The appeal of GLP-1 weight-loss medications, including Wegovy and Ozempic, is starting to fade as healthcare professionals express concerns over their increasing use, potential side effects, and the unrealistic expectations many patients have regarding their effectiveness.
These drugs have garnered significant attention for not only aiding in weight loss but also for their promising potential to reduce the risk of heart attacks, strokes, certain cancers, and even Alzheimer’s disease. However, questions about their accessibility, affordability, and long-term viability have begun to overshadow these benefits.
Peter Antall, chief medical officer of the digital health company Lark, explained, “There is almost a backlash kind of sentiment going on,” emphasizing that while the drugs’ power remains undebated, their real-world application is raising alarms among practitioners. He added, “The shine is coming off how they’re being used in real practice.”
Millions are now turning to these anti-obesity drugs, produced by pharmaceutical giants Novo Nordisk and Eli Lilly, as well as more affordable alternatives from compounding pharmacies. Despite their life-changing potential, these medications are often burdened by high costs and inconsistent insurance coverage, limiting access for many.
Ethan Lazarus, a physician specializing in obesity medicine, pointed out a critical issue: “Everybody just thinks it’s this miracle fix.” He clarified that while the drugs can be effective, they come with challenges such as their hefty price tags, the risk of side effects, and the requirement for ongoing use. “Do I really want to be taking this injection for the rest of my life?” he questioned.
Research has shown that most patients discontinue the medications within two years, with many using them for less than a year. The primary reasons include prohibitive costs—Ozempic can cost nearly $1,000 a month, while Wegovy is even more expensive—along with periodic drug shortages and gastrointestinal side effects, such as nausea and diarrhea, as well as rarer but serious issues like pancreatitis.
Christopher McGowan, an obesity specialist and gastroenterologist, highlighted concerns about the long-term effects of stopping these medications. “What happens to the body and mind when these medications are discontinued?” he asked. Studies suggest that discontinuing GLP-1s can lead to weight regain, which may negatively impact metabolic health.
One critical concern is “weight cycling,” the process of losing and regaining weight, which can worsen metabolic health. Dr. McGowan noted that while GLP-1s help reduce both fat and muscle mass, when discontinued, the regained weight is primarily fat. This could result in a lower basal metabolic rate, diminished strength, and higher risks of fractures and bone density loss.
The FDA has issued warnings regarding unapproved versions of GLP-1 drugs that have not been rigorously tested for safety and efficacy. In addition, Robert F. Kennedy Jr., the Secretary-designate for the Department of Health and Human Services, has recommended that people prioritize lifestyle changes and healthier eating before resorting to medication.
Experts also agree that more research is needed to understand the risks associated with fluctuating between using and stopping these drugs. Cardiologist C. Michael Gibson, who both prescribes and uses GLP-1 medications, emphasized the importance of identifying whether the negative outcomes are linked to the medications themselves or individual patient factors.
While the market for these drugs continues to grow, there is promising research being done on alternative treatments that could make these medications more affordable and easier to tolerate. Companies like Knownwell are gathering data suggesting that patient coaching and monitoring may significantly improve adherence and overall success with these drugs.
Looking ahead, the development of oral versions of GLP-1s that eliminate the need for injections could further drive demand and accessibility, potentially lowering costs and improving patient outcomes. “I think these prices will come down in a couple of years,” Antall predicted, while acknowledging that the current landscape is disorganized and fraught with challenges for patients’ health.
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