Clinical Management of Obesity and the Evolution of Treatment Drugs, Devices

According to a study published in 2006 in the Journal of the American Medical Association (JAMA), despite increasing efforts over the last several years by government organizations, physicians, public health administrators and the media to stem the tide, obesity isn’t going away. The researchers found that the prevalence of overweight and obesity among children and adolescents, and of obesity among men, increased significantly between 1999 and 2004. If one applies the prevalence of extreme obesity from the study to the total US adult population, there are about 9.9 million morbidly obese women and 3.9 morbidly obese men, totaling 13.8 million; these figures include only those with a BMI of 40 or above, and does not include those people with a BMI of 35 or higher and at least two co-morbidities caused by obesity. To include the latter group would make the number much higher. Reasons put forth for the growth of obesity over the last 100 years include a more sedentary lifestyle, increase in the amount of high fructose corn syrup (HFCS) sugars in foods, and convenience of fattening fast foods. However, while it’s easy to point to these reasons, researchers have found others that may be equally, or even more, responsible for the thickening waistlines.

Once thought to be caused by greedy overeating and laziness, overweight and obesity are now known to be created by a complex interwoven array of reasons: physical, hormonal, environmental and psychological. While researchers know much more about the causes than was known a decade ago, they also admit that there is much that is still not understood. The research may ultimately lead to drug targets, new surgical procedures and the development of devices and vaccines to prevent or reverse overweight and obesity. However, moving from finding a hormonal cause or a process pathway to putting a drug on the market can be the work of decades.

Once a drug has been developed, there are still the hurdles of regulatory approval to be overcome. Sanofi-aventis knows all about this; the company pulled its FDA application for rimonabant, known as Acomplia in the EU, when the FDA committee implied that it would unanimously recommend denial of market approval due to concerns about potential psychological side effects of the drug. To make matters worse, EU sales have not been meeting expectations. One result of the rimonabant problems was that the market forecast for pharmaceutical treatment of obesity immediately dropped, as the US would have been the largest market for this drug; that dampening of the market is reflected in this report. Another outcome was the immediate appearance of rumors to the effect that Sanofi-aventis might end up on the block; it had had very high hopes for rimonabant, hopes which have, for the time being, been dashed.

What is clear is that populations around the world are increasing in the percentage of overweight and obese individuals—of all ages, both sexes, and virtually all races. The WHO estimates that there are 1.6 billion overweight people globally, and 400 million are obese. In ten years, predicts WHO, the number of overweight will increase by 40%—to 2.2 billion.

Obesity puts a burden on so many aspects of life that the socioeconomic cost is almost inevitably enormous—as well as challenging to quantify. At the individual level, there is the lower quality of life, days missed from work, decreased wages, premature retirement, potentially unemployment, and the medical costs of related illnesses, which may include depression, cardiovascular disease, joint and arthritic problems, diabetes, stroke, etc. At the societal level, there is the mounting healthcare bill, as well as the increased costs falling upon employers due to missed work days. The healthcare bill would increase even if no one in the US was obese, because of the wave of aging baby boomers. But add to this wave the additional costs of treating the co-morbidities of obesity, and the magnitude of the wave increases significantly.

The ideal treatment for weight loss is lifestyle modification through diet and exercise. 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. Researchers have concluded that, given the current available treatments, the only effective, long-term treatment for morbid obesity is bariatric surgery. 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 lose the excess weight and keep it off.

There continues to be a private sector market for these devices. Patients may resort to private payment for the surgery for one or more reasons, such as long waits, perhaps years, for the surgery; little or no insurance coverage for the device and surgery; or lack of regulatory approval for the device in the patient’s country. Some patients travel to other countries where the procedure may be available more quickly or at a lower price. However, the majority of the recorded surgical procedures are performed under insurance coverage; relatively few patients can afford to pay out of pocket for surgery that may cost $25,000-30,000 or more, including medical follow-up, travel, nursing care, special nutritional needs, etc.

All in all, there is a strong market for the clinical treatment of overweight and obesity. That market is forecast to reach about $6.4 billion globally by 2015, on a revenue compound annual growth rate (CAGR) of 23.2%, and a unit CAGR of approximately 19%. That figure includes prescription drugs for weight loss and maintenance, over-the-counter alli from GlaxoSmithKline; devices used in bariatric surgery; and the predicted sales of drugs and devices with anticipated market launches during the study period.

See “Worldwide Market for the Clinical Management of Obesity, 2007-2015” (Report S825, 188 pages, 70 Exhibits, 38 Company Profiles, September 2007)

Description: The report is a detailed market and technology assessment and forecast of the products and technologies in the clinical management of obesity. The report describes the current and projected patient population in obesity, detailing their incidence in the U.S., Europe, and Rest of World, and the clinical practices in obesity management encompassing surgical approaches, medical supervised severely restricted diets, drug therapies, OTC treatments, biopharmaceuticals, non-pharmacologic approaches and weight maintenance approaches. The report describes clinical trends in the management of the obese. The report details the products on the market and the status of those in development for bariatric surgery, drug therapy, gastric stimulation devices, brain stimulation devices, combination therapies and genetic therapy, and provides current and forecast of the market for these products in the U.S., Europe and Rest of World. The report profiles key companies in the market, detailing the current products, products in development, market position and overall businesses in obesity management.

Report #S825, “Obesity Treatment Market Worldwide”, is available for purchase online.


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