The introduction of glucagon-like peptide-1 (GLP-1) receptor agonists, comparable 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 towards GLP-1s – whether or not as a result of they’re ‘competitors’ for my observe (they aren’t), or that possibly 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 unbelievable instruments that can assist to alter individuals’s lives for the higher. However they aren’t the complete puzzle; they’re solely only a piece, and there are some very actual limitations to their use.
Current 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 that could be attributed partially to GLP-1 medicines, there are good causes to consider that these medicine is not going to drastically scale 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 Drugs in Addressing Inhabitants-Large Epidemic
Price and Accessibility: These medicines are tremendous costly – as in, over $15,000 a yr in some instances. It is 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 by means of Medicare or Medicaid, many don’t.
A latest 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 yr mark. The explanations for going off the meds embody value, unintended effects, or sluggish weight reduction.
In different phrases, so many individuals who would seemingly 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 general).
The patents for a number of of those medicines are up in March, 2026, that means that inexpensive generic variations of semaglutide will seemingly be available on the market shortly after that. Will they be far 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 most likely 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 burden misplaced utilizing semaglutide was regained inside a yr after therapy 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 modifications comparable to rising bodily exercise.
Limitations on Efficacy of GLP-1 Agonist Drugs: 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 advanced components, together with socioeconomic disparities, meals system points, and sedentary existence. Conversely, GLP-1 medicines primarily goal processes comparable to urge for food regulation and insulin sensitivity. These are clearly necessary, however to actually impact change on weight problems charges, there needs to be a complete focus not solely on pharmacology, but in addition public well being interventions. A 2023 evaluate in Nature Medication proposed that initiatives to handle this difficulty which have 4 components: informing the general public about diet, enabling them to make health-promoting selections, motivating them to make modifications to their routines and habits, and influencing behaviour by way of social norms and different strategies.
The evaluate steered rising energetic transport, rising healthcare payor incentives, bettering entry to and affordability of wholesome meals, limiting availability and media advertising and marketing of high-calorie meals, bettering meals labeling, reformulating meals merchandise to be extra healthful, and rising entry to weight administration packages and bariatric surgical procedure.
Aspect Results and Contraindications: Frequent unintended effects of GLP-1 medicines, comparable to nausea, vomiting, and gastrointestinal discomfort, can deter adherence. Moreover, these medicine are contraindicated for people with sure circumstances, comparable 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 food regimen do must 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 that most meals and snacks needs to be nutrient-dense to keep away from nutrient deficiencies and promote general 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, complete grains, and fruits, helps maintain fullness and helps blood sugar management. Don’t sleep on beans or soy meals as a solution 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 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 food regimen.
Hydration and Small, Frequent Meals: Folks on GLP-1 medicines usually expertise nausea, which will be mitigated by staying hydrated and consuming smaller, extra frequent meals. On nauseous days, incorporating meals which can be mild on the abdomen, comparable to soups and smoothies, may help.
Conscious Consuming Practices: GLP-1 medicines scale back urge for food, creating a possibility to observe aware consuming. Slowing down throughout meals, savoring meals, and listening to starvation cues may help reinforce wholesome consuming behaviors.
Rising Weight Loss Drugs
Along with current GLP-1 receptor agonists, a number of promising weight reduction medicines are below improvement or awaiting approval:
- Orforglipron Eli Lilly is growing Orforglipron, an oral GLP-1 receptor agonist. This remedy may present another for sufferers preferring to not use injectables.
- CagriSema (Cagrilintide/Semaglutide Mixture) Novo Nordisk is advancing this mix remedy, displaying 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 combating 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 sturdy public well being efforts. By integrating dietary methods, selling equitable entry to care, and tackling systemic points, we will make significant progress towards reversing the tendencies in weight problems.
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