“The medication’s going to be 50 percent of your journey, and the other 50 percent is still what you choose to eat and the exercise you’re going to put in.” — Obesity specialist Dr. Rocio Salas-Whalen
Last week, I discussed the mechanism of GLP-1, a popular semaglutide sold under the brand names Ozempic, Wegovy and others. While semaglutides are mainly prescribed for control of Type 2 diabetes (insulin resistance) and treatment of obesity, they’re starting to look like magic bullets for a host of other health issues, including:
Cardiovascular disease: In 2024, the Food and Drug Administration approved semaglutides to treat heart disease after studies showed they could cut the risk of strokes and other heart-related deaths by 20 percent.
Kidney disease: Also approved by the FDA earlier this year. One study found semaglutides led to a 24 percent drop in the risk of kidney failure in patients with Type 2 diabetes.
Alzheimer’s disease: Alzheimer’s has been linked to insulin resistance in the brain, leading to ongoing trials that indicate semaglutides can reduce the incidence of Alzheimer’s for people with Type 2 diabetes.
Depression: Ongoing trials, with promising indications that semaglutides can alleviate chronic depression.
Alcoholism: In a nine-week long double-blind trial last year, half of 48 alcoholics were given semaglutides, the other half placebos. The semaglutide group reported needing fewer drinks and less craving. Studies are now underway to see if semaglutides can be used to treat other addictions, including nicotine and opiates.
However, like all meds, semaglutides have downsides, including those no one knows about, since they’re too new for long-term studies.
Expense. Until recently, you’d be looking at around $1,000 per month for one of the standard semaglutides. That’s just come down to about $500 per month. As patents run out and pharma companies figure out generic workarounds, prices will surely keep dropping. (Even so, if only people with disposable income can afford these drugs, that could cement the stereotypical association between being fat and being poor.)
Long-term use. Like every diet and exercise plan, once someone comes off using semaglutides, chances are (in at least two-thirds of cases) they’ll regain their original weight. Or worse: The common “yo-yo effect” often leads to patients ending up heavier than when they began the regime. The trick, according to obesity experts, is to treat semaglutides as adjuncts, not replacements, for nutrition and exercise. Ideally, obese patients’ initial weight loss will motivate them to feel more in control of their bodies, leading them to embrace a healthy lifestyle. The goal, then, is to eventually reduce semaglutide injections to microdoses, or even wean off the drugs completely.
Unsuitability for “casual” weight loss. While they’re very effective for obese patients (BMI 30+) who typically lose 15 to 20 percent of their body weight in the first year, they’re not so good for someone slightly overweight who wants to drop 10 pounds for, say, an upcoming wedding. That’s because a reduction in calories leads to losing both fat and lean body mass (i.e. muscle and bone). With obese patients, that’s a worthwhile trade-off, but it’s unhealthy for a slightly overweight person who can’t afford to lose muscle tissue.
Side effects. These vary from uncomfortable to (in rare cases) dangerous. Many patients experience nausea, vomiting, diarrhea, constipation, increased heart rate and heartburn while the body adjusts to the meds.
With obesity levels everywhere rising exponentially, semaglutides offer the promise of controlling what otherwise looks like a pandemic. Still, as I see grocery shelves loaded with junk food and drink, I do wonder: Why are we treating the symptoms, rather than the cause?
Barry Evans (he/him, barryevans9@yahoo.com, planethumboldt.substack.com) isn’t a doctor. Nothing here should replace discussions with your physician.
This article appears in A Place to Stop and Rest.