[INTERVIEW] Pharma firms playing pivotal role in obesity epidemic battle

As the world grapples with the obesity epidemic, pharmaceutical companies are increasingly tapping into the fast-burgeoning market for weight-loss drugs.

Arya M. Sharma, left, professor emeritus of medicine at the University of Alberta, Canada, and Sasha Semienchuk, general manager of Novo Nordisk Korea, pose for a photo after an interview with the Korea JoongAng Daily on June 30 in southern Seoul. [SHIN HA-NEE]

As the world grapples with the obesity epidemic, pharmaceutical companies are increasingly tapping into the fast-burgeoning market for weight-loss drugs.

And yes, we need these medications to fight obesity, says Dr. Arya M. Sharma, because "eat healthy and exercise" cannot be a permanent fix-all solution for this serious chronic disease.

“When I talk to my patients, I tell them that ‘bodies like to gain weight, but they don't like to lose it,’” said Sharma.

“So any time you try to lose weight, there are lots of biological mechanisms that will defend you against weight loss.”

Sharma, who is considered one of the leading experts in the field of medical treatment of obesity, is a professor emeritus of medicine and past chair of obesity research and management at the University of Alberta, Canada. He is also the founder and former scientific director of Obesity Canada.

“The way these [weight-loss] medications work is that they make it more difficult for the body to defend its weight,” explained the professor.

Ozempic, a diabetes medication known for its off-label use for weight loss, and Wegovy, are notable examples.

Novo Nordisk, a Danish pharmaceutical company that makes Ozempic and its weight-loss drug Wegovy, is one of the pioneers in the field. Wegovy, a once-weekly injectable prescription drug, works similarly to a gut hormone called GLP-1, and as a result helps regulate appetite and food intake.

Wegovy was approved by the Ministry of Food and Drug Safety in April and is approaching market release in Korea. Demand for weight-loss drugs is strong in the country, which, like any other part of the world, has been struggling with the rising obesity rate in recent years.

However, Korea is yet to fully recognize obesity as a chronic disease that needs lifelong treatment, said Sasha Semienchuk, vice president and general manager of Novo Nordisk Korea.

“Everyone has an opinion about obesity, but whether it is based on science and understanding is often, I would say, not the case,” said Semienchuk, addressing wide-ranging misconceptions surrounding the disease.

“Here in Korea, recognizing that obesity is a serious issue, managing it like any other serious chronic disease, and advancing the science is something we take very seriously at Novo Nordisk,” said the vice president.

Sharma visited Korea to deliver a presentation during the Obesity Summit conference, attended by Semienchuk and other field experts.

The Korea JoongAng Daily sat down with Sharma and Semienchuk to discuss the prevalence of the issue of obesity in today’s society and the inflow of new medications entering the weight-regulation drug market, at the Grand InterContinental Seoul Parnas hotel in southern Seoul on June 30.

This interview has been edited for length and clarity.

Q : What are some of the biggest misconceptions about obesity?

A. Sharma: I think the biggest misconception about obesity is that it's only a lifestyle problem, and that you can solve it by simply changing your lifestyle.

We now know obesity is much more complex than that.

There are lots of biological factors like genetics involved, as well as important environmental factors that include stress, exposure to a lot of tasty food and also lack of sleep.

The misconception about losing weight also has a lot to do with biology, because the biology of weight regulation is that when you try to lose weight, your body is going to fight you since it does not want to lose weight. No matter what attempts you make at weight loss, your body will always try to put the weight back on.

In fact, what we've seen is that once you have obesity, it generally becomes a lifelong problem that is going to require long-term management, like every other chronic disease.

We're not realizing that when you have obesity, you're going to need to find a treatment that works for you, then you would have to stay on that treatment probably forever, otherwise, the weight will come back.

Semienchuk: Here in Korea, we don't see obesity being treated as a serious chronic disease in the same way that other diseases like diabetes or cardiovascular disease are treated.

Unfortunately, the rate of obesity in Korea is increasing, with 36 percent of people in Korea being obese. And the figure goes as high as 46 percent for Korean men.

The definition of an Asian population of obesity is above 25 body mass index (BMI), versus a Western population’s 30. So at those lower BMIs compared to the Western population, the comorbidities, whether it be cancer or diabetes, are at the same rate.

So that means while Asian patients might look smaller, their risk is equally high with obesity.

How do researchers address the difference in body composition, diet and lifestyle of the Asian population compared to the Western population in developing and prescribing obesity treatment?

