Is the weight over? Ozempic is just the beginning

Sascha: [00:00:02] From Equity Mates Media. This is The Dive, the podcast that asks website businesses to be all business. I'm your host, Sascha Kelly. In the future, obesity may be a choice. That is the bold statement being made by the pharmaceutical companies behind a generation of new weight loss drugs. If you're a follower of Hollywood like me, you may have heard of the big one. And that's ozempic.

Audio Clip: [00:00:29] It's the talk of tiktok. The topic Ozempic has over 300 million views with scores of users crediting the drug for their weight loss success. 

Sascha: [00:00:39] But it's just the tip of the iceberg because recent trials of new drugs have yielded even better results than Ozempic, which just last year made headlines as a miracle drug. Might soon be old news. It's Friday, the 14th of July. And today I want to know what is happening with the rapid developments of weight loss drugs and are they really living up to the hype? To talk about this today, I'm joined by my colleague here at Equity Mates. It's Alec Renehan. Alec, welcome to The Dive.

Alec: [00:01:10] Sascha, good to be here. This weight loss drug story is one that just keeps on building. And we did an episode on this podcast in August last year and fast forward just shy of a year and there's been even more developments. 

Sascha: [00:01:24] Yeah, I felt like when we talked about it last year, it was something on the periphery or something on the horizon, and a lot of people talked to me after we did this episode and said, I found this so fascinating. And then in the six months after, it seems like, especially if you look at glossy magazines like I do, it seems to be the unwritten commentary everywhere that a Zen pick is like the big thing that all well, I don't want to say all A-listers, because that'll get me in trouble. But like some A-listers are using to help them get in those very pretty dresses. 

Alec: [00:01:55] Yeah, but this isn't just a health or a celebrity story. This is a business story as well. Barclays Bank have called this story the, quote, story of the decade. So there's a business story unfolding here as well. 

Sascha: [00:02:09] So, Alec, if you have been living under a rock like you might happily be no judgement here. Can you introduce me to Ozempic? 

Alec: [00:02:19] Yeah. So Ozempic is made by the Danish pharmaceutical company Novo Nordisk, who are about 100 years old and they're really on the forefront of diabetes research and diabetes drugs. Ozempic is a once a week self-administered injection of semaglutide. Now a study published in the New England Journal of Medicine in 2021 illustrated the potential of Ozempic and really kicked off the hype. It studied just shy of 2000 adults and split them into a drug group and a placebo control group, and then measured their weight loss over 68 weeks. So a scratch over a year. The group that took Ozempic lost 14.9% of their body weight on average, which was about 15.3 kilos. And then the control group lost about 2.4% of their body weight. So 15% of their body weight lost in a little over a year. That study saw interest explode. We saw Hollywood celebrities, as you mentioned in your introduction, billionaires. Elon Musk has been a vocal proponent of the Ozempic sister drug. Look over here and here in Australia. We lived through an Olympic shortage last year.

Audio Clip: [00:03:33] Everyone on their own is going to try and everybody lying. Everyone's like, oh, smaller, poorer shit. Like. You're on Ozempic or one of those things. 

Sascha: [00:03:43] And it uses Semaglutide is that right? 

Alec: [00:03:45] Yeah, Semaglutide is the compound and then Ozempic is the brand name. 

Sascha: [00:03:50] Okay. 

Alec: [00:03:51] Semaglutide belongs to a class of medications known as glucagon, like peptide one receptor agonists or GLP one. 

Sascha: [00:04:01] Alec, you're going to have to give me the dummies version of what that meant.

Alec: [00:04:05] Yes. So we've had weight loss drugs before. And, you know, a lot of them are probably not that effective with a lot of side effects. The difference here is that this drug is just trying to mimic a hormone that is already in our body. It mimics this GLP hormone which is released in our gut when we eat.

Audio Clip: [00:04:25] Hormones are the body's messengers running from one place to another, prompting certain cells into action. When we eat, our bodies produce a bunch of hormones to aid in the process of digestion. One of them is GLP one, the hormone that tells us when we're full. This is a sequence of amino acids that make it up. And this is Semaglutide, the generic name, for example. It's made to mimic a GLP one.

Alec: [00:04:49] This GLP one homer does a few things, but importantly, when we're talking about weight loss, it prompts the body to produce more insulin, which reduces blood sugar. So Semaglutide was developed by Novo Nordisk in 2012 to look like this GLP hormone. It was approved a few years after that. By 2020, it was prescribed more than 4 million times in the United States. 

Sascha: [00:05:14] And that's why it's so important in relation to diabetes, because that's all about the body's ability to produce insulin. 

Alec: [00:05:22] Yeah, that's right. It was developed as a diabetes drug, Novo Nordisk being focussed on diabetes and then the weight loss benefits started to emerge. 

Sascha: [00:05:33] And there's other drugs that are following in his mpix footsteps. They're just like the pioneers in this space, aren't they? 

