresses a significant gap in obesity management by demonstrating that those who struggle with one form of treatment may benefit substantially from the timely addition of another.
Most obesity management guidelines recommend an initial six-month period of lifestyle intervention before considering medication. These lifestyle modifications typically involve reducing calorie intake, increasing physical activity, and employing behavioural strategies such as tracking food consumption and exercise. These interventions are often delivered through structured counselling sessions, where trained professionals help participants set realistic goals and provide accountability. However, research indicates that up to 50 percent of individuals undertaking lifestyle interventions alone do not achieve a clinically meaningful weight loss of at least five percent of their starting weight.
Dr Jena Shaw Tronieri, Senior Research Investigator at the Center for Weight and Eating Disorders in the Department of Psychiatry at the University of Pennsylvania, noted the critical lack of research into next steps for individuals who do not respond adequately to behavioural therapy alone:
“Surprisingly little is known about how to help patients who struggle to lose weight when they are already receiving frequent lifestyle counselling sessions. Some experts have suggested that adding an anti-obesity medication should be the next step, but no studies have tested whether this approach actually improves weight loss.”
Early Intervention Leads to Greater Weight Loss
The research team, led by Tronieri, assessed an early intervention approach by identifying individuals who had lost less than two percent of their initial body weight after four weeks of weekly behavioural sessions (equating to less than one pound per week for most participants). These individuals were then randomly assigned to receive either the anti-obesity medication phentermine hydrochloride (15.0 mg per day) or a placebo while continuing with 24 additional weeks of behavioural intervention.
Phentermine, an appetite suppressant, is the longest-approved weight-loss medication currently available, having received U.S. Food and Drug Administration (FDA) approval in 1959.
The results demonstrated a significant disparity in weight loss outcomes:
- Participants who received only the placebo alongside behavioural counselling lost an average of 2.8 percent of their initial weight over the 24-week period.
- In contrast, those who received phentermine experienced a weight loss of 5.9 percent—more than double the amount lost by the placebo group.
For context, an individual weighing 250 pounds (approximately 113 kg) at the study’s outset would have lost around 15 pounds (6.8 kg) with the medication, compared to roughly 7 pounds (3.2 kg) with behavioural therapy alone.
Meanwhile, individuals who were “early strong responders”—those who had already achieved notable weight loss in the first month—continued with lifestyle interventions alone and achieved an additional 5.1 percent reduction in their initial weight over the same six-month period.
Implications for Obesity Treatment
Dr Tronieri emphasised the importance of adapting obesity treatment strategies to prevent disengagement and improve patient outcomes:
“Our results strongly support the addition of anti-obesity medications for patients who do not achieve meaningful weight loss with behavioural methods alone. They also suggest that the medication can be introduced early in treatment, rather than waiting until a patient completes a full six-month programme. Early intervention is crucial because patients who don’t see initial results are more likely to become discouraged and discontinue treatment altogether.”
The study’s findings offer a potential framework for healthcare professionals supporting individuals who find it challenging to lose weight through lifestyle changes alone. While this study focused on phentermine, researchers caution that additional trials are necessary to determine whether newer FDA-approved medications, such as semaglutide or tirzepatide, could yield even greater improvements.
Study co-author Dr Thomas A. Wadden, Professor of Psychology in Psychiatry, noted:
“If the people who were early non-responders took one of the newer approved medications, like semaglutide or tirzepatide, it’s likely they could easily double or triple their weight loss compared to phentermine. Additional research is needed to confirm this hypothesis.”
Future Research Directions
The study was funded by the National Institutes of Health (NIH) and the National Institute of Diabetes and Digestive and Kidney Diseases (K23DK116935). Researchers aim to build upon these findings by exploring the effectiveness of alternative medications and refining treatment protocols to maximise weight loss outcomes for those who do not respond to behavioural interventions alone.
This study represents a significant step towards more personalised obesity management, with early introduction of medication offering a promising approach for individuals who find it difficult to achieve weight loss through lifestyle modifications alone.
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GLP-1 agonists improve kidney transplant outcomes in people with type 2 diabetes
A recent study has demonstrated that people with type 2 diabetes who have received kidney transplants experience significantly improved survival rates and a lower likelihood of organ failure when prescribed glucagon-like peptide-1 (GLP-1) receptor agonists, a class of medications originally developed to manage diabetes and now widely used for weight management.
Obesity is a well-documented risk factor for type 2 diabetes and is associated with an increased risk of postoperative complications, including inflammation, organ rejection, and premature mortality. Previous research had indicated that people who had undergone kidney transplantation and subsequently took GLP-1 agonists exhibited a slower decline in kidney function compared to those who had not received the medications. However, there had been uncertainty regarding their routine use in this population due to concerns about potential adverse effects, including pancreatic inflammation, liver complications, and a theoretical increased risk of a rare form of thyroid cancer, particularly in individuals taking immunosuppressive medications to prevent transplant rejection.
Significant Reduction in Organ Failure and Mortality
The new study, conducted by researchers at NYU Langone Health and published in The Lancet Diabetes & Endocrinology, aimed to clarify the benefits and risks of these medications in kidney transplant recipients. The findings revealed that people prescribed GLP-1 agonists—most of whom began treatment within three years of transplantation—were 49% less likely to experience transplant failure, defined as the cessation of kidney function necessitating a return to dialysis, compared to those not taking the medication. Additionally, those prescribed GLP-1s had a 31% lower risk of mortality within five years of starting the treatment.
Dr Babak J. Orandi, MD, PhD, lead investigator of the study, transplant surgeon, and obesity medicine specialist, emphasised the significance of these findings:
“Our study results are the strongest evidence to date that GLP-1 agonist drugs are largely safe and effective tools for addressing type 2 diabetes in kidney transplant recipients.”
Dr Orandi, an associate professor in the Departments of Surgery and Medicine at NYU Grossman School of Medicine, further noted:
“Our research offers a large amount of real-world clinical data to guide the management of benefits and risks of GLP-1 use in kidney transplant recipients.”
