The market is abuzz with a new group of FDA-approved weight-loss drugs called GLP-1s, which decrease appetite, regulate blood sugar and slow stomach emptying, making you feel full sooner and for a longer period of time.
Retatrutide, an experimental drug still in clinical trials, has been shown to help patients lose one-quarter of their body weight on average. The problem is that these drugs are expensive, typically over $1,000 per month, and might require lifelong use in the absence of sustainable lifestyle changes.
One recent study showed that although patients experienced substantial weight loss with a GLP-1 over 16 months, most of the weight returned within one year. These medications could represent one of the biggest breakthroughs ever in health and longevity, and one of the best opportunities to reduce the global cost of health care in developed countries. However, without appropriate behavioral changes, including nutrition and physical activity, patients might develop a lifelong dependency on the drug, resulting in cumulative side effects and, paradoxically, a global increase in the cost of health care.
The United States has long had the highest cost of health care per capita among wealthy nations. In 2021 spending hit $4.3 trillion, or roughly $12,900 per person, which is double that seen in the rest of the developed world. Obesity is already a major factor in driving up the cost of health care, amounting to $147 billion in annual costs. It affects either directly or indirectly 100.1 million (41.9%) adults and is a risk factor for all of the 10 leading causes of death in the U.S. It is strongly implicated in heart disease, stroke, kidney failure and chronic liver disease.
Obesity is also a known risk factor for at least 13 cancers, Alzheimer’s disease and other forms of dementia. Outcomes for COVID-19, respiratory disease and auto accidents are also negatively affected when people are overweight.
Although most GLP-1 medications are effective for weight loss, a number of them are as yet FDA-approved only for insulin-resistant diabetes. There is, however, an active trend among pharmaceutical companies that have already secured FDA approval for diabetes to then seek approval for weight loss.
Aside from GLP-1s, other drugs in the mix include GIPs, also drugs that act on glucagon and SGLT-2s.
Active management of patients who have been prescribed these medications, whether for weight loss, diabetes or both, is essential. The goals are to understand active conditions and existing treatment, monitor for adverse affects of the GLP-1 medications, adjust other medical treatment as weight loss progresses and diabetes improves, and work to optimize behavioral health. Education and active coaching are also essential to refining lifestyle and ultimately maintaining gains made.
GLP-1s have enormous potential to normalize weight and improve insulin-resistant diabetes, reducing the risk of most of the leading causes of death, resulting in greater longevity and improved life quality. They might also reduce the total cost of health care.
This can be achieved only by engaging with patients using a “whole person” approach with attention to physical, behavioral and social elements. Coaching and education are essential for sustainable change. If successful, patients will be able to wean off the GLP-1s once optimal weight is achieved.
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Ira “Kawika” Zunin is a practicing physician and medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center. Contact him via email at info@manakaiomalama.com.
