Estimating the lives that could be saved by expanded access to weight-loss drugs

Abstract

Obesity is a major public health crisis in the United States (US) affecting 42% of the population, exacerbating a spectrum of other diseases and contributing significantly to morbidity and mortality overall. Recent advances in pharmaceutical interventions, particularly glucagon-like peptide-1 (GLP-1) receptor agonists (e.g., semaglutide, liraglutide) and dual gastric inhibitory polypeptide and GLP-1 receptor agonists (e.g., tirzepatide), have shown remarkable efficacy in weight-loss. However, limited access to these medications due to high costs and insurance coverage issues restricts their utility in mitigating the obesity epidemic. We quantify the annual mortality burden directly attributable to limited access to these medications in the US. By integrating hazard ratios of mortality across body mass index categories with current obesity prevalence data, combined with healthcare access, willingness to take the medication, and observed adherence to and efficacy of the medications, we estimate the impact of making these medications accessible to all those eligible. Specifically, we project that with expanded access, over 42,000 deaths could be averted annually, including more than 11,000 deaths among people with type 2 diabetes. These findings underscore the urgent need to address barriers to access and highlight the transformative public health impact that could be achieved by expanding access to these novel treatments.

Keywords: diabetes; drug access; mortality; obesity; weight-loss drugs.

Fig. 1.

(A) Distribution of the US adult population across BMI categories. (B) Percentage of population eligible (solid) for weight-loss drugs and the current uptake rate (hatch). (C and D) Percentage of eligible population among insurance categories (C) and states (D).

Fig. 2.

Distribution of the US population across BMI categories with various levels of uptake of weight-loss drugs among eligible individuals.

Fig. 3.

(A) State-level annual deaths averted per 100,000 population. (B) Distribution of averted deaths per capita among overweight and obese individuals with type 2 diabetes and obese individuals without type 2 diabetes.