Risk of Diabetic Retinopathy
While the study found no increased risk of pancreatic inflammation, liver complications, or thyroid cancer in those prescribed GLP-1s, it did identify a 49% higher likelihood of developing diabetic retinopathy, a leading cause of blindness. This eye condition occurs when elevated blood sugar levels damage the retina’s blood vessels, particularly in cases where blood glucose control is adjusted too rapidly.
Study senior investigator and epidemiologist Dr Mara McAdams-DeMarco, PhD, an associate professor in the Departments of Surgery and Population Health, highlighted the need for close monitoring:
“Our findings also show that while the benefits of GLP-1 drugs are significant, their use does come with some added risk of diabetic retinopathy, suggesting that physicians need to carefully monitor the eye health of kidney transplant recipients with diabetes who are started on these drugs.”
Dr Orandi further elaborated on this point, stating that individuals with poorly controlled diabetes should be screened for diabetic retinopathy prior to starting GLP-1 therapy. He also recommended a gradual titration of the medication dosage in people with severe diabetes or pre-existing eye conditions.
Study Overview and Future Research
The study analysed medical records from the U.S. Renal Data System, which integrates data from the Organ Procurement and Transplantation Network, the U.S. Centers for Medicare and Medicaid Services, and Medicare claims related to prescription drug use. Researchers reviewed data from 18,016 kidney transplant recipients with pretransplant diabetes in the United States between 2013 and 2020. Of these, 1,916 individuals were prescribed GLP-1 receptor agonists, including semaglutide, liraglutide, and dulaglutide, marketed under brand names such as Ozempic, Wegovy, Saxenda, Victoza, and Trulicity.
The study also found that those prescribed GLP-1s were more likely to be younger, female, Black, and from lower-income backgrounds than those who were not prescribed the medication. The researchers emphasised the need for further studies to investigate the biological mechanisms by which GLP-1 agonists enhance kidney health post-transplantation.
Type 2 diabetes remains one of the primary causes of end-stage kidney disease, and with a quarter of a million individuals in the United States currently awaiting a kidney transplant, identifying treatments that improve post-transplant outcomes is of critical importance.
Funding and Disclosures
The study was supported by National Institutes of Health grants R01AG077888, K02AG076883, R01DK114074, R01DK120518, K01DK132490, and K24AI144954.
Besides Dr Orandi and Dr McAdams-DeMarco, researchers involved in the study included Yui Chen, MHS; Yiting Li, MPH; Garyn Metoyer, MD; Michael Weintraub, MD; Sunjae Bae, MD, PhD; Nicole Ali, MD; Bonnie Lonzo, MD; Christine Ren-Fielding, MD; Holly Lofton, MD; Akash Gujral, MS; and Dorry L. Segev, MD, PhD. Additionally, Krista Lentine, MD, from Saint Louis University in Missouri, contributed as a co-investigator.
Dr Orandi has served on an advisory board for Boehringer Ingelheim. Dr Lofton has received advisory board fees, research funding, and speaking fees from Novo Nordisk, Eli Lilly, and Currax. Dr McAdams-DeMarco has received speaking fees from Chiesi. Dr Segev has served as a consultant or received speaking fees from AstraZeneca, Behring, CareDx, CSL, Jazz Pharmaceuticals, Mallinckrodt, Novavax, Novartis, Optum Health Education, Sanofi, Thermo-Fisher Scientific, Transmedics, and Veloxis. None of these companies were involved in the current study. The terms of these relationships are being managed in accordance with NYU Langone Health’s policies and procedures.
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GLP-1 drugs may reduce risk of leukaemia and lymphoma in people with type 2 diabetes
A recent study published in JAMA Network Open suggests that individuals with type 2 diabetes (T2D) who are treated with glucagon-like peptide-1 receptor agonists (GLP-1RAs) may have a lower risk of developing haematologic cancers, including leukaemia and lymphoma, compared to those using insulin or metformin.
Background
Both obesity and type 2 diabetes are recognised as independent risk factors for various types of cancer, including haematologic malignancies. GLP-1RAs have emerged as a promising therapeutic option due to their benefits in weight management, immune modulation, and glycaemic control. Previous research has linked GLP-1RAs to a lower incidence of solid tumours, yet their relationship with haematologic cancers remains largely unexplored. This study sought to fill this knowledge gap by comparing cancer risks in individuals receiving GLP-1RAs versus those using metformin or insulin.
Study Overview
Researchers conducted a retrospective cohort analysis using the TriNetX database, a large repository containing health records for approximately one-quarter of the United States population. The study included individuals with a T2D diagnosis who were prescribed either GLP-1RAs (such as exenatide, lixisenatide, tirzepatide, liraglutide, albiglutide, semaglutide, or dulaglutide), insulin, or metformin between 30 April 2005 and 31 October 2023.
To ensure robust comparisons, individuals with a prior diagnosis of haematologic cancer or those who had been prescribed antidiabetic medication before their T2D diagnosis were excluded. The study’s primary objective was to assess the incidence of first-time haematologic cancer diagnoses across different treatment groups. Two separate analyses were conducted: one comparing GLP-1RA users to metformin users and another comparing them to insulin users.
To account for potential confounding factors, the study employed propensity score matching based on multiple variables, including weight status, demographic characteristics, diabetic complications, body mass index (BMI), glycated haemoglobin (HbA1c), cancer screening history, genetic predisposition, exposure to radiation, intensive care unit (ICU) admissions, concomitant antidiabetic therapies, adverse social determinants of health, and exposure to cytotoxic agents. The researchers then utilised Kaplan-Meier survival analysis and Cox proportional hazard models to estimate cumulative cancer incidences and hazard ratios with 95% confidence intervals.
Key Findings
The study identified over 1.6 million individuals with type 2 diabetes. Among them, 51,617 were prescribed GLP-1RAs, 938,602 received insulin, and 611,115 were treated with metformin. The average duration of GLP-1RA prescriptions was 485 days. Following propensity matching, 50,590 participants were included in the GLP-1RA–metformin comparison, and 47,716 were included in the GLP-1RA–insulin comparison.
