The return of the miracle drug

by Marc Brush

In August of 2022, Morgan Stanley issued a research report called “Why obesity drugs may be a new blockbuster pharma category.” The report posits that social perceptions of obesity will ultimately downplay the lifestyle factors behind weight gain and steer consumers into doctors’ offices to ask for pharmaceutical solutions.

“We believe the treatment of obesity is on the cusp of moving into mainstream primary care management,” says Mark Purcell, an equity analyst at the firm. “The clear precedent for investors is treatment for high blood pressure, which went from a nascent category in the 1980s to a $30 billion market in the 1990s.” Morgan Stanley goes on to size an obesity treatment market at $54 billion by 2030, up dramatically from just $2.4 billion today.

What could this mean for supplements? Thanks to Ozempic, Wegovy, Rybelsus, Mounjaro and more drugs in the pipeline, obesity could quickly join the list of top therapies for pharmaceutical manufacturers. The statistics suggest a bonanza for pharma. By Morgan Stanley’s estimates, 650 million people across the globe are clinically obese, with just 7% diagnosed and recommended for medical treatment. This contrasts markedly with other chronic conditions associated with lifestyle, like diabetes with 80%–90% treatment rates.

At first blush, this looks like a slow-motion disaster for supplements, as millions of consumers, frustrated by the failed promise of weight-loss products, retreat from natural products toward the documented efficacy of blockbuster drugs. “I think drug treatment of obesity will become more normalized,” says Susan Kleiner of High Performance Nutrition. “Surgical interventions are much more invasive and damaging. It’s hard to imagine a supplement working as effectively as the upcoming crop of drugs.”

Still, there are silver linings and opportunities to breathe new life into a weight management category of supplements, battered and tarnished by years of fad ingredients and bad actors chasing the quick buck. As patients begin to seek medical treatment for obesity, supplements could play a complementary—and longer-lasting—role in the weight-loss equation, if the industry rises to meet the moment.

How we got here

The molecule driving this weight-loss revolution is semaglutide, a GLP-1 (that’s glucagon-like peptide-1) receptor agonist, stimulating the hormones in the body that lead to satiety. Patients who take semaglutide feel fuller longer, and they eat less. GLP-1 agonists also help to boost insulin and lower blood sugar, which further increases satiety.

The FDA first approved semaglutide in 2019 as Rybelsus, a drug from Novo Nordisk targeting blood sugar control for diabetics. Ironically, given the new wave of semaglutide drugs that come as “skinny pens” for weekly at-home injection, Rybelsus was applauded by FDA as “the first GLP-1 receptor protein treatment approved for use in the United States that does not need to be injected.” Also of note, Rybelsus came right out of the gate with a boxed warning about the potential increased risk of thyroid tumors, a warning that persists for semaglutide to this day.

Cut to 2022 and the new wave of semaglutide drugs, also from Novo Nordisk, captured the zeitgeist, thanks to celebrity hype and some key influencer voices, like Elon Musk's. On Twitter, the platform he now owns, Musk responded to a comment that described him as looking “fit, ripped, and healthy.” How’d he do it? Through fasting and a semaglutide drug, Wegovy.

Wegovy is approved for weight management, and it’s twin, Ozempic, is technically approved for diabetes, though off-label use and supply shortages have led to Ozempic becoming the default in public discourse for semaglutide as a weight-loss miracle. The reason for the sustained attention on these drugs is simple—they work. Research demonstrates a 15% reduction in bodyweight over the course of a year, and many experience faster results.

Aside from black box warnings from early rat studies, risk indications for semaglutide are a mixed bag. Many patients report wanting to eat less and wanting to drink less alcohol. Some report concern over “Ozempic face,” a gaunt and tired appearance that comes from rapid weight loss in the face itself. More common side effects include nausea, constipation, dry mouth and GI upset. According to UCHealth, the healthcare system affiliated with the University of Colorado School of Medicine, about 1 in 5 patients stop taking semaglutide because the side effects prove unmanageable.

