Weight loss drugs are increasingly dominating headlines, but should they instead be understood as obesity management medicines?

This episode of Connecting Citizens to Science explores the growing global debate surrounding GLP-1 medicines, obesity as a complex chronic disease, and the wider implications for health systems, equity and access across different global contexts. The discussion examines the benefits these medicines may offer beyond weight reduction, alongside concerns around affordability, regulation, stigma and widening inequalities between those who can access treatment safely and those who cannot.

In this episode:

Dr Fatima Cody Stanford - Associate Professor of Medicine and Pediatrics at Harvard Medical School and Massachusetts General Hospital.

Dr Fatima is an obesity medicine physician-scientist whose work focuses on obesity as a chronic disease, cardiometabolic health and improving equitable access to evidence-based care. Alongside her clinical and research work, she contributes to national and international policy discussions through roles including the Lancet Commission on Obesity and the 2025 US Dietary Guidelines Advisory Committee, while also mentoring underrepresented researchers through NIH-funded programmes.

Dr Swarup K. Chakrabarti - Consulting Director at Biotech Consulting Services.

Dr Swarup is a biomedical scientist and translational research professional with experience spanning academia, biotechnology and interdisciplinary human health research across India and the United States. His work has explored inflammation, metabolic disease and the wider societal impact of GLP-1 therapies, including questions around long-term health outcomes and access in lower-resource settings.

• The Impact of Weight Loss Drugs on Health and Society in India | Biores Scientia

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Dr Kim Ozano: Hello and welcome to Connecting Citizens to Science.

I'm your host, Dr. Kim Ozano, and this is a podcast where we explore

global health and development.

Today, we're discussing a group of medicines that we are hearing termed

weight loss drugs, and we're asking what that framing really means in reality.

Is that framing missing the bigger picture?

Dr Fatima Cody Stanford: People think obesity is just a matter of calories and

in calories out, and the reality is that this is a complex multifactorial disease.

When we understand that, we begin to undo the bias and stigma that plagues

individuals that have this disease.

Dr Kim Ozano: We've seen these medicines across the world being used to manage

obesity and other related cardiometabolic conditions, and there is evidence of the

benefits beyond weight reduction alone.

But alongside these opportunities, we must ask important questions around stigma,

access, affordability, regulation, and how all of these relate to widening health

inequalities between those who can access the medicine safely and those who cannot.

To help us do this, we have two guests bringing perspectives from

both clinical practise and research.

We have Dr Fatima Cody Stanford, who is an obesity medicine physician scientist

and Associate Professor of Medicine and Paediatrics at the Harvard Medical School

and Massachusetts General Hospital.

Her work focuses on obesity as a chronic disease, health equity, and

improving access to evidence-based care for underserved communities.

We are also joined by Dr. Swarup Chakrabarti, who is a biomedical

scientist and translational research professional whose work spans academia,

biotechnology, and human health research across India and the United States.

His recent work in publication has explored the wider health and

societal impacts of weight reduction medicines, including access and

regulation in low resource settings.

Let's get into the conversation.

Dr. Fatima, welcome to Connecting Citizens to Science.

We're really happy to have you with us for today's really important discussion

where we're looking at what is often termed weight loss drugs, and we hear

that language used quite a lot around the world, and we're trying to understand

the impact this has on health systems and what it means for the future in terms

of inequalities but before we begin, I think it's really important that we

understand the framing of obesity and its relationship to health more widely.

Dr Fatima Cody Stanford: Yes, absolutely.

Thank you so much for allowing me to explain this.

I wanna talk about obesity as a multifactorial disease process.

Where genetics, development, environment and behaviour all play

a role in a person's likelihood of developing this disease.

And when we recognise the complexity of this disease process, we recognise

that when we talk about medications that are managing individuals with obesity,

we recognise it's not just about the weight loss itself, but it's about

managing these complex processes that have led a person to develop obesity.

And as we talk about this, we need to recognise the bias and stigma

associated with treating these individuals, the over 1 billion people

worldwide, that have this disease.

