Ida Marie Odgaar/Ritzau Scanpix/Sipa USA via AP Images
The market for weight loss medications is expected to swell to $100 billion by 2030.
The NBA and the NFL are often called “copycat leagues.” As soon as a team installs a successful new style or an unbeatable play, every other coach scrambles to imitate it. The Golden State Warriors showed you could ride three-point shooting to a championship, and now every team spaces the floor. In football, we’ve seen this with the “West Coast” offense, the rise of dual-threat quarterbacks who can run and pass, and plenty of other wrinkles. Original thoughts are immediately socialized.
It makes sense to emulate winners in sports, where tactics are transparent and there is a single victory condition. In other spheres, focusing only on what worked in the past can lead to neglect. That’s especially true in pharmaceuticals, another copycat league where all the prodigious marketing muscle and research energy often goes toward making a slightly better version of an existing product. Lifesaving cures for specific illnesses are as disfavored as prestige adult dramas at the movie theater: Both are no match for a mass-market blockbuster.
That’s what we’re seeing with what I’d call the Ozempic gold rush, where virtually every major pharmaceutical company is scrambling to put out a weight loss drug in pill form. Fighting obesity is definitely important, and a reliable weight loss formula could not only reduce spending on bariatric surgery and the dieting industry, but help with a whole host of ailments associated with being overweight. It’s a whole lot better than the copycatting of Viagra a while back.
But that doesn’t mean patients benefit from every drug manufacturer piling onto the weight loss bandwagon. Health isn’t like hockey—there are a multiplicity of diseases and problems out there. The profit motive, naturally, is driving this response, and it will be why, in a few years’ time, you might have 50 weight loss pills to choose from while shortages still prevent cancer patients from receiving their treatments.
It’s worth pointing out that Ozempic, a once-a-week injectable, isn’t approved by the FDA as a weight loss medication. The drug, with an active ingredient known as semaglutide, targets hunger-regulating hormones in the body, and was brought to market by Novo Nordisk for Type 2 diabetes in 2017. But it has become a social media and Hollywood phenomenon, with users claiming that it not only helps them shed pounds by slowing the digestive system and suppressing appetite, but that it may curb addictive behaviors. Doctors have since begun to prescribe it off-label for weight management.
Wegovy, another Novo Nordisk injectable that’s just a larger dosage of Ozempic, was approved in 2021 for patients with significant obesity or with weight-related conditions, like high blood pressure or high cholesterol.
The obvious next step would be to produce a pill form of such a drug. Now, diet pills have a long and sometimes tattered history, including overdoses and medications that were pulled from the market. But these seem more promising than, say, fen-phen; many people are too needle-shy to stick themselves once a week; and pills are cheaper to produce than injections. Drug companies would view a pill-based version of an effective appetite suppressant as a killer app. The fact that these types of drugs must be taken continuously to be effective also puts dollar signs in the eyes of drug company executives.
As numerous major pharma companies chase the golden diet pill, a record number of vital drugs are in shortage, including such common ones as antibiotics and children’s Tylenol.
In this case, Novo Nordisk already has a pill version of semaglutide; it’s called Rybelsus, and it was approved for diabetes patients in 2019. New research released this past weekend shows that the majority of users without diabetes in a clinical study lost an average of 15 percent of their body weight when given a higher dosage of Rybelsus, a similar level to Wegovy. Novo Nordisk is likely to seek approval for Rybelsus as a weight loss drug.
The fact that side effects to semaglutides include nausea, diarrhea, and vomiting—which generally doesn’t accompany healthy eating and exercise—suggests there are potential downsides to a wonder drug–based approach to obesity. (The side effects are reportedly higher with the pill version, and yes, the thought has crossed my mind that anything that makes you repeatedly vomit will probably lead to losing weight.) But bad habits being what they are, if a drug can really reverse chronic weight gain, that’s positive.
This would seem to be the end of the story. One drug company figured out an effective weight loss medication, got approvals for it, and stands to make a fortune. With 70 percent of Americans either overweight or obese, and with serious disease complications arising from that, this enrichment has the side benefit of being rather good for the world, and even possibly for health expenditures. It’s certainly cheaper to prescribe a pill than staple a stomach.
Of course, that’s not the end of the story. Eli Lilly has a slightly different injectable called Mounjaro that was approved last May, again for Type 2 diabetes; it’s likely to get approved for weight management this year. A second Lilly injectable, retatrutide, showed a 24 percent reduction in body weight after 48 weeks in a Phase 2 clinical trial. Lilly also has a pill under development called orforglipron.
These six drugs are all pretty similar; they differ mainly in what hunger-regulating hormones they target. But that hasn’t stopped other pharmaceutical companies from producing more. Amgen is working on a hormone-targeting drug. Boehringer Ingelheim and Zealand Pharma are teaming up on something similar. Versanis Bio is working on one. Pfizer has two pills in development; it recently discontinued one when patients started developing higher liver enzymes, but the other has performed decently in trials.
It seems like a lot of companies chasing each other to reinvent the same weight loss therapy. But the market for these medications is expected to swell to $100 billion by 2030. Any pharmaceutical firm would want a slice of that market.
A reasonable person can suggest that obesity isn’t the only thing being targeted here. After all, the Ozempic craze went viral due to Hollywood types and influencers wanting to tighten their bodies and their faces. The popularity has led to shortages and limits on distribution. In a shortcut nation, these drugs are at least sometimes being used to look better for a date or a role rather than as serious disease management. The way the (rather dubious) body mass index is used as a health indicator makes close to three-quarters of Americans eligible for this treatment; the sheer size of that market explains the gold rush.
Meanwhile, as numerous major pharma companies chase the golden diet pill, a record number of vital drugs are in shortage, including such common ones as antibiotics and children’s Tylenol. Cheap, generic cancer drugs are so hard to find that patients are being denied treatment due to lack of supply. The opportunity cost of piling into a copycat drug when there are untreated diseases out there is one thing; failing to supply enough existing drugs to fight diseases right now is shocking.
The supply chain problems, particularly for generic drugs, are fairly well known: a concentrated set of ingredients coming mostly out of India and China, a system of bulk purchasing for hospitals that leads generic manufacturers to see no money in manufacturing certain products. But when people are getting sick or even dying because there isn’t enough product available, and drug companies are spending a lot of effort on getting a beach-body pill done, the realities of our for-profit drug system become very real.
It’s hard to know quite how to deal with this without fundamentally overhauling the way the drug industry works. You’re not going to get for-profit businesses to ignore the lure of profits available with blockbuster drugs. So maybe the answer lies in moving generic drugs that the government can manufacture and produce itself out of the private sector. Corporations don’t seem to want the hassle anyway. And there’s plenty of reason why the public sector should be at the forefront of promoting the general welfare.