The real dark sides to Ozempic and its ilk are quite practical. Insurance coverage is spotty at best, and the monthly hit for these drugs can reach $1,700—earning them a reputation as designer weight-loss drugs for the rich and famous. This raises immediate concerns around health equity, as Black and Hispanic communities experience higher obesity rates.

There’s also the lifetime commitment required here. Rebound weight gain can be fast and furious for patients who stop taking semaglutide. In its list of eight reasons to beware of “diabetes drugs for weight loss,” UCHealth makes it clear: “If you lose weight with these new drugs, you likely will need to keep taking the medications forever to keep the weight off.”

“If you look at the claims and indications,” says Shawn Baier, vice president of business development at TSI Group, “these are often Type 2 diabetes products. The one everybody’s piggybacking on is satiety—slowing gastric motility, feeling fuller, increasing insulin production. That creates an environment where weight loss is easy to achieve, but you’re still missing the lifestyle changes necessary to maintain results after the drugs go away.”

A paradigm shift

If Morgan Stanley is right, then weight management will look a lot different for supplement marketers in the coming years. Expect less talk about lifestyle and behavior and more talk about genes and obesity as a true disease. This makes excess weight less shameful as a topic and more fertile terrain for the body-positive messaging already hitting the marketplace.

“I believe we are starting to understand weight management from a mechanistic perspective,” says Mike Bush, managing partner at GrowthWays Partners. “It will take some time for the ethical, clinically studied ingredients to fully land in market as nonprescription solutions, but they will. It’s such a huge opportunity.”

Kleiner sees opportunity for brands and professionals to develop new communication skills that emphasize “health without a bodyweight bias.” Strategies that promote movement and physical activity to support energy, wellness and fitness, rather than strict bodyweight, will be key. “While the weight category will never go away, I think it’s less interesting as we move from millennials to Gen Z,” she says. “They don’t want to reflect their parents’ ideals, goals, values or cultural vocabulary, and, in fact, they prefer to reject the intense focus on weight management.”

Companies are already busy with direct-to-consumer programs in market, including Ro, a company known for telehealth access to Viagra but that also offers physician consults and prescription pharmaceuticals for a range of conditions. Ro’s Body Program incorporates Ozempic or Wegovy plus smart scales, nutritional counseling and a set goal of 15% weight reduction in a year. Notably, the $135 monthly fee does not include the cost of the drugs.

As society continues to evolve and perceive obesity more as a disease worthy of drug intervention and less as a choice, where does that leave supplements and lifestyle? “It depends on how consumers view this,” Baier says. “We know we need to lose weight as a society, but now we’re using a Type 2 diabetes drug to do it. That’s a temporary fix. Let’s make sure we’re looking at supplements and lifestyle for long, sustainable health improvement.” It’s a fair point, but a point that society just refuses to learn, time and again, as the quick fixes surface to offer a path of least resistance.

“It sounds amazing that these drugs are going to help us to deal with the problems of the Western diet,” says Eric Anderson, managing director at NXT USA, “but is that really the issue? We have no idea how this will ultimately work out. We can’t cast aside good choices—healthy foods, quality supplements, exercise, good sleep—for a magic drug.”

Impact on supplements

One thing is already clear: Ozempic has added new significance to satiety as a promising path toward weight loss, as opposed to the well-trodden paths of old, such as stimulants and fat burners. It’s also disrupting whole categories of weight management that never saw it coming.

Weight Watchers recently purchased Sequence, a digital medical platform that prescribes semaglutide drugs, to service customers whether or not they stay on the diet plan. “Smaller lifestyle modification coaching programs are partnering with either remote prescribing physicians, to allow access to the drugs, or with labs, to do the blood tests for clients who are accessing the drugs on their own,” Kleiner says. “There is certainly a fear that online weight-loss coaching programs may disappear.”

