It is still a moot point whether GLP-1s such as Novo Nordisk’s Wegovy and Eli Lily’s Zepbound are medical breakthroughs or a short-cut method to reduce weight. There is sufficient data on the health benefits of these drugs beyond reducing weight — they mitigate diabetes, kidney failure, sleep apnea and heart disease. Most users appreciate their immense social value.
GLP-1s have changed the treatment protocol of obesity but there are issues of ethics for the medical professionals — who should take them?
There is a huge market for both Wegovy and Zepbound. The FDA has approved these drugs on the basis of body mass — a body mass index of 30 or more are eligible. Those with a body mass index of 27 or higher with a weight-related condition such as high BP or sleep apnea can take them. Some 57 million Americans satisfy these criteria. They are of the working age group. Some 14 million retirement age Americans satisfy these criteria. These drugs, once commenced, are to be taken for life.
The issue is whether anyone satisfying these criteria should be prescribed these drugs. Medical professionals differ. Some are perfectly healthy at the BMI specified. And some have weight-related complications. There should be a distinction between these two.
Another issue is the shortages of these drugs and their high prices. Medical professionals will have to prioritize patients who should be prescribed these anti-obesity drugs.
The approach to GLP-1s should be evidence-based. Obesity experts will release a report in 2025 to this end. The criteria to define clinical obesity should be decided. At times, excess weight raises the risk of other health issues. Doctors should be able to identify who have the true disease of obesity (they must be treated early), and those who have excess 10-20 pounds, crossed BMI threshold and yet are healthy.
Users of GLP-1s gain weight if the ongoing treatment is discontinued. This is also true for those who have weight-related issues. The issue therefore, is when is someone’s weight loss enough. The doctors advise them to continue and to stick to lifestyle changes. The risk is that such long term continuation makes you lose muscle along with fat. This influences nutritional requirement.
There is no consensus among the medical professionals to manage obesity using drugs. Is BMI the right metric? Or should it be the weight-to-height ratio? Should the health markers be considered? The picture becomes more complicated because of the health benefits of GLP-1s that accrue, regardless of the quantum of weight loss
Doctors have standardized treatment goals for cholesterol, sugar and BP since the criteria are now well-settled. In case of obesity drugs, patients have strong opinions on these criteria despite evidence of what is good and bad.
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