U.S. Doctor Groups Debate Best Use of New Weight-Loss Drugs

As powerful new obesity drugs enter the U.S. market, medical associations are keen to advise their members on how to best use them for patients. That is where the debate begins.

Some specialists advocate for broad use of drugs like Novo Nordisk’s NOVOb.CO Wegovy, alongside a healthy diet and exercise. Others recommend prioritizing them for high-risk patients, who have other conditions that are exacerbated by excess weight.

And some are considering more complex, patient-specific assessments to determine the best course of action, according to a Reuters review of existing guidelines and interviews with doctors and executives from six medical associations as they contemplate updating their own guidance.

Their recommendations will influence treatment and coverage for nearly 115 million U.S. adults and children who are obese, as well as a significant percentage of overweight Americans who have other health risks such as heart disease or diabetes.

U.S. health insurance companies take into account specialist medical guidelines, among other data, in deciding whether to pay for a treatment. Wegovy, which costs nearly $1,350 a month, has yet to receive wide coverage from private health plans.

Wegovy is approved for use in the United States and Europe, while a similar drug from Eli Lilly and Co LLY.N known as Mounjaro is expected to receive U.S. approval later this year.

The medications helped patients shed up to 15% and 20% of their weight, respectively, in large clinical trials, more than previously approved weight-loss treatments.

The clinical trials spanned two years, meaning any longer-term consequences are not yet known, and many patients may need to stay on the drug to keep off the weight.

“These new compounds are game changers, there’s no doubt about it,” said Anthony Comuzzie, chief executive of The Obesity Society. “But obesity is a complex condition.”

The society, whose members comprise many leading U.S. obesity researchers and clinicians, is assembling an expert committee to recommend when to start patients on these drugs and how to integrate that into other types of treatment, Comuzzie told Reuters.

The group last provided obesity treatment guidelines in 2013 alongside the American Heart Association and American College of Cardiology. It aims to issue new recommendations early next year, and plans more frequent updates as data becomes available.

“You may want to use one of those new drugs to achieve the initial treatment, and then move people on to other interventions to maintain what’s been achieved,” Comuzzie said.

The American Association of Clinical Endocrinology (AACE) said it plans to put out new guidelines on diagnosis, staging, and medical management of obesity in early 2024, having last issued guidance in 2016.

The Endocrine Society plans an update of its weight-loss drug guidelines for summer 2025, 10 years after it last published guidance.

Novo Nordisk and Eli Lilly, which provide some funding to The Obesity Society and the Endocrine Society and partner with AACE, would not say whether they were engaging with medical associations on the creation of new guidelines.