Nearly three-quarters of American adults are overweight, while about 40% are obese. These numbers are huge, as are some of the people the numbers refer to. Weight-loss drugs are all the rage these days. It is difficult to imagine that it took years for scientists to figure out peptide drugs for diabetes were also good for weight loss in overweight adults.
Weight loss peptide drugs, known as GLP-1s, work by reducing appetite, slowing down gastric emptying, and boosting feelings of satiety. Newer versions of GLP-1 drugs feature additional ways to reduce overeating. These are sometimes referred to as GLP-2 and GLP-3, meaning second and third generation GLP-1s. For example, Novo Nordisk recently applied to the FDA to add Cagrilintide to Ozempic. Cagrilintide is a synthetic hormone that controls appetite. That feeling of nausea some people get after a heavy meal when offered more food is related to amylin, a hormone that controls appetite. The natural hormones that control the desire to eat last only a few short minutes, but synthetic GLP-1 peptides that mimic them have a half-life of about a week. That is why dosing only requires one shot a week.
GLP-1 drugs used to be expensive, with a list price of well over $1,000 a month. In 2023, the American Enterprise Institute estimated the list prices of Ozempic was $936, while Wegovy was $1,349 (both are composed of Segmaglutide). Those prices have fallen significantly in the last few months. Growing competition is one reason. Another is the Trump Administration’s strong-arm negotiations with drugmakers. Possibly a third reason is that demand curves are downward sloping. That means drug companies will sell an order of magnitude more drugs if they lower the price to what people can afford.
Cost is not the only reason people shy away from GLP-1 drugs. A few people complain about adverse gastrointestinal distress (nausea, bloating, diarrhea). Some people even complain that the joy of a good meal is gone. Sunlight News reported people foregoing GLP-1 doses during the week of Thanksgiving so they could enjoy the holiday. Seniors on GLP-1 drugs should also take protein supplements to avoid excess muscle loss.
The new weight-loss drugs work well, but the dosage must rise month after month. They also must be taken for a lifetime. The New York Times reports that about half of people who begin taking them stop within a year. From NYT:
Another study of 125,474 people with overweight or obesity found that almost 47 percent of those with Type 2 diabetes and nearly 65 percent of those without diabetes stopped taking GLP-1s within a year — a high rate, said Dr. Ezekiel Emanuel, a health services researcher at the University of Pennsylvania and senior author of the study.
Patients over age 65 were 20 to 30 percent more likely than younger ones to discontinue the drugs and less likely to return to them.
Without maintenance doses, the pounds soon reappear.
That usually means regaining weight and losing the associated health benefits, including lower blood pressure, cholesterol and A1c, a measure of blood sugar levels over time.
The obesity rate for people aged 65 and over is around 40%. Thus, they are prime candidates for obesity drugs. One problem is cost. Even with insurance coverage, many Medicare Advantage plans only cover GLP-1 drugs for diabetes and sever obesity, not just people who are overweight. While TrumpRx will make weight-loss drugs as low as $149 a month for some people who pay cash, many seniors may feel that nearly $1,800 a year is beyond their budget. Others claim side effects cause them to stop taking the drugs, including muscle loss and nausea. Finally, some people may prefer enjoying the affordable luxury of food. A professor once remarked that a reason many poor people are overweight is because food is one of the few pleasures they can afford. Although effective GLP-1 drugs are not necessarily a magic bullet against obesity.
Read more at NYT: Older Americans Quit Weight-Loss Drugs in Droves