Wegovy, Mounjaro… Are obesity drugs “miraculous” or dangerous?

The "miracle" obesity drugs Wegovy and Mounjaro may become prescribed by general practitioners and therefore be reimbursed. Fabrice Delaye, Swiss journalist and author of a book on Ozempic, the other miracle cure, deciphers this social phenomenon.

The effect is undeniable. This new class of drugs, originally antidiabetics, actually helps obese people lose weight, and dramatically so. Everyone is talking today about Ozempic, Wegovy, and Mounjaro, the fruits of various speculations, particularly financial, with a turnover of around 20 billion euros worldwide. The three drugs allow you to lose weight effortlessly, no more restrictive diets. While Americans are snapping up these new treatments, France intends to facilitate and regulate access to them. Fabrice Delaye, a Swiss journalist specializing in science, has written an investigative piece, in the style of a detective novel: "Ozempic, the Obesity Revolution" (Ed. Odile Jacob).

Ozempic, Wegovy and Mounjaro “miracle molecules” or not, how does it work?

All three drugs, Ozempic, Wegovy, and Mounjaro, all offer roughly the same molecule: GLP-1, an analog of glucagon-like peptide-1 receptors. This hormone is produced in the gut after eating and sends a message to the pancreas to produce insulin. This hormone treats diabetics who no longer produce insulin and has been repurposed for obese people because researchers realized it sends a satiety signal to the brain. Since this molecule's lifespan is too short to travel to the brain, a way had to be found to prolong its effect to ensure its appetite-suppressant properties.

Is weight loss proven?

Since the medications work on appetite loss, they work very quickly. The average weight loss is 15% after a few weeks of treatment: dozens of kilos without effort. This drug can solve a major global public health problem: there are more than a billion obese people in the world. So obviously, the prescription is for morbidly obese people, not American stars who want to lose 3 kilos. In the United States, it's a rush, everywhere, we'll have to be in control.

In your book, you address the issue of the potential adverse effects that such a craze can also cause. Do we have any perspective?

The first Ozempic molecules were marketed in 2005 for diabetics, and we have 20 years of experience. So yes, like any medication, there are side effects, including more or less uncomfortable gastrointestinal disorders. A few cases of pancreatitis have been reported in diabetics, where this condition is relatively common. Thyroid cancers were reported in laboratory mice in 2008, but these rarely affect humans.

In France, access to this medication is complicated: only specialist doctors can prescribe it, subject to certain conditions. However, the French government now intends to extend the prescription option to general practitioners. Good idea?

In Switzerland, where I live, we were one of the first countries to reimburse. Yes, it's a good idea, but we need to regulate the prescription. People with obesity are psychologically weakened by numerous failures linked to successive diets. In Switzerland, we have implemented reimbursement over three years, during which prescribing doctors are required to supervise the therapy with the support of multidisciplinary teams. If people lose 30 kilos, we help them change their behaviors in a sustainable way, to stabilize: healthy diet, appropriate physical activity.

“The price is not insignificant, the treatment costs between 200 and 300 euros per month…”

Could these drugs be prescribed for life?

The price is not insignificant, the treatment costs between 200 and 300 euros per month. We have already experienced supply tensions for these drugs, which are initially prescribed for type 2 diabetics. Certainly, according to the Medicines Agency, these new drugs constitute an interesting therapeutic tool for people who are failing, faced with a situation of significant overweight. In just a month in France, the agency should authorize general practitioners to prescribe . I remind you that almost 50% of French people are today overweight or obese, the public health issue is significant.

What are the conditions?

A comprehensive, lasting change in behavior is needed: a healthy diet, appropriate and regular physical activity. The latest epidemiological studies in the United States conducted on a large number of people treated with these molecules show a positive effect, in addition to the drastic weight loss, on several associated pathologies: cardiovascular, kidney, liver, and even Alzheimer's. However, it may be that weight loss is the cause of these beneficial side effects on comorbidities and therefore the molecule, but indirectly.