European Doctors Advocate Novo Nordisk and Eli Lilly Weight-Loss Drugs as Primary Obesity Treatment Options

• Most effective drugs for obesity and its complications are semaglutide, tirzepatide, new European guideline says
• Certain GLP-1 drugs are best for specific complications
• The non-binding guideline emphasizes economic considerations in obesity treatment

Oct 2 (Reuters) – Novo Nordisk’s (NOVOb.CO)opens new tab and Eli Lilly’s (LLY.N)opens new tab blockbuster weight-loss drugs should be the first medicines doctors reach for to treat obesity and its complications, a major European medical association advised on Thursday.

Semaglutide, the active ingredient in Novo’s Wegovy and Ozempic, and tirzepatide, sold as Zepbound and Mounjaro by Lilly, are so effective that they should be the first choice in almost all cases when substantial weight loss is necessary, according to a new guideline from the European Association for the Study of Obesity published in Nature Medicine.

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When a lesser degree of weight loss is required, other medications can be considered, including liraglutide, an older, less effective drug from the same class, naltrexone–bupropion, and phentermine-topiramate, the guideline says.

Novo shares were up 2.2% at 1007 GMT, outperforming European pharmaceuticals peers.

The EASO guidelines are non-binding on individual countries.

Semaglutide, tirzepatide, and other drugs from the class known as GLP-1 agonists are completely transforming care of obesity and its complications, coauthor Dr. Andreea Ciudin of Vall d’Hebron University Hospital in Barcelona said in a statement.

Although no treatment algorithm can replace the nuanced clinical judgment necessary for comprehensive patient care, the new guidelines can serve to support therapeutic decision-making in obesity, she said.

SPECIFIC DRUGS FOR SPECIFIC CONDITIONS

The guideline authors analyzed previous clinical trial results, evaluating the impact of medications on weight loss, their safety profile, and their effectiveness in the presence of specific complications.

For patients with the physical consequences of too much fatty, or adipose, tissue, tirzepatide should be considered as the first-line treatment for addressing obstructive sleep apnea, and semaglutide for those with knee osteoarthritis, the authors determined.

For patients with conditions linked with obesity-related metabolic and immune dysfunction, they recommend semaglutide as a first choice for those with a history of heart disease or stroke, tirzepatide for individuals with non-alcoholic fatty liver disease, and either tirzepatide or semaglutide for those with prediabetes or type 2 diabetes.

The class of drugs was originally developed to treat type 2 diabetes.

While the drugs are expensive and economic considerations are complex, the cost of not treating obesity at early stages, “thus enabling the progression to complications and end-organ damage, should be weighed equally in health policy and clinical decision-making,” the guideline authors wrote.

The management of obesity should not be limited to weight loss and its complications but should focus on enhanced mental well-being, physical fitness, social functioning, and overall health and quality of life as well, they also said.

Most of the newer medications have not been evaluated for the treatment of individual complications, they acknowledge.

Still, the authors say, the weight-loss effects have been strongly associated with improvements in various complications and there is growing potential for them to positively influence a broader range of disorders such as chronic kidney disease, neurodegenerative diseases, polycystic ovary syndrome, certain cancers, and mental health conditions.

“Given the rapid advances in the field of medications to treat obesity, EASO intends to update the present treatment algorithm regularly to incorporate the latest available evidence,” society President Professor Volkan Yumuk of Istanbul University-Cerrahpaşa said in a statement.

The American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association, and The Obesity Society jointly advised in June that GLP-1 treatment must be accompanied by nutritional and lifestyle strategies.

“Although GLP‐1s alone can produce significant weight reduction and related health benefits, several challenges limit its long‐term success for individuals and populations,” including gastrointestinal side effects, risk of nutrient inadequacies, muscle and bone loss, high costs, frequent discontinuation, and weight regain,” the advisory said.

Reporting by Nancy Lapid; Editing by Caroline Humer, Bill Berkrot and Louise Heavens

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Nancy has been a health news reporter and editor at Reuters for more than a decade, covering important medical research advances. She is the author of our twice-a-week Reuters Health Rounds newsletter.

What are the key mechanisms through which Wegovy (semaglutide) and Mounjaro/Zepbound (tirzepatide) contribute to weight loss?

The Shifting Paradigm in Obesity Management

European medical professionals are increasingly endorsing medications like Novo Nordisk’s Wegovy (semaglutide) and Eli Lilly’s Mounjaro (tirzepatide) – and now Zepbound (tirzepatide) – not merely as adjuncts to lifestyle interventions, but as primary treatment options for obesity. This represents a significant shift in how obesity, a chronic disease, is approached. For years, the focus remained heavily on diet and exercise, often with limited long-term success. Now, a growing body of clinical evidence supports the efficacy of these GLP-1 receptor agonists and dual GIP/GLP-1 receptor agonists in achieving significant and sustained weight loss.

