The obesity market has seen unprecedented demand in recent months. Since its US approval in 2021, Novo Nordisk’s blockbuster drug Wegovy (semaglutide) has generated millions in sales.
According to GlobalData analysis, glucagon-like peptide-1 (GLP-1) receptor agonist sales for the type 2 diabetes and obesity markets will reach more than $125bn in 2033.
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The rise in popularity of GLP-1 therapies has also impacted the sales of devices used to perform bariatric surgeries for weight management. James Ferguson, president and surgical general manager, at Teleflex, notes that the impact of the GLP-1 therapies on bariatric surgeries was seen in the third quarter of 2023. The increase of GLP -1 utilisation has led device manufacturers to understand where weight loss medications fit within the bariatric patient care pathway “the new normal”.
The World Health Organization (WHO) has recognised obesity as a global crisis. The agency predicts the global costs of overweight and obesity to reach $3trn per year by 2030 and more than $18trn by 2060. Considering the scope of the obesity crisis, Sandeep Makkar, global president of endomechnical and energy for Johnson and Johnson (J&J) MedTech, says multidisciplinary management skills are required to treat the burden of this disease.
Drug and device symbiosis – the “new normal”
Makkar notes that the number of patients pursuing surgical interventions to manage obesity is quite low: “Patients with a body mass index (BMI) of greater than 35 have a less than 1% chance of reaching lasting normal body weight without any intervention. But despite long-term data showing that bariatric surgery remains the gold standard for sustained weight loss, only about 1% of the surgically eligible candidates get surgery. This is due to a variety of reasons including people either not being aware of the impact of the surgery or being too afraid of surgery.”
The adoption of GLP-1 therapies has subsequently resulted in a decline in bariatric surgeries. Makkar notes that the popularity of these therapies also presents a wonderful opportunity as it has raised awareness about obesity and as a result more and more people are considering obesity management and associated chronic conditions.
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By GlobalDataThere are multiple obesity therapies on the market and in development, and these have varied safety and efficacy profiles, says Makkar. However, patients may not prefer these therapies as they can be cost-prohibitive or there is a reasonable likelihood that the gains are reversed if the patient stops taking GLP-1 therapies. A combination of these factors could lead to a patient seeking a more enduring weight loss solution.
Makkar compares obesity management with cancer care, where one treatment is not superior to all others but is personalised based on patient characteristics. The cancer care algorithm has taken decades to evolve and is continuously developing to accommodate new adjuvant therapies.
Developing the obesity management algorithm is where MedTech can show up in stronger terms in terms of its partnership with scientific societies, such as the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO), says Makkar. He lays out the steps to develop these algorithms. First, we need to partner to gain insight into patient pathways, including data on patient preference of therapy of surgery, reasons for preferring one over the other, and long-term drop-off rate.
Makkar comments: “I think the second opportunity to partner is around the scientific research collaboration to inform new patient pathways and guidelines – do you start someone with the GLP-1 drugs, and if so, what kind of GLP one? What is the patient selection profile before you put them into surgery? Or who gets the GLP-1 after surgery.”
“If you fast forward five to ten years, there are going to be medicines for weight loss, there are going to be surgeries like bariatric surgery for weight loss and durable maintenance. And then there will be endoscopic devices and procedures that are much less invasive than surgery but don’t require constant adherence to the medicines. I think those three are going to coexist,” says Dr Harith Rajagopalan, co-founder and CEO of Fractyl Health.
Teleflex global surgical clinical affairs director Justin Clements says in cases where patients are morbidly obese with a BMI over 50, the current medications are not enough to reduce the patient’s BMI to a healthy weight that reduces significant comorbidities (cardiovascular disease, prediabetes, and osteoarthritis). In these cases, surgical interventions can be quite beneficial.
People with a high BMI of 50 who would greatly benefit from surgical intervention but are considered a surgical risk could benefit from a prior GLP-1 treatment, says Makkar. A GLP-1 preconditioning therapy could help patients reach optimal weight and reduce the risk associated with the surgery.
Fractyl Health is developing an endoscopic outpatient procedure, Revita, to maintain body weight. The device is intended to prevent weight gain following GLP-1 treatment. Ravita has received breakthrough device designation from the US Food and Drug Administration (FDA) for weight maintenance.
The company is evaluating the Revita device in a pivotal trial, REMAIN-1 (NCT06484114), for weight maintenance. The study will investigate the device’s safety and efficacy on body weight maintenance in obese patients who have achieved at least 15% weight loss on Eli Lilly’s GLP-1 therapy Zepbound (tirzepatide).
Innovations in bariatric surgeries
Makkar notes that robotic surgery is a growing trend in bariatrics. It is expected to grow double digits through 2030.
“One another trend that I’m seeing, is an increasing trend of hybrid procedures, where surgeons are using laparoscopic staplers and staple line reinforcements in conjunction with the robot,” says Makkar.
Hybrid procedures are developed as surgeons and hospitals are trying to balance the cost of bariatric procedures. Furthermore, the instruments in the laparoscopic environment are far more advanced, which lends to the use of hybrid techniques taking hold.
Endoscopic interventions were identified as another emerging trend by Makkar. “In the past, you were limited with the flexibility of your scopes. But now endoscopic interventions such as sleeve gastroplasty are making more advances in efficacy and safety. Some results are showing long-term total body weight loss.”
Makkar also notes that advances in visualisation, instrumentation and guided technology are expected to propel growth in this segment.
Teleflex has developed a purpose-built Titan SGS stapler for gastric tissue for sleeve pouch creation in bariatric procedures. Clements says that the stapler was developed to increase the reproducibility of the ideal laparoscopic sleeve: “The variation of lap sleeve gastrostomies poses a significant problem for surgeons across the world as inconsistency over trying to create this tubular shape of the sleeve. These inconsistencies can lead to side effects such as nausea, vomiting and gastroesophageal reflux. Our device has shown superior clinical outcomes that reduce these side effects.”
An observational study of the Titan stapler showed that patients were more likely to be discharged within 24 hours of surgery when LSG was performed using the Titan SGS stapler, compared with multi-fire staplers. The use of the Titan stapler was also associated with less nausea and vomiting and fewer 30-day readmissions.
The bariatric surgery market size dropped from $97m in 2015 to $66m in 2023 but is projected to reach $80m by 2033, say Selena Yu and Graysen Vigneux, medical analysts at GlobalData. Other innovations in obesity management include a weight loss implant by BariaTek Medical, a swallowable intragastric balloon by Allurion, and a “molecular sieve” SiPore21 to suppress weight gain by Sigrid Therapeutics.
The medical device industry is still coming to grips with the disruption caused by the almost overnight popularity of GLP-1 therapies. The industry is responding with enthusiasm to partner with the pharmaceutical sector to achieve rapid and sustained weight loss. The sector is also showing innovation in making bariatric surgery safer and less invasive by using laparoscopic, robotic, and endoscopic equipment.
Along with direct interventions to reduce weight, the medtech industry is finding new ways to integrate into the obesity management space. This includes data analysis to personalise obesity treatment and remote monitoring to help achieve weight loss.
