The introduction of glucagon-like peptide-1 (GLP-1) receptor agonists, corresponding to semaglutide (Ozempic and Wegovy) is a breakthrough within the administration of weight problems. These medicines have confirmed to be very efficient in selling weight reduction and bettering blood sugar ranges.
Whereas lots of people might imagine that I’ve one thing in opposition to GLP-1s – whether or not as a result of they’re ‘competitors’ for my observe (they aren’t), or that perhaps I don’t agree with utilizing prescribed drugs over weight loss program for weight reduction. I wrote all about that right here.
I imagine the brand new class of weight reduction medicines are unimaginable instruments that may assist to vary folks’s lives for the higher. However they aren’t the whole puzzle; they’re solely only a piece, and there are some very actual limitations to their use.
Latest analysis suggests that weight problems charges within the US have dropped very barely – from 46% in 2022 to 45.6% in 2023. There was a 700% enhance in using GLP-1 agonist medicines between 2019 and 2023.
Though even a 0.04% change in weight problems charges might point out a basic downward development which may be attributed partially to GLP-1 medicines, there are good causes to imagine that these medication is not going to drastically scale back the prevalence of weight problems…not less than, not now. However why?
The reply to this query is multifaceted and sophisticated.
Limitations of GLP-1 Medicines in Addressing Inhabitants-Extensive Epidemic
Price and Accessibility: These medicines are tremendous costly – as in, over $15,000 a 12 months in some circumstances. This can be a large barrier for individuals who can’t afford to pay out of pocket, or who don’t have personal insurance coverage protection. Even for these with personal insurance coverage, firms usually cap spending or period for GLP-1 medicines. Whereas some folks qualify for GLP-1 meds by way of Medicare or Medicaid, many don’t.
A current listening to of the US Senate Committee on Well being, Training, Labor, and Pensions revealed that Ozempic prices 15x extra in the US than in Germany. Information on affected person discontinuation of GLP-1 receptor agonist medicines is inconclusive, however numbers vary from round 50% inside 3 months to 75% by the two 12 months mark. The explanations for going off the meds embrace value, unwanted effects, or sluggish weight reduction.
In different phrases, so many individuals who would doubtless profit drastically from these medicines, simply can’t entry them in any respect, or for lengthy sufficient. Entry is decrease for folks in sure racial and ethnic teams, that are additionally the teams which have the best charges of weight problems (and the bottom entry to healthcare general).
The patents for a number of of those medicines are up in March, 2026, that means that cheaper generic variations of semaglutide will doubtless be available on the market shortly after that. Will they be rather more inexpensive? Solely time will inform.
Sustainability of Results: Whereas GLP-1 medicines are efficient for weight reduction, analysis means that these medicines are in all probability a long-term dedication. For many individuals, their advantages are contingent on continued use. A research from the STEP 1 trial highlighted that two-thirds of the load misplaced utilizing semaglutide was regained inside a 12 months after therapy discontinuation. Because the numbers point out, some weight regain is probably going, however that’s not essentially true for everybody.
Once I work with purchasers who’re on GLP-1 agonist medicines, we focus not solely on meals, but in addition on relationship with meals and with way of life modifications corresponding to growing bodily exercise.
Limitations on Efficacy of GLP-1 Agonist Medicines: In response to Dr. Spencer Nadolsky, D.O. and Weight problems and Lipid Specialist, these meds do have their limits.
Proper now, the common is round 20% weight reduction with Tizepatide (Mounjaro). For a 400 pound particular person, that will imply 80 kilos misplaced. That particular person nonetheless has weight problems.
Along with this, Dr. Nadolsky bolstered the truth that not everybody responds to those medicines.
Root Causes of Weight problems: Weight problems is pushed by advanced elements, together with socioeconomic disparities, meals system points, and sedentary life. Conversely, GLP-1 medicines primarily goal processes corresponding to urge for food regulation and insulin sensitivity. These are clearly vital, however to essentially impact change on weight problems charges, there must be a complete focus not solely on pharmacology, but in addition public well being interventions. A 2023 evaluation in Nature Drugs proposed that initiatives to handle this challenge which have 4 elements: informing the general public about vitamin, enabling them to make health-promoting decisions, motivating them to make modifications to their routines and habits, and influencing behaviour by way of social norms and different strategies.
The evaluation steered growing energetic transport, growing healthcare payor incentives, bettering entry to and affordability of wholesome meals, limiting availability and media advertising of high-calorie meals, bettering meals labeling, reformulating meals merchandise to be extra healthful, and growing entry to weight administration packages and bariatric surgical procedure.
Facet Results and Contraindications: Frequent unwanted effects of GLP-1 medicines, corresponding to nausea, vomiting, and gastrointestinal discomfort, can deter adherence. Moreover, these medication are contraindicated for people with sure circumstances, corresponding to kidney illness, sure cancers, and a historical past of pancreatitis.
The Position of Dietary Interventions
GLP-1 medicines are efficient for most individuals, however modifications in weight loss program do should be a part of their use. Dietary methods can improve the efficacy of therapy whereas supporting long-term well being.
Listed below are some suggestions for consuming whereas on a GLP-1 medicines:
Prioritize Protein and Fiber: GLP-1 medicines sluggish gastric emptying, selling early satiety. Which means most meals and snacks must be nutrient-dense to keep away from nutrient deficiencies and promote general well being. A weight loss program wealthy in lean proteins (e.g., meat and fish, tofu, eggs, Greek yogurt and ricotta, beans and lentils) helps to take care of muscle mass. Getting ~25+ grams of fiber per day from greens, entire grains, and fruits, helps maintain fullness and helps blood sugar management. Don’t sleep on beans or soy meals as a method to get high-quality protein and fibre in a single place!
Reduce Extremely-Processed Meals: Processed meals excessive in refined carbohydrates, added sugars, and unhealthy fat can counteract the advantages of GLP-1 medicines. I like to recommend specializing in entire, minimally processed meals to enhance general metabolic well being. That additionally means minimizing alcohol and different lower-quality meals to assist maximize vitamins in your weight loss program.
Hydration and Small, Frequent Meals: Folks on GLP-1 medicines usually expertise nausea, which could be mitigated by staying hydrated and consuming smaller, extra frequent meals. On nauseous days, incorporating meals which are light on the abdomen, corresponding to soups and smoothies, may help.
Conscious Consuming Practices: GLP-1 medicines scale back urge for food, creating a possibility to observe conscious consuming. Slowing down throughout meals, savoring meals, and listening to starvation cues may help reinforce wholesome consuming behaviors.
Rising Weight Loss Medicines
Along with present GLP-1 receptor agonists, a number of promising weight reduction medicines are underneath growth or awaiting approval:
- Orforglipron Eli Lilly is growing Orforglipron, an oral GLP-1 receptor agonist. This treatment might present an alternate for sufferers preferring to not use injectables.
- CagriSema (Cagrilintide/Semaglutide Mixture) Novo Nordisk is advancing this mixture remedy, displaying vital weight reduction results in early trials.
- Retatrutide Retatrutide is a triple-hormone receptor agonist, with early research reporting substantial weight discount.
- VK2735 Viking Therapeutics is exploring VK2735, an oral remedy with promising preliminary outcomes.
Conclusion
GLP-1 medicines provide vital advantages for people scuffling with weight problems, however they aren’t a panacea for the broader epidemics. Addressing these advanced, multifactorial challenges requires a complete strategy that mixes medical innovation with strong public well being efforts. By integrating dietary methods, selling equitable entry to care, and tackling systemic points, we are able to make significant progress towards reversing the tendencies in weight problems.
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