GLP-1 medications are changing how people think about weight loss and how they actually lose weight, driving changes in views about obesity care among health systems and providers and affecting the broader US economy.
These drugs hold the potential to help address what continues to be an increasing obesity problem in the US. A 2024 study in The Lancet found the US obesity rate has at least doubled in adults and older adolescents since 1990.
Still, just a small percentage of people have used GLP-1 agonists and many do not know much about them. A KFF tracking poll in May found 6% of US adults were currently taking a GLP-1 medication, and 1 in 8 had taken one either for weight loss or to treat a condition like diabetes. The survey found 82% of poll participants had at least a little knowledge about the drugs, and 32% said they had “heard a lot” about them.
“Almost half of [US] adults are living with obesity, and this isn’t just a lifestyle issue,” said Warner Roberts, chief commercial officer at Calibrate, a program for employers and individuals that combines weight loss lifestyle coaching and GLP-1 medications. Roberts said during an Advisory Board webinar that dealing with lifestyle-related conditions is a challenge for providers and a cost driver.
“The system is not built to treat obesity as the root cause,” Roberts said. “It’s become a game of clinical Whac-A-Mole. Doctors are doing their best but they are stuck playing defense battling prior authorizations, managing downstream effects and not the disease itself. And the results – medications are used without support, short-term wins followed by long-term costs. Frustrating providers, frustrating patients.”
While there is a lot of media attention on these medications as part of the solution, they are not new. Since 2005, a number of them have been approved by the FDA to treat type-2 diabetes, one of the comorbid conditions Warner referred to, such as exenatide, or Byetta; liraglutide, or Victoza; dulaglutide, or Trulicity; semaglutide, or Ozempic; and tirzepatide, or Mounjaro. Continued research led to the first GLP-1 drugs approved for weight loss in people with obesity or overweight: liraglutide or Saxenda in 2014, semaglutide as Wagovy in 2021 and tirzepatide as Zepbound in 2023.
“Certainly with the GLP-1s coming on the market, weight loss was a nice surprise,” said Sophia Thomas, doctor of nursing practice and a past president of the American Association of Nurse Practitioners. “When they first came to market for diabetes, they noticed a side effect was weight loss.”
A potentially complex treatment option
The patient side of the equation can be complex, as some experts believe these medications, whether for diabetes or weight loss, may need to be taken throughout a person’s life, as a direct treatment or maintenance therapy.
Researchers are evaluating the impact of stopping the medications. Study results have been mixed so far, and while weight loss can be significant, results are dependent on a range of variables, such as participants, type of drug used, comorbidities, length of use and target outcomes.
A big fear is that because the drugs suppress appetite, stopping them may reignite hunger and lead to weight regain. That also could potentially undo any metabolic improvements that can go hand-in-hand with weight loss, such as in diabetes and blood pressure.
A study in the Journal of the American Medical Association supported that view, along with one in the journal Diabetes, Obesity and Metabolism that found that after stopping semaglutide for one year, people had regained two-thirds of the weight they had lost. Researchers said weight regain has been reported after stopping other obesity medications, and overall data “confirm the chronicity of obesity and highlight the importance of maintaining long-term pharmacological treatment for weight management in people with obesity.”
The success of GLP-1 medications can depend on how long people use them. A January study published in JAMA Network Open that included 125,474 patients on the medications found that 46.5% of those with type 2 diabetes and 64.8% of those without stopped taking the drugs within one year. Researchers noted that weight loss success, income level, medication costs and adverse effects were associated with decisions to continue or stop the medication.
Kanoe Namahoe, 54, was diagnosed with type 2 diabetes in January and has high blood pressure. The diabetes diagnosis was a wake-up call to take better care of her health, including through diet and exercise. She also has struggled with her weight over the years, so she had to come to grips with the process of dealing with all of it together.
“Some of these other issues can improve so that I will be able to get off of some of these other medications because that’s the whole thing. I just don’t want to be chained to medications the rest of my life,” said Namahoe, director of content for SmartBrief Education and Business Services.
She also was not keen on the idea of taking medication to help her lose weight.
“So, I was going on Ozempic for the diabetes thing and that’s what I had to tell myself, because I didn’t like the idea of taking medication to lose weight,” she said. “It felt like a copout. But what I’ve discovered is that it is not a copout. It is the thing that helps me be OK.”
Health care provider support is important
Namahoe is not traveling this road alone. She relies on her health care provider, who she sees regularly, to guide her and answer questions.
“I was seeing her almost monthly from January through April and now that I’m on the higher dosage (of the medication), I’m not going to see her for a few more weeks,” Namahoe said. “But we communicate back and forth all the time.”
Data from the Advisory Board found that 79% of people taking a GLP-1 medication received the prescription from their primary care provider or a specialist, instead of online or through a medical spa.
Thomas said it is important for patients to see their health care provider regularly, and care should be individualized to account for other conditions, such as hypertension. GLP-1 drugs can have significant side effects, especially gastrointestinal issues related to constipation or nausea. And they come with a warning about the potential for thyroid cancer.
