The introduction of glucagon-like peptide-1 (GLP-1) receptor agonists (Ozenpic and Wegoby) is a breakthrough in the management of obesity. These drugs have been proven to be extremely effective in promoting weight loss and improving blood sugar levels.
Many people may think I have something against GLP-1, but maybe because they are a “competition” for my practice (they aren’t), or I may not agree to use medicines in my diet to lose weight. I wrote everything about it here.
I think the new class of weight loss pills is an incredible tool that will help change people’s lives for the better. But they are not the whole puzzle. They are just works and there are very realistic limitations to their use.
Recent studies suggest that obesity rates in the US have dropped very slightly. From 46% in 2022 to 45.6% in 2023. There has been a 700% increase in GLP-1 agonist drug use between 2019 and 2023.
Even a 0.04% change in obesity rate may indicate a general downward trend due to some of the GLP-1 drugs, but there is good reason to believe that these drugs will not significantly reduce the prevalence of obesity… at least not now. but why?
The answer to this question is multifaceted and complicated.
Limitations of GLP-1 drugs in dealing with population-wide epidemics
Cost and Accessibility: These drugs are extremely expensive, sometimes over $15,000 a year. This is a major barrier for people who cannot afford to pay from their pocket or are not covered by private insurance. Even those with private insurance often limit the spending or duration of GLP-1 drugs. Some people are qualified for GLP-1 drugs through Medicare or Medicaid, but many do not.
A recent hearing by the US Senate Committee on Health, Education, Labor and Pensions revealed that Ozempic costs 15 times more in the United States than in Germany. Although data on patient discontinuation of GLP-1 receptor agonist drugs is inconclusive, the numbers range from about 50% within three months to 75% in the second year. Reasons for taking off your medication include costs, side effects, or slow weight loss.
In other words, many people who are likely to benefit greatly from these drugs will not be able to access them at all or long enough. Access is lower among people of certain racial and ethnic groups, and is also the group with the highest percentage of obesity (and overall the least access to health care).
Some patents for these drugs went into operation in March 2026, meaning that cheaper generic versions of semaglutide are likely to be on the market later. Are they much more affordable? Only time can be seen.
Sustainability of Effects: GLP-1 drugs are effective in weight loss, but studies suggest that these drugs are probably long-term commitments. For many people, their benefits are conditional on continued use. The study in the step 1 trial highlighted that within one year of treatment discontinuation, two-thirds of the weight lost with semaglutide was restored. As the numbers show, there is a high chance that some weight will be restored, but that doesn’t necessarily apply to everyone.
When working with clients using GLP-1 agonist drugs, we focus not only on food, but also on the relationships with lifestyle changes such as increased food and physical activity.
Limitations on the effectiveness of GLP-1 agonist drugs: According to Dr. Spencernadorsky, DO and obesity and lipid experts, these drugs have limitations.
Currently, the average weight loss is about 20% with cizepatide (Mounjaro). For a 400 pound person, that means 80 pounds will be lost. The person is still obese.
In addition to this, Dr. Nadolsky reinforced the fact that not everyone responds to these drugs.
The root cause of obesity: Obesity is driven by complex factors such as socioeconomic disparities, food system problems, and sedentary lifestyles. Conversely, GLP-1 drugs primarily target processes such as appetite regulation and insulin sensitivity. While these are obviously important, there should be a comprehensive focus not only on pharmacology but also on public health interventions to actually change obesity rates. A 2023 review of Nature Medicine proposed an initiative to address this issue, which has four parts. It informs the public about nutrition, allows for health promotion choices, motivates them to change their daily lives and habits, and influences behavior through social norms and other methods.
This review suggested increased aggressive transport, increased incentives for medical costs, improved access and affordability to healthy foods, limited availability of high-calorie foods and media marketing, improved food labeling, healthier food reforms, increased access to weight management programs and increased bariatric surgery.
Side Effects and Contraindications: Common side effects of GLP-1 drugs, such as nausea, vomiting, and gastrointestinal discomfort, can block compliance. Furthermore, these drugs are contraindicated for individuals with certain conditions, such as kidney disease, certain cancers, and history of pancreatitis.
The role of dietary intervention
GLP-1 drugs are effective for most people, but dietary changes should be part of their use. Dietary strategies can increase the effectiveness of treatments while supporting long-term health.
Here are some dietary tips while using GLP-1 medications.
Prioritize proteins and fibers: GLP-1 drugs slowly make your stomach empty and promote early satiety. This means that most diets and snacks need to be nutritious intensive to avoid nutritional deficiencies and promote overall health. A diet rich in lean protein (meat and fish, tofu, eggs, Greek yogurt and ricotta, beans and lentils, etc.) can help you maintain muscle mass. By obtaining ~25 grams or more of fiber per day from vegetables, whole grains and fruits, it maintains bloating and supports blood sugar control. Don’t sleep with bean and soy foods as a way to get high quality protein and fiber in one place!
Minimize Ultra-Highly Processed Foods: Processed foods that are high in refined carbohydrates, sugar additions, and unhealthy fats can counter the benefits of GLP-1 drugs. It is recommended to focus on the overall minimally processed foods to improve overall metabolic health. It also means minimizing alcohol and other low-quality foods to maximize the nutrients in your diet.
Hydration and small frequent diet: GLP-1 drug people often get nauseous. On nausea days, you can incorporate stomach-friendly foods such as soups and smoothies.
Mindful Dietary Habits: GLP-1 medications reduce appetite and create opportunities to practice mindful diet. Slowing down while eating, tasting food, or listening to hunger cues can help strengthen healthy eating behaviors.
New weight loss pills
In addition to existing GLP-1 receptor agonists, several promising weight loss drugs are currently under development or awaiting approval.
Orforglipron Eli Lilly is developing Orforglipron, an oral GLP-1 receptor agonist. This drug may provide an alternative to patients who prefer not to use injectables. Cagrisema (Cagrilintide/Semaglutide combination) Novo Nordisk is currently undergoing this combination therapy and has shown significant weight loss benefits in early trials. Retatrutide retatrutide is a triple hormone receptor agonist, and early studies have reported significant weight loss. VK2735 Viking Treatment is investigating VK2735, an oral therapy with promising preliminary results.
Conclusion
GLP-1 drugs offer great benefits for individuals suffering from obesity, but they are not the panacea of the broader epidemic. Addressing these complex and multifactorial challenges requires a comprehensive approach that combines healthcare innovation with robust public health initiatives. By integrating dietary strategies, promoting equitable access to care, and addressing systemic issues, meaningful advances can be made to reverse the obesity trend.
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