And as we think about this complexity, we have to recognise all the levers that

are playing a role that are affecting these individuals that have obesity.

Also want us to recognise as we go into this episode of using person first

language, people first language, to treat these patients with dignity and respect.

Eliminating use of words that are stigmatising, like the use of the word

obese or morbid as it relates to obesity.

We wouldn't do this with other disease processes, and we wanna make sure that we

treat these patients with the kindness, dignity, and respect that they deserve.

Dr Kim Ozano: We talked a bit earlier about the term weight loss

medicines as well, and you have quite strong opinions on that term.

Can you break that down for us a little bit more?

Dr Fatima Cody Stanford: So, these medications, what we now term them,

are obesity management medications, or OMMs, because these medications

do more than just cause weight loss.

When we look at, for example, trials that have been utilised or have been studied

to manage these medications, the SELECT trial for semaglutide or medications

like Ozempic or Wegovy, or the SURMOUNT trial for tirzepatide, which is a dual

agonist under the terms of Mounjaro or Zepbound, we realise these medications do

a lot more than just cause weight loss.

They actually reduce the risk of stroke or heart attack, or obstructive sleep apnoea,

or actually the risk of kidney disease, or what we call metabolic associated

steatotic liver disease, what was previously known as fatty liver disease.

And so, when we think about this, how do we just call them weight loss medications?

These medications are treating cardiometabolic health.

They're actually leading to better health outcomes for individuals.

So, to just call them weight loss medications is actually a misnomer.

These are obesity management medications, and actually we could even call

them cardiometabolic medications if we wanna really call them what

they are actually intended to do.

Dr Kim Ozano: Fantastic.

I think that brings us very smoothly to Dr Swarup You wrote an article,

'The impact of weight loss drugs on health and society in India', some

of the aspects and the multifactorial elements that have been raised by Dr

Fatima are also echoed in your article.

Can you tell us a bit more about why you wrote the article and

some of the aspects within it?

Dr Swarup K. Chakrabarti: So, there have been many reports that certain

population may not lose weight, but they have improved cardiometabolic activity.

So, ideally, I think the paradigm should be shifted to a health span drug.

There are 12 hallmarks of ageing.

So, we wrote an article where we described that this weight loss drug,

they affect each of the ageing hallmarks.

So, basically, they can improve the health span, right?

And now I'm coming back to your question actually.

So, in the context of India, there are many people, they are obese in

the society, and sometimes people tend to look down upon the people who are

obese, so, what happened is that since the patent has expired two months back

in India actually, so now a lot of pharmaceutical company, and you know that

India is the pharmacy of the world, so, a lot of pharmaceutical companies, they

started developing the, the non-patent formulations, and a lot of people they're

using due to cosmetic reasons also, they are apparently healthy, right?

But still, they are, they just want to lose weight to, to look beautiful.

So, it's a body image perception, okay?

And there is a strong divide between the urban and the rural society.

In the urban society, what happens is that this is more of a stigma.

The in the urban society, people tend to stay slim, okay?

And that's the, that's the gold standard of looking beautiful.

Okay?

But in the rural area, they want to have a little bit of bigger body and

that they describe as beautiful, okay?

But that now, all these weight loss drugs are moving to the rural area and

they are started taking those drugs.

Dr Kim Ozano: So, alongside these changing ideas around body image and

social expectations, there's also a growing argument that's being made

around the wider health and economic impacts of these medicines, particularly

in countries that are managing large burdens of chronic disease.

That's something you explored in your article, isn't it?

Dr Swarup K. Chakrabarti: So, the plan is that if you can reduce the weight,

okay, you can manage the cost, the healthcare cost associated to manage

all the diseases in terms of expense.

So, if you spend a lot of money on the weight loss drug it can increase your

one-time cost, but it each actually can decrease the recurring cost to

manage the cardiovascular disease, or apparently the neurogenic disease.

Dr Kim Ozano: The difference in context between urban and rural I

felt was particularly interesting.

And we're all aware of image driving the weight loss medicines

or obesity management medicines.

Dr. Fatima, what are you experiencing that's similar to that?