Comparison with Metformin
GLP-1RA use was associated with a significantly lower risk of myelodysplastic syndromes (MDS) and myeloproliferative neoplasms (MPN) when compared to metformin. However, the researchers noted that metformin itself has been linked to cancer-protective effects, which may explain why the overall reduction in haematologic cancer risk associated with GLP-1RAs was limited in this comparison. Ultimately, no statistically significant difference was observed in the combined risk of all haematologic cancers between GLP-1RA and metformin users.
Comparison with Insulin
In contrast, when compared to insulin users, those prescribed GLP-1RAs exhibited a markedly lower risk of developing a range of haematologic cancers. Specifically, GLP-1RA users had a significantly reduced risk of lymphoid leukaemia, myeloid leukaemia, MPN, MDS, amyloidosis, non-Hodgkin lymphoma, monoclonal gammopathy, and multiple myeloma. Overall, GLP-1RA use was linked to a 54% lower risk of developing any haematologic malignancy compared to insulin use.
Implications and Conclusion
The findings suggest that GLP-1RAs may offer protective effects against haematologic cancers, particularly in comparison to insulin. This effect is likely influenced by the immunomodulatory properties of GLP-1RAs and their role in promoting weight loss. Notably, these protective associations appeared to be independent of glycaemic control, potentially due to a reduction in pro-inflammatory cytokines that are involved in the dysregulation of haematopoiesis and the development of conditions such as MPN and MDS.
Despite these promising results, the study has several limitations. Residual confounding factors cannot be entirely ruled out, and the analysis did not explore dose-response relationships or account for potential age-related variations in cancer risk. Additionally, as this was a retrospective study relying on diagnostic codes from electronic health records, inaccuracies in coding and unmeasured confounders could have influenced the results.
The authors emphasised that metformin, a comparator in the study, is already known to have cancer-protective properties, which may explain why the benefits of GLP-1RAs appeared more pronounced when compared to insulin rather than metformin. Given these findings, GLP-1RAs could represent a promising avenue for reducing cancer risk in individuals with type 2 diabetes. However, further research is required to elucidate the underlying biological mechanisms and confirm these observational findings in prospective clinical trials.
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Rising prescriptions for obesity management medications reflect growing public interest
The number of prescriptions for obesity management medications (OMDs) has increased significantly in recent years, with a corresponding rise in online search activity, according to a study published on 29 January in JAMA Network Open.
Dr Philipp Berning, from Johns Hopkins University School of Medicine in Baltimore, and colleagues conducted a repeated cross-sectional study examining prescription patterns and online search trends for OMDs. Their research explored the correlation between the growing use of these medications and public engagement, analysing trends visually and performing quantitative correlation calculations.
The study revealed that a total of 69,213,936 prescriptions for OMDs were dispensed in the United States during the research period. The data showed a steady increase in prescription rates, rising from 0.76 to 0.80 million between July 2017 and June 2018, and from 1.29 to 1.51 million between March 2023 and February 2024. This represents a mean annual growth rate of 5.3 per cent. By February 2024, the total number of OMD prescriptions reached 1.5 million in a single month, accounting for 0.41 per cent of all prescriptions issued during that time.
Among the most commonly prescribed OMDs were phentermine, semaglutide (marketed as Wegovy), liraglutide (Saxenda), and tirzepatide (Zepbound). By February 2024, phentermine had approximately 0.74 million monthly prescriptions, while Wegovy and Zepbound had 0.42 million and 0.25 million monthly prescriptions, respectively.
Online search trends closely mirrored these prescribing patterns. Search volumes for Wegovy, Zepbound, and phentermine in February 2024 were recorded at 636.3, 468.9, and 301.8 searches per 10 million, respectively. The strongest correlation between prescription rates and online search volumes was observed with Wegovy and Zepbound, indicating heightened public interest in these newer treatments.
“These findings may provide insight for health care professionals and policy makers, as they highlight the rapid adoption by clinicians (including nonphysician professions) of state-of-the-art obesity treatments and their growing public interest,” the authors wrote.
One author of the study disclosed financial ties to the biopharmaceutical industry, a factor that should be considered when interpreting the findings.
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Researchers aim to minimise side effects of obesity medications through groundbreaking study
A pioneering £1.2 million research initiative is now underway at University College London (UCL) and the Rowett Institute at the University of Aberdeen, seeking to refine the effectiveness of weight-loss medications while reducing their associated side effects. The study, funded by the Medical Research Council, will investigate the precise mechanisms through which these drugs act in the brain, with the goal of developing improved treatments that minimise discomfort while maximising therapeutic benefits.
The Promise and Challenges of Semaglutide
Semaglutide, an anti-diabetic medication marketed under brand names such as Wegovy and Ozempic, has gained widespread recognition for its ability to support weight management. The drug works by acting on the brain to reduce food intake, helping people with obesity or overweight to achieve significant weight loss.
However, despite its effectiveness, semaglutide can produce unpleasant side effects, including nausea and vomiting. These adverse reactions can make it difficult for individuals to adhere to long-term treatment, ultimately reducing the drug’s overall effectiveness in managing weight.
Investigating the Brain’s Role in Drug Response
Leading the study are Professor Lora Heisler of the Rowett Institute and Professor Stefan Trapp of UCL Biosciences, who will spend the next three years mapping out how semaglutide interacts with the brain. Their research will focus on identifying specific neural pathways that influence different aspects of eating behaviour, such as reducing meal size, encouraging healthier food choices, slowing digestion, and diminishing the brain’s reward response to highly palatable foods.
Crucially, the study will also examine the pathways responsible for triggering nausea and other unwanted side effects. By distinguishing between these different mechanisms, the researchers aim to uncover ways to modify how the drug acts in the brain, potentially paving the way for future medications that retain semaglutide’s benefits without the drawbacks.
Aiming for More Effective and Tolerable Treatments
Professor Trapp highlighted the importance of this research in advancing obesity treatment, “While semaglutide and similar drugs have been very effective in helping people with diabetes and show much promise in helping people to lose weight, we still do not know that much about how exactly they work in the brain.”