Alec: [00:05:39] Yeah, that's right. And that's why we're going back to this story today, because Ozempic may have been the first blockbuster drug, but we're saying new drugs in clinical trials yield even better results. So to give you a I guess, a look at some of the other drugs out there. Novo Nordisk has another Semaglutide drug, the same compounds sold under different brand names. The main difference is just the amount of semaglutide in each dose and what they've been approved for. But there are other GLP one like obesity drugs out there. Now forgive me, some of my pronunciation here is going to be butchered. Okay, Novo Nordisk have another one under the brand name sex offender which uses the compound Liraglutide Eli Lilly, the drug company has one Teresa pied, which is sold under the brand name Monaro. But the reason that we're talking about this story today is another Eli Lilly drug that has just gone through phase two clinical trials, retatrutide. 

Audio Clip: [00:06:43] In the Eli Lilly Labs, the revolution in weight loss, drugs, races ahead. This is about pushing the envelope further in this research, right? 

Audio Clip: [00:06:51] It's using old molecules as the benchmark and trying to make things that are better. 

Audio Clip: [00:06:57] Today, the company announcing data for its newest drug, an injection called ready triggered. 

Sascha: [00:07:02] Alec, that's amazing. You know, it's always that kind of first lead or the one that has the best PR company that you talk about. I didn't I knew that was Wegovy because we did this story last year Ozempic, obviously because it's in the news, but had no idea there were all those other brand names as well. That last drug you're talking about has seen some incredible results, though, hasn't it?

Alec: [00:07:23] That's right. So let's go back to Ozempic trial that was published in 2021. The study participants lost an average of 15% of their body weight in 68 weeks. Eli Lilly's Phase two trial has seen participants lose an average of 24% in 48 weeks. So to compare that ozempic 15% in 68 weeks compared to 24% in 48 weeks. 

Sascha: [00:07:49] So losing more body weight over a shorter period of time. Yes. And Alec, the reason that this is really important and why it's a business story. Why we're talking about it today is because the world is living through an obesity and type two diabetes crisis. And that is a big story. Let's pick that up after the break. Welcome back to The Dive, where we revisit a story that we talked about a little bit last year but kind of before this space exploded, we talked about Wegovy, the miracle drug that was helping people lose weight. And then Ozempic kind of took over and took the market shares in terms of brand name. But Alec, you've just been telling me there's a whole world of these drugs being developed out there. And the reason this is a business story that's particularly interesting to us is because there is the background of this health crisis that we're all living through on a global scale. There's an obesity and type two diabetes crisis. Can you tell me a little bit more about that? 

Alec: [00:08:55] Yeah, the numbers are pretty stark. So globally, the World Health Organisation estimates that more than a billion people are obese, including a lot of kids zooming in on the U.S. Obesity affects 42% of the adult population and 20% of children. A Harvard study found that roughly two out of three American adults were either overweight or obese. And the CDC, the Centre for Disease Control, also found that more than 37 million Americans have diabetes, about one in ten and approximately 90 to 95% of them have type two diabetes. So it's pretty stark Here in Australia, the numbers aren't as bad, but they are pretty bad. The Australian Bureau of Statistics National Health Survey from 2017 and 18 found that 67% of Australian adults were overweight or obese. And the Australian Institute of Health and Welfare found that almost 5% of Australians were living with type two diabetes. That's the numbers today, Sascha. But the trend is perhaps the scariest thing, according to estimates from Yale. By 2035, obesity will affect nearly a quarter of the world's population. Now, Sascha, we should say that the way I just presented that information puts obesity and diabetes as negative things in and of themselves. And there's obviously a big debate in this community around, you know, healthy at any weight. And the ways that we measure obesity and the validity of those measures. But I think what is undeniable is that your risk of weight related diseases goes up as you get heavier. And type two diabetes can have terrible health related consequences. They're certainly not good trends.

Sascha: [00:10:46] Yeah, definitely. And I also think it's important to note that weight loss drugs aren't new, but the ones that we've seen previously don't tend to work and they often have significant side effects. So is there something different about these drugs and how they're being developed? 

Alec: [00:11:01] Yeah, they work. I mean, I don't. But if that is the difference, like right before these drugs, the choices were weight loss drugs that didn't really work. You know, there were classes like appetite suppressant drugs and other things like that or surgery. And these drugs do have side effects that we should be clear about. Nausea, vomiting, diarrhoea, abdominal pain, constipation. But the studies that are coming out are just blowing people's minds because they're actually working like weight is falling off. It still requires the correct diet. It still requires exercise. Like it it makes it easier. It doesn't make it easy. But the fact is that they work.

Sascha: [00:11:49] Yeah, I think you said something that I want to pick up on, and that is that it is early days. Obviously they've been through scientific trials, but they are still new. It's breaking new ground. So do we know exactly what happens when people stop taking these drugs? 