“I recommend seeing patients initially within a month to see if they are tolerating the medication,” Thomas said. “Then I see them in a month to six weeks to titrate the dosage. Those can even be telehealth visits. Then after that, every three months or so to monitor weight and vital signs.”
Namahoe said the lifestyle changes she has made, combined with the medication, has cut her HbA1C levels from over 10 in January to 6.4 now. Her blood pressure readings also have improved, she said, “which my doctor credits to changes I made in diet and working out.” She described her weight loss as steady and healthy.
GLP-1s are costly
GLP-1 drugs are expensive, and many health insurance plans do not cover them. For people without insurance coverage, the monthly cost can be $1,200 or more. Some pharmaceutical companies, however, like Eli Lilly and Co., have discount programs for people who do not have insurance, bringing the costs down by about half.
Medicare may cover GLP-1s for diabetes or cardiovascular disease but not for weight loss. Medicaid determinations are made by each state and while some pay for the drugs, many do not, and some of those that do are reconsidering their decision.
Online providers offered compounded GLP-1 drugs to individuals at a discounted price when the medications were first approved and high demand created shortages, but the FDA earlier this year deemed the shortages were over and banned most compounded sales of the drugs. There were concerns about the ingredients used in the compounded formulas and that patients buying the drugs online did not have support from health care professionals.
How bariatric surgery fits into the picture
Warner said Calibrate “flips the script,” offering access to the medications as part of a more holistic obesity treatment model for individuals or for employers to offer as an employee benefit. He said it is clinician-led and evidence-based, and includes health monitoring and lifestyle changes. “ Every member gets a tailored plan. And a path to bariatric surgery if appropriate,” he said, adding that the program delivers 19% sustained weight loss at 36 months.
Bariatric procedures or surgery were go-to options for many people prior to GLP-1 medications. Bariatric surgery is covered by many commercial insurance plans and Medicare and Medicaid, but bariatric endoscopy may not be covered.
Gabriela Marmolejos, a research consultant with the Advisory Board, said the popularity of the new weight loss medications will affect the volume of bariatric procedures. Advisory Board research predicts a 22% decline in bariatric surgery by 2029. Data from 809 hospitals show a 32% decrease in bariatric surgery volumes from 2022 to 2024.
“Consumer preferences are making hospitals rethink their weight loss programs,” Marmolejos said. “It’s affecting their revenue – with a decline in bariatric surgeries.”
Hospitals are reimaging their weight-loss programs, Marmolejob said, and integrating medical and surgical programs and cross-training clinicians. “The growing number of patients seeking weight loss may eventually lift bariatric procedure volumes,” she added. “We haven’t seen it yet but it could happen.”
Marmolejobs noted two studies have shown that combining GLP-1s and bariatric surgery may be more cost-effective than each intervention on its own.
Dr. Rashmi Advani, director of bariatric endoscopy at Mount Sinai’s Center for Interventional Endoscopy and an assistant professor of medicine at the Icahn School of Medicine, said GLP-1 medications address one barrier to patients considering bariatric surgery or bariatric endoscopy – access to health care facilities that provide this type of care.
“So, GLP-1s came out in the perfect time, frankly, because not only can almost everybody prescribe it who’s comfortable prescribing it, but you can also have many clinics and sites offering this compared to bariatric endoscopy or bariatric surgery,” said Advani, a member of the American College of Gastroenterology.
Advani noted that the cost of the GLP-1 medications, side effects and the potential of having to take them long term are drawbacks. “So, in sort of the bariatric endoscopy and bariatric surgery realm, we advocate for more of a combined approach.”
That could include bariatric surgery or endoscopy followed by a short course of GLP-1 medications. The goal is to maximize the weight loss while being able to get patients off the drug in the future in a way that “they don’t feel like they’re going to regain the weight.”
Weight loss using GLP-1 medication varies by individual, but data suggest it is from 10% to 20% of total body weight over one year. Anecdotally, some patients have seen greater weight-loss totals.
Advani said the combined approach may lead to better weight loss results in the long term. She said a combined approach with endoscopic sleeve gastroplasty could lead to an average weight loss of about 28% to 30% of total body weight, and with bariatric surgery, it could be from 25% to 40%.
“So, you’re still gaining quite a bit of benefit from those slightly more invasive approaches in combination with the GLP versus just being on the GLP alone,” she added.
GLP-1 drugs change shopping habits
GLP-1 medications are affecting more than just how people diet. They also are changing how people shop for groceries.
A study published in the Cornell SC Johnson College of Business Research Paper Series found that in homes where at least one person was using the weight-loss medication, spending on groceries dropped 5.5% within six months, driven by fewer purchases of calorie-dense, processed foods. The study also found an 8.6% decrease in spending at coffee shops, fast-food chains and limited service restaurants.
“We’re seeing their impact on consumer preferences for groceries, food, alcohol, travel, fitness solutions and even clothing sizes,” Marmolejos said. “In the health care industry they’re changing consumer expectations for how to lose weight, the timeliness of weight loss and the types of providers offering weight management support.”
There are more than 100 GLP-1 drugs in the development stages, and researchers are looking at using them for a variety of indications far beyond weight loss or diabetes control. Yet it will be years before their full impact on patients, providers and the economy are fully known.
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