Early next year, marketing is set to resume for Novo Nordisk weight-loss drug Wegovy. Ads featuring Queen Latifah were one facet of the drug’s launch efforts that had to be put on hold after the Danish pharma company became a victim of its own popularity.
Wegovy is part of a new class of medicines called GLP-1s. While originally developed for diabetes, they have proven extremely effective for weight loss. The drug, a once-weekly self-injection pen, was approved by the Food and Drug Administration in 2021 for treating obesity after a clinical trial showed it helped patients lose an average of 15% of their body weight. That eclipsed findings for older obesity drugs like Novo’s own Saxenda.
Rising global obesity rates would suggest pent-up demand for efficacious weight-loss medications, but Novo admitted to stumbling in anticipating this. The drugmaker then ran into manufacturing problems for Wegovy and couldn’t keep up with demand.
What may also have caught the company flat-footed was the possibility that Wegovy would become a viral sensation on social media. Yet that’s exactly what happened, as Elon Musk tweeted about its weight-shedding potential in October.
Wegovy’s cousin, the less expensively priced diabetes injection Ozempic, has Tinseltown abuzz. Doctors say Hollywood elites are using the drug (which contains the same active molecule, semaglutide, but in a slightly different dosage) to stay thin. And Ozempic-based slimming strategies have become an unintended weight-loss trend on TikTok.
All of this landed the two Novo brands on the FDA’s list of drugs in short supply. Novo has prioritized patients who had already initiated treatment (resulting in Wegovy sales of about $700 million, far below the $2 billion that some analysts had projected for 2021/2022 sales), but many have been ordering custom-made versions from compounding pharmacies to skirt restrictions.
Meanwhile, the company said it has gradually ironed out the supply chain issues that have hampered production and is aiming to restock the U.S. market this month. That should enable prescribing to kick back in and commercial activities to resume.
The relaunch is but one factor set to drive what analysts predict will be a big expansion of the U.S. obesity market in coming years. Worldwide revenues from obesity drugs are set to grow to $54 billion by 2030, according to a report by analysts from Morgan Stanley. That’s up from $2.4 billion this year.
The report, “Unlocking the Obesity Challenge: a >$50bn market,” predicts that Novo and Eli Lilly, whose similar GLP-1 drug tirzepatide was approved this year for diabetes and in October snagged fast-track designation for its weight loss version of the drug, will capture a 40% share of this eventual top-12 therapeutic category. They attribute this to the companies’ deep drug pipelines as well as the promise of higher-quality weight-loss products.
Like semaglutide, tirzepatide mirrors the impact of GLP-1s, which are gut hormones that work to increase satiety, while promoting an additional hormone known as GIP. Tirzepatide helped obese people lose as much as 22.5% of their body weight in a Lilly study, a result on par with the effectiveness of bariatric surgery.
Tirzepatide, which Lilly expects will be approved for weight loss next year, could face similar supply constraints as Wegovy, analysts from SVB Securities cautioned in an investor note. The bank is forecasting about $26 billion in annual sales for tirzepatide by 2030, one-third for diabetes and two-thirds for obesity.
Several other biotech companies — from Amgen and Altimmune to Zealand Pharma, Hanmi, Regor Therapeutics, Sciwind Biosciences and vTv Therapeutics — have assets in earlier stages of development.
Morgan Stanley compares the dynamic in the obesity sector to that of the hypertension arena in the 1980s, when the arrival of effective therapies swayed doctors that high blood pressure was a treatable condition. Indeed, the influx of this new wave of “diabesity” medicines is helping physicians, who traditionally have not approached obesity as a chronic ailment, see it as a disease to be treated, rather than a lifestyle condition controllable through diet and exercise.
Science is doing its part to help to erase that stigma. Researchers, for instance, have shown that, even after weight loss is achieved through dieting, hormonal changes brought on by obesity prompt the body to revert to the original weight.
Yet the category has a long way to go to realize its megablockbister potential. The Government Accountability Office estimates that just 3% of an estimated 72 million obese adults were prescribed anti-obesity medications. According to another study, it’s only about 2% of Americans.
Marketers promoting these new weight-loss drugs will have their work cut out for them. While scientists seem to have knocked out the “let’s blame the individual” variable from the great debate over what causes weight gain, it’s still the predominant rationale in our society.
This manifests in reductionist advice, such as telling people to eat healthier and exercise more — which, of course, is akin to addressing energy dependence solely by asking the public to inflate their car tires to the proper air pressure. And that doesn’t mention the raft of diet books, apps and self-styled experts who rake in billions off food and exercise fads.
“Management of diabetes has already undergone a major conceptual change, but more work is needed to promote a weight-centric focus,” analyst Mark Purcell and the Morgan Stanley team concluded in their report.
Indeed, as scientists gain a better understanding of the disease’s underlying biology, marketers need to continue to work to change the patient narrative around obesity. One way could be to double down on the aforementioned, Queen Latifah-fronted “It’s Bigger Than Me” campaign, which is designed to tackle the stigma surrounding obesity treatments.
