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Doctors and Obesity: Are healthcare professionals ready for the new anti-obesity medications?
Sarah Rickwood, Vice President, EMEA Thought Leadership
Helena Bayley, Consultant, EMEA Thought Leadership
Dec 13, 2024
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  • Doctors and Obesity: Are healthcare professionals ready for the new anti-obesity medications?

The global market for anti-obesity medications (AOMs) will pass $30bn in 2024, with the rollout of Novo Nordisk’s semaglutide and Lilly’s tirzepatide. While tirzepatide is branded as Mounjaro in Europe, semaglutide is branded as Wegovy for its obesity indication but is already a household name for obesity treatment (off label) as Ozempic. This is only the start of the AOM market – there are over 140 AOM agents in clinical development, including 10 in Phase III. They span over 50 mechanisms of action and include oral formulations as well as injectables. Even with supply issues and, to date, limited or absent public coverage of AOMs in Europe, the market for privately covered prescriptions has grown strongly. In Germany, IQVIA data suggests that at the end of 2024 almost 100,000 patients use AOMs privately; in Denmark, almost 100,000 patients are paying privately for Wegovy alone; and in the UK, over 400,000 patients are paying for AOMs out of pocket. As these are prescribed agents, healthcare professionals in these countries are gaining experience in the use of AOMs even before widescale reimbursement.

The UK is at the leading edge of both the AOM private market and AOM health system coverage: NHS England and Wales’s Health Technology Assessor, NICE, released guidance on the use of Wegovy on the NHS in 2023, limiting use to a specialist weight management service for up to two years.1 In 2024, draft guidance recommended use of Mounjaro for obesity in primary care settings at a lower threshold of body mass index (BMI), with no restriction on treatment duration.2 An agreement with NHS England proposes rolling out Mounjaro to those in greatest need first – BMI of at least 40 kg/m2 and at least 3 weight-related co-morbidities – with an ultimate goal of 220,000 patients on Mounjaro in the first three years.3 A wider group of doctors, including general practitioners (GPs), will start to prescribe the new AOMs for their patients over the next few years in the UK. What do they think about these medications and the companies behind them, and are they ready for the next stage of obesity treatment?

IQVIA undertook a primary market research exercise with UK doctors in October and November 2024 to discover more about their experience of and perspective on treating patients with obesity. The sample included GPs and internal medicine specialists (IMs), diabetologists and endocrinologists, and cardiologists. All survey respondents had at least three years’ medical practice, spend 70% or more of their time in clinical practice, and had seen or treated over 50 patients living with obesity in the last three working months. In fact, the average number of patients with obesity seen was significantly higher – GPs/IMs saw an average of 141 patients in the last three months, diabetologists and endocrinologists 151, and cardiologists 133.


Awareness of the latest AOM molecules and brands is lowest among GPs/IMs

IQVIA’s primary research was conducted shortly after the 3rd October announcement of the NHS England/Lilly deal for the phased launch of Mounjaro for obesity. Despite this being prominent in the news, the first medication mentioned by GPs and IMs when asked “Which drugs for managing of patients living with obesity are you aware of, even if you have not prescribed them?” was, in 54% of responses, the much older and less effective orlistat and its brand names Xenical and Alli (figure 1). Semaglutide and associated brand names were mentioned first by 38% of GP/IMs, with tirzepatide at just 3% – below the older GLP-1 liraglutide (Saxenda). Given that the Mounjaro rollout plans for primary care physicians to be prescribers, there is a huge awareness challenge to be overcome, and very rapidly.

By contrast, among specialist doctors the newer obesity agents are much more front-of-mind: over three quarters of specialists surveyed first mentioned a GLP-1 agonist in response to the question above. These frequently included both semaglutide and tirzepatide for diabetologists and endocrinologists, while for cardiologists, semaglutide was heavily dominant. This can be attributed to Novo Nordisk’s SELECT trial, which demonstrated the cardiovascular benefits of semaglutide; this is explored in more depth below. Cardiologists also had a greater tendency than the other specialties to give the International Non-proprietary Name (INN) of new GLP-1s, rather than the brand name.