He noted that his laboratory has conducted extensive studies on the glucagon-like peptide-1 receptor (GLP-1R), the brain target of semaglutide. By mapping out the drug’s mechanism in greater detail, Trapp and his team hope to contribute to the development of more refined medications with fewer adverse effects.
Professor Heisler further emphasised the potential impact of their findings, “There is huge interest in how the brain targets of semaglutide and similar drugs could be switched on in a slightly different or more targeted way. Drugs that can do this could work better, have effects that last longer, and produce specific therapeutic obesity treatment benefits without the nausea side effect.”
She also pointed out that such research is only possible due to recent technological advancements, stating, “We can only now do these types of studies because of the latest technological advances, and we expect our results will provide the blueprint to develop even better obesity medications in the future.”
Implications for Future Obesity Treatments
This study could play a crucial role in shaping the next generation of obesity medications, offering new treatment options that are not only effective but also better tolerated. As more people turn to pharmacological treatments for weight management, research like this is essential to ensuring that these interventions remain both accessible and sustainable for long-term use.
By deepening the scientific understanding of how semaglutide works in the brain, researchers at UCL and the Rowett Institute aim to refine and improve the treatment landscape, ultimately providing more effective and tolerable solutions for individuals seeking to manage their weight through medical therapy.
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GLP-1 drugs linked to fewer surgery complications in people with diabetes
Individuals living with diabetes who were prescribed GLP-1 receptor agonist medications, such as tirzepatide and semaglutide, experienced significantly lower rates of hospital readmission, wound reopening, and haematoma following surgery, according to a large-scale study. The research was conducted by experts from Weill Cornell Medicine, Columbia University Vagelos College of Physicians and Surgeons, and NewYork-Presbyterian.
Published on 20 December in the Annals of Surgery, the study analysed anonymised hospital data from 74,425 surgical procedures performed on 21,772 individuals with diabetes over a three-and-a-half-year period, concluding in July 2023.
The findings revealed that individuals prescribed GLP-1 receptor agonists—commonly referred to as GLP-1 drugs—demonstrated a:
- 12% reduction in the likelihood of hospital readmission within 30 days post-surgery,
- 29% decrease in the risk of wound reopening within six months, and
- 56% reduction in the risk of haematoma (a localised collection of blood caused by bleeding) at the surgical site compared to those not on these medications.
“These findings from such a large number of patients and procedures suggest that taking these drugs shouldn’t worsen overall post-surgical complications and may even reduce the likelihood of some of them,” said Dr Jason Spector, senior author of the study, chief of the division of plastic and reconstructive surgery at Weill Cornell Medicine and NewYork-Presbyterian/Weill Cornell Medical Center, and a professor of surgery at Weill Cornell Medicine.
Background on GLP-1 Medications
GLP-1 receptor agonists were originally developed in the early 1990s to manage diabetes, with the first medications reaching clinical use in 2005. In 2014, regulatory authorities, including the US Food and Drug Administration (FDA), approved their use for treating obesity. These drugs function by activating the GLP-1 receptor on cells within the pancreas and other organs, thereby stimulating insulin release, which subsequently lowers blood sugar levels and suppresses appetite.
The recent widespread adoption of GLP-1 drugs prompted Dr Spector and first author Dr Seth Aschen, then a plastic surgery resident at NewYork-Presbyterian/Weill Cornell Medical Center, to investigate whether individuals with diabetes undergoing surgery face a greater or reduced likelihood of complications while on these medications.
Study Methods and Analysis
The research team analysed anonymised electronic health records from NewYork-Presbyterian/Weill Cornell Medical Center and NewYork-Presbyterian/Columbia University Irving Medical Center. They reviewed all surgical procedures involving individuals with diabetes from February 2020 to July 2023, ensuring at least six months of follow-up data for each case.
The investigators focused on hospital readmission rates within 30 days and four other post-surgical complications over the follow-up period. These included wound reopening, haematoma, bleeding, and infection. To ensure robust comparisons, a “propensity matching” system was employed to pair individuals prescribed GLP-1 drugs with similar individuals not taking these medications. This approach minimised the influence of external factors unrelated to the drugs themselves.
Key Findings
Surprisingly, the results indicated that individuals with diabetes taking GLP-1 medications were slightly less likely to require hospital readmission within 30 days of surgery, suggesting a reduction in overall complications.
Among specific complications studied:
- Bleeding and infection rates were consistent between both groups.
- The risk of wound reopening and haematoma was significantly lower in individuals taking GLP-1 drugs. Specifically, those prescribed these medications had 71.1% of the risk of wound reopening and 44.0% of the risk of haematoma compared with those not on GLP-1 drugs.
Understanding the Underlying Mechanisms
While the exact reasons for these beneficial outcomes remain unclear, diabetes is known to impair wound healing, potentially increasing post-surgical risks. Interestingly, the study found that better blood sugar control was unlikely to explain the positive effects, as individuals on GLP-1 drugs had slightly higher average blood sugar levels than their counterparts.
Other research suggests that GLP-1 medications may enhance wound healing through mechanisms such as reducing clotting, promoting the formation of new blood vessels to nourish tissues, and lowering inflammation. “These mechanisms may help explain the observed benefits,” Dr Spector commented.
Future Directions
Dr Spector and his team are now expanding their research to examine whether GLP-1 drugs influence post-surgical complications in individuals without diabetes.
By shedding light on these potential benefits, this study underscores the importance of further research into GLP-1 medications and their broader implications for improving surgical outcomes.
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Mounjaro Gains Momentum in the UK’s Private Obesity Treatment Market, Outpacing Wegovy
In the UK’s private obesity treatment market, Eli Lilly’s Mounjaro is becoming the preferred choice over Novo Nordisk’s Wegovy, according to insights from online pharmacies and patients. The shift suggests that the U.S.-based pharmaceutical company is challenging its European competitor’s early dominance in the sector.
