It’s hard to turn on the TV or read any publication these days without seeing ads for, or references to, the increasing number of GLP-1 Agonists that have been approved for or are being used for weight loss (Ozempic, Wegovy, Zepbound, Saxenda, Mounjaro, etc.). The reason for this is that these drugs (many of which are primarily indicated for treatment of diabetes) have been shown to produce significant weight loss – up to 20% in some patients.
The popularity of these drugs, which has been driven by heavy traditional and social media marketing, has spawned a large number of physical and virtual companies with licensed providers who are willing and able to write, and in some cases fulfill, prescriptions for GLP-1s (which remain in short supply). While these providers are well within their rights to prescribe these medications, they also have an obligation to disclose the significant clinical and financial issues that accompany them.
Good News for Many
On the most basic level, GLP-1s are good news for the 70% of our nation’s population who are overweight or obese (or as in the current parlance “have overweight” or “have obesity,” to indicate that these are medical conditions rather than lifestyle choices), and potentially for the cost of our healthcare system as a whole.
As stated in my new book, Here Be Dragons, extensive national research has irrefutably shown that obesity is a significant individual and public health issue that is tied to increased morbidity and mortality and lower quality of life.
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Research also has shown that obesity-related health issues account for more than 20% of all healthcare costs – a staggering $170 billion annually – and that healthcare costs for obese individuals are on average 40% higher than for normal-weight individuals. So it’s hard to argue that these new drugs, and others in this class that are sure to follow, are not good news on multiple levels.
Clinical Issues
However, GLP-1 Agonists are not the silver bullet that some believe. The first issue is that they don’t work for everyone, either because no significant weight loss is achieved or because the drugs’ side effects are too difficult to tolerate (nausea, vomiting and diarrhea are among the most common, though there are other less common but more serious ones). It is estimated that as many as one-third of those who try GLP-1s end up discontinuing them for one or both of these reasons.
Other issues include the fact that GLP-1s achieve weight loss by stimulating muscle as well as fat loss. This can have serious consequences for older patients in particular, who have less muscle mass to begin with. And even for those who lose a lot of weight without the most common side effects there can be unanticipated problems, including the need for some GLP-1 patients to have “body contouring” surgery to eliminate excess skin that is no longer needed after significant and possibly too rapid weight loss.
In addition, there is some evidence that GLP-1s increase the incidence of unplanned pregnancies (by interfering with the effectiveness of birth control pills) and cause complications during elective surgeries. Perhaps the biggest problem, though, is that many patients regain most of their lost weight and lose most of the cardiometabolic benefits of weight loss within a year after they stop using GLP-1s.
Financial Challenges
The fact that a significant part of the weight loss and health gains are lost when patients stop taking the drugs would not be as much of an issue if they were less expensive, but at a current average list price of about $1,000 per month in the U.S. (vs. $155 per month for Ozempic in Canada and $59 per month in Germany), taking GLP-1s for life is unaffordable for most American patients. Contributing to this problem is the fact that many third-party payers (health insurers and employers) are not covering the cost of these drugs, narrowly restrict those who are covered and/or have limited the time that coverage is provided.
Insurance coverage denials and limitations are of course frustrating for the millions of patients who would truly benefit from GLP-1s, but adding the significant additional cost of these expensive and potentially ubiquitous drugs (Goldman Sachs has predicted that the anti-obesity drug market will reach $100 billion annually by 2030 – a 16X increase over what it is today) to the costs of supporting other expensive new treatment modalities and the growing healthcare costs of an aging population is a decision that cannot be taken lightly. Medicare, for example, has thus far stuck to its longstanding policy of not covering weight loss treatments, though the agency recently announced that they would cover Wegovy for heart disease.
A case might be made that an “investment” in covering the costs of GLP-1s would be more than offset over time by reduced obesity-related healthcare costs. However, in our current healthcare system, there is no guarantee that a covered GLP-1 patient will be insured by the same carrier long enough for this payback to occur, and a recent analysis by the Congressional Budget Office (as yet unpublished) has reportedly concluded that covering the weight loss drugs at their current prices would cost the federal government more than the savings from the medication’s benefits.
Qualified Breakthrough
So, while GLP-1 Agonists are a most welcome addition to the weight loss arsenal, they are not a silver bullet – either clinically or financially – and these limitations should be communicated to potential patients up front. GLP-1s have proven to be remarkably effective for many overweight and obese patients, but they don’t work or cannot be tolerated for a significant portion of this population.
Also, some of the unanticipated consequences are meaningful (e.g. muscle loss), and weight is often regained as soon as patients stop taking them. Finally, GLP-1s are unaffordable for most patients without third-party coverage, which is still in doubt and may be limited at best.
In light of all this, other approaches to weight loss must continue to be considered. Bariatric surgery has proven to be a good option for some patients, other less expensive drugs can be tried, and weight loss programs based on healthy eating and regular exercise remain foundational in all treatment regimens. As is usually the case, no single treatment for most complex medical conditions works for everyone for a variety of reasons, and GLP-1s – as significant a breakthrough as they appear to be – are no exception.
Web Golinkin (webgolinkin.com/), author of the Amazon bestseller Here Be Dragons: One Man’s Quest to Make Healthcare More Accessible and Affordable, has been CEO of six companies over the last 35 years, including FastMed, RediClinic and Health Dialog. He also co-founded and chaired the Convenient Care Association, a national trade association of organizations that provide consumers with high-quality, convenient and affordable healthcare in retail-based locations. Golinkin has been widely covered in the national media and has spoken at numerous healthcare conferences.