The initiative consisted of four PSAs in which Latifah, inspired by characters she has played during her acting career, encouraged people to treat obesity as a health condition rather than the result of laziness.
The above misperceptions inspired another Novo marketing effort: a video that portrayed obesity as a “battle with biology.” “You’re Not Alone” won Gold at the MM+M Awards.
When Novo restarts marketing in early 2023, it has a chance to build on what has already become a more empathetic tone in the media. News stories increasingly portray obesity as a treatable disease.
But the drugmaker will need to counter a parallel explosion of social-media misinformation involving diabesity therapies. Take the TikTok videos documenting weight loss via Ozempic use, which have garnered hundreds of millions of views. Ozempic’s popularity among relatively healthy people isn’t supported by scientific evidence – and it’s not approved by the FDA for weight loss. Those ubiquitous Ozempic commercials – you know, the “Oh! Oh! Oh! Ozeeeeempic!” spots – don’t mention weight loss until the very end, as the drug’s side effects are being read.
Wegovy itself is only recommended for people who are obese or overweight with a coexisting condition related to weight, such as high blood pressure, Type 2 diabetes or high cholesterol. It’s not designed for those who want to occasionally slim down.
Thus Wegovy may benefit from DTC advertising to help differentiate the drug, cut down on confusion in the market and prevent future shortages of Ozempic caused by off-label use for weight loss. Some physicians report that Mounjaro, the brand name of Lilly’s GLP-1 drug approved by the FDA in May for treatment of diabetes, is similarly being written for weight loss.
The newest weight-saving drugs shouldn’t be touted as end-all solutions for obesity. Ozempic, for one, might make a person lose weight, but that person would likely have to remain on the drug indefinitely in order to keep the weight off. One clinical trial run by Novo showed that semaglutide-takers who switched to placebo gained back most of the weight they had lost after 20 weeks.
Moreover, unless these individuals have celebrity money, they run the risk of going broke in the process. A month’s worth of Ozempic injection pens can be had for $900 apiece; Mounjaro costs $974 for four weekly doses. Wegovy is priced at $1,350 for a month’s supply, which includes four pens. A once-a-day semaglutide pill called Rybelsus, also sold by Novo, lists for $850 for a 30-day supply. Insurance coverage for any of the drugs is reportedly hard to line up.
Which brings us to our next point: Promotion will need to win over skeptical physicians and payers, for whom weight loss remains something of a vanity project.
After all, It wasn’t until 2013 that the American Medical Association classified obesity as a chronic disease. Another contributor to clinicians’ skittishness has been the lack of safe and effective treatments.
Abbott pulled diet drug Meridia off the market in 2010 due to its safety. A decade later, it was Belviq’s turn, as the FDA ordered Arena and Eisai to recall it due to cancer risk. Perhaps most notable of all was the 1997 withdrawal of a pair of diet drugs that made up the combination fen-phen, which was linked to heart-valve damage and rare but potentially fatal lung disease.
These issues haven’t done much to facilitate payer uptake, either. Sluggish market access was one reason previous obesity pills, including brands like Vivus’s Qsymia and Orexigen’s Contrave, never became blockbusters. It didn’t help that the treatments didn’t confer all that much weight loss — only about 5% of body weight — and had other unpleasant side effects.
By contrast, it took five weeks for Wegovy to reach the same weekly Rx volume that it took Saxenda four years to reach. And prescriptions may take off again, especially if obesity is written into treatment guidelines emphasizing substantial weight reduction as a way to head off the progression of diabetes – and if more internists jump on the treatment bandwagon.
Despite the AMA’s formal declaration a decade ago, cultural norms change slowly. Novo has said it could take two to three years to shift attitudes among PCPs. Endocrinologists and weight-management specialists tend to have a better understanding of the obese patient’s hormonal dilemma.
Even if Novo does win over doctors, though, ensuring access in obesity will be the greater challenge, as many insurance plans still do not cover anti-obesity medications. Nor does Medicare, the publicly funded health insurance for seniors. Without coverage, the costs for treatment make it unreachable for all but the well-heeled.
The company is hoping a landmark trial designed to prove Wegovy’s cardiovascular benefits will sway some skeptics. That, in turn, could support passage of a bill moving through Congress proposing to expand Medicare coverage to include obesity screening and treatment.
Last but not least, companies will need to reassure patients that some of Wegovy’s odd side effects are worth it. To wit: Online forums as well as unpaid celebrity endorsements of the drug, including one by noted venture capitalist Marc Andreessen, are replete with testimonials on how the drug has changed people’s relationship with food.
On the other hand, desperate times may call for desperate measures. Statistics from the National Institutes of Health show that more than 40% of Americans qualify as obese, which raises their risk of heart disease, stroke and Type 2 diabetes.
While the new wave of diabesity treatments may not be a panacea for this crisis — and the notion that excess weight is somehow a moral failure persists in some quarters — these medicines seem to have a promising future.