The popularity of Mounjaro stems from its greater efficacy in supporting weight loss, as confirmed by six online pharmacies and two individuals using the drug. Despite some pharmacies charging up to 40% more for Mounjaro’s introductory doses compared to Wegovy, its effectiveness appears to outweigh the higher cost for many users.
“Mounjaro is now vastly outstripping Wegovy,” stated James O’Loan, CEO of Chemist4U. According to O’Loan, over the past three to four months, approximately 70% of his pharmacy’s sales have been attributed to Mounjaro.
Private market growth
Chemist4U and Simple Online Pharmacy estimate that as many as 500,000 people in the UK are using either Mounjaro or Wegovy via prescriptions obtained through private online pharmacies. Unlike Wegovy, which is accessible through the National Health Service (NHS) but only in specialist obesity clinics under limited conditions, Mounjaro is currently unavailable through the NHS. However, it is expected to become available next year.
The government revealed last year that NHS services had the capacity to treat around 35,000 patients with Wegovy, but no public data exists on the number of prescriptions issued.
Mounjaro entered the UK market in February 2024, marking one of the first launches outside the U.S. and one of a few countries where it directly competes with Wegovy. Novo Nordisk introduced Wegovy in the UK in September 2023. Government statistics indicate that approximately two-thirds of adults in the UK are living with overweight or obesity, making the country a significant market for obesity treatments.
Rising demand for obesity medications
The global obesity drug market is projected to reach a value of $150 billion annually within the next decade. The UK, as one of Europe’s more populous markets, is witnessing significant growth in demand for obesity treatments.
O’Loan reported that Chemist4U is selling approximately 40,000 pens of Mounjaro and Wegovy combined each month, with each pen representing about one month’s supply. The pharmacies interviewed noted that availability of both medications has stabilised since the summer following an earlier period of shortages.
Online listings indicate that one-month starter doses of Wegovy cost between £109 and £138. Similarly, Mounjaro starter doses are priced at approximately £115.
Novo Nordisk’s leadership in the obesity drug market made it Europe’s largest company by market capitalisation last year. However, increasing competition from Eli Lilly has led to a 16% decline in Novo’s market value since its peak in June. Lilly’s rapid growth has boosted its shares by 37% this year, outperforming Novo’s 12% gain.
Comparative efficacy
Clinical trial data have played a pivotal role in shaping preferences for Mounjaro. Before regulatory approval, trials demonstrated that individuals using Wegovy achieved an average weight reduction of 15%, while Mounjaro users saw nearly 23% weight loss when combined with a balanced diet and exercise.
Recent study results, published last week, provided the first direct comparison between the two medications under identical trial conditions. These findings reinforced Mounjaro’s superior effectiveness in facilitating weight loss.
Novo Nordisk declined to comment on UK sales but emphasised that prescribing decisions should prioritise individual patient needs. Eli Lilly also declined to comment.
With patients increasingly weighing up different GLP-1 medications, supporting clinicians to match the right treatment to the right person is the focus of professional training such as the College of Contemporary Health’s GLP-1RAs in Practice: Prescribing, a CPD-accredited online short course.
Individual experiences and pharmacy trends
Alan, a 54-year-old financial services professional from London, switched to Mounjaro in March 2024 after using Wegovy since October 2023. Concerned about hitting a weight loss plateau, he opted for Mounjaro despite needing to start at the lowest dose and gradually increase. Within the first month, Alan lost one kilogram—more than he had achieved on the highest dose of Wegovy before switching.
“Efficacy drove my switch,” Alan explained. “It was a no-brainer; it seemed the obvious thing to try.”
Pharmacy data align with such individual accounts. Matt Vickers, clinical director at Juniper Pharmacy, reported that 70% to 80% of their new clients are opting for Mounjaro. Similarly, UK pharmacy chain Superdrug dispensed three times as many prescriptions for Mounjaro as Wegovy in October. Online pharmacy MedExpress noted a growing preference among new customers for Mounjaro.
Another individual, John, who preferred to use his middle name, began his weight loss journey with Novo Nordisk’s diabetes medication Ozempic, which contains the same active ingredient as Wegovy. John lost 18 kilograms using Ozempic and exceeded his goal by shedding an additional 20 kilograms. Despite this success, he plans to transition to Mounjaro in January to further enhance his outcomes.
Future outlook
The competition between Mounjaro and Wegovy highlights a rapidly evolving landscape in obesity care, with patients prioritising efficacy and accessibility. As demand continues to grow, both manufacturers will likely play a critical role in shaping the future of obesity management in the UK and beyond.
CCH insight
Behind the headline market race sits a real clinical question: how to choose the most appropriate GLP-1 medication for each individual, and how to manage patients moving between them. CCH’s GLP-1RAs in Practice: Prescribing CPD short course (2 CPD hours, fully online, CPD-accredited) equips prescribers to make exactly those judgements – from selecting the right treatment and initiation through to titration and side-effect management – so decisions are driven by clinical need rather than headlines.
Explore GLP-1RAs in Practice: Prescribing →
Anti-obesity medications linked to reduced alcohol consumption in weight loss study
A recent study published in JAMA Network Open has revealed intriguing insights into the behavioural effects of anti-obesity medications (AOMs), particularly their impact on alcohol consumption. Conducted within the WeightWatchers (WW) Clinic telehealth weight management programme, the research examined alcohol use patterns among participants who initiated AOMs, with nearly half reporting a decrease in alcohol consumption.
How Do Anti-Obesity Medications Impact Alcohol Use?
AOMs, particularly glucagon-like peptide-1 receptor agonists (GLP-1 RAs), are well-established for promoting significant weight loss. However, emerging evidence highlights their potential benefits beyond weight management. GLP-1 RAs have been associated with reduced incidence and recurrence of alcohol use disorder, hinting at their broader therapeutic scope.
Understanding the mechanisms underpinning these effects is vital. Comparative studies examining how different AOMs influence alcohol use could pave the way for enhanced approaches to weight management and addiction treatment. This research underscores the need for further exploration of the behavioural impacts of these medications.
