Perspectives across metabolic and obesity care – 1/29

Dear Friends, I trust the week was good; albeit grey and gloomy in Philadelphia; the light is now shining bright here on Sunday evening [and my apologies for being somewhat biased]… GO E-A-G-L-E-S to Super Bowl LVII.

Back to obesity… love your thoughts and review of the below, as always.


  • A nice video of how new obesity drugs work.
  • 60 Minutes on CBS News was an advert for Novo Nordisk.
  • 44,000 patient follow-up study of bariatric surgery from Utah database reveals all cause mortality reduction of 16% over 40 years!


  • Been a quiet one this week; do let me know if I missed anything of note.


  • Ed Silverman at STAT News writes this week on a physicians’ group that has filed a complaint with the FDA on the recent 60 minutes segment on CBS News regarding GLP-1 weight loss drug Wegovy. The complaint argues that Wegovy was ‘extensively promoted’ without mention of side effects, that the comments were from two experts who are paid consultants to Novo Nordisk, who itself was named as a program advertiser at the start of the segment, and alternatives for weight loss were not discussed. Overall, the complaint cited the ‘…content was promotional rather than educational…’ and ‘…failed to comply with FDA regulations…’ though the article mentions an attorney, Dale Cooke, who says this appeared to be a ‘…straightforward reporting segment…’ which seems to make sense to me.
  • Rachel Cohrs, again in STAT News, reports that ‘Legislation to allow Medicare to cover obesity medications has languished in Congress for more than a decade.’ such that the ‘…Treat and Reduce Obesity Act… would both allow Medicare to cover obesity drugs and enable more health care providers to provide intensive behavioral therapy for obesity to Medicare patients.’ The article reiterates a known [and rather challenging] fact that ‘…list price for diabetes drug Ozempic (sometimes used off-label to treat obesity) is $892, while the list price for its weight-management drug Wegovy is about $1,349.’


  • Forbes Health published an article entitled Obesity Statistics, headlining with a photo of a pair of denim jeans with a measuring tape as a belt – my first take here is that there is too much focus upon weight and size with respect to obesity, and very little on obesity as a chronic disease that affects physical, behavioral and social health. Five lines into the article are adverts for Weightwatchers, Noon and Perfect Body, and further down the article are adverts for weight loss supplements [all as Forbes Health featured partners]. This is mostly a listing of facts regarding obesity, such as medical costs for obesity in the U.S. tend to be 30% to 40% higher than those for people without obesity, and that childhood obesity has more than tripled in the US in the past three decades. The article closes to mention actions such as exercising regularly and managing stress, with a mention of prescription medication, and working with a health coach, but nothing on surgical intervention.
  • An article titled ‘…HOLLYWOOD’S ‘WONDER DRUG,’ OZEMPIC’ referred to ‘…The use of the injectable drug Ozempic has become so widespread among celebrities and influencers as a quick weight-loss option…’ citing Jameela Jamil and Remi Bader among influencers focused upon ‘…”trendy” options for weight loss – especially for influencers and celebrities.’ The article mentions that ‘The hashtag #ozempic on TikTok currently has 425 million views.’ and ‘Publications have referred to Ozempic as ‘Hollywood’s secret.’ Not sure if this is helpful or harmful, to a disciplined approach to GLP-1 mania.
  • An article in the New York Times focused upon ‘…an unwanted side effect: facial aging.’ and how after losing weight from GLP-1 agonists, ‘.. may turn back your biological age, but it tends to turn your facial clock forward.’ from Dr. Tepper, a plastic surgeon in New York. This is leading to a new opportunity to treat ‘Ozempic face’ from fillers at $5K a pop, through to a deep plane face lift at $75K. Gosh – as you can imagine, these are all out-of-pocket charges, and it seems that there is truly a furore upon us now, at multiple levels.
  • More Ozempic fever from the UK in the Daily Mail with ‘…craze from slimming jab…’ and ‘…genuinely incredible’ drug…’ though ‘…experts warn that it is not a magic bullet to keep weight off in the long term.’ Another article in the Daily Mail focuses upon ‘…nearly a dozen websites selling semaglutide, the active ingredient in Wegovy and Ozempic, for between $80 and $300 for up to two months’ worth.’ and one website with ‘…a tutorial teaching people how to mix the ingredients and inject them.’
  • The Atlantic weighs in [sorry!] on ‘How the new obesity pills could upend American society.’ through ‘…putting the U.S. in the early stages of a drug boom.’ The note that ‘the drugs’ first clientele is likely to be the richest Americans, not the poorest.’ with respect to higher rates of obesity and diabetes in low-income Americans. The startling math that if every obese American were on semaglutide at $15K a year, then we would spend approximately $2.1Tr per year, or about 10% of the entire U.S. economy is almost crazy; however, the direct spend from disease caused by obesity and overweight as per the Milken Institute report from 2018 was $480.7B, with an additional $1.24Tr in indirect costs related to lost economic productivity, i.e. the total cost of chronic diseases due to obesity in 2016 was $1.72 trillion, equivalent to 9.3 percent of the U.S. GDP that year. This certainly makes for an interesting and fruitful discussion on the forward implementation of GLP-1 medications – are we ready?!


  • Researchers from the UK, Europe, Australia, Canada, and USA published in Obesity journal this week, research [funded by Novo Nordisk] on semaglutide 2.4mg or placebo in 174 participants, known as the STEP5 trial. Mean body weight reduction was 14.8% [semaglutide] and 2.4% [placebo] for adults with overweight/obesity, over 104 weeks, or two years. The purpose of the study was to assess craving control, positive mood, craving for savory and craving for sweet though responses to the Control of Eating Questionnaire; almost all responses favored semaglutide versus placebo, and further that improvements in craving domains are associated with greater weight loss. This is a great study that serves to underpin the control of eating behind the weight loss mechanism of semaglutide.
  • Data from researchers in Utah was published in Obesity journal on almost 44,000 patients, half of which had bariatric surgery, with 40 [yes, forty] year follow-up! All-cause mortality was 16% lower in the surgery group, ranging from a reduction of deaths by 29% from cardiovascular disease, 43% from cancer and 72% from diabetes. However, the suicide rate was 2.4 times higher in surgery patients, primarily in those at ages of surgery between 18 and 34 years; this likely necessitates a greater focus upon psychological screening and post-surgery follow-up of behavioral status. I am excited about this report, not only because of the valuable outcomes of bariatric surgery, but also to promote further research in mechanisms to drive such outcomes. Even more interesting, though the numbers are small, is that the effect size for gastric sleeve was greater than that for gastric band or gastric bypass. The research study garnered media spots at healthlineUS News and HCP Live.

Kind regards, Raj


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