Cover Story: China Formally Enlists ‘Miracle’ Drug in Fight Against Ballooning Obesity Rate

Fang Xia, a 24-year-old woman from China, struggled with obesity that severely impacted her physical and psychological health. Her situation improved significantly after starting treatment with semaglutide, a glucagon-like peptide-1 (GLP-1) analog that mimics a hormone to induce a sense of fullness, aiding in weight loss. Fang was among the first in China to receive the drug initially developed for diabetes but used "off label" for weight loss. After ten months, she lost over 50 pounds, lowering her Body Mass Index (BMI) from 32.9 to 22.6, thus placing her within the healthy range [para. 1][para. 2][para. 3].

Fang's success story aligns with new guidelines issued by the Endocrinology Branch of the Chinese Medical Association (CMA) in July, advocating the early inclusion of this medication in weight management strategies. China faces a significant obesity issue, with nearly half of its 1.4 billion population deemed overweight or obese. The CMA collaborated with experts from various fields to formulate these guidelines, reflecting the complex nature of obesity and the need for a comprehensive treatment strategy [para. 4][para. 5].

Semaglutide, marketed under the brand Ozempic and made by Novo Nordisk, saw a notable increase in sales in China, grossing $698 million in 2023. Other pharmaceutical giants like Eli Lilly, along with local companies Huadong Medicine Co. Ltd. and Shanghai Benemae Pharmaceutical Corp., also sell similar drugs in China. According to Nomura, China's GLP-1 market could grow at an annual rate of 23%, reaching $11.4 billion by 2033. This growth is expected to be driven by competitive pricing and extensive sales networks [para. 6][para. 7][para. 8].

Globally, obesity remains a widespread issue with 2.5 billion adults classified as overweight or obese in 2022, according to the World Health Organization (WHO). Projections indicate that by 2030, China could have 540 million overweight and 150 million obese people aged 20 to 89. This surge contributes to substantial healthcare costs and multiple health issues, emphasizing the necessity for a national strategy to shift public perceptions and promote proactive weight management [para. 12][para. 13].

The popularity of GLP-1 drugs was a significant topic at a recent conference in Beijing attended by over 1,200 professionals. The conversation highlighted how these drugs, if paired with traditional interventions like lifestyle changes, could provide better long-term outcomes [para. 14][para. 15][para. 16]. Despite their increasing use, the high cost of GLP-1 medications and limited comprehensive insurance coverage in China restrict accessibility. Price disparities between hospitals and e-commerce platforms further complicate access [para. 17][para. 18].

Moreover, long-term success with GLP-1 drugs remains challenging, with data showing over 80% of patients regain significant weight within five years. Experts suggest combining these drugs with lifestyle modifications to enhance outcomes. New guidelines allow overweight patients to start medication if lifestyle changes don’t result in at least a 5% weight loss within three months, marking a significant shift in obesity treatment strategies [para. 19][para. 20][para. 21].

Despite the rising number of obese individuals in China, fewer than 20% seek hospital treatment, often preferring self-management or unreliable methods. This reluctance, spurred by stigma and misinformation, can lead to severe health complications. Experts recommend early intervention to prevent these outcomes, stressing the need for consistent and clear obesity treatment protocols [para. 30][para. 31][para. 32].

Efforts to decentralize obesity treatment and integrate it into general health education, starting from medical schools, could further enhance effective management. Multidisciplinary diagnosis and treatment models are being advocated, yet the implementation faces financial and structural challenges. Experts call for a more integrated, personalized approach to obesity treatment [para. 41][para. 42][para. 43][para. 44][para. 45].

Contributors to this report include Chen Xi, Zhou Xinda, Zhao Jinzhao, and Tan Chen. Contact reporter Denise Jia at huijuanjia@caixin.com [para. 46][para. 47].