This country morphed into the hottest market for obesity drugs

After Brazil got hooked on junk food, a medication that costs RM627 a month is flying off the shelves

By James Paton & RT Watson / BLOOMBERG

First Brazilians started gobbling up junk food. Now, they’re clamouring for weight-loss drugs.

Brazil, where the obesity rate has surged over the past decade, is now the biggest growth driver for weight-loss treatments in the world and the No 2 market for Saxenda, Novo Nordisk A/S’ industry-leading drug. Waistlines have expanded after the country became a key target for makers of packaged food.

Whether they can afford it or not, increasing numbers of frustrated patients are paying more than US$150 (RM627) a month out of their own pockets for the medicines. 

Chaves has lost the last 30lb with Saxenda, but is forced to stop because of the cost

“We have a huge amount of people coming here wanting Saxenda,” said Bruna Kury, a doctor in Rio de Janeiro. Some have even started using the treatment before they visit her office in the beachside suburb of Barra da Tijuca, buying the medication over the counter, she said.

A global obesity epidemic is opening up avenues of growth for the drug industry in developing nations like Brazil and other markets beyond the US, where almost four in 10 adults fall into that category. More than 700 million people are now considered obese worldwide, raising the risk of diabetes, heart disease and cancer, and driving healthcare costs higher.

After launches in Mexico and Chile, Novo plans to bring the injectable drug to two more Latin American nations, adding to its list of more than three dozen markets globally. The company also cited better than expected sales in places ranging from the Middle East to South Korea. In Brazil, like everywhere aside from limited programmes in Denmark and the United Arab Emirates, the costs of obesity medications aren’t covered by the state-run health system.

“We’re surprised by the uptake and the willingness to pay out of pocket,” Novo CEO Lars Fruergaard Jorgensen said in an interview. “We see stronger growth outside the US than in the US.”

Polls ahead of Brazil’s presidential election showed healthcare — the second-biggest chunk of the government’s budget — is one of voters’ main concerns, according to local media. Newly elected President Jair Bolsonaro’s administration plans an immediate audit of health spending.

Tatiana Chaves, who lives in the affluent Rio neighbourhood of Ipanema, said she cut her weight from a life-threatening peak of more than 400lb to 230lb through bariatric surgery, exercise, diet and — finally — medication, which she was able to buy with support from her father. She lost the last 30lb with Saxenda, but was forced to stop because of the cost.

“I wanted to keep going, at least until I hit my goal,” said Chaves, 39. “But there’s no way to do it right now.”

Brazil’s obesity rate has surged to more than 22%, a trend they attribute to unhealthy food, a lack of physical activity and people staying indoors to avoid violence in some areas

The appetite for weight-loss treatments in this South American nation of more than 200 million people reflects a mounting health problem that in many cases requires medicine, on top of changes to diet and exercise, according to doctors. Brazil’s obesity rate has surged to more than 22%, a trend they attribute to unhealthy food, a lack of physical activity and people staying indoors to avoid violence in some areas. Genes also play a role.

Brazil trails only the US, accounting for about a fifth of global obesity drug prescriptions, according to Novo, which cited data from research firm IQVIA. The US occupies more than one-third of the market.

“The number of prescriptions may be high compared to other countries,” said Maria Edna de Melo, president of the Brazilian Association for the Study of Obesity and Metabolic Syndrome. “But it’s still really low when you compare it to the number of patients who need the treatment.”

Food companies have grown increasingly aggressive in ensuring low-cost products are widely available, contributing to weight gain in nations such as Brazil. They also pressure governments to hold off on passing soda taxes or laws that could hurt sales, according to Marion Nestle, a nutrition, food and public health specialist at New York University (NYU).

“Developing countries with rising incomes are great places to market relatively inexpensive but highly profitable junk foods,” she said in an email.

That helps explain why drug companies now have started to focus on emerging markets such as Brazil, Russia, India and China, which are forecast to help fuel a more-than-threefold increase in the size of the obesity-drug market through 2021, according to London-based consulting firm Visiongain Ltd. Saxenda’s global sales are projected to double to more than US$1 billion within six years.

Although patients should get a prescription for the drug, it’s often not required at pharmacies in Brazil, physicians said. Kury, the Rio specialist, said she regularly meets patients who started using the medicine without advice. She worries about patients taking the wrong drugs or doses and doctors without expertise in obesity entering the field.

Novo is aware of purchases without prescriptions, but estimates that they are a small part of sales because they mean patients would be ineligible for price discounts, said Morten Lammert, a VP who oversees the company’s commercial obesity strategy. While the drug is meant for excessively overweight people with health problems tied to obesity, a desire to look better in this body-conscious country is part of the story as well.

Following Saxenda’s introduction in Brazil two years ago, Novo also has added medical and sales staff in the country, while seeking to raise awareness about obesity as a disease that often requires medical treatment, he said. The company is looking to build a foundation for the next generation of obesity drugs it hopes will be more potent than today’s medicines, which deliver weight loss of about 5% to 10%.

Saxenda isn’t alone in Brazil, though Novo estimates it has about 40% of the market by sales. Also available is sibutramine, doctors said.

It was the main ingredient in Abbott Laboratories’ Meridia, a drug pulled in the US eight years ago amid heart attack and stroke risks. Abbott today doesn’t sell sibutramine yet smaller players do in Brazil, and at a tiny fraction of the cost of Saxenda.

The perception of obesity as self-inflicted adds to the hurdles for the medications, on top of a lack of reimbursement and modest results.

Experts such as NYU’s Nestle say the condition is far better to prevent than treat.

Danielle Ribeiro lost 20lb in about three months by combining Saxenda and daily workouts. The 29-year-old unemployed engineer, now 135lb, said she’s not obese or overweight but believes her body fat level was too high. Her payments for medicine and other programmes come to US$300 a month, more than Brazil’s minimum wage.

“You take a photo and it doesn’t look good,” she said.

Kury, a CrossFit enthusiast as well as a doctor, said the medicine is suitable for many people struggling with extra weight who come through her doors, often helping them quickly shed pounds. She said her office has been buzzing with clients in recent weeks as summer draws near.

“People want a result before Carnival,” she said.