Obesity Medicine: New Therapies Transform Treatment, Yet Challenges Remain

Obesity medicine is transforming rapidly, with the market potential reaching $150 billion by the early 2030s, providing more – and more effective – treatments for what’s now recognized as a disease that has long been misunderstood. 

Despite these advances, challenges to treating obesity persist. More than half of patients stop treatment within a year, reflecting ongoing care access issues, weight bias and stigma. As our understanding deepens, the field is shifting toward individualized approaches that address obesity as a complex, chronic condition, requiring ongoing management rather than short-term solutions. 

To further explore the breakthroughs and barriers in obesity medicine, we recently convened our 2^nd Annual BMO Obesity Summit in New York. I was honored to again share the stage with Dr. Katherine Saunders, M.D., Obesity Physician & Co-Founder, along with her husband, Sloan, of FlyteHealth. Co-hosting this important discussion was my colleague Malcolm Hoffman, Senior Equity Research Associate of BioPharma at BMO Capital Markets. 
 

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Access to life-changing, approved obesity medication continues to grow, expanding by approximately 50% each year. In addition, the number of physicians certified by the American Board of Obesity Medicine has increased to nearly 10,000 today from 4,000 in 2020.  

The introduction of GLP-1 agonists has, of course, been a key breakthrough for treatment, transforming the health of millions of people. Wegovy’s approval in 2021 marked the first time a single medication was available that was associated with more than 10% total body weight loss.  

“Previously, the medications we had were about 5% to 9%, so this was a huge breakthrough in our ability to help patients in ways we were never able to before,” said Dr. Saunders.  

Since then, available therapies have only improved. Trial data suggests patients taking Wegovy experience as much as 15% total body weight loss, while those taking Zepbound show even greater results of up to 22% weight loss, with many more therapies in the pipeline.  

“We’re now able to transform people’s lives and help them lose more weight than they ever expected and, more importantly, achieve health outcomes they never could have achieved before,” noted Dr. Saunders.  

But these new options are serious medications to treat serious medical conditions. She added that patients don’t always need the most aggressive therapy, and many can benefit, at least initially, from other treatment approaches. 

“In no other area of medicine do we jump right to the big guns right away,” she said.  

Just 30% to 40% of patients remain on GLP-1 medications for obesity after one year, said Dr. Saunders, which often results in re-gaining weight. This dropout rate stems partly from a misconception that these drugs are a temporary approach, when obesity requires ongoing management like other chronic diseases. 

Improving these numbers takes trust and education, she explained. Her own medical practice takes a comprehensive approach to treatment, screening patients for biomarkers, specific medications, sleep apnea and other conditions, for example, that may influence weight gain.  

Indiscriminate GLP-1 prescribing is not the answer – though it can be tough to convince people given the ubiquity of therapies like Ozempic in popular culture.  

“Don’t get me wrong, I’m a huge proponent of GLP-1s. They’ve transformed our field and are a really important tool for us,” she said. “But when a patient presents to us, it’s really important for us to spend a good amount of time with them to understand every single factor that is contributing to weight gain and every single barrier that is preventing weight loss.” 

It is worth noting that while Dr. Saunders’ practice successfully tackles the many causes of obesity, with a remarkable 80+% treatment compliance rate among patients, the industry faces other challenges. Her approach highlights the importance of comprehensive care for weight management patients to drive successful outcomes.  

Ongoing weight bias and stigma, for example, that wrongly puts the blame on patients for the disease can act as significant barriers to access to effective obesity treatment. There also remains significant need for improved insurance coverage, access to care and patient advocacy, all of which are works in progress.   

“It’s so frustrating as a provider to want a certain medication for a patient and just not be able to get it,” said Dr. Saunders. She believes that the future focus should not only include the development of therapies but also include a thorough examination of how the system manages obesity as a chronic disease. “Fighting for education and advocacy is really important.”