When Nadeem Sarwar got a call asking him to work on stopping people becoming obese, he was“quite confused”.
The pharmaceutical industry was abuzz with excitement about a new generation of miracle weight-loss injections that could help people lose an average of 15pc of their body mass by suppressing appetite.
Front and centre of this medical revolution were Wegovy, a weight loss drug, and Ozempic, a diabetes treatment that has been prescribed off-label for shedding pounds.
The treatments, which were developed by Danish pharmaceutical company Novo Nordisk, not only helped with weight loss but lowered the risk of heart attacks and strokes.
Countries have been clamouring to get their hands on the treatments to help ease pressures on their creaking healthcare services, with Novo Nordisk making around £32m in profit from the jabs every day.
Novo Nordisk was the company that had called Sarwar.
“I said to the chief executive, ‘you want me to make things that stop people getting the disease that you currently make medicines for?’”
It was, he was told, “exactly what we want you to do”.
Sarwar, a Scottish pharmaceutical veteran, took the job. He now heads up Novo Nordisk’s recently established “transformational prevention unit”, which is anchored in the UK.
The team currently has around 20 people working in the division, spread across its offices in Oxford, London, Copenhagen and Boston.
Staff are a mixture of “hardcore” lab scientists, digital technologists and external partnerships specialists, all working on how to “predict, pre-empt and prevent” obesity.
“If we’re going to defeat obesity, we have to do more than just treat it,” Salwar says.
It may seem like new obesity-preventing drugs would pose a threat to Novo Nordisk’s business. The company currently commands a 55pc share of the market for GLP-1 medicines, as the new generation of weight loss jabs are officially known.
However, the market is becoming increasingly competitive as rival pharmaceutical companies seek to muscle in. The likes of AstraZeneca and Roche are developing their own weight-loss drugs, while Eli Lilly already has a jab on the market.
In this environment, it is unsurprising that Novo Nordisk is seeking to break new ground. If its scientists crack the problem, the rewards could be significant.
The market for weight-loss jabs, for example, is forecast to be worth as much as $90bn (£70bn) in the next few years.
To end obesity altogether, scientists first must figure out what causes it.
The challenge of trying to predict what causes it has been “one of the most complicated maths problems that I’ve encountered”, Sarwar says.
The43-year-oldhas spent his career looking at how data can be used to predict illnesses and make better drugs. He has held posts at Pfizer and research giant Eisai, and was last year named joint chairman of the UK government’s dementia mission.
At Novo Nordisk, he and his team are sifting through vast reams of data to understand what makes people overweight. The reasons can vary widely.
“An 18-year-old woman who puts on weight because she tried to give up smoking – that’s a fundamentally different biology and psychology than say, a 55-year-old woman going through perimenopause,” Sarwar says.
“We need to understand what is driving the disease in this person versus that person.”
Novo Nordisk is one of the partners in collaborative research programme Our Future Health, which has invited millions of volunteers to provide health data, while it is also working with top biomedical database UK Biobank.
Artificial intelligence and machine learning tools have been scouring the data to try and find patterns and identify what puts someone at an accelerated risk of becoming obese.
Efforts tofind a calculation to predict obesity mark a major step-change in perception of the condition.
For years, obesity was seen as an issue that could be simply solved through telling people to “eat less and move more”.
However, scientists now believe that obesity is a disease that, theoretically, could be treated like any other.
“The science is evolving and with that there is a realisation that this is not a disease of choice or a disease of moral failure,” Sarwar says. “This is a biological disease that has many causes and is one that has many consequences downstream.”
More than one in eight people in the world are clinically obese.
In the UK, three in 10 adults fall into the category. The epidemic costs the NHS around £6.5bn a year, with this figure expected to rise to £9.7bn by 2050.
Obesity is the second-biggest preventable cause of cancer. People over the weight threshold are more than 2.5 times more likely to develop high blood pressure and five times more likely to develop Type 2 diabetes.
Sir John Bell, Britain’s life sciences champion and Covid vaccine tsar, says obesity is “the single biggest health threat”.
But how can you treat it?
Sir John thinks the most plausible way would be tougher laws around the sale of fatty foods.
Novo, on the other hand, is hoping atreatment can be found. What exactly it would look like is an open question.
“What would a drug to prevent obesity look like?,” says Sawar.
“Is that something you’d want to take once a year? Is it something you want to take in a very convenient way? Would it be better implemented one way in one country versus another? There’s a lot of things that we need to figure out.”
Novo Nordisk says it is taking a “multi-pronged” approach to stopping people gaining too much weight.
The company wants to “intercept that path so that they don’t become obese”, Sarwar says. “Or, we can at least delay the time to which they will become obese.”
An “interception” could be a drug, or through finding ways to sway behaviour.
If Novo can crack the code, it would likely prove revolutionary. Curing obesity could help countries keep more people in work and out of hospital beds.
It may also force a rethink of how exactly health services around the world work.
“Today, we’ll wait until someone is a patient and once they’re in, we activate the healthcare systems,” Sarwar says.
“But what if we didn’t do that? What if we intervened to stop people becoming patients in the first place? And so would it be through healthcare systems that we have today, which are typically more disease-centric? We don’t know.”
He admits that there are “lots of unknowns”.
For new preventative drugs, a significant hurdle would be proving they actually work: ultimately, if effective, a person never becomes overweight. The proposition has already raised some eyebrows in the drugs industry.
Other potential roadblocks lie ahead, not least how regulators would view these treatments.
“But those are not reasons to not explore those questions,” Sarwar says.
There is increasingly a sense of urgency within Novo Nordisk,he says. Sarwar himself feels “the clock is ticking”.
“If we’re serious about defeating obesity, it requires solutions to prevent the disease as soon as possible,” he says. “And we want to deliver something yesterday.”
His team “behave with an impatience”.
“We want to be unshackled from the usual kind of bureaucracy and the usual delays you can experience in large organisations.”
This restlessness is driven by the knowledge that the number of people around the world tipping into obesity is getting higher by the day.
Sawar says: “We want to get these things out there imminently because the burden of the disease is so large and the trajectory is currently accelerating.”
While the drug industry is celebrating the recent breakthrough in treating obesity, for Sawar and his team it is just the start.
