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 apply (they aren’t), or that perhaps I don’t agree with utilizing prescribed drugs over food regimen 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 alter individuals’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 could point out a common downward pattern that could be attributed partially to GLP-1 medicines, there are good causes to consider that these medicine is not going to drastically cut back the prevalence of weight problems…at the least, not now. However why?
The reply to this query is multifaceted and complex.
Limitations of GLP-1 Medicines in Addressing Inhabitants-Large Epidemic
Price and Accessibility: These medicines are tremendous costly – as in, over $15,000 a yr in some instances. This can be a big 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, corporations usually cap spending or length for GLP-1 medicines. Whereas some individuals qualify for GLP-1 meds via Medicare or Medicaid, many don’t.
A current listening to of the US Senate Committee on Well being, Schooling, Labor, and Pensions revealed that Ozempic prices 15x extra in the USA 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 yr mark. The explanations for going off the meds embrace price, unintended 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 individuals 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 total).
The patents for a number of of those medicines are up in March, 2026, that means that inexpensive generic variations of semaglutide will doubtless be in the marketplace shortly after that. Will they be way more reasonably priced? 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 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 additionally on relationship with meals and with life-style adjustments corresponding to rising 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 typical 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 strengthened 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 necessary, however to actually impact change on weight problems charges, there ought to be a complete focus not solely on pharmacology, but additionally public well being interventions. A 2023 evaluation in Nature Drugs proposed that initiatives to handle this concern which have 4 elements: 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 by way of social norms and different strategies.
The evaluation advised rising energetic transport, rising 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 rising entry to weight administration applications and bariatric surgical procedure.
Facet Results and Contraindications: Frequent unintended 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 Function of Dietary Interventions
GLP-1 medicines are efficient for most individuals, however adjustments in food regimen do have to be a part of their use. Dietary methods can improve the efficacy of remedy 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 ought to be nutrient-dense to keep away from nutrient deficiencies and promote total well being. A food regimen wealthy in lean proteins (e.g., meat and fish, tofu, eggs, Greek yogurt and ricotta, beans and lentils) helps to keep up 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 strategy 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 entire, minimally processed meals to enhance total metabolic well being. That additionally means minimizing alcohol and different lower-quality meals to assist maximize vitamins in your food regimen.
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 can be light on the abdomen, corresponding to soups and smoothies, might help.
Aware Consuming Practices: GLP-1 medicines cut back urge for food, creating a chance to apply 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 beneath improvement or awaiting approval:
- Orforglipron Eli Lilly is creating Orforglipron, an oral GLP-1 receptor agonist. This treatment may present another for sufferers preferring to not use injectables.
- CagriSema (Cagrilintide/Semaglutide Mixture) Novo Nordisk is advancing this mix remedy, exhibiting important 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 important advantages for people battling weight problems, however they aren’t a panacea for the broader epidemics. Addressing these complicated, multifactorial challenges requires a complete method 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 traits in weight problems.
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