Dr Fatima Cody Stanford: I do think we have these trends of looking at

these medications for their aesthetic benefit, which was not what they

were intended for, and then looking at them for their health benefits.

As someone who treats patients exclusively for health benefits, I only treat patients

with disease processes, but as we see the become more popularised, here in

the US and around the world, we do see this divide of aesthetics versus health.

We can't negate the fact that people do gravitate to these

medications for aesthetics.

But as we think about this from a global context, particularly if

we're looking at lower resource settings, we have to move ourselves

back towards what are the intended health benefits of these medications?

Getting back to what are the reasons that we're using these medications,

and we're finding more and more reasons beyond the benefit of obesity and

diabetes for the utilisation of these medications, moving away from how

'pretty' or 'how gorgeous' do I look with these medications, to looking at what's

beneath the hood, what are we seeing with organ benefits for these medications?

And as we move into looking at the wide scale use of these medications,

particularly a lower resource settings, who's going to be able

to get access to these medications?

Right now, there's a dichotomy between the haves and the have nots.

And the have nots aren't typically getting access to these medications, even when we

know there is a need for utilisation for the variety of metabolic health reasons

that they could potentially be used for.

And that's one of my biggest concerns right now from a global perspective.

Dr Kim Ozano: Yeah.

I think that leads very well to what was raised in your article,

Dr Swarup, where you've talked about access and regulations.

So, you see the people that can afford the medicines that are regulated, and those

that can't, are engaging with the black market, which presents different risks.

Could you talk about that a little bit?

Dr Swarup K. Chakrabarti: Yeah.

So, in India there is a there is a regulatory body called the DCGI, and that

is managed by the government of India.

And even if a company produces a generic drug, it has to go some sort of trials.

It's not an extensive trials but, it's this very small trial.

And that's a danger associated with those generic drugs.

The thing is that all the branded drugs, they have gone through

an extensive clinical trial.

The phase one, the phase two, and the phase three, and the cohort

size is extremely large, right?

And and there is another problem with the low cost drug actually,

they're still the same compound, but the formulations and the making

of this complex is very complex.

Because this is a peptide hormone, it's not like a small molecule, so

the reproducibility is a problem, and we know that this, the, this

weight loss drug, they have some serious severe side effects.

Dr Fatima Cody Stanford: I think what you're maybe getting at is really this

issue of equity and access, and if we're really talking about equity and

access, particularly in lower resource settings, and those that have the lowest

ability to pay are getting equity in terms of what that actual compound is.

And I think that's really paramount if we're looking at research and

development, which you're saying the time put in, that we ensure that the rigour

that's put into the development of a compound is ensured that those persons

are getting the actual same compound.

I want the person that has the highest potential to pay, the billionaire,

to get the same as someone who has a lower resource setting to make sure

that they're getting equity and getting the actual agent that has been studied

with the highest level of rigour.

Dr Swarup K. Chakrabarti: Then how do you do that?

Because the people in the low resource system, they don't have the

money to buy those branded drugs.

So what I suggest that the government, this insurance, you have this in the

USA, the Medicare or Medicaid, I think the Indian government should cover, or

they should make a negotiation with the top pharma company, so that this could

be covered under the insurance, under the health insurance, so that, you know,

these people who are living in a low risk resource setting, then they they can

have those kind of base quality drugs.

Dr Fatima Cody Stanford: Absolutely.

I wouldn't say that we're doing it well here in the United States.

I think that there's a lot that can be done to, to cover these for individuals

that are older adults who are under Medicare or those who come from lower

resource settings that are under Medicaid.

And I implore the US Government to do better, but I think this can

be done better on a global scale.

Absolutely.

Dr Kim Ozano: I think what we're also seeing here in the UK is the

prioritisation of spending high amounts in the home to sustain

families on these medicines.

Is that something that you see playing out in different contexts as well?

Dr Fatima Cody Stanford: I do see, for example, that while the price has come

down, as was previously mentioned by Dr. Swarup, that the cost has come down

from, looking at US dollars, from a thousand to $1,600 a month to between

300 to four 50 US dollars a month.

