Trend: A Wellness Check for Weight Loss Drugs in 2024
The arrival of the “Ozempics” shook up the weight-loss-focused wellness world, which is now beginning to figure out its future role. While some businesses started prescribing the new drugs, more companies are now creating companion fitness and nutrition programs to combat issues caused by their use. But the long future is integrative drug + wellness programs that could honestly deliver holistic health.
In our new Future of Wellness report, a key trend is how a “Wellness Check for Weight Loss Drugs” lies ahead. In the last year, Big Pharma’s incredibly effective new drugs like Ozempic and Mounjaro swiftly upended behavior-change approaches to weight loss. They revealed that weight loss is much more a matter of biology than willpower and they instantly created challenges for behavior-change-focused wellness businesses, like dieting platforms, gyms, and wellness resorts. A big driver of the wellness market has always been weight loss—in the past, very explicitly, and in recent years, more tacitly, as “weight loss” became a dirty word after hard-fought body positivity gains.
The new “magic pricks” ripped open (once again) the weight loss Pandora’s box, and the trend is about how their impact on the wellness world will evolve—and likely become more intense— in the near future. One thing is certain: more people will be taking these drugs, and more drugs are coming. Seventy-plus new medications are in development, and they will take different approaches, such as Amgen’s for example, aimed at less frequent dosing. Predictions are that more employer health plans will cover them. And if so far only a handful of countries (like France, Hungary, Germany, Austria, Sweden, the US and the UK) have approved them, more certainly will. Big “gray markets” for compounded versions of the drugs are already exploding from China to Europe.
With people clamoring for the drugs, and intensifying shortages, our trend covers how a number of health and wellness companies quickly pivoted to the (profitable) path of prescribing them, sometimes after only a short questionnaire. These companies included direct-to-consumer telemedicine brands like Ro or Found, or weight loss platforms like WeightWatchers and Noom—along with countless “med-spas.”
We all know the debates around the drugs in general—and around wellness companies rushing to prescribe them. Proponents, citing their clear effectiveness (people lose 15-20% of weight), argue they are the most powerful weapon yet in ending the obesity epidemic, which would save many millions of lives. Evidence trickles in that they may have a host of other positive health outcomes, from curbing addictions to improving cardiovascular health. Critics call out potential side effects and the lack of a clear picture about long-term health impacts, especially for a “forever” drug. They also fear that they will reinforce discriminatory beliefs that thin equals healthy, and that—with a cost of over $1,000 a month—the people who need them most won’t be able to afford them.
More doctors are getting vocal (see articles below) about how these drugs represent another “magic pill” that does nothing to address prevention, or the root cause of the world’s weight problems—from our increasingly sedentary lives to a food industry cranking out over-processed, addictive foods. And while they’re very effective, they cannot deliver holistic health: healthy food, exercise and mental wellness are still crucial. The “wellness” part of weight loss (and a larger goal of holistic health) has been quickly forgotten in all the sudden hope and hype.
So, if chapter one saw corners of the health/wellness market jumping to prescribe the drugs, chapter two—now unfolding—is fitness and nutrition companies creating “wellness companion” programs to address a serious side effect: the loss of lean muscle mass.
But chapter three, which will unfold over years, will be the medical-wellness world finding new ways to provide honest, holistic and drug-inclusive weight loss approaches. These will include fitness and healthy food, but also experimenting with new approaches to behavior change and individualized plans that analyze metabolic health and genetic factors. It’s not surprising that many wellness businesses suffered a bit of a “deer in the headlights” response to the new drugs, as they have not yet figured out their position on them or their future role.
The future: The medical-wellness space will figure out evidence-based, holistic health programs for the drug-takers, as well as the most effective ways to get people off them and allow them to stay off them. It’s safe to say that Big Pharma won’t be working on either.
New “wellness companion” programs for weight-loss drug takers
The research indicates that one big problem with the new drugs is a loss of lean muscle mass. The STEP 1 and SUSTAIN 8 trials found that about 40% of weight lost on the drugs was lean muscle. That’s a problem for all, but especially older people and post-menopausal women (big consumers of the drugs), who are at greater risk for falls, frailty, malnutrition and bone loss. And because a majority of people who take the drugs stop them within a year, without any accompanying behavior change that can mean conditions like sarcopenic obesity: you regain the weight you lost but now have a worse body composition. A recent New York Times article cited doctors on the seriousness of the issue, noting that the drugs cause the development of frailty in older patients “in months instead of years.” As Dr. Michelle Hauser, obesity medicine director at Stanford University put it, “Just because we’re losing weight doesn’t always mean we’re getting healthier.”