Study Overview
This study included participants from the WW telehealth weight management programme who had initiated an AOM between January 2022 and August 2023 and refilled their prescription between October and November 2023. Participants using AOMs prior to enrolment or with a history of bariatric surgery were excluded, as these factors may alter alcohol use disorder risk.
The study adhered to rigorous ethical and reporting standards, receiving approval from the Henry Ford Health institutional review board and following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Data were deidentified, negating the need for informed consent.
Participants completed baseline surveys capturing demographic details, including age, sex assigned at birth, race, ethnicity, height, weight, and weekly alcohol consumption. Their body mass index (BMI) was calculated from self-reported height and weight. Follow-up surveys assessed changes in alcohol use at the time of AOM refill. Statistical analyses, including multivariate logistic regression, evaluated alcohol use trends, with R software used for computations.
Findings
The study included 14,053 participants, 86% of whom were women, with an average age of 43.2 years and a mean BMI of 36. Most participants (86%) were prescribed second-generation GLP-1 RAs, such as tirzepatide or semaglutide, while others received first-generation GLP-1 RAs, bupropion/naltrexone, or metformin. Participants represented a spectrum of obesity classes: 41.3% were classified as obesity class I, 26% as class II, and 21% as class III.
At baseline, 53.3% of participants reported alcohol use. Among this group:
- 45.3% reduced alcohol consumption after starting an AOM.
- 52.4% reported no change in their drinking habits.
- 2.3% experienced an increase in alcohol use.
Across all participants, 24.2% experienced a reduction in alcohol use. Individuals with higher obesity classes and greater baseline alcohol consumption were more likely to report reduced alcohol use. Participants prescribed bupropion/naltrexone showed a higher likelihood of reducing alcohol consumption compared to those on metformin. However, after adjusting for weight loss, this association lost statistical significance, suggesting that reductions in alcohol use may be partly mediated by weight loss rather than medication-specific effects.
On average, participants experienced a 12.7% reduction in initial body weight over approximately 224.6 days between AOM initiation and follow-up.
Interpreting the Results
The findings point to several potential mechanisms driving reduced alcohol use. Pharmacologically, naltrexone, a component of some AOMs, is known to suppress alcohol cravings. GLP-1 RAs may also diminish the rewarding effects of alcohol consumption. Additionally, behavioural factors associated with weight management programmes, such as encouragement to limit alcohol for calorie control and cognitive restraint, likely contributed to these outcomes.
Conclusion
This study highlights a notable secondary benefit of AOMs: their potential to support reduced alcohol consumption among individuals managing obesity. Nearly half of participants who consumed alcohol at baseline reported a decrease in their intake after starting AOM therapy. These findings offer promising implications for the dual role of AOMs in addressing obesity and its associated behavioural challenges. Further research is essential to deepen our understanding of these interactions and optimise therapeutic approaches in weight management and addiction care.
Biden proposes expanding Medicare and Medicaid to cover anti-obesity drugs
On Tuesday 26th of November, 2024, United States President Joe Biden announced a groundbreaking proposal to expand coverage of anti-obesity medications, such as Novo Nordisk’s Wegovy, to millions of individuals enrolled in Medicare and Medicaid. This initiative aims to significantly reduce out-of-pocket costs for eligible participants, with potential savings of up to 95%.
The proposal could make advanced weight management medications, particularly GLP-1 receptor agonists, accessible to a larger segment of the population. These drugs have demonstrated an average weight reduction of up to 20% and have been proven to lower risks of type 2 diabetes, heart attacks, and cardiovascular-related deaths. Without insurance coverage, these medications can cost as much as $1,000 monthly, placing them out of reach for many.
Current Coverage Gaps
At present, Medicare—a government health insurance programme—covers GLP-1 drugs like Eli Lilly’s Mounjaro and Novo Nordisk’s Ozempic for managing diabetes but does not extend coverage to versions such as Wegovy, which is approved specifically for treating obesity. Medicaid, a state-run programme, has the option to cover these drugs, but many states choose not to include them.
The new regulation proposed by the Department of Health and Human Services (HHS), published in the Federal Register, would mandate Medicare coverage of anti-obesity drugs. This could expand access for an estimated 3.4 million individuals with Medicare and an additional 4 million adults enrolled in Medicaid. If enacted, the policy would take effect in 2026.
Potential Political Hurdles
The timeline for implementation coincides with the start of the incoming administration, potentially complicating the policy’s future. President-elect Donald Trump’s nominee for Health Secretary, Robert F. Kennedy Jr., has expressed reservations about tackling obesity with medication, favouring lifestyle interventions such as healthy eating. This stance has led some analysts to view the proposal as a potential political flashpoint.
Ge Bai, a professor of health policy and management at Johns Hopkins University, commented, “This is setting up a political landmine for the Trump administration.” She noted that the incoming government’s anticipated focus on cost-cutting could fuel criticism if coverage of these drugs is scaled back. Democratic Senator Ron Wyden echoed this sentiment, vowing to hold the Trump administration accountable to ensure no regression in expanding access to these medications.
Larry Levitt, Executive Vice President for health policy at the non-profit KFF, highlighted the uncertainty surrounding the policy’s implementation. “RFK Jr. has expressed scepticism of these drugs, but Dr. Oz has praised them,” he said, referencing Trump’s selection of Dr Mehmet Oz, a television personality and surgeon, to lead the Centres for Medicare and Medicaid Services (CMS). Levitt suggested that the White House would ultimately decide, adding, “It may hesitate to block coverage that would likely be popular among many seniors.”
Financial Implications
The CMS estimates that expanding Medicare coverage for these medications would cost the federal government approximately $25 billion over the next decade, with Medicaid incurring an additional $11 billion in costs. States would bear around $4 billion of the Medicaid expenses. The total projected Medicare drug spending during this period is $2.1 trillion.
The Congressional Budget Office (CBO) has provided a broader perspective, estimating that Medicare coverage of anti-obesity drugs would increase federal spending by about $35 billion over eight years. Direct federal costs are expected to rise from $1.6 billion in 2026 to $7.1 billion by 2034.
