This will be biggest blockbuster drug in history

Mounjaro has a chance to become the biggest blockbuster drug in history.

I’m not exaggerating.

Have you heard about this medication yet?

If you’re like most of my patients - and most of the people who could be taking it - then Mounjaro hasn’t come on your radar yet.

But that’s only a matter of time. You’re going to start seeing it everywhere and you’re going to hear about lots of people who are taking it.

Mounjaro is a treatment for obesity that also happens to treat diabetes.

It’s the best-in-class drug on the market when it comes to helping people lose weight.

The medical treatments for weight loss are effective, under-covered, and underused

The past few years have seen a scientific revolution in safe and effective weight loss treatments, which have been oddly under-covered in the media and often underutilized by physicians.

Don’t get me wrong here - I always push my patients towards lifestyle interventions before medical treatments. But today’s newsletter isn’t about the way that lifting weights and eating protein is better for weight loss than doing cardio and going plant-based.

In the real world, diet and exercise are simply unsuccessful for long term weight loss for many of my patients.

And that’s where medical treatments for weight loss can come in, because these treatments are real and they’re spectacular. .

For reasons that are unclear to me, a medical treatment for weight loss has a stigma that a supplement doesn’t.

I previously wrote a newsletter about semaglutide, a safe and effective drug for weight loss.

You may have heard about semaglutide as Ozempic or Wegovy. It’s also marketed in a pill that they call Rybelsus. It remains unclear why semaglutide needs 3 different brand names.

The data to support semaglutide for weight loss comes from the STEP-1 trial, which showed an average weight loss of 15% of body weight over about a year on semaglutide injections once a week. That’s 30 pounds of weight loss for the average 200 pound human.

75% of patients who were able to take semaglutide for a year lost more than 10% of their body weight and a third lost more than 20%.

It’s pretty incredible, especially when you consider that semaglutide also reduces heart attack, stroke, and cardiovascular death.

And bariatric surgery - surgery that leads to weight loss - also has really strong data to support its safety and effectiveness.

Let’s talk about how Mounjaro works before we discuss how effective it is

The generic name for Mounjaro is tirzepatide, which you’ll sometimes see used instead.

Whether there’s truly a difference between generics and brand name drugs is up for debate, but since tirzepatide is exclusively made by Eli Lilly, we’ll stick with Mounjaro because that’s what you’ll see.

Mounjaro works similarly to Ozempic in that it stimulates receptors for a substance called glucagon-like peptide-1 (GLP-1), but it also has an effect of stimulating glucose-dependent insulinotropic polypeptide (GIP) receptors as well.

All of that means that by functioning as both a GLP-1 and GIP agonist, Mounjaro essentially mimics some of the physiologic effects of eating, signaling to both the brain and the rest of the body that we are nourished.

Interestingly, GLP-1 agonists were first isolated from the saliva of Gila monsters, animals that only eat once or twice a year.

And as I’ve written before, nature is the best source of drugs in the world.

The effectiveness of Mounjaro is astounding

The SURMOUNT-1 trial compared Mounjaro at several different doses to a placebo medication.

A once weekly injection of this drug produced incredible results:

• Average weight loss of 15% of body weight at 5mg weekly dose and weight loss of 20% of body weight at a 10mg weekly dose

• More than 50% of patients in the 10mg dose lost 20% of their body weight

• A decrease in waist size of almost 5.5 inches at the 10mg weekly dose

• A 25% drop in triglycerides and a 7 point drop in systolic blood pressure

• Only about 7% of patients had to stop the drug because of side effects (nausea, diarrhea, and constipation being the most common side effects)

Seriously, the data are incredible:

The 7% discontinuation from a side effect is similar to the semaglutide (Ozempic) trial, but the percentage of patients reporting serious adverse events is lower with Mounjaro.

In real life, patients on Mounjaro lose weight and feel better, essentially effortlessly

My experience with prescribing this drug has been quite successful.

People describe that their appetite is spontaneously less and they’re able to make better food choices.

The majority of them feel no other adverse events. A lot of patients on Ozempic report nausea or bloating - anecdotally, I’ve seen a much lower percentage of people reporting that they can’t take Mounjaro than Ozempic or it’s cousins (Trulicity and Victoza are the most common other drugs in this class).

And the weight loss is real.

I haven’t been prescribing it for that long, but I’m already seeing success.

For the people on the medication, most of whom have tried without success to lose weight many times in their life, the effortless nature of success on Mounjaro is quite inspiring and encouraging.

I’ve noticed that weight loss will spur some folks towards healthier overall behaviors.

The positive impact here snowballs - when you see an impact on weight loss that inspires healthy behavior, it leads to more weight loss, which leads to more healthy behavior.

The self-reinforcing nature of that feedback loop is awesome.

A drug like Mounjaro has a gigantic potential market: basically everyone

The term “obesogenic environment” has been used to describe the modern world - easy availability of too many nutrients, a world built around convenience, high levels of stress, poor sleep, little physical activity.

In other words, obesity has won.

And so while it’s tempting to become cynical about the trends worsening the underlying causes of obesity or the Medical-Pharmaceutical-Agricultural complex, I find it much more productive to focus my energy on helping individuals who want to improve their lives than to fight Big Ag or argue about nutrition on the internet.

Sustained weight loss is hard and most people struggle with it.

To talk about Mounjaro and other drugs as a viable method of helping people lose weight isn’t to say that making smarter diet choices and getting more exercise aren’t important.

They certainly are.

But in the world I live in, we should use all the tools we have available to us to help people.

The downsides of these weight loss drugs are very real: you need to inject them, and they’re often expensive.

But the upside is clear too: helping people lose weight through a safe and effective medication isn’t just the future - it’s here today.