The two main weapons in fighting muscle loss are strength training and a diet with the right amount of protein. There is now a wave of fitness brands, nutrition startups and meal-delivery services launching new “wellness companion” programs to solve the issue. Upscale fitness brand Equinox rolled out a strength training program for people on the Ozempics; weight-loss telehealth company Noom launched a diet- and exercise-focused “Muscle Defense” program; obé Fitness partnered with telemedicine platform Found for a new MuscleGuard workout program.
On the nutrition front, there’s been a flurry of activity: meal-delivery company Daily Harvest launched a “companion food collection” for drug-takers; supplement giant GNC just released Total Lean GlucaTrim to help drug-takers retain muscle mass; and nutrition startups, including Berry Street and Nourish, that connect people with nutritionists, have rolled out services for people on the drugs. The Ozempics also raise a much bigger question about a world where less food is consumed, and Nestle’s CEO has stated that “companion products” filled with the right vitamins, minerals and nutrients will be launching soon.
The Wall Street Journal recently went in-depth on how pharma companies are working to create new weight-loss compound drugs that work to combat semaglutide muscle loss. We now live in a world where another drug is needed to simulate the effects of exercise for people taking a drug that can easily be perceived as a substitute for exercise.
An opportunity: drug-takers report being inspired to do “more wellness”
Some early research—and testimonials of drug-takers in the media—suggest that people’s new weight loss on the drugs inspires them to get more broadly healthy. For instance, Morgan Stanley research analysts found that people taking the drugs report exercising far more: those who exercised weekly jumped from 35% pre-medication to 71% after taking it. People who had been on Ozempic for one to two years reported to NBC News that taking the drug had “kick-started lifestyle changes, such as enabling them to exercise in ways they couldn’t before”—and that they eat much healthier. Ozempic takers report being more physically able and motivated to exercise, and generally report that they want to tackle “what’s next” for their health.
We need studies on the impact of integrative weight-loss drug programs (including the drugs, exercise, healthy food, mental health support, etc.) vs. a “just-the-drugs” approach–on weight-loss and overall health results. We also need to understand if integrative programs can encourage long-term behavior change and more maintainable results, whether people stay on the drugs or stop taking them. Would pairing the drug with behavioral interventions mean people could take a lower dose, or take the drugs less frequently?
The websites of the weight-loss drugmakers, and almost every doctor interviewed, endlessly repeat the mantra that the drugs aren’t meant to replace a healthy lifestyle, but to work in tandem with one. Dr. Shiara Ortiz-Pujols, an obesity specialist, pointed out something interesting that we didn’t know: most of the major studies on the impressive results of weight loss drugs—such as the 2021 JAMA study—had all participants, whether taking the drugs or the placebo, also receiving lifestyle interventions, such as counseling, increased exercise and a reduced calorie diet, for the year-plus study duration. As she puts it, “this is an often-overlooked component when weight loss drugs are hyped on social media and in the news.” This is the kind of research that needs to be untangled to create the right programs for people.
Signs of more integrative models?
In the US, you’re bombarded with ads from telemedicine companies promising weight loss drugs with one quick call. If our trend argues that the medical-wellness world will ultimately work on creating drug-inclusive—but more holistic weight loss programs, it still remains largely predictive. You see some signs of attempted integration. Noom Med (the prescribing wing of the weight loss platform) teaches users about healthy eating, exercise and stress-reduction. Restore Hyper Wellness (US wellness centers) prescribes compounded weight-loss drugs combined with ongoing InBody scans that monitor body fat percentage and muscle mass, metabolic health blood panels, telehealth support, and a program “paired” with fitness and healthy food. US fitness chain LifeTime launched its Miora Longevity and Performance clinic concept, which prescribes compounded weight-loss drugs combined with a program that includes doctors, nurses, fitness training, physical therapy, nutrition offerings, biomarker testing, etc. to provide drug-users with a companion wellness program. More health clubs and wellness centers will follow this playbook, and we will see more broad-range weight-management clinics that combine nutrition, exercise, and drug intervention into a single footprint store. Time will tell how integrative such programs actually are.
It’s hard to identify what the big, respected medical-wellness destinations are doing with the new drugs or integrative approaches. Nearly a year ago, Canyon Ranch’s medical director, Stephen C. Brewer, reported to The Wall Street Journal that they had “prescribed medication to some guests who had diabetes and were overweight but they are reluctant to do so for others who haven’t exhausted other avenues for weight loss.” In our trend, we note that Pritikin Longevity Center hasn’t gotten into prescribing the drugs so far.
Weight loss drugs will only continue to explode, but pushing injections without companion lifestyle interventions could compound the public health issue rather than solve it. There is so much to gain if we move beyond lip service for integrative solutions—to getting them right. We think that is the future.
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