Question: Which drugs for managing patients living with obesity are you aware of, even if you have not prescribed them?
Note: INN = International Non-proprietary Name
Sources: IQVIA Integrated Insights Tracker: Obesity, UK report, Nov 2024; EMEA Thought Leadership analysis

On closer examination, the differences in brand awareness between these specialties become more apparent. Figure 2 illustrates the number of doctors who named each brand without being prompted, followed by the number of remaining doctors who said they were aware of the brand when asked explicitly. Unlike figure 1, this extends beyond the first AOM named by each doctor to include all AOMs named and is specific to the brand name (apart from for orlistat, where the INN is included).

Again, overall cardiologists demonstrated low brand awareness, rarely naming any of the five brands unprompted. This is partly a reflection of the medical culture in the UK, where doctors routinely prescribe the INN. However, even when prompted, cardiologists frequently reported being unaware of a drug, especially Mounjaro, while again Ozempic stands out as having greatest familiarity. The opposite is true of diabetologists and endocrinologists, who demonstrate consistently high brand awareness relative to other doctors, with the exception of Ozempic – a drug not indicated for obesity. For GPs and IMs, as figure 1 suggests, awareness of GLP-1s is lower: 14% are not familiar with Mounjaro, while Ozempic is named more frequently than Wegovy, despite being indicated for diabetes rather than obesity.

Question 1: Which drugs for managing patients living with obesity are you aware of, even if you have not prescribed them?
Question 2: Which of the following drugs used for the management of patients living with obesity are you aware of?
Sources: IQVIA Integrated Insights Tracker: Obesity, UK report, Nov 2024; EMEA Thought Leadership analysis


Doctors’ AOM prescription decisions vary substantially by specialty

Brand awareness is undoubtedly closely linked to doctors’ prescription considerations and decisions. To examine this for AOMs, the adoption ladders in figure 3 illustrate doctors’ prescribing habits across the specialties for four drugs: specifically, they show the percentage of doctors who a) have considered prescribing, b) have previously prescribed, c) prescribe regularly, and d) most often prescribe each drug for obesity.

The majority of GPs and IMs report having considered prescribing all four of these obesity agents, but it should be noted that this primary research is perceptual: in the UK, GPs cannot prescribe Wegovy or Mounjaro on the NHS. In practice, these doctors almost certainly will not have prescribed either agent, unless they have prescribed them privately. It is therefore unsurprising that Ozempic and Xenical/Alli are consistently highest on the GP/IM adoption ladder, but striking that these products have almost identical profiles, with each being the obesity drug of choice for one third of doctors. Slow adoption of new obesity agents among GPs/IMs therefore extends beyond brand awareness and is reflected in prescription decisions. The finding from IQVIA’s In-depth Patient Insights in Obesity4 that many patients feel obesity is not taken seriously by primary care doctors suggests that this AOM inertia among GPs and IMs stems from a broader challenge: these doctors are not keeping up with the pace of change in this condition.

Diabetologists and endocrinologists, however, heavily favour GLP-1s over orlistat as their AOM of choice, and their adoption ladder shows that they regularly prescribe a variety of agents. As specialists in this area, they are up to date with obesity treatments and also have long-standing experience with GLP-1s for diabetes, dating back to the European Medicines Agency’s approval of Byetta in 2006. Mounjaro is their most common drug of choice – a preference which likely relates to diabetes prescriptions, as these doctors treat both conditions, and many patients have both – but Ozempic and Wegovy also represent significant portions. Therefore, diabetologists and endocrinologists are not attached to a single AOM at present, possibly because they each have slightly different advantages, and some are also in short supply: verbatim analysis shows that many of these doctors are particularly aware of Mounjaro being a dual GLP-1 GIP receptor agonist with high potency, while several mention the cardiovascular effects of Ozempic and Wegovy. For all three agents, they frequently mention the high efficacy in weight loss. 