While Kleiner and many natural products experts would prefer to see coaching matched with the therapeutics, whether supplements or drugs, this is likely wishful thinking. “Ultimately, many people will yoyo, since they won’t be able to have continuous insurance coverage to stay on the drug,” Kleiner says. When they stop, and the pounds come back, Kleiner sees those patients coming back to lifestyle modification. “Nothing will work as well as the meds,” she says, “but if you can’t stay on them, customers may turn to supplements during their noncovered times.”

This positions supplements as alternatives to drugs when the costs run too high, but there’s also a world in which supplements work in complement to semaglutide. Insider recently profiled a woman who lost 104 pounds in nine months as semaglutide quieted the “food noise” in her head. Despite the price tag and side effects of nausea, bloating and dry mouth, this woman stuck with the drugs and added multivitamins into the mix to make sure her reduced appetite didn’t lead to nutritional deficiencies. This is an emerging piece of the Ozempic story, as malnutrition and deficiencies emerge as real threats, given the appetite loss resulting from semaglutide drugs.

“Weight loss too often refers to fat loss,” Baier says. “We don’t pay enough attention to body composition. With these new drugs, I wonder, are people eating the right way or simply not eating?” If patients get full from a bag of potato chips, they could fall short of the macro- and micronutrients necessary in a healthy diet, not to mention proteins.

“To maintain muscle, we need the metabolic machinery to burn more fat,” Baier says. “When you stop using a drug like Ozempic, you’ve probably lost muscle mass, making it even harder to maintain that weight loss.” This puts protein—or an ingredient like TSI’s muscle health ingredient MyHMB—back on the radar as a necessary complement to the poor diets resulting from semaglutide use.

While foods and supplements are not drugs, some do contain the compounds necessary to work through those GLP-1 pathways. Think bitter foods here, such as coffee, grapefruit, hops and Himalayan Tartary Buckwheat, the ancient crop being commercialized by Big Bold Health for immune performance. There’s also berberine, a bitter-tasting compound from the roots and stems of plants like goldenseal.

Another likely outcome from the success of Ozempic is further entrenchment of the pharmaceutical industry in its core business model, as opposed to any renewed interest in supplements as a consumer products category. “I fear that pharma will see such huge profits from off-label options here that they will push further away from the supplement space,” Bush says.

Weight management as a category

None of this has put a halt to innovation in weight management supplements so far, and the buzz around GLP-1 agonists could inspire a new front for irresponsible product development. “This category has been limited largely to stimulants, but now things are changing,” Bush says. “Due to the astronomical cost of the current Rx options, I predict some bad actors will appear, trying to take advantage of the wave.”

Bush is not alone in this thinking. “I predict within three months you will find a natural product that claims to do the same thing as these miracle drugs,” Anderson says. “Many supplements are marketed as alternatives to pharmaceuticals. I’m surprised we haven’t seen Ozempic alternatives already.”

It’s no surprise that two industry veterans like Bush and Anderson would share this concern, because weight loss is notorious for chasing fads and capitalizing on the quick fix. For every creatine that persists and gathers science to support it, there’s a coral calcium (or raspberry ketone or green coffee bean extract) capturing headlines for a brief moment and leaving a bad taste in its wake.

“To really improve weight outcomes, we need to get people making healthier choices,” Baier says. He points to Iovate’s Hydroxycut, a bestselling weight management supplement for many years running, deploying marketing campaigns that put the supplement inside a larger context. Rather than position the product as a stand-alone miracle cure, the message is softer and holistic. Hydroxycut is just a part of “your personal weight-loss journey.”

“Supplements help, but they’re one piece of it,” Baier says. “Companies are taking on the responsibility to educate and try to fix the whole problem.” This is the sensible answer for lasting outcomes and sustainable results in weight management, and a marked contrast to the noise surrounding Ozempic and its semaglutide relatives. Time will tell if consumers ever choose to get the message.

This article was included in Nutrition Business Journal's Condition Specific Issue. Visit the NBJ Store to learn more or subscribe.