The ideal treatment for weight loss is lifestyle modification through diet and exercise: as Aristotle said, “Moderation in all things.” However, the compliance rate for this method of treatment is very low: according to some studies, less than 2% of obese people who lose excess weight through diet and exercise are successful in keeping it off for two or more years. Any eventual drug treatment for overweight and mild obesity is likely to involve combination therapy, i.e. the prescription of two or more drugs, in addition to lifestyle changes, in order for the patient to successfully both lose the excess weight and keep it off.
Researchers have also concluded that, given the current available treatments, the only effective, long-term treatment for morbid obesity is bariatric surgery. Several devices used in bariatric surgery are on the market in either the EU or the US, or both; several others, including second generation gastric banding, are under development. Companies are at work inventing and testing entirely novel products, such as items made to fit into the upper mouth; neurological devices to be applied to the stomach or brain; and innovative ways to perform the surgery.
Realizing the staggering potential in this market, the pharmaceutical sector is very active in research and development for the treatment of overweight, obesity and even morbid obesity. The lure is clear: produce a drug or a combination of drugs which results in clinically significant weight loss over placebo, with few or acceptable side-effects, and this drug would be a blockbuster. More companies have a drug in the pipeline for the treatment of overweight and obesity than for morbid obesity, although a few companies have set their sights on morbid obesity. Manhattan Pharmaceuticals was one of these. Some of the medical devices have been in use for several years; others are still in the development and testing stages. The move is towards less invasive procedures, and is now in the area of utilization of natural orifices, such as the mouth, for reaching the surgical site. Another interesting development involves disabling or even cutting the vagus nerve in the stomach, leading to decreased appetite. At this time, only various versions of the adjustable gastric band and the inflatable gastric balloon are on the market.
The world market for clinical management of obesity is forecast to reach about $6.4 billion by 2015, on a revenue compound annual growth rate (CAGR) of 23.2%, and a unit CAGR of approximately 19%. The prices vary widely between the price for a year of pharmaceutical treatment and the price for the surgically implanted medical devices; the unit price in the table reflects the weighted average based upon the forecasted sales and prices for drugs and devices.
The increase in sales is based upon the net effect of a number of factors, including:
- Increasing attention paid by governments, public health systems, physicians and patients to the enormity of the obesity problem and to its growth rate
- The introduction of new medical devices via regulatory approval in the US and EU, and their subsequent acceptance by physicians and their patients
- Regulatory approvals and market launch of new, more effective drugs with relatively more acceptable adverse side effects
- Increase in the number of overweight, obese and morbidly obese individuals worldwide, and an increase in the percentage of eligible patients who seek treatment
- Increased reimbursement for surgery, pharmaceutical treatments, and combinations the two
From "Worldwide Market for the Clinical Management of Obesity, 2007-2015." Report #S825.