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This week, I am highlighting an important commentary published in The Lancet, discussing the context and implications of the current global obesity medication shortage.

The medications currently available that we are talking about here are semaglutide (labeled as Ozempic for type 2 diabetes, and Wegovy for weight management), and tirzepatide (Mounjaro, currently approved only for type 2 diabetes).

The reason for the shortages is simple: With the advent of new medications that show impressive and previously unsurpassed weight loss efficacy, fueled by the power of social media, the demand has exploded at a pace that was unexpected, and no pharmaceutical company could have been expected to keep pace with.

In many countries, Ozempic is the only of these medications available, and is thus being prescribed both for type 2 diabetes, and for weight management in people who don’t have type 2 diabetes.  Some countries have restricted availability to people with type 2 diabetes.  As the authors note, this implies that obesity is somehow less important to treat than diabetes, trivializing the benefits of weight management medication, and propagating weight stigma and bias.

Others have objected to weight management medication outright, stating that we should be preventing obesity rather than treating it.  Authors draw a powerful analogy : Would we ever consider preventing cancer, but not treat it?   Of course not.  We need to do both. Full stop.

Some hold the belief that obesity medications should not be used or paid for, because people should just be able to ‘do it on their own’.  As blogged extensively previously, our natural human biology vigorously defends our weight, which is why very few people have success, and even fewer have sustained success, with lifestyle changes alone.

As weight management medications are expensive, and insurance/coverage is limited, many people pay out of pocket for these medications.  This widens an already broad health care disparity, and leaves people with lower socioeconomic status, including many people from minority ethnic groups, without access to these important treatments.  Lower socioeconomic status is associated with a higher prevalence of obesity and related complications, so this is clearly a group of people who could benefit from these treatments that are financially out of reach.

Authors shed some positivity on the cost issue for the future, pointing out that these medications eventially lose their patent protection (meaning that cheaper biosimilar (‘generic’) versions can be produced).  There are also new developments in the pipeline (eg oral non-peptide options, as blogged previously) that may (hopefully) hit the market at a lower cost.

As authors note, we must ask ourselves why we hold the treatment of obesity to a different standard than other chronic diseases. For what other disease do we regard treatments as ineffective becuase they do not fix the societal and environmental issues that contribute to disease prevalence?

Only when we begin to overcome the biases that the current drug shortages have highlighted will we be able to capitalize fully on these extraordinary scientific advances in clinical practice. 

Disclosures:  I am an investigator in clinical trials of semaglutide and tirzepatide.  I receive honoraria as a continuing medical education speaker and consultant from the makers of semaglutide (Novo Nordisk) and tirzepatide (Eli Lilly). 

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