How can the pharmaceutical industry contribute to treating obesity as a disease?

Through continually deeper understanding of what happens in an obese patient, society is finally preparing to face this epidemic – and pharma supports this movement. Anti-obesity drugs are the up-and-coming blockbuster drugs, promising to generate a big market with future compounds. As a new player in the field, there are many aspects to consider, from understanding the competition, to benchmarking the current state of the art, as well as supportive aspects for obese patients, looking at Patient Support programs (PSPs) and reimbursement. In this article, Alcimed has a look at current developments!

What is obesity and is it a disease?

While the global Covid19 pandemic has been widely discussed since 2020, it is interesting to notice that the silent but no less dangerous pandemic of overweight and obesity has been present in Western society for decades with no end in sight. Overweight is primarily defined by an individual’s body mass index (BMI). The BMI corresponds to a person’s weight in kilograms (or pounds) divided by the square of height in meters (or feet)^[1]. A BMI of above 25 is considered overweight, a BMI of over 30 is considered obese.

Obesity is defined as a disease by the international statistical classification of diseases and related health problems (ICD) code E65-E68 that includes “obesity and other hyperalimentation”. Obesity has been recognized as a disease since 1948 by the World Health Organization (WHO) and prognoses indicate that by 2030, the majority of adults will be overweight or obese, world-wide.

Why should we care about obesity?

Detrimental consequences of being obese and overweight have long been established, ranging from cardiovascular diseases to vast metabolic complications such as type 2 diabetes mellitus (T2DM) or even the metabolic syndrome (MS). Obesity can also decrease one’s quality of life (QoL), with longer duration of the obese condition leading to deeper rooted health complications up to death. Increases of healthcare expenditures due to obesity and its comorbidities could further threaten public insurance plans.

Why can’t we get rid of obesity?

First and foremost, today’s environment is very obesogenic, meaning that it promotes obesity through physical, economic, politic, social, and/or cultural factors. The sedentary lifestyle, lack of exercise, and convenience food being very calorically dense are factors that are thought to mainly drive societal obesity. In addition, genetic predispositions are lively discussed and researched, meaning that some individuals may have a higher likelihood of becoming obese and pass on this likelihood to generations to come.

Aside from habits, there is strong evidence showing that the body fights against a change of body weight. In the obese patient specifically, it is thought that signals from the adipose tissue telling the brain that they have had enough food are no longer working well, the individual may have become resistant to these signals. In addition, hormones from the intestines signaling fullness may not be sufficient to break the habit of the individual. A greater signal may be helpful to reactivate the induction of satiety.

The pharmaceutical industry’s contribution to obesity management and the challenges ahead

Develop innovative drugs and compounds for the treatment of obesity

Luckily, pharma companies have been researching on these pathways. Originally developed for diabetes, a comorbidity of obesity, the active compound glucagon-like peptide 1 (GLP-1) has shown great benefits for individuals trying to reduce their food intake. GLP-1 is a hormone produced by the gastrointestinal tract upon food intake to signal to the brain that nutrients are consumed and the stomach is expanding. GLP-1 based drugs are currently the most promising drugs on the market. This race is led by Novo Nordisk and closely followed by Eli Lilly. Further pharmaceutical companies have realized the possibility to treat obesity through GLP-1 analogues and additional active compounds are jumping on the wagon to engage in this lucrative market. In 2023, 2 299 clinical studies on clinicaltrials.org are ongoing. Various additional compounds are in development to induce an additive effect to GLP-1, such as glucose-dependent insulinotropic polypeptide (GIP). Its main function is to slow gastric emptying and induce insulin secretion, amongst others. A drug combining the two compounds is currently being investigated for treating obesity by Eli Lilly.

Build patient assistance programs in tandem with treatment

In addition to the R&D knowledge, it is important to consider aspects surrounding the drug. In chronic diseases such as obesity, patient support programs (PSPs) may make or break the success of a drug. Understanding the importance of PSPs and the way to set it upright in connection with the drug can be the difference between a success and a costly measure not providing any benefit. Establishing supportive measures to a drug is a completely different business model and relatively new in the industry. It has been shown to be immensely important for the patients and its importance is even more supported by the switch of the healthcare system to a patient-centric approach. Getting to know this area is crucial to support patients, support drugs, and support profit in the long-term for pharma companies. But PSPs are more than an add-on to a drug. It can provide holistic support to patients and induce changes in lifestyle through targeted nutrition programs, personalized mental coaching and physical activity.

Meet the challenges of obesity drug reimbursement

Furthermore, anti-obesity drugs are facing a challenge regarding their reimbursement. Currently, the reimbursement strategy is undergoing vast changes and differs greatly between countries. A large challenge for reimbursement of anti-obesity drugs is the large and increasing number of patients which could be a threat for the balance of the public insurance system. Also, evidence that the amount of weight loss achieved through drug is beneficial for the healthcare system in the long-term needs to be generated and provided.

Obesity, as a chronic disease and an epidemic, is finally getting the attention needed to reduce its social burden. The pharma industry entering the space is a compelling component but there is still a lot to unpack. There’s great hope for the obesity market to launch a blockbuster drug and greatly help patients, with a huge pipeline of new drugs potentially coming our way sooner than later. To engage in this thriving market, players must be prepared: understanding current R&D advancements, developing compound combination strategies, sufficiently supporting drug through PSPs and reimbursement strategies, will be crucial for success.

Alcimed is closely following the rapid developments in this field and is ready to support you on these topics! Don’t hesitate to contact our team.

[1] Centers for Disease Control and Prevention, USA

About the authors,

Diane, Project Manager in the Alcimed’s Life Sciences team in Germany
Saida, Consultant in the Alcimed’s Life Sciences team in Germany