Alec: [00:12:04] Yeah, that is the question, Sascha. The long term consequences haven't really been measured because Semaglutide is a compound that was only created in 2012. But we are starting to see studies of what happens when people go off the drugs. And surprise, surprise, a lot of the weight comes back on. Okay, so there was one study done of 327 participants where they measured them for 68 weeks on the drugs and then another 60 weeks of the drugs between week zero and week 68, the average weight loss was 17.3%. Pretty incredible. 

Sascha: [00:12:46] Significant. There's a huge number. 

Alec: [00:12:49] But then the participants stopped taking the drug and the average amount of weight regained was 11.6%. Okay. So that resulted in a net weight loss of 5.6% from week zero to week 120. 

Sascha: [00:13:08] So Alec, the big question then, what happens next? 

Alec: [00:13:10] There is a gold rush in this space. That's the starting point. We are seeing so many new drugs developed right now. All of these drugs have to be injected there once a week. Injections. But Novo Nordisk, Eli Lilly and Pfizer are all racing to create oral versions of these GLP one based obesity drugs. The estimates for how big this market is going to be a pretty astonishing by 2030. Bloomberg predicts that obesity drug sales will reach $44 billion. Morgan Stanley research suggests that by 2030 as well, it will be 54 billion. Barclays Bank think a hundred billion by 2030. And what we're saying is so much of the health and weight loss space to re-orientate themselves around this sector, I'm sure anyone that listens to podcasts have probably heard online health portals and websites start talking about their weight loss treatments. And even though it is illegal to advertise prescription drugs in Australia, they're certainly getting as close as they can. Weightwatchers. The publicly listed big weight loss company has recently got into the action. They acquired a company called Sequence, which is a telehealth provider that provides members access to diabetes and weight loss drugs. The industry is really oriented themselves around these drugs. 

Sascha: [00:14:39] Yeah, it's super interesting because I think the two crucial things that come out of it for me, Alec, is the fact that once you stop, you tend to put a fair bit of the weight back on. So it's kind of going to encourage maybe lifelong use of the drugs if you need it.

Alec: [00:14:56] Isn't isn't that the whole knock on pharmaceutical companies such that they never work on the cure, they just work on the treatment. This is their treatment to white. 

Sascha: [00:15:06] Yeah, it's just so fascinating. I don't know how I feel about it yet. It's one of those faces that I think I'm going to just watch with real curiosity and intrigue about what happens.

Alec: [00:15:17] There is an article, I think it's very early days, but Novo Nordisk have spoken about the next generation of drug they want to produce is a drug that stops people getting obese in the first place, which is pretty exciting. But does that just mean that everyone's taking a preventative drug just for the off chance that they get obese? Like, what does that look like? How do you know who needs to take that drug anyway? A whole can of worms to be opened at some point. 

Sascha: [00:15:44] I know, because I think, um, the crucial bit that's missing for me. Well, the two things is that the opening statement of obesity being a choice when obviously drugs cost money and you have to have the money to buy them in the first place. And then also the idea that there aren't so many other factors that contribute to your weight, whether that be psychological or class or cultural way of living, what you're eating, you know, it's not just a one size fits all solution. 

Alec: [00:16:12] Two points to close it out there, Sascha, on the cost thing. These drugs cost money but obesity also costs money. Mhm. And there would be a lot of actuaries in a lot of health departments around the world saying that an investment in these drugs upfront will save governments orders of magnitude more money on the back end in the healthcare system. So a lot of governments already subsidise these drugs for diabetes in Australia. Ozempic is on the Pharmaceutical Benefits Scheme for diabetes, that is, pushes to get governments to subsidise them for weight loss as well. And then secondly, on the psychological side of it all, one thing that I was reading on from some of those studies and articles about these drugs is that for so many people who have been big, there's a level of stigma or a level of shame around this size because society sees obesity as a personal failing, a lack of self-control, a lack of effort, lack of willpower, whatever it is. But the fact of the matter is, a lot of obesity is related to, you know, people's individual bodies and their hormones. And these drugs are a testament to that, that if you start to regulate hormones differently or produce hormones differently, you get a different result. And so I think for some people it's shifting the psychology of obesity. And it is, you know, a problem to be solved rather than a personal failing.

Sascha: [00:17:41] I think that's such an eloquent way of looking at it. At the end, Alec and I going to make a personal recommendation that I've listened to the quickie, which is a Mamma mia news show, if we've talked about the business case today, but their host has been using Ozempic and talked quite openly about how that process has been sourcing the drug in Australia. So if you are still fascinated, that's where I go for round two of listening to a podcast about it today. But Alec, I think let's leave it there. 

Alec: [00:18:09] It sounds good, Sascha. 

Sascha: [00:18:10] All right. We'll be back in your feeds on Monday. Hit subscribe. Send us to a friend who might be fascinated in this. But until next time.