Redefining Obesity Success in the GLP-1 Era: Q&A with Brian Hilberdink

In a conversation with Pharmaceutical Executive, Brian Hilberdink, president of U.S. Human Pharma, Boehringer Ingelheim discussed the rapidly evolving GLP-1 landscape in obesity care, emphasizing the need to redefine success beyond weight loss alone and toward comprehensive metabolic health.

Hilberdink described the field’s shift to recognizing obesity as a complex metabolic disease, underscoring the importance of targeting visceral fat, liver health, and preservation of lean muscle mass. He outlined Boehringer Ingelheim’s strategy in obesity, including development of next-generation incretin-based therapies and combination approaches designed to improve metabolic outcomes rather than solely driving pounds off the scale.

In the conversation, Hilberdink also addressed structural barriers to care, ranging from limited coverage and employer carve-outs to high out-of-pocket costs, and stressed that access and long-term adherence, not delivery route alone, will determine the real-world impact of GLP-1 therapies.

A transcript of Hilberdink’s conversation with Pharmaceutical Executive can be found below.

Pharmaceutical Executive: The GLP-1 landscape has rapidly evolved from a diabetes-focused therapy to a cornerstone of obesity care.What do you see as the next phase of obesity innovation?
Brian Hilberdink: I really believe that obesity is evolving kind of similar to the way Type Two Diabetes evolved. In Type Two diabetes, once upon a time we blamed the patient for not taking care of themselves and giving themselves type two diabetes, and then we understand that it's a much more complex metabolic disease. And I think we're finally at that tipping point now, where the average clinician, and hopefully the average person, is understanding more about this being a complex metabolic disease, where we need to stop judging people living with this disease and really try to find evidence-based solutions to help people.

The next evolution really should be about evolving beyond just looking at pounds on the scale as an indicator of success, and really looking at overall metabolic health, looking at things like what type of weight are we losing, are we getting at the so-called bad fat, visceral fat, are we making sure that the liver is healthy, an absolutely vital organ, and making sure that you can have overall good metabolic health? Are we preserving lean muscle mass?

I think we're getting to that point of a greater level of sophistication, where we're moving beyond weight bias to understanding this is more of a disease, and we're also looking at the fact that success isn't just about losing weight, of course its hugely important, but there's more than just those pounds on the scale.

PE: The industry conversation is shifting from "how much weight can a patient lose?" to "what does meaningful metabolic health actually look like?" Why does the distinction between weight loss and meaningful metabolic health matter for patients and the healthcare system?
Hilberdink: We know that obesity remains a significant burden on the healthcare system. If you think about all of the comorbidities that are associated with obesity, going even beyond diabetes and cardiovascular disease, we know that if we can really get to the root of the problem and help patients with this complex metabolic disease, we can hopefully avoid a lot of those comorbidities and a lot of the massive downstream cost on society.

So, I mean, big picture, that's why it's super important. But now, let's talk about the individual person living with obesity, are we setting people up for success if they lose weight? Maybe they have a period of time where they feel good standing in front of the mirror, because of the pounds that have come off the scale, but fundamentally, have we really advanced their metabolic health? And what does that look like?

I mentioned before that there's kind of good fat and bad fat. The bad fat is that visceral fat, the fat that tends to accumulate around the abdomen that surrounds our organs, and if we can get better at reducing visceral fat, if we can make sure that somebody has a healthy liver, knowing that 75% of patients living with obesity already are living with Masaldi, so having this metabolic dysfunction associated condition is highly problematic, because if you don't have a healthy liver, it's going to be very difficult to have overall strong metabolic health. So, again, understanding that the parameters go beyond just pounds and looking at that overall health for the patient.

PE: Where does Boehringer Ingelheim stand on the question between oral or injectable GLP-1’s being the future of obesity care?
Hilberdink: Just like other disease states like diabetes, we need to have multiple treatments. We need to have multiple treatments with multiple mechanisms of action, and it's also good to have different delivery options. We, as an industry, took a huge stride when we went from once daily injectables to once weekly, which is where Survodutide, which Beoehringer will be bringing to the marketplace, will play.

I do not believe that the injection barrier is the primary barrier. I think that an oral is a good option for patients, but I think again the primary barrier is access to treatment, and I think what's going to keep patients on treatment is hitting their overall goals. Again we need to define goals going beyond those pounds on the scale. So when we start unpacking the fact that the average patient is only staying on treatment for six months, and then maybe cycling to another treatment, and going through this roller coaster of gaining weight, losing weight, gaining weight, can we get people to a healthier weight in a sustainable way, and again get them overall healthy, which I think is way more important than the actual delivery mechanism.

PE: How is Boehringer Ingelheim’s deliberate GLP-1 strategy different from competitors?
Hilberdink: So, our belief is first off, let's put the patient at the center, let's understand where they're at, let's understand the journey that we've been on for people living with obesity. We believe that the time is right to really elevate the focus on overall metabolic health. So, with Survodutide, the product that we're looking to bring to the market, now we have something that is a unique mechanism of action.

This is a novel glucagon GLP-1 dual agonist, and has the potential to reduce fat in the liver, and it has the potential to reduce visceral fat and help to preserve lean muscle mass, potentially in a different way than what current therapies are doing. Really thinking again holistically about metabolic health, part of it is going to be the molecule itself, but part of it is going to be what other surrounding support can we put around the patient, because we don't want anyone to think that a pharmacological intervention alone is what's going to help a patient get on this journey of being in healthy weight and overall metabolic health.

We really endeavor to be a company building on our history and heritage in metabolic health with a very well-known type two diabetes and cardiovascular chronic kidney disease drug and really leverage some of the knowledge that we have in the disease state to maybe provide something a little broader than what we currently see in the marketplace.

I should mention that Boehringer is not just looking at a single modality, we do have a triple agonist that's currently in development, which would be a first in class, and we're looking at other things in our pipeline, so Boehringer being a significant committed R& D-based company, we believe that we will be in this obesity metabolic health space for many years to come.