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 drugs 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 apply (they aren’t), or that possibly I don’t agree with utilizing prescription drugs over food regimen for weight reduction. I wrote all about that right here.
I imagine the brand new class of weight reduction drugs are unimaginable instruments that can assist to vary folks’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% improve in the usage of GLP-1 agonist drugs between 2019 and 2023.
Though even a 0.04% change in weight problems charges could point out a normal downward development which may be attributed partially to GLP-1 drugs, there are good causes to imagine that these medication won’t drastically cut 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-Large Epidemic
Value and Accessibility: These drugs are tremendous costly – as in, over $15,000 a yr in some circumstances. It is a large 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 drugs. Whereas some folks qualify for GLP-1 meds by 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 US than in Germany. Knowledge on affected person discontinuation of GLP-1 receptor agonist drugs 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, negative effects, or gradual weight reduction.
In different phrases, so many individuals who would probably profit enormously from these drugs, simply can’t entry them in any respect, or for lengthy sufficient. Entry is decrease for folks 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 drugs are up in March, 2026, that means that inexpensive generic variations of semaglutide will probably be in the marketplace shortly after that. Will they be far more reasonably priced? Solely time will inform.
Sustainability of Results: Whereas GLP-1 drugs are efficient for weight reduction, analysis means that these drugs 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 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 purchasers who’re on GLP-1 agonist drugs, we focus not solely on meals, but additionally on relationship with meals and with way of life modifications 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 common is round 20% weight reduction with Tizepatide (Mounjaro). For a 400 pound particular person, that may 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 drugs.
Root Causes of Weight problems: Weight problems is pushed by complicated components, together with socioeconomic disparities, meals system points, and sedentary life. Conversely, GLP-1 drugs primarily goal processes corresponding to urge for food regulation and insulin sensitivity. These are clearly vital, 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 overview in Nature Drugs proposed that initiatives to deal with this concern which have 4 elements: 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 through social norms and different strategies.
The overview steered rising energetic transport, rising 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 rising entry to weight administration packages and bariatric surgical procedure.
Aspect Results and Contraindications: Widespread negative effects of GLP-1 drugs, corresponding to nausea, vomiting, and gastrointestinal discomfort, can deter adherence. Moreover, these medication 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 drugs are efficient for most individuals, however modifications in food regimen do should 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 drugs:
Prioritize Protein and Fiber: GLP-1 drugs gradual gastric emptying, selling early satiety. Because of this 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 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!
Reduce Extremely-Processed Meals: Processed meals excessive in refined carbohydrates, added sugars, and unhealthy fat can counteract the advantages of GLP-1 drugs. I like to recommend specializing in complete, 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: Individuals on GLP-1 drugs usually expertise nausea, which may be mitigated by staying hydrated and consuming smaller, extra frequent meals. On nauseous days, incorporating meals which are mild on the abdomen, corresponding to soups and smoothies, might help.
Conscious Consuming Practices: GLP-1 drugs cut back urge for food, creating a chance to apply aware 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 drugs are below growth or awaiting approval:
- Orforglipron Eli Lilly is creating Orforglipron, an oral GLP-1 receptor agonist. This remedy might present an alternate for sufferers preferring to not use injectables.
- CagriSema (Cagrilintide/Semaglutide Mixture) Novo Nordisk is advancing this mixture 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 drugs provide important advantages for people combating 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 will make significant progress towards reversing the developments in weight problems.
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