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 enhancing 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 follow (they aren’t), or that perhaps I don’t agree with utilizing prescription drugs over weight-reduction plan for weight reduction. I wrote all about that right here.
I consider the brand new class of weight reduction medicines are unimaginable instruments that can assist to vary individuals’s lives for the higher. However they aren’t all the 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% improve in using GLP-1 agonist medicines between 2019 and 2023.
Though even a 0.04% change in weight problems charges could point out a normal downward pattern that could be attributed partly to GLP-1 medicines, there are good causes to consider that these medicine won’t drastically scale back the prevalence of weight problems…no less than, not now. However why?
The reply to this query is multifaceted and complex.
Limitations of GLP-1 Medicines in Addressing Inhabitants-Vast Epidemic
Price and Accessibility: These medicines are tremendous costly – as in, over $15,000 a yr in some instances. This can be a enormous barrier for individuals who can’t afford to pay out of pocket, or who don’t have non-public insurance coverage protection. Even for these with non-public insurance coverage, firms usually cap spending or length for GLP-1 medicines. Whereas some individuals 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 USA than in Germany. Knowledge 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 yr mark. The explanations for going off the meds embrace value, uncomfortable side effects, or sluggish weight reduction.
In different phrases, so many individuals who would possible profit vastly from these medicines, simply can’t entry them in any respect, or for lengthy sufficient. Entry is decrease for individuals in sure racial and ethnic teams, that are additionally the teams which have the very 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 inexpensive generic variations of semaglutide will possible be in the marketplace 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 most likely a long-term dedication. For many individuals, their advantages are contingent on continued use. A examine from the STEP 1 trial highlighted that two-thirds of the load misplaced utilizing semaglutide was regained inside a yr after remedy discontinuation. Because the numbers point out, some weight regain is probably going, however that’s not essentially true for everybody.
After I work with shoppers 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 adjustments 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 complicated elements, together with socioeconomic disparities, meals system points, and sedentary existence. Conversely, GLP-1 medicines primarily goal processes corresponding to urge for food regulation and insulin sensitivity. These are clearly essential, however to essentially impact change on weight problems charges, there ought to be a complete focus not solely on pharmacology, but in addition public well being interventions. A 2023 overview in Nature Drugs proposed that initiatives to deal with this problem which have 4 components: informing the general public about vitamin, enabling them to make health-promoting decisions, motivating them to make adjustments to their routines and habits, and influencing behaviour through social norms and different strategies.
The overview steered growing energetic transport, growing healthcare payor incentives, enhancing entry to and affordability of wholesome meals, limiting availability and media advertising of high-calorie meals, enhancing meals labeling, reformulating meals merchandise to be extra healthful, and growing entry to weight administration packages and bariatric surgical procedure.
Facet Results and Contraindications: Widespread uncomfortable side effects of GLP-1 medicines, corresponding to nausea, vomiting, and gastrointestinal discomfort, can deter adherence. Moreover, these medicine 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 adjustments in weight-reduction plan do must be a part of their use. Dietary methods can improve the efficacy of remedy whereas supporting long-term well being.
Listed here are some ideas for consuming whereas on a GLP-1 medicines:
Prioritize Protein and Fiber: GLP-1 medicines sluggish gastric emptying, selling early satiety. Which means that most meals and snacks ought to be nutrient-dense to keep away from nutrient deficiencies and promote general well being. A weight-reduction plan 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, complete grains, and fruits, helps maintain fullness and helps blood sugar management. Don’t sleep on beans or soy meals as a technique to get high-quality protein and fibre in a single place!
Decrease 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 complete, 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-reduction plan.
Hydration and Small, Frequent Meals: Individuals on GLP-1 medicines usually expertise nausea, which might be mitigated by staying hydrated and consuming smaller, extra frequent meals. On nauseous days, incorporating meals which can be mild on the abdomen, corresponding to soups and smoothies, might help.
Conscious Consuming Practices: GLP-1 medicines scale back urge for food, creating a possibility to follow conscious consuming. Slowing down throughout meals, savoring meals, and listening to starvation cues might 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 medicine 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 supply vital advantages for people battling weight problems, however they don’t seem to be a panacea for the broader epidemics. Addressing these complicated, multifactorial challenges requires a complete strategy that mixes medical innovation with sturdy 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 traits in weight problems.
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