Obesity is a chronic disease whose prevalence - especially in the Western world - is increasing to epidemic proportions.
Many studies have found that obesity increases the risk of many diseases such as fatty liver, type 2 diabetes, sleep apnea, cardiovascular diseases and even cancer.
The accepted therapeutic paradigm for the treatment of obesity is a behavioral change in lifestyles mainly related to nutrition.
It is a simple equation - to lose weight, the energy intake should be lower than the energy expenditure.
However, anyone who has been on a diet during their lifetime knows the challenge of starting weight loss and maintaining the results over time.
Losing the extra pounds causes an increased appetite and a slower resting metabolic rate.
For many years, the treatment of obese people was through bariatric surgery (surgery to shorten the stomach) designed to limit the volume of the stomach, allow weight loss and maintain the gains over time.
However, many avoided this method of treatment due to the fact that it is an invasive surgical procedure that may cause irreversible complications, as well as due to the development of advanced medical treatments for the treatment of obesity - which are considered effective in reducing weight at rates similar to surgery.
From treating diabetes - to treating obesity
One of the drugs that has become popular in the world is Ozampic, which was originally developed for the treatment of diabetes, and in 2021 received approval from the world's health authorities to also treat obesity at a dose of 2.4 mg per week (under the name "Vigovi"). The drug, which is manufactured by the Danish pharmaceutical giant "Novonordisk" ", was able to prove a 17% reduction in body weight through a mechanism that works to induce early satiety and slow emptying of the stomach. These days a study is being conducted in an advanced phase (phase three) that tests the effect of the drug on weight loss at a dose of 7.2 mg per week, and the results are expected to be published Towards the end of the year.
Another promising drug is called "Mungero".
Last November, the American authorities approved the treatment developed by the American pharmaceutical company "Eli Lilly" for the treatment of obesity, under the name "Zepbound" (in Israel it was decided to keep the name Mongero for all labels), after it demonstrated a weight loss of up to 26%.
The drug, which originally helps treat diabetes, acts on the receptors for the satiety hormones secreted in the intestine, GIP (the hormone that prevents the secretion of gastric juices) and GLP1 (a hormone that causes satiety to soak and the stomach to empty more slowly).
In recent days, the American Food and Drug Administration (FAD) estimated that in light of the great demand in the world, a shortage is expected and it will be difficult to obtain the treatment in the coming months in the pharmacies.
Not only shots - also balls
The potential inherent in drug treatments for the disease of obesity, as well as the desire to expand the target audience by facilitating the method of use, led the pharmaceutical giants to try to develop drugs also in pills and not just by subcutaneous injection.
One of the drugs under development is called "Orforglipron" which is also developed by the American company "Eli Lilly".
The mechanism of action of the treatment, which is still in the stage of clinical trials, is slightly different from the two existing drugs.
The drug contains a substance that is not a peptide (chains of amino acids) in order to mimic the activity of the GLP1 hormone, bind to the receptors that secrete insulin and finally make the patient not feel hungry all the time.
According to preliminary studies published about six months ago, after 36 weeks of treatment, the drug resulted in an average loss of about 15% of body weight.
On the one hand, this is a lower rate than "Mongero" and on the other hand, treatment with tablets may remove the barrier of some patients who are afraid of needles and injections.
The American pharmaceutical giant "Pfizer" also decided to roll up its sleeves and enter the field.
The company, which is known to the general public mainly thanks to the development of the corona vaccines, announced last May the first research findings of the drug "Danuglipron" administered through pills.
The treatment was supposed to be given twice a day and lead to significant weight loss.
However, the company announced that they are waiving the dosage and will settle for a one-day tablet - after many patients in the study withdrew as a result of side effects of nausea and vomiting.
The American company "Amgen" is trying a slightly different strategy.
The treatment she is developing is at an advanced stage and is based on the GLP-1 hormone while blocking the GIP hormone.
According to the company, the goal is to bring to the development of a drug that will lead to faster weight loss through a lower and more frequent dose, while successfully maintaining the weight over time.
According to the first findings of a relatively small study - treatment with the highest dose of the drug MariTide led to a 14.5% weight loss over 12 weeks.
Some analysts predict success for the treatment, which they estimate could reach a target of $150 billion in annual sales.
The price is expected to decrease.
There are more studies on new molecules that are under development, and many companies that see the huge potential are trying to join the race to develop drugs to treat obesity.
In addition, in the coming years, the patent of many molecules developed to treat obesity will expire, and it will be possible to produce biosimilar drugs (drugs that imitate the original drugs at a lower cost).
The combination of the two processes - development of new formulations and loss of rights to pharmaceutical patents - may have a positive effect on drug prices.
However, it is important to remember - despite the expected impressive pipeline of drugs, success in the treatment does not rely only on the drug treatment.
The treatments - as effective as they may be - are a tool to start the process.
In many cases, personal medical treatment and follow-up is necessary in order to minimize or prevent side effects, dose changes, drug combinations, drug replacement, and more.
In order to succeed in the process and maximize it, there is a need for peripheral care with the personal accompaniment of a support system that combines a professional team - medical, nutritional and emotional - to change lifestyles and preserve the results over time.
Those who do not make the change may gain their weight back and it does not matter if the treatment is surgery, pills or injections.
The author is a doctor specializing in obesity, a member of the Obesity Medicine Association and the director of the Medical Center for the Treatment of Obesity
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Ozmpic