This is still quite exorbitant for most families.

And so there is a rationing of resources for things that are essential, like

food and other grocery items to saying, okay I really need this medication.

I'd rather try to spend this on the medication ration food for the family.

And we are seeing this play out in the global sphere.

Dr Kim Ozano: And is that happening in India also?

Dr Swarup K. Chakrabarti: Yeah, I think so.

And there is a another point I'd like to include is that moral hazard.

So, I'm not an economics, but you say the moral hazard is that when

you have something very easy, quick fix, you tend to use that, right?

You think about the children, right?

Know the children are becoming very obese.

Now, actually I think it's happening worldwide.

People are like from nine to 14 or 15 or 16 years of the adolescent, they're

becoming very obese and the part of the reason actually they don't do a

lot of exercise , but what happened is that since they have this, these

drugs you can lose weight very easily.

So, I think their inclination to use that as a shortcut instead of

doing an exercise and other things.

So, that's the moral hazard that our people tend to use those, when you either

don't have the time or you just use those drugs to keep your health in good shape.

And that really affects the children actually, because they're

in their development phase.

They really need to have those kind of exercise going on and

body so that they're growing.

But one thing I like to add, there is a growing eagerness

about living longer, right?

So that's the longevity drugs, right?

So, a lot of people, they are thinking that they are, they're rephrasing

this weight loss as a longevity drug.

I can assure you that because there is a gap, that health span

and there is a lifespan, okay?

There is nothing wrong if you want to extend your life, right?

But at the same time, if you can extend your health span so your

quality of life will be improved.

So, what I tend to think that these drugs actually can improve the health span.

Dr Kim Ozano: I think that conversation is almost something that

we would have another episode on.

As we move forward with these medicines being much more available, what's

your take home message about who gets those medicines, who doesn't, and

what we need to be thinking about?

Dr Fatima Cody Stanford: I think that the medications that we have,

these obesity management medications are a potential tool in the toolkit.

They will not solve obesity.

They're one tool that have the ability to help treat the population, but we have

to use them in the context of the global sphere, recognising that individuals from

lower resource settings will unfortunately not always get access to them.

And that those that have versus those that have not, will have a

better ability to gain access, which means they'll have a better ability

to treat this disease of obesity.

We must fight for equity.

We must fight for access for those that potentially have worsened

chronic disease related to the use of these medications in the over 200

obesity related diseases that these medications have the potential to treat.

I think that we must be vigilant in our desire and our quest to treat these

patients, giving them the dignity, the kindness and respect that they deserve

as we do with all other chronic diseases.

Dr Kim Ozano: Thank you very much and Dr Swarup, reflecting on that, but

particularly the case in India, your article was one of the few that we could

find looking at low resource settings.

So, as medicines for obesity management move forward within context like India,

what should they be thinking about?

Dr Swarup K. Chakrabarti: I think this is a this is the fascinating

development because the this release of the non-patented drugs as opposed to

the branded drugs, that will definitely improve the acuity because in India,

though it is the third largest economy in the world, there are a lot of

people, they are, they don't have a real resource to buy those branded drugs.

So, the generic drugs can help them a lot.

And there are many effects of this, the weight loss drugs, they're

independent of that obesity also.

So, in that case, the cheaper drugs can help to, uh, alleviate some of the

cardiovascular diseases and which are found to be some, in some cases, in

indeed non-independent of the weight loss.

And in India there is a huge problem of cardiovascular diseases and apart

from diabetes and obesity also.

So, I think, the people of the people, generally the people of this low,

they're living in a low resource setting.

They have a good chance of living a healthy life just by using the

drugs so that they can stay away from the other diseases which

are very expensive to treat.

Dr Kim Ozano: Thank you.

So, we've seen both opportunities and risks, I think within the India setting

and some key things to look out for.

It's that balance between improved health from the medicines and what they offer

against regulation and managing that equity between I think Dr. Fatima, those

who have, and those who don't have.

So, I think, it's still early days and we're seeing that

play out across the globe.