This change isn’t about dismissing the importance of healthy habits; it’s about recognizing that obesity is a complex physiological condition often requiring pharmacological intervention. The conversation around weight management is evolving.

Understanding the Medications: Wegovy, Mounjaro & Zepbound

These drugs mimic naturally occurring hormones in the body, influencing appetite and food intake. Here’s a breakdown:

* Wegovy (Semaglutide): A GLP-1 receptor agonist originally approved for type 2 diabetes, Wegovy is now specifically indicated for chronic weight management.It works by slowing gastric emptying, increasing feelings of fullness, and reducing appetite. Clinical trials have demonstrated an average weight loss of around 15% in patients using Wegovy alongside lifestyle changes.

* Mounjaro/Zepbound (tirzepatide): A dual GIP and GLP-1 receptor agonist,tirzepatide has shown even more impressive results in clinical trials. Zepbound, the higher-dose version specifically for obesity, has demonstrated average weight loss exceeding 20% in clinical studies. It impacts both appetite and glucose regulation.

* Mechanism of Action: Both classes of drugs work on the brain’s appetite centers, reducing cravings and promoting satiety. They also improve insulin sensitivity, which is particularly beneficial for individuals with obesity and related metabolic disorders.

Why the Change in Approach? Evidence & Clinical Data

The advocacy from European doctors isn’t based on hype; it’s rooted in robust clinical data. Several factors contribute to this shift:

1. High Obesity Rates: Europe, like much of the world, is facing an obesity epidemic. Customary methods haven’t adequately addressed the scale of the problem.
2. Chronic Disease Recognition: Obesity is now widely recognized as a chronic, relapsing disease, not simply a matter of willpower. This understanding necessitates a more thorough and frequently enough pharmacological approach.
3. Clinical Trial Results: Landmark trials, such as the SELECT trial with semaglutide demonstrating cardiovascular benefits in overweight/obese individuals without diabetes, have bolstered confidence in these medications.
4. comorbidity reduction: these drugs have been shown to improve or resolve obesity-related comorbidities like type 2 diabetes, hypertension, sleep apnea, and non-alcoholic fatty liver disease (NAFLD). This holistic benefit is a key driver of physician support.

Benefits Beyond Weight Loss: A holistic Impact

The advantages of utilizing these medications extend far beyond the numbers on the scale.

* Improved Cardiovascular Health: Reduced risk of heart attack, stroke, and other cardiovascular events.

* Diabetes Management: Enhanced glycemic control and potential for diabetes remission.

* Reduced Joint Pain: Weight loss alleviates stress on joints, improving mobility and reducing pain.

* Enhanced Quality of Life: Improved physical function, mental well-being, and overall quality of life.

* Metabolic Syndrome Resolution: Advancement in multiple metabolic risk factors associated with metabolic syndrome.

Practical Considerations for Patients & Physicians

While these medications offer significant promise, they aren’t without considerations:

* Side Effects: Common side effects include nausea, vomiting, diarrhea, and constipation. These are typically mild to moderate and often subside with continued use.

* Cost & Access: The cost of these medications can be substantial, and access may be limited depending on healthcare systems and insurance coverage.

* Lifestyle Integration: These drugs are most effective when combined with lifestyle modifications,including a healthy diet and regular physical activity. They are not a “magic bullet.”

* Long-Term Use: Obesity is a chronic condition, and long-term medication use may be necessary to maintain weight loss.

* Monitoring: Regular monitoring by a healthcare professional is crucial to assess efficacy, manage side effects, and ensure overall health.

real-World Examples & emerging Trends

Several European countries are actively integrating these medications into their national obesity treatment guidelines. For exmaple, the UK’s National Health Service (NHS) has begun offering Wegovy to eligible patients through a structured weight management program. Denmark has also seen widespread adoption.

Furthermore,research is ongoing to explore the potential of combination therapies and personalized treatment approaches based on individual patient characteristics.The future of obesity treatment is highly likely to involve a more tailored and multifaceted approach,with medications playing a central role.

Addressing Concerns & Misconceptions

There’s been some public debate surrounding the use of these drugs, with concerns about potential rebound weight gain after discontinuation. While this is a valid concern, studies suggest that maintaining lifestyle changes after stopping medication can mitigate this risk. It’s crucial to have open and honest conversations with patients about