Pushback on Pricing
The high cost of anti-obesity medications has been a point of contention. Senator Bernie Sanders has called on pharmaceutical companies like Novo Nordisk and Eli Lilly to lower their prices. “We cannot allow Medicare and Medicaid to simply be a cash cow for Novo Nordisk and Eli Lilly,” Sanders said.
Intense demand for these drugs has already caused supply shortages, with many individuals turning to less expensive compounded alternatives sold online, according to recent reports from Reuters.
Biden’s Broader Healthcare Agenda
This proposal is part of Biden’s wider push to make healthcare and prescription medications more affordable. Previous measures include capping insulin costs for Medicare recipients at $35 and limiting annual out-of-pocket prescription drug expenses for seniors to $2,000. The Inflation Reduction Act also mandated price negotiations between pharmaceutical companies and Medicare, resulting in significant price cuts for 10 drugs, ranging from 38% to 79%, set to begin in 2026. Ozempic and Wegovy are expected to be included in the next round of negotiations, with new prices introduced in 2027.
While former President Trump also sought to reduce drug costs during his first term, his measures were blocked by a federal judge, highlighting the contentious nature of pharmaceutical pricing reforms.
Looking Ahead
As the rule’s comment period remains open until 27 January—just after the next presidential inauguration—the future of this policy is uncertain. The proposal represents a significant shift towards recognising obesity as a complex medical condition requiring comprehensive treatment options. However, its success will depend on political will, public support, and the continued balancing of costs with public health outcomes.
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AstraZeneca reports early success for experimental obesity pill in Phase I trial
AstraZeneca announced on Monday (4th of November) that its experimental oral treatment for weight loss, developed in collaboration with China’s Eccogene, has shown promising safety and tolerability outcomes in an early-stage Phase I trial. According to AstraZeneca, side effects were consistent with those expected in the GLP-1 drug class, which includes some of the most effective weight-loss medications currently on the market.
The Phase I trial, involving 72 participants, was focused on assessing the safety and tolerability of the treatment, a critical objective for early-stage clinical trials. Participants included both volunteers of a healthy weight without obesity, and individuals living with type 2 diabetes. This diverse enrolment provided AstraZeneca with an initial understanding of how different individuals might tolerate the treatment.
Sharon Barr, AstraZeneca’s Executive Vice President of Biopharmaceuticals R&D, expressed confidence in advancing the treatment to Phase II clinical trials based on the encouraging results. “These initial findings have given us the confidence to move forward,” Barr stated during a media briefing ahead of the ObesityWeek conference in San Antonio, Texas, where the data would be presented. She confirmed that one of the upcoming trials would focus on the average reduction in body weight among participants living with obesity or who have overweight. AstraZeneca aims to complete this study by the end of 2025.
When AstraZeneca first announced its partnership with Eccogene in 2023, the company committed up to $2 billion to licence this once-daily oral treatment, hoping it might offer a more convenient alternative with fewer side effects than existing injectable treatments. Currently, injectable GLP-1 receptor agonists such as Eli Lilly’s Zepbound and Novo Nordisk’s Wegovy lead the market. Barr highlighted AstraZeneca’s optimism for the treatment’s future, remarking on its potential to offer a safer alternative to injectables, which often present a high barrier for long-term adherence among people seeking weight loss.
Barr noted a “dose-dependent increase in nausea and vomiting,” typical of the GLP-1 receptor agonist class. GLP-1 receptor agonists function by slowing down digestion and promoting a feeling of fullness, which can lead to reduced food intake. Both Zepbound and Wegovy belong to this drug class. Importantly, AstraZeneca’s trial results did not reveal any serious adverse events, which Barr believes will support the treatment’s safety profile moving forward.
When AstraZeneca’s Chief Executive, Pascal Soriot, announced the Eccogene deal, he acknowledged that AstraZeneca had joined the obesity treatment market later than competitors Novo Nordisk and Eli Lilly, both of whom had already achieved notable success with their injectable GLP-1 agonists. However, AstraZeneca remains optimistic about its potential within this market segment. Unlike many other treatments currently in development, AstraZeneca’s obesity pill is a small molecule, which may enable it to be used in combination with other small molecule drugs. Barr emphasised this as a crucial factor, noting that “more than 60% of people with obesity or who have overweight also live with at least one other medical condition.”
In the competitive landscape, AstraZeneca is not the only company advancing oral treatments for obesity. On the same day, U.S. biotech company Viking Therapeutics released results from its early-stage trial for an oral obesity treatment that, according to analysts, compared favourably to some competitors. Viking’s positive results led to a 9% increase in its share price. Similarly, Pfizer and Eli Lilly are also working on oral weight-loss drugs within the GLP-1 drug class, with their products currently in later-stage clinical trials.
AstraZeneca’s continued progress in the obesity treatment field highlights its commitment to addressing a growing health challenge affecting millions worldwide.
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New research reveals anti-obesity drug offers life-changing relief for arthritis
A new clinical trial across 11 countries has shown that a groundbreaking anti-obesity drug offers substantial relief from the pain associated with obesity-related knee arthritis, significantly enhancing the ability of individuals to engage in daily activities like walking. This research, the first of its kind, has proven that one of the latest generation of anti-obesity medications can indeed help manage arthritis. The medication in focus, semaglutide, was found to provide pain relief comparable to that of opioid-based treatments.
At the close of the trial, many participants reported such a reduction in pain that they no longer qualified to continue in the study, says Dr Henning Bliddal, a rheumatologist at Copenhagen University Hospital, Bispebjerg and Frederiksberg, who was involved in the trial. “They received a treatment so effective that they were essentially ‘treated out of the study,’” he explains.
These results represent a promising development for those with knee osteoarthritis, notes Dr Leigh Callahan, an epidemiologist at the University of North Carolina, Chapel Hill, who commented on the study findings. “The results are important and could be helpful” for those managing knee osteoarthritis, she says.
