Tirzepatide and Semaglutide (Mounjaro, Wegovy) are probably not worth the money

In this post I argue that Tirzepatide and Semaglutide (also known as Mounjaro, Wegovy) are probably not worth it for therapeutic purposes. The small increase of expected life expectancy by treating mild or moderate obesity is not justified by the high, recurring costs of these drugs.

On the other hand, if one desires to lose weight for vanity purposes or for fitness (like ‘making weight’), then one can consider the high price as being like paying for any other cosmetic procedure or performance enhancement. Indeed, bodybuilders are taking these drugs to cut fat. Same for social media influencers.

Stephan J. Guyenet, author of The Hungry Brain, in a Feb 2023 episode of the Ezra Klein podcast “Our Brains Weren’t Designed for This Kind of Food” endorses these new weight loss drugs, arguing that the recurring cost is like any other long-term medical treatment, like treating diabetes or hypertension. But these drugs are really expensive: about $15,000/year, as mentioned on the podcast. If insurance companies cover it, perfect, the debate is settled. Take it.

But what if insurance companies do not cover it, and you are forced to pay out of pocket? Or for off-label use by a private clinic, as some people are doing? Guyenet’s example of diabetes is not really befitting because diabetes medication is much cheaper and easily and readily covered by the vast majority of insurers.

The data shows that men with moderate or mild obesity lose on average of 2-3 years of expected average life expectancy (about 1 year for women), so instead of living to 80, dying at 78 or 77, which is not that much. This is less than I would have expected given all the dire language surrounding the discussion of obesity. I would have expected a decade, like for smoking. Only severe or morbid obesity, which is much more uncommon, reduces like expectancy by a decade.

Part of this can be explained by the fact that medical technology has gotten a lot better over the past half century at treating the chronic complications of obesity, such as hypertension and diabetes. Only at the very tails does it matter: if one aspires to live to 100, then being thin seems to be a necessity, but not so much between the ages of 75-85.

I have also seen a related argument that obesity, counterintuitively, reduces healthcare costs, due to premature death. The reduction of complications arising from obesity by taking Semaglutide may be offset by costly end-of-life care later in life, coupled with the high recurring cost of taking Semaglutide, so it’s not like these drugs reduce long-term medical spending.

Although effective obesity prevention leads to a decrease in costs of obesity-related diseases, this decrease is offset by cost increases due to diseases unrelated to obesity in life-years gained. Obesity prevention may be an important and cost-effective way of improving public health, but it is not a cure for increasing health expenditures.”

So anyway, because people tend to start gaining weight after the age of 30, how much would it cost to take Tirzepatide or Semaglutide for a lifetime? (As mentioned in the podcast, these drugs do not cure obesity; the drugs must be taken for life or the weight will return.) So someone who takes these drugs at 40 after becoming mildly obese could expect to have to take them for another 40 years–the remaining duration of one’s life–as part of a lifelong weight control regimen.

At $15,000/year, and assuming a 3% annual increase due to inflation, is quite a lot of money. It works out to a little over $1.1 million over 40 years, or about $550,000/year for those the extra two years of life expectancy by not being obese, paid out of pocket. Is that worth it? I think not, unless, obviously, prices come down. Also, I am ignoring the ‘quality of life’ variable. Severe obesity would definitely compromise quality of life, but I think making a quantitative determination for something like mild obesity is harder.