Sharma: One might think that Korea has no obesity problem compared to other places in the world. But the fact is that although people are smaller, their risk for metabolic diseases like diabetes and cancer is actually as high as the risk for people in the United States.

So in fact, Korea has an obesity problem that is as big as the problem in the United States or in any other Western country for that matter.

To address that, there is ongoing research trying to find out why Asian people have so much higher risk, which has a lot to do with body fat distribution. And of course, there are genetic factors that account for those differences.

That means that treatments such as medications have to be tested in Asian populations.

For example, Novo has been doing specific studies on Asian populations because the way that these medications work, the effectiveness and even maybe the dose that you need may be different for them compared to Caucasian populations.

So both from an etiology side and also from a treatment side, we still have a lot of work to do to try to find the optimal definition and treatments for people in Korea and other Asian countries.

Professor Sharma, you have been working with the KSSO for the past 20 years. How would you compare Korea’s research effort and patient management capabilities in obesity issues from other countries? Sharma: Interestingly, Korea has been one of those countries, perhaps the only Asian country, where obesity has been taken quite seriously not only from a scientific perspective but also from a treatment perspective.

Although we did not have good treatments for obesity till now, I know that a lot of my Korean colleagues have been very active in the research.

And I remember coming to Korea almost 20 years ago to visit hospitals that actually had obesity centers at a time when you would not find obesity centers in other places in the world.

The KSSO has been very active in this field, and I think even Western societies can learn a lot from Korea.

The KSSO recently signed a collaboration agreement with the European Association for the Study of Obesity (EASO), and I think it is very important because a lot of work that has been done here may not be known outside of Korea. Since the EASO is a large organization with 37 member countries, it will give a lot more exposure to the science done in Korea.

A number of new weight regulation drugs are coming out in the market following Novo Nordisk’s Wegovy. What do you consider Novo Nordisk’s biggest strength over its competitors?

Semienchuk: Personally, I don’t see them as competitors, but more as collaborators.

We’re proud that Novo Nordisk is celebrating our 100th anniversary this year. We have been doing research and development in obesity for the last 20 years, but very much on our own.

Obesity remains a very undertreated disease area.

The more companies that are involved and engaged in research and development and disease awareness, the better. So we're welcoming them, and actually finding it quite exciting that patients have more therapy and treatment options.

For Novo Nordisk specifically, we're very committed to the long-term management of obesity. We have an extensive clinical trial program here in Korea with Korean patients and collaborations with the KSSO.

We also very much recognize that obesity is, I would argue, one of the most complex diseases to treat. Pharmacotherapy or drugs are only one very small part of that.

And supporting that patients have access to treatment, and good care is something we are very committed to.

For example, we have a program called “Truth About Weight” for patients to understand the science and physiology of obesity, because so many things are misunderstood about obesity for a number of reasons, including cultural ones.

While we, as a pharmaceutical company, are very proud of our research and development, we also recognize that it's only a small piece of it.

In Korea, we have a very long-term commitment to the patients and research. That is not only in terms of pharmacotherapy but is a full commitment to making sure that patients reach good outcomes, have access to medicines, and education, and improve disease awareness.

What is Novo Nordisk’s business plan in Korea?

Semienchuk: Novo Nordisk has about 100 people dedicated to obesity specifically here in Korea, something we are very proud of.

All of our major obesity clinical trials are ongoing here in Korea, and that means we are working with Korean opinion leaders, researchers and patients.

We want to bring our R&D [research and development] capabilities and therapy to Korea, but also see a big role in terms of working with KSSO around education and recognizing the complexity of treating obesity like diabetes by the overall community.

Nobody asks "When do you stop treatment?" when it’s insulin or antihypertensive. People recognize that those diseases are chronic and require medical management and support.

And we hope to have that same recognition here in Korea for obesity.

Could you offer pieces of advice for those who are seeking weight-loss medications?

Sharma: The best advice I can give anybody living with obesity is to talk to your doctor.

Right now, because of the excitement about these treatments, there's a lot of information on the internet, that may not be exactly true or apply to you as a patient.

And then, if you do need these medications, how do you get those medications? The biggest challenge in this area is now "how do we make the medications available to everybody who needs them?" because we are talking about millions of people. This is not a rare disease, but something that affects 20 to 30 percent of the population.

Semienchuk: If somebody has diabetes they go see a diabetologist, and if they have cancer they go see an oncologist. I would encourage the same for those struggling with obesity as a disease, to go see an expert that can help them manage that disease, rather than social media.

BY SHIN HA-NEE [shin.hanee@joongang.co.kr]