As we come to the close of the episode now, Dr. Fatima, one piece of advice

moving forward for anyone who's wanting to understand or do research in the

sphere of obesity management medicines.

Dr Fatima Cody Stanford: I think we first need to look at this

from a longer, a longer game.

Many times when we're looking at this, particularly from an economic perspective,

most of the studies are very short lived.

We look at this from a one to three year 'return on investment' for a

lack of better way of saying it.

And so, we say, 'oh these are cost prohibitive'.

We only look at what is our ability to look at cost over a short term

When we really look at the diseases that we're looking at, these are ones

that require a longer lens or a longer aperture or widened aperture to really

look at the potential for the benefit that could be gleaned for individuals

that are on these medications.

If you look at here in the US looks at the congressional budget office,

they often look at a three- year lens.

But when we're treating these diseases, you can't really glean the benefit from

looking at such a shortened timeframe.

We need to look at this over five, 10 plus years to really look at the

benefit that you could potentially glean to look at how could this overall

benefit the global sphere of individuals that have this disease process.

When we pull back these agents, so let's say someone goes on the agent

and you pull it back, there's gonna be weight regain, there's gonna be a

reemergence of cardiometabolic disease, and so we don't get a chance to see the

potential benefits from these agents.

We have to be thinking about the full length of time that patients could glean

benefit, which is over a long course, chronic treatment of a chronic disease,

obesity, and the 200 plus diseases that are offsprings of those disease.

I think that's really important for us to think about as we think about

this from a global perspective.

Dr Kim Ozano: So, really focused on longer term studies that go beyond those

political cycles that we see in investment a across the world and really thinking

lifespan, and as people come on and off, we need to understand what that means.

So, thank you.

I think that's a really good piece of advice.

Dr. Swarup, one piece of advice for people who are interested in this area.

Dr Swarup K. Chakrabarti: Yeah, I think I will just echo Dr. Fatima,

maybe in a different phrasing.

I think, since the release of these branded drugs, we

need a longitudinal study.

The weight loss drugs are such a lot of money, right, and that's a

one-time cost, but in order to assess whether it is really makes sense,

because then you have to follow the population for a longer period of time.

It's a longitudinal study, so it's post-market surveillance.

So that whether this one time investment or short time investment

on weight loss drug can alleviate the long-term recurring cost associated

with the cardiovascular disease, neurogenic disease, and also diabetes.

And the, especially this is very important is that, as the people

tend to become older, they have this cognition deficiency, dementia.

So, if we can manage these drugs, can manage the dementia, okay.

So, generally it can improve the lifespan, definitely it can

increase the health span also.

And the people, they don't have to leave on a caregiver dependent on the caregivers

so they can live their own life.

So, the quality of the life will be improving.

So, in order to do that so you have to have an assessment that, or these,

the short term cost or expense on the weight loss death can alleviate

the long-term economic cost, economic burden associated in managing these

G drugs and whether that can improve the health span and the quality of

the life until the individual dies.

Dr Kim Ozano: So, it's really about that cost benefit analysis and long-term

surveillance to see the impact on quality of life over the lifespan of individuals.

So, thank you very much to both of you for being guests on

connecting citizens to science.

I've certainly learned a lot today and a lot to go away and think about.

Wow.

Today's discussion has been wonderful and really opened my eyes to a lot

of the opportunities and challenges around obesity management medicines.

Particularly, we talked about that framing and how it's being misunderstood and

moving from terms like weight loss, drugs towards obesity management medicines.

It helps to recognise obesity as a complex, chronic, and multifactorial

disease rather than this issue of individual responsibility alone.

We've also explored how these medicines are linked to a much wider range of

health outcomes, including cardiovascular disease, diabetes, kidney disease,

and longer- term quality of life.

But alongside the opportunities, this episode has really highlighted

some of those significant tensions around access, affordability,

regulation and equity, particularly within lower resource settings.

Importantly, we've heard concerns that as demand grows globally, there's a real risk

that health inequalities are gonna widen.

Throughout this series, we'll be continuing to examine inequalities

within health and development, so make sure you subscribe wherever you get your

podcasts, but for now, stay connected.