Top Takeaways from WSJ Health Forum: The Business of Weight-Loss Drugs

The Wall Street Journal’s annual Health Forum, recently hosted in Boston, brought together an influential community of business leaders, investors, policymakers and experts to dive into the trends, technologies and innovations reshaping the business and science of health.

The skyrocketing popularity of weight loss drugs like Ozempic and Wegovy continue to dominate headlines and show no signs of slowing down anytime soon. We tuned in to a session on the business of these weight-loss drugs for a deeper understanding of the science behind how they work, existing barriers to patients such as cost and coverage, and what the weight loss drug pipeline looks like in the future and what it could mean for the future of obesity care.

Read on for top takeaways from an informative Q&A session with Dr. Florencia Halperin, Form Health chief medical officer, who discusses the sustainability of these drugs, their efficacy against obesity and how telehealth companies can regulate their distribution.

Ozempic and Mounjaro retrain how your body processes food using the hormone GLP-1:

‍Obesity is a disease. Our bodies regulate our weight in a very tight fashion. We have mechanisms to drive energy storage from eating food, and we have mechanisms to stop ourselves from doing that. GLP-1 is a hormone that our bodies make in the intestine. In the pancreas it helps us secrete insulin, in the brain it gives a signal to slow down eating. GLP-1 receptor agonists are medications that mimic this hormone that we make. Originally, they were developed to treat diabetes because of their effect on insulin and then it was also applied to obesity because of the ability to tell the brain to slow down eating and suppress appetite.

Every individual has a weight setpoint. A combination of genetics, hormonal, biological and environmental factors determines where our weight wants to be and where our physiology is regulating our weight to level out. These drugs lower that setpoint, telling our bodies we don't need to eat more. They're also saying we're ok at this lower weight, we don't need to invoke all of the mechanisms to go back to the higher weight. They help people lose weight and keep the setpoint lower.

Stopping the medications stops the progress:  

‍In the scientific community the data is very clear: the medications work while you take them. We are programmed to store energy, to survive. The reason we have this weight setpoint is to survive, it drives the behaviors that we need to keep our stores in stock.

When you lose a lot of weight, in away it's a physiologic crisis where our bodies are like wait a second, we don't have enough here, and it invokes all mechanisms to gain weight back, such as driving hunger hormones. Trials have shown that when patients stop the medications, they re-gain the weight.

Telehealth can act as a necessary barrier to prevent the misuse of these medications:

‍Telehealth is a care delivery mode, what's important is that we still think of this as medical care for a metabolic disease which is obesity. It’s important to review medical history, get records from the patient’s primary provider and make sure it doesn’t interact with other medications. Obesity is a risk factor for hundreds of other medical issues. It’s important to think of the whole health of the individual, such as whether they have diabetes, sleep apnea, etc.

Access issues, coverage issues and shortages are significant barriers to patients:

‍Medicare usually drives what insurance companies will do. For decades, Medicare has not covered medications for anorexia, weight loss or weight gain. Where we need to shift is seeing this as a treatment for obesity, a metabolic disease. We need to focus on is data such as semaglutide lowering cardiovascular disease and cardiovascular events and death by about 20%. We need to shift to the fact that we are treating the disease and treating the downstream complications as opposed to the number on the scale. There is a bill, The Treat and Reduce Obesity Act, that is being proposed as a way to broaden access to obesity treatment.

GLP-1’s will continue to evolve. In the next 3-5 years, we’ll see longevity and treatments that last longer:

‍Exciting broad categories are ahead.GLP-1 is not the only access that drives weight regulation so we're seeing development of drugs in different classes, and we're learning that combinations of therapy often drives better results than single agents.

We're going to be able to focus on not just weight loss, but quality of weight loss. Some of the drugs in the pipeline are medications that will help boost muscle mass. Also of note, the GLP-1 receptor agonist are biologic medications, and they are very expensive to produce. We're now seeing small molecule production and data starting to come out on this kind of class, which could mean the cost could come down a lot.

And we’ll see longevity and treatments that last longer. Shifting from a twice a day injection to a once-a-week injection. There are studies about driving gene therapy, maybe leveraging our bodies own production of GLP-1s, stimulating with gene therapy to drive GLP-1 in the body instead of taking it externally. There's a tremendous pipeline of research development drugs, which is very exciting for patients who have obesity and need treatment options.

While there were many great takeaways from this session, one main thing is clear - these medications aren't going anywhere. And those who are focused on chronic care management or lifestyle support for patients are going to have to figure out a way to work with them given the elevated demands of consumers.