The fact that medical research into vaccines and treatments for cancer and neurodegenerative diseases generates billions in revenue is indisputable. What no one could have foreseen, however, is that the game would ultimately be won by… obesity. Ozempic, a drug for diabetes, unexpectedly generating billions of dollars in profits has shaken up the global pharmaceuticals market, foregrounding the treatment of obesity and fueling profit forecasts of up to $200 billion by 2031.
So what’s next? This is the arena in which almost all the world’s pharma giants are currently battling it out, as they embark on a frantic search for the next weight-loss drug sensation. It seems there’s going to be a lot more choice in this category of medication in the near future…
In Greece, like everywhere else in the world with the US leading the way, people have been flocking to pharmacies in the thousands since 2022 to secure their supply of a medication which promises significant weight loss without the need for austere diets or hours of pain in the gym. But are things as they seem? Are there any side-effects? To date, experts have linked the drugs in question to nothing more serious than nausea and diarrhea; if there are any more serious side-effects, they have still to come to light.
How does the new drug work?
As the scientists explain, the new drug’s secret is based on four core mechanisms: it increases glucose-dependent insulin secretion, inhibits the production of glucagon by pancreatic cells, helps empty the stomach rapidly, and suppresses appetite by promoting a feeling of fullness through its effect on the central nervous system.
Simply put, anyone who takes the drug feels full quickly, without this meaning that they are using a drug that does nothing more than trick the central nervous system. The fact that the side-effects are so manageable turned the new drug into an overnight sensation, causing significant market malfunctions worldwide that deprived people with diabetes of an essential medication.
Big Pharma’s shift toward the pharmaceutical treatment of obesity was rendered still more frenzied of late by the discovery of another drug—tirzepatide—which is now also available (in limited quantities) in Greek pharmacies. Studies have actually shown that users can achieve even greater weight loss with the new medication (26%, compared to an average loss of 15% with semaglutide), and it is the first drug that is officially indicated for both obesity and diabetes.
From Hippocrates to the WHO
What we should not lose sight of is that obesity is as much a disease as diabetes. It was actually Hippocrates who first pointed this out when he wrote that “obesity is not only a disease in itself, it is also the precursor of other ailments.”
In 1948, the World Health Organization recognized obesity as a chronic condition and included it in the International Classification of Diseases; since 2000, it has listed obesity as a complex disease, while also stating that it is a chronic serious condition that requires long-term strategies for its effective prevention and management.
However, while it has been acknowledged for over two decades now that obesity is a scourge and a public health risk, for budgetary reasons, national health systems continue to avoid policies which target it, limiting themselves to prevention.
Today, however, a new avenue of treatment has opened up in addition to surgery, which was the main—and highly effective—mode of treatment until now. And this is none other than the prescription of medications, the rapidly growing market in which is estimated to reach $150 (or even $200) billion worldwide by 2031.
Obesity reaches epidemic proportions
According to figures from the Health Ministry, obesity has reached epidemic proportions, as the prevalence of people worldwide who are overweight or obese has doubled since 1980, with one third of the world’s population now considered overweight or obese. In Europe, it has been estimated that 30%-70% of adults in EU countries are overweight and 10%-30% are obese, and it is predicted that these rates are likely to reach 89% and 50% respectively by 2030. According to recent epidemiological data on a representative sample of the adult population of Greece, 37.6% of Greeks are overweight (45% of men and 30.6% of women) and 32.1% are obese.
The treatment of obesity requires expertise and communication with the patient to forge a therapeutic alliance to reduce weight. Lifestyle changes are necessary, including limiting calorie intake, adopting a healthy diet, and increasing physical activity. When measures aimed at lifestyle and diet fail to reduce weight, medication or even surgery is indicated.
Treating the condition with medication
In Europe, medication for losing and keeping the weight off is recommended to support lifestyle and dietary interventions in people with a Body Mass Index (BMI) of over 30, or 27 if comorbidities are present.
The weight loss that can be achieved with these drugs is in excess of 10%-15%, which also helps with cardiometabolic regulation and prevents the complications that can occur with obesity. Of course, these drugs are not taken alone, and are always prescribed in combination with a specific diet and exercise regime.
However, according to Alexandros Kokkinos, Professor of Pathology at the Medical School of the University of Athens, the treatment of obesity is changing rapidly and will be unrecognizable just a decade from now.
“We will have a host of new pharmaceutical molecules, which could achieve weight-loss results approaching those currently achieved through surgery. At the same time, the results of large-scale cardiovascular disease studies will have been published and most likely proven that the new treatments are harmful to neither the heart nor the liver. I also believe that health systems will be reimbursing a higher percentage of the cost of medication of this sort a decade from now, which will have brought the prices down,” Professor Kokkinos notes.
He views the setting up of more obesity clinics within public hospitals to be a step in the right direction. By law, these clinics are linked with diabetes centers and clinics: “They are each staffed by a pathologist and a diabetes specialist who “orchestrate” the treatment together. We need a dietician, too, who is there to give the patient instructions on diet and exercise. Together, we can then decide whether to start the patient on medication immediately, if that is what they want—and if they can afford it,” he adds.
Surgery: the last resort
On the subject of surgery, experts say that metabolic-bariatric surgery is particularly effective at treating excess body weight in cases where diets and/or exercise have not worked. In this regard, Professor George Skroubis, Professor of Surgery at the University of Patras and head of the Metabolic-Bariatric Surgery Unit at the city’s General University Hospital, says that such procedures are successful not only in bringing about immediate weight loss, but also in keeping a patient’s weight at a healthy level after the operation.
Greece at present has only a few hundred weight-loss surgeries are performed each year. This is due to the low reimbursement rate set for such procedures, which make them too costly for most patients.
