“…We’ll discuss the SURMOUNT-1 trial, which honestly, if I had a crystal ball, I think we may look back on in 20 years as one of the most impactful trials in all of medicine over the early 21st century.”
As heard on a medical podcast about weight loss drugs.
Yes, obesity is a crisis that requires understanding and commitment. But when new weight loss drugs are fetishized on a popular medical podcast, doctors in training are misled to think obesity can be solved with a weekly injection. Let’s look at some more quotes.
“The contemporary environment, the way we eat, move, and live is obesogenic.”
Agree.
“It’s the best way that I found to think about it. You can remove yourself from the blame game of individual responsibility, food companies, and farm subsidies, and focus on what matters. What can we do to help our patients dealing with obesity?”
Hold on. If the problem is an obesogenic environment, why are food companies and farm subsidies unimportant?
The clinical trial at issue was published in the New England Journal of Medicine in 2022. This is the celebrated journal where one of the podcasters happens to be a guest editor.
Called SURMOUNT-1, the trial took ~2500 obese adults and split them into four groups: three different doses of tirzepatide (brand name Mounjaro) and one placebo group. The tirzepatide groups did lose significant weight in a dose-dependent fashion over 72 weeks compared to the placebo group.
All participants received lifestyle counseling every month for three months, then every three months until conclusion of the trial. The goals were a 500 kCal deficit and 150 minutes of moderate exercise per week.
Interestingly, data around these lifestyle goals were not published. One has no sense of participant adherence to the proposed calorie deficit and exercise plan. Is it possible that lifestyle made the study design simply as lip service to the FDA?
Eli Lilly manufactures tirzepatide and funded SURMOUNT-1, representing an inherent conflict of interest that has become commonplace. Can you imagine Eli Lilly employees and affiliates designing, conducting, analyzing, and summarizing the trial in an unfavorable manner? This is the underlying problem.
Referring to the durability of weight loss, one podcaster says, “We can’t really draw definitive conclusions on long-term effect of tirzepatide. And so we don’t know what’s gonna happen five years or 10 years down the road. We do have a sense that when you come off of these drugs, you regain the weight pretty rapidly…”
Why not just, stay on it forever then? When the podcaster asked another about side effects, he replied:
“We don’t know what we don’t know! SURMOUNT-1 followed these patients for a little over a year, but what does that look like a decade down the road? I really don’t think anybody can answer that question for us. But in all the data that we have now, the results of SURMOUNT-1 are really promising to me as a way to help our patients who are struggling to lose weight.”
The takeaway then for the podcast’s thousands of young physician listeners is to pitch obese patients on tirzepatide despite zero long-term safety data and the high chance of rapid weight gain on stopping the medication.
Don’t get me wrong. These medical podcasts are well intended and can be quite helpful in breaking down complex physiology. Nor should we boycott tirzepatide or its class of GLP1/GIP receptor agonists. Obesity carries its own risks and a weight loss drug can be the lesser evil in some cases. But glorifying pharmaceutical products and their trials makes us look more like drug dealers than doctors committed to treating the root causes of obesity.
https://www.nejm.org/doi/full/10.1056/NEJMoa2206038
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