What the new obesity drug Zepbound means for the Black community

OPINION: The inclusion of Zepbound in the fight against obesity could revolutionize health care in many Black communities.

Editor’s note: The following article is an op-ed, and the views expressed are the author’s own. Read more opinions on theGrio.

:Last week, Eli Lilly introduced Zepbound, a powerful new addition to the ever expanding arsenal of obesity drugs. And Black people need to take notice. 

Zepbound, a close relative of Mounjaro, shares the popular weight loss drug’s active ingredient but is specifically designed for weight management, unlike Mounjaro’s indication for type 2 diabetes.

The inclusion of Zepbound in the fight against obesity could revolutionize health care in many Black communities, which face a disproportionately high burden of obesity and its associated health issues compared to any other racial or ethnic group in the United States. 

According to the Centers for Disease Control and Prevention (CDC), four in 10 Americans, totaling about 100 million, are living with obesity; with nearly half (48%) of African-American adults, living with obesity compared to a third (32.6%) of whites. Recent estimates from the National Health and Nutrition Examination Surveys have found that over one third of adults over age 60 are living with obesity with older Black women coming in at the highest rates.

Statistics such as these are even more alarming given the many health risks associated with this deadly condition. Higher rates of diabetes and heart disease, which are highest in Black communities, are intimately tied to obesity; but simply carrying 20 to 30 pounds of extra weight has been linked to more than 200 serious health conditions including cancer, high blood pressure, and most recently, COVID-19.

But using Zepbound as part of a comprehensive weight loss plan that includes getting seven to eight hours of sleep, eating right and daily exercise may be the key to turning these statistics around.

Zepbound shows promise, but is it attainable?

Zepbound has shown superior weight loss results compared to Ozempic, making its availability highly promising — particularly for individuals with prediabetes or newly diagnosed diabetes seeking remission through weight loss — leaving many to wonder if this drug could become a cornerstone treatment for both weight loss and diabetes management in Black communities.

Clinical studies demonstrate that individuals who take Zepbound as prescribed for a year or more, along with diet and exercise, achieve significant weight loss — up to 25% of their body weight at the drug’s highest dose (15 mg). Despite these impressive results, Zepbound is not a replacement for lifestyle modifications such as reducing salt and sugary snack intake or engaging in strenuous exercise four to five times a week. Combining lifestyle changes like exercise and healthy eating with Zepbound treatment maximizes weight loss benefits and promotes long-term weight loss maintenance, even after discontinuing the medication.

However, like insulin and many other treatments, cost remains a significant barrier preventing Black people from accessing this crucial medication.

Zepbound’s high cost — around $1,060 for a one-month supply — puts the drug beyond the reach of many Americans who lack the financial means or insurance coverage to afford expensive medications. A recent federal survey revealed that nearly 40% of Americans cannot cover a $400 emergency expense. Coverage by federal insurance programs like Medicare and Medicaid could alleviate this issue.

Earlier this year, pharmaceutical companies such as Eli Lilly and Novo Nordisk petitioned Congress to repeal a 20-year-old ban on Medicare coverage for weight loss drugs. The companies argue that Medicare coverage under Part D would provide these weight loss medications to millions of people who need them but cannot afford them otherwise. Medicaid and private insurance companies may follow suit.

Alleviating type 2 diabetes drug shortages

The rebranding of Mounjaro as Zepbound for weight loss has significant implications, as it will enable Eli Lilly to manufacture the drug specifically for each indication — Mounjaro for type 2 diabetes management and Zepbound for weight management — alleviating potential drug shortages. In other words, the rebranding ensures that people with diabetes will not have to compete with those seeking the drug for weight loss. Now, individuals seeking the drug for weight loss will have access to an FDA-approved medication specifically designed for that purpose, while Mounjaro’s supply can be dedicated to those who need it to manage their type 2 diabetes, a welcomed sight for people like talk show host Sherri Shepard and others who have cited concerns over Mounjaro shortages due to drug siphoning for weight loss.

Even more, insurance companies will be at greater liberty to deny off-label claims for Mounjaro, Ozempic, Wegovy and other medications indicated for type 2 diabetes management, now that Zepbound has been approved exclusively for weight loss.

BMI strikes again

The Zepbound injection approved by the U.S. Food and Drug Administration (FDA)  is indicated for adults with obesity (with a Body Mass Index (BMI) of 30 kg/m2 or higher), or those who are overweight (with a BMI of 27 kg/m2 or higher) and also have weight-related medical problems such as hypertension, dyslipidemia, type 2 diabetes mellitus, obstructive sleep apnea or cardiovascular disease, to lose weight and keep it off.

While this general criterion may seem non-exclusionary, using BMI as the sole criterion for prescriptions eligibility may inadvertently exclude Black people who require weight loss but do not technically qualify based on this measure. The limitations of BMI as a measure of weight status have long been recognized. This controversial metric, widely used to categorize individuals as underweight, normal weight, overweight or obese, fails to account for crucial factors such as differences in body type, percentage of muscle to far, fat distribution (fat around the waist generally poses a higher health risk than fat elsewhere), and overall metabolic health. Additionally, this flawed and outdated metric is based on white men and has limited applicability to other racial and ethnic groups. Emerging research suggests that waist-to-hip ratio may be a more accurate indicator of health as it relates to weight.

Zebound: Far from a magic pill

The potential for Zebound in the fight against obesity in Black communities is astounding, but it’s hardly a magic pill. Zepbound may not be suitable for everyone and individual results may vary. It also works best in combination with consistent sweat-breaking exercise and dietary modifications. Although some people may experience weight loss initially, profound rebound weight gain is common once the drug is discontinued. Side effects and drug-drug interactions should also be considered. Common side effects include:

• Nausea
• Diarrhea
• Vomiting
• Constipation
• Abdominal pain
• Indigestion
• Injection site reaction
• Fatigue
• Allergic reactions
• Belching
• Hair loss
• Heartburn

Therefore, Zepbound should never be initiated without prior consultation with a health care professional. Still, Zepbound’s approval for weight management is a win for the Black community and all those who have been seeking a way to lose those hard to lose pounds. Let’s hope efforts to increase the popular drug’s affordability and accessibility turn Zepbound’s potential into a reality. 

Dr. Shamard Charles is the executive director of graduate studies in public health at St. Francis College and sits on the Medical Advisory Board of Verywell Health (Dot Dash-Meredith). He is also host of the health podcast, The Revolutions Within Us. He received his medical degree from the Warren Alpert Medical School of Brown University and his Masters of Public Health from Harvard’s T.H. Chan School of Public Health. Previously, he spent three years as a senior health journalist for NBC News and served as a Global Press Fellow for the United Nations Foundation. You can follow him on Instagram @askdrcharles or Twitter @DrCharles_NBC.

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