Eli Lilly considers testing weight-loss drugs in people who are not overweight

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Eli Lilly is considering testing its blockbuster weight-loss drugs in people who are not overweight but are at risk of weight gain, in an early sign that the drugmaker may look to broaden the rollout of the medications beyond obese patients.

Dave Ricks, Eli Lilly’s chief executive, told the Financial Times that the drugmaker behind Mounjaro and Zepbound was drawing up plans to study its anti-obesity medications among people with a body mass index (BMI) that does not classify as overweight.

He said: “Maybe the cut-off point of [a BMI of] 27 we use in northern Europe and the US for entry into the studies isn’t appropriate. Maybe we should use [a BMI of] 25. Long term, should we look at health maintenance? Maybe we will.”

The trials studying Eli Lilly’s weekly anti-obesity injection Zepbound and its experimental weight-loss pill orforglipron included patients with a BMI of 30 and over, or those with a BMI of 27 and above who had a weight-related health complication. But Ricks argued there may be a case for lowering the threshold, especially for orforglipron which results in more modest weight loss.

Ricks said it was possible the drugs, part of a class of medicines known as GLP-1s, could be rolled out to people with a BMI below 25 who are classified as having a healthy weight but have “a BMI of 24.9 and [are] saying I’d like to not get diabetes in my life . . . or vascular dementia” or face an increased stroke risk.

His comments suggest Eli Lilly is exploring ways to expand the market of what is expected to be the most popular class of drugs ever, which could generate up to $130bn a year in peak annual sales, according to Goldman Sachs projections. Globally, 890mn adults suffer from obesity and a further 1.6bn are classified as overweight.

Ricks added there was a case for lowering the BMI cut-off for certain ethnic groups, such as Pacific Islanders, who “it’s known and documented that they contract type-two diabetes earlier in life and at a lower BMI”.

“We should probably do work, and we are looking at work in those populations where the cut-off we use . . . is probably not appropriate for disease prevention,” he said.

The huge demand for Zepbound, as well as Novo Nordisk’s Wegovy, has led to both medications being designated as under shortage by the US Food and Drug Administration. Both companies have poured tens of billions of dollars into building manufacturing capacity.

Eli Lilly has been vocal in discouraging the use of Zepbound for cosmetic purposes among wealthy individuals and celebrities who are not overweight but being prescribed the drug off-label, arguing the limited supplies need to get to diabetic and obese patients who need them most.

The drugmaker paid for a primetime commercial slot at this year’s Academy Awards to urge people that Zepbound was not “for the smaller dress or tux, for a big night, for vanity”.

“We’re not that comfortable with that right now,” said Ricks, referring to the use of the drugs for cosmetic purposes. “Over time, we may develop a better understanding of that from a scientific sense . . . and certainly from a practical sense . . . but right now, I think what we can say is that’s inappropriate, and we have a very clear point of view on that.”