Our wave of revolutionary weight loss drugs can be a miracle if we get it right

It’s the usual ritual at the start of a new year. We see it reflected in media advertisements highlighting new diet plans, exercise regimens and weight loss programs. “Before” and “after” images show people smiling as they enjoy the outdoors in their stylish outfits accentuating new, svelte bodies. 

It’s powerful marketing for a population that is constantly searching for tools, and sometimes magic formulas, to lose pounds and maintain the weight loss. 

More than 40 percent of Americans suffer from obesity. Over 230 chronic diseases are worsened by living with obesity and the annual medical cost is $172 billion. The impact of obesity on the health of patients and the overall economy is monumental.

This past year, several medications that are used to treat diabetes have been approved for weight loss in patients with obesity. The class of drugs is glucagon-like peptide 1, or GLP-1, agonists. They not only lower blood glucose levels by stimulating insulin secretion but also slow the transit of food from the stomach to the small intestines. This results in feeling full faster and longer which increases satiety and decreases the drive to eat more. 

The gut-brain pathway is complex and is being studied in patients with and without diabetes to further understand the role of GLP-1 agonists for long-term weight management as well as other health benefits such as lowering the risk of heart and kidney diseases and even strokes. 

A study published in the New England Journal of Medicine found that with weekly injections of GLP-1 agonists, there was a 15 percent reduction in body weight versus only 2.4 percent in the placebo group in one year. This translates into a 28-pound difference between the two groups with an associated reduction in cholesterol, blood pressure and glucose levels. These are significant results. 

However, GLP-1 agonists are currently expensive, need to be injected and have, like all medications, potential side effects. Those include nausea, vomiting, diarrhea, pancreatitis, gastroparesis, endocrine malignancies, hair loss, sarcopenia (muscle resorption) and depression among other issues. Concern over malnutrition, including sufficient protein consumption, has also increased. 

Despite the side effects, these agents have been a game changer in how health care providers and patients view obesity treatment. Even popular weight loss programs such as Weight Watchers, which traditionally focus on nutrition, food plans and support, now embrace the use of these medications for weight management and have been actively recruiting clinicians to oversee these programs. Celebrities tout their weight loss and how these medications have changed their lives, inspiring the general public to want greater access to these costly drugs. 

In healthcare, we’ve seen similar degrees of enthusiasm for other past interventions such as bariatric surgical procedures such as the lap band and drug combinations for weight loss like fen-phen. Over time, their risks and benefits were further elucidated impacting health care decisions and even the removal of fen-phen from the market.  

Long-term studies for GLP-1 agonist administration will be informative, especially for patients without diabetes. Already there is discussion on how to manage patients on these medications who need anesthesia or colonoscopy preparation since gastrointestinal transit is reduced. 

Fortunately, all this attention has translated into prolific conversations on obesity in the healthcare system, legislatures and advocacy organizations. 

In 2023, the National Consumer League developed the Obesity Bill of Rights and the Treat and Reduce Obesity Act was reintroduced into Congress with bipartisan support. These efforts can enhance public education and reduce the stigma and bias associated with obesity and, if adopted, will expand obesity screening and treatment coverage.

New interventions have radicalized the care of patients with obesity. But we can’t lose sight that there are significant inequities in our healthcare system. 

Ironically, those most afflicted by obesity are from a lower socioeconomic status and may never have access to these drugs. In several parts of the United States, there are food deserts where people don’t have accessible and affordable nutrition. Imagine the impact if industry would support these locations by building grocery stores with some of the profits that are generated from these medications.  

In the words of Benjamin Franklin, “An ounce of prevention is worth a pound of cure.”

Saralyn Mark, M.D., is an endocrinologist, the founder of SolaMed Solutions LLC and the American Medical Women’s Association’s COVID-19 lead. She is a former senior medical and policy adviser to the White House, the Department of Health and Human Services and NASA.