The study results, published today in the New England Journal of Medicine, were backed and designed by Novo Nordisk, a pharmaceutical company headquartered in Bagsværd, Denmark, and the manufacturer of semaglutide. Sold under the brand names Ozempic for diabetes management and Wegovy for obesity treatment, semaglutide has gained attention for its multifaceted effects. Dr Bliddal served briefly as a paid consultant for Novo Nordisk during the planning phase of the trial.
Osteoarthritis, a common age-related condition that leads to joint stiffness and pain, often affects the knee joint most frequently. Individuals living with obesity are at higher risk of developing knee osteoarthritis, as the added weight places increased strain on their joints. Furthermore, obesity tends to exacerbate the symptoms of osteoarthritis, notes Dr Callahan. The pain from osteoarthritis often prevents people from engaging in physical activities, making it challenging to achieve weight loss solely through lifestyle adjustments, adds Dr Bliddal.
The clinical trial enrolled around 400 participants across five continents, randomly assigning them to receive either weekly injections of semaglutide or a placebo, combined with guidance on healthy eating and physical activity. At the start of the trial, all participants had obesity, and their average pain score was 71 on a 100-point scale — a level where everyday activities, such as walking, were significantly painful.
After 68 weeks of receiving injections, those who were administered semaglutide had lost considerably more weight than those in the placebo group. Additionally, participants who received the drug reported a notably larger reduction in pain, with their scores on the pain scale dropping by an average of 42 points compared to 28 points for those given a placebo. Participants also experienced marked improvements in day-to-day mobility, such as being able to climb stairs more easily.
According to the study authors, the pain relief may stem partly from the reduced weight load on the knee due to weight loss. However, semaglutide also possesses anti-inflammatory properties, which could contribute to its effectiveness in alleviating pain.
Despite these promising benefits, Dr Bliddal expresses concern about the long-term implications of using semaglutide for managing knee arthritis pain. “Do these individuals continue using semaglutide indefinitely to manage their pain?” he asks. Evidence shows that most people who stop taking anti-obesity medications tend to regain the weight they had lost. Additionally, these drugs come at a high cost, with monthly expenses potentially reaching several hundred US dollars.
Dr Callahan underscores that while the trial results are “very exciting,” it is essential for individuals to combine anti-obesity medications with lifestyle modifications to maintain weight loss in the long run.
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Weight loss surgery declines by 25 percent as anti-obesity drug use climbs
A recent study reveals a significant shift in obesity treatment approaches among privately insured patients, with a marked increase in the use of anti-obesity medications, such as Ozempic and Wegovy, paralleled by a substantial decline in weight-loss surgery. This research, conducted by Brigham and Women’s Hospital in collaboration with Harvard T.H. Chan School of Public Health and the Brown School of Public Health, has been published in JAMA Network Open.
The study tracked a large cohort of over 17 million adults with private health insurance who had been diagnosed with obesity, excluding those with diabetes, between 2022 and 2023. Findings indicate a 132.6 per cent rise in patients prescribed glucagon-like peptide-1 receptor agonists (GLP-1 RAs), with rates climbing from 1.89 to 4.41 per 1,000 patients. During this same period, however, the proportion of patients undergoing metabolic bariatric surgery dropped by 25.6 per cent, from 0.22 to 0.16 per 1,000 patients.
Senior study author Thomas C. Tsai, a metabolic bariatric surgeon at Brigham and Women’s Hospital, highlights that this is “one of the first national estimates of the decline in utilisation of bariatric metabolic surgery among privately insured patients corresponding to the rising use of blockbuster GLP-1 RA drugs.”
In the study’s analysis, the researchers observed that only a minority of patients pursued either pharmacologic or surgical treatment, with 94.7 per cent of patients with obesity receiving neither intervention. Of those who sought treatment, 5 per cent opted for GLP-1 RAs, while just 0.3 percent underwent bariatric surgery. Among the individuals who opted for surgery, a higher medical complexity was noted compared to those choosing GLP-1 RAs.
“Metabolic bariatric surgery remains the most effective and durable treatment for obesity. National efforts should focus on improving access to obesity treatment — whether pharmacologic or surgical — to ensure patients can receive optimal care,” said Tsai, who also serves as an assistant professor of surgery at Harvard Medical School and in health policy and management at Harvard T.H. Chan School of Public Health.
Despite the promising efficacy of GLP-1 RAs in managing obesity and its associated health concerns, such as diabetes, Tsai cautioned that these medications come with limitations, including high costs, restricted supply, and gastrointestinal side effects that may lead to discontinuation and potential weight regain.
The surge in GLP-1 RA use raises important questions about the long-term impact of this shift away from surgical intervention. “As patients with obesity increasingly rely on GLP-1s instead of surgical intervention, further research is needed to assess the impact of this shift from surgical to pharmacologic treatment of obesity on long-term patient outcomes,” Tsai said. “With the national decline in utilisation of metabolic bariatric surgery and potential closure of bariatric surgery programmes, there is a concern that access to comprehensive multidisciplinary treatment of obesity involving pharmacologic, endoscopic, or surgical interventions may become more limited.”
This change in treatment patterns also presents an opportunity to expand accessibility to both surgical and pharmacologic interventions, according to co-author Ateev Mehrotra, chair of the Department of Health Services, Policy and Practice at the Brown University School of Public Health. “Metabolic bariatric surgery and GLP-1 RAs are both effective interventions for patients with obesity, yet less than 6 percent of patients in our study received either form of treatment,” he noted.
The authors call on clinicians and policymakers to monitor this evolving treatment landscape carefully, ensuring that patients have access to effective obesity management options. The findings emphasise a need for further research to understand the benefits and drawbacks of surgical versus pharmacologic treatments, especially as the latter gains popularity in clinical practice.
Funding and Disclosures:
Tsai disclosed receiving grants from the National Center for Advancing Translational Sciences, National Institutes of Health to Harvard Catalyst, the Harvard Clinical and Translational Science Center, as well as financial support from Harvard University and its associated academic health care institutions.