GLP-1s: Why should you care?

This is a free preview of a paid episode. To hear more, visit www.eatinginamerica.coYou’ve got a healthy weight, or you are not interested in weight loss, or at least in weight loss using available medical paths like GLP-1s or bariatric surgery – why should you care about GLP-1s?GLP-1s are a factor in the continued fast rise in health care costs in America. If you don’t need them or take them but you have medical insurance or just pay federal taxes, you are likely still affected by the cost and popularity of GLP-1s. (I might point out that most people don’t ever have cancer, but their insurance payments help save the lives of those who do. Maybe it can be seen as a sort of actuarial scientist’s form of karma.) No matter our personal stance, GLP-1s are having an impact on the health and economic well-being of America.I was writing today’s update on GLP-1s when I noticed a Boston Globe Editorial that mused about how the City of Boston wants to control the cost of GLP-1 medications for its employees, how that dilemma was common now across employers and insurers throughout government and industry, and what could be done to control GLP-1 pricing. The end of this podcast is what I posted in the Globe as comment both on its Editorial and the other comments of Globe readers.Also, today, many GLP-1 questions are popping up. GLP-1s and muscle mass – worry or no worry? Stretching out the GLP-1 dose schedule when a patient’s target weight level is reached would be a great way to save money…but does it work without weight re-gain?Also, what is happening with GLP-1 pricing, new products, and Ozempic patent expirations? And could GLP-1s really be made for only $3 a dose? There’s a lot going on.To our questions.If you are using or contemplating using a GLP-1 you have likely been made to worry about the fact that dieting causes loss of the soft tissue we like, such as muscles, along with loss of fatty tissue, which we don’t like. A lot of the anxiety about GLP-1 muscle loss is generated by social influencers and nutrition and conditioning hawkers. Not to worry…but do step up with the strength conditioning.The bigger you are the more muscle you need to support and control your weight. Strength and conditioning is always important, but especially so during weight loss. And, unlike dieting, where will-power is a very poor tool for permanent results, I do recommend putting will-power into play as much as possible if strength exercises are not your thing. Improvements can be seen from workout to workout, whether in the gym or your living room. The important thing is to start and continue on a regular basis, finding as many ways to enjoy yourself and take pride in your gains as possible.A small study has found that once some patients reach their target weight on a GLP-1 they can reduce the frequency of their doses without regaining weight. This finding is hopeful for GLP-1 patients having difficulty with the long-term cost of the medication, but much more research is needed to understand the risks and conditions required for success in any reduced dosing approach. We do know that a complete stopping of GLP-1 treatment is strongly linked to weight regain. Proceed with caution if thinking about a reduced dosage and be sure to consult your health care provider.The Trump administration’s work to reduce GLP-1 costs is welcome but, so far, not a huge game changer. Continued pressure on pricing may come from the introduction of competing medications, but manufacturers other than Novo Nordisk and Eli Lilly have not yet made application to the FDA for any product approvals.But there is room for improvement. A new study released in preprint found that semaglutide, the ingredient in Wegovy and Ozempic, could be sold for $12 a month in generic liquid form for injection and $36 a month in generic pill form, a dramatic savings over the cost of the Novo Nordisk brands.With Novo Nordisk semaglutide patents expiring this year in China, India, Brazil, Canada, Turkey and five other countries, and no patent protection in 150 other countries, theoretically by the end of this year 85% of the world’s population with the disease of obesity could be living in a country with a generic semaglutide medication available.Meanwhile, Novo Nordisk just received fast-track approval for a high-dose form of Wegovy in a pen. The dose in Wegovy HD is three times greater than the highest dose in regular Wegovy and average weight reduction is 21%, compared to 15% with regular Wegovy.Novo Nordisk has also just put its Wegovy pill on the market. Eli Lilly has applied on the fast track for approval for its new GLP-1 pill, Orforglipron. Unlike the Wegovy pill which must be taken on an empty stomach at least 30 minutes before eating anything, Orforglipron can be taken with or without food.That’s a rundown of the some of the biggest news in GLP-1s.The following is based on my response to the Boston Globe Editorial on GLP-1 coverage for City of Boston employees. The Editorial advocated compromises that could result in some people who were already on a GLP-1 being removed from coverage for their medication. The comments featured a lot of folks who were of the mind that will-power and exercise were all that is required for weight loss.Quote: I’m a nutritional epidemiologist and publish EatingInAmerica.co. I have studied the obesity epidemic in America, what has caused it, and the GLP-1 drugs. These highly effective medications are saving lives and reducing chronic disease, including obesity, diabetes, cardiovascular disease, kidney disease, osteoarthritis, and sleep apnea, and generally making life better for millions of Americans.Because of the arbitrarily high prices of GLP-1 medications in America, the point at which health care savings from GLP-1s exceed their costs is somewhere in the future, requiring the decision to cover them at this moment to be based in large part on difficult estimates of the value of these medications to the quality of life of a patient.There is still stigma on these medications because of some remaining popular belief, evidenced in many of the comments to the Boston Globe Editorial, that GLP-1s are the easy way out of unhealthy weight and that all that is required to restore a healthy weight is will-power and exercise. My personal opinion is that because of this remaining attitude it is easier for insurers and employers to restrict coverage to GLP-1s and save money.But why are we thinking about the use of medications to control weight at all? Best would be if we could roll back the clock 50 years to the beginning of the obesity epidemic, or 60 years to when ultraprocessed food was allowed to start taking over our food environment and put strong protections in place against the making and marketing of unhealthy food.