Questions (in reverse order of appearance in graphic): 1) What do you most often prescribe to patients for managing their obesity? 2) Which drugs do you currently prescribe on a regular basis for managing patients living with obesity? 3) What else have you ever prescribed for managing patients living with obesity? 4) Which other drugs have you considered prescribing for managing patients living with obesity?
Note: results shown for four selected drugs
Sources: IQVIA Integrated Insights Tracker: Obesity, UK report, Nov 2024; EMEA Thought Leadership analysis


Clinical news reaches specialists, but other channels are needed for primary care doctors

As the obesity market becomes increasingly competitive and crowded, moving up the adoption ladder will become more challenging. With brand awareness still developing, especially among GPs/IMs, medical affairs will be a key differentiator in this market. As figure 4 illustrates, doctors’ perception of companies is closely linked to their prescribing behaviour, emphasising that reputation matters. Cardiologists are evidently aware of Novo Nordisk, and their prescription decisions reflect this, with semaglutide their preferred agent (Ozempic is top, possibly because Wegovy can only be prescribed by specialist obesity services).

Question: “Now you will see a list of statements related to pharmaceutical companies. Please let us know which company you associate the attribute with the most.”
Sources: IQVIA Integrated Insights Tracker: Obesity, UK report, Nov 2024; EMEA Thought Leadership analysis

Verbatim analysis shows that when asked what makes semaglutide unique, a considerable number of cardiologists mentioned cardiovascular outcomes, and evidence from additional trials. This confirms that clinical news – in this case, the cardiovascular benefits of semaglutide shown in the SELECT trial – is effective at raising awareness among the relevant specialists. Interestingly, the survey results suggest that currently cardiologists do not assume that cardiovascular risk reduction is a GLP-1 class effect; instead, they associate it with semaglutide specifically. As more outcomes trials read out, we can expect that specialist doctors will be inclined to prescribe AOMs with label claims that correspond to the conditions they treat.

The emergence of new clinical evidence appears to have far less of an impact on GPs – a finding supported by verbatim analysis. Other, more promotional approaches are therefore required to raise awareness. IQVIA’s ChannelDynamics data suggests there has been some level of UK promotional activity of semaglutide and tirzepatide to GPs, and this is something that companies will need to prioritise going forward, especially as the market becomes more crowded and complex, and achieving substantial share of voice becomes more challenging.

The obesity market is changing at pace, and 2025 will be a critical year for its development. In the UK, Mounjaro will start to be rolled out across NHS England and Wales. Doctors’ AOM awareness, perception and decision-making will evolve rapidly, and tracking this closely will be an important first step to ensuring that doctors are aware of the benefits that new treatment options provide. There will be major trial readouts, such as SURPASS-CVOT with cardiovascular outcomes data for tirzepatide in type II diabetes patients, and evoke and evoke+ on the neuroprotective effect of semaglutide in early Alzheimer’s disease. As a result, obesity will continue to be very high profile at a time when doctors will gain more direct experience with these agents.


IQVIA’s Integrated Performance Tracker: Obesity

These primary research findings are derived from IQVIA’s Integrated Performance Tracker: Obesity, a dedicated, multi-dimensional and multi-country tracking of the evolving market for obesity prescription medications and the performance of individual brands and molecules. The Tracker combines country level primary research among healthcare professionals with Social Media listening across both the general public and healthcare professionals, as well as IQVIA sales and patient-level data to provide insights on real world use of obesity agents. For more information, please contact us.


References

1 Semaglutide for managing overweight and obesity; NICE guidance, 4 September 2023: https://www.nice.org.uk/guidance/ta875/resources/semaglutide-for-managing-overweight-and-obesity-pdf-82613674831813

2 Tirzepatide for managing overweight and obesity; NICE draft guidance, June 2024: https://www.nice.org.uk/guidance/GID-TA11156/documents/draft-guidance-2

3 For first phase of Mounjaro's obesity rollout in England, only a limited number of patients will have access; Fierce Pharma, 4 December 2024: https://www.fiercepharma.com/pharma/only-highest-need-patients-england-will-get-lillys-tirzepatide-obesity-first-phase-rollout

4 In-depth patient insights in obesity highlight the need for a holistic, individualised approach to therapy; IQVIA blog, 25 November 2024: https://www.iqvia.com/locations/emea/blogs/2024/11/in-depth-patient-insights-in-obesity-highlight

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