shutterstock 1981403039 450x300 bdjkqz

Obesity: Weight loss drugs no quick fix for tackling public health crisis

​ ​ 

Weight loss drugs such as Ozempic and Wegovy are rising in popularity – however, experts have warned that the drugs are not a silver bullet solution to the problem of obesity in Europe, a complex and multifactorial public health issue.

Demand for weight loss drugs is skyrocketing. Danish pharmaceutical company Novo Nordisk, the manufacturer of Wegovy and Ozempic, is seeing unprecedented profits – to the point that the company’s revenues are responsible for a big part of Denmark’s economic growth.

“[The demand for weight loss medicine] is an indication that obesity is a significant problem in all welfare societies and that people perceive it as a problem,” Kjeld M?ller Pedersen, professor of health economics at the University of Southern Denmark, told EURACTIV.

Obesity is a “complex multifactorial disease”, according to last year’s WHO report on obesity in Europe. The disease which leads to an increased risk for many non-communicable diseases (NCDs) such as cardiovascular diseases, 13 types of cancer, and type 2 diabetes.

Overweight or obesity leads to more than 1.2 million deaths across the WHO European Region every year, is the fourth highest cause of death after high blood pressure, dietary risks and tobacco use, and is one of the leading factors for disability. It also leads to significant extra burdens on health systems.

A body mass index (BMI) over 30, a rough equation for determining weight to height ratio, defines when a person is obese. Assessing someone’s BMI has been widely criticised as an accurate measure of an individual’s health as it – among other things – fails to differentiate between fat and muscle. However, the metric is still widely used, including by the WHO as they argue there is still “strong evidence” that increasing BMI is linked to ill health.

The Spanish EU Council Presidency also has obesity, specifically amongst children, on its list of priorities this autumn. In Spain, 62% of the population is overweight, of which 24% is obese, according to the WHO.

“It is clear that childhood overweight and obesity continue to be a major public health challenge in Europe. Furthermore, there are serious concerns that the COVID-19 pandemic and the current economic situation in Europe may have further exacerbated this problem, especially for children and adolescents in a situation of greater vulnerability,” a presidency spokesperson told EURACTIV.

Prices unfit for struggling health systems

Wegovy, currently available in Denmark, Norway and the US, is slowly being introduced to newer markets. It has been on the German market for a month, however major shortages due to production capacity have dampened its launch – alongside high prices for weekly injections. Prices start at around EUR170 a month, rising to EUR300 as the dosage increases.

Due to it being approved as a treatment for type 2 diabetes, Ozempic can be reimbursed by health systems in some countries, however Wegovy, which is purely approved for weight loss, cannot. The two medicines both contain the active substance semaglutide – although different amounts – and reduce appetite.

Danish regions have warned that they expect to spend approximately 1.1 billion DKK (EUR147.6 million euros) on reimbursement for medicines containing semaglutide. This is almost double the amount spent last year on the same medicine.

This sky-high bill could mean that the Danish health system, already under pressure from a tight budget and a lack of workforce like many other countries, would need to save money elsewhere. To counter costs, the Danish Medicines Agency is looking into changing the reimbursement scheme for these medicines.

Prices like these are one reason why these new, effective weight loss medicines are not a quick fix for health systems wanting to reduce the health burden from obesity, said Kjeld M?ller Pedersen.

“If [every Danish person with a BMI over 30] gets the most potent medicine, it would cost around 24 billion DKK (EUR3.2 billion) a year under the current reimbursement rules,” he said, referring to an answer from 28 August from the Danish health minister Sophie L?hde to a question from the Danish parliament’s health committee. Here they estimate a cost of between 23.9 and 27.9 billion DKK a year.

“This would not only knock the bottom out of the healthcare economy, but also the national economy,” Pedersen explained.

Considering that the cost of the [Danish] regional healthcare system was around 130 billion DKK in 2022, a bill like that is impossible to foot. For it to be an option, prices would need to be lowered.

In comparison, a study funded by Novo Nordisk, estimated the burden of obesity in Denmark to be EUR2.2 billion per year.

Moreover, weight loss medicine often has to be taken over a longer period of time. When a person stops taking it, the appetite returns and individuals are very likely to put the weight back on.

According to Pedersen, the best way to lower the health burden of obesity is to take a range of other measures to change behaviours, such as taxing products high in sugar.

“It is doubtful that it will be as effective as Novo’s weight loss medicines. This is what we are going to be seeing with the situation in Denmark, and also in most other countries,” he said.

WHO: No country has taken all measures

Such drugs are not a “silver bullet”, Francesco Branca, WHO director of nutrition and food safety, said earlier this year. Marketing restrictions, taxation, and school nutrition are some of the WHO’s highlighted recommended interventions in their past reports, the latest of which was published in 2022.

“We can’t find that country which has implemented at least half of this comprehensive package,” Kremlin Wickramasinghe, head of WHO Europe’s Office for Prevention and Control of NCDs, told EURACTIV.

“So we won’t be able to solve obesity or see a reduction in obesity in any single country, when they have not implemented this comprehensive package of policies,” he added.

These recommendations are not new. According to Wickramasinghe, they have not changed for the past 10 years, and failure to fully implement them comes down to barriers such as a lack of prioritisation and training of the health workforce to address obesity properly.

Moreover, dealing with obesity as a disease comes with challenges different to those of other diseases, such as diabetes or cardiovascular disease.

“The challenge here is for obesity is that most of these prevention issues lie outside the responsibility of the health ministry. When it comes to labelling, taxation, marketing or urban planning, these are purely outside the boundary of the health ministry,” Wickramasinghe explained.

[Edited by Giedre Peseckyte/Nathalie Weatherald]

Read more with EURACTIV



Leave a Reply

Your email address will not be published. Required fields are marked *