Ozempic, Wegovy and similar drugs are being touted as helpful for seemingly every condition under the sun, but we need to pump the brakes a bit, writes Andre Picard.Hollie Adams/Reuters
Not a day goes by, it seems, without GLP-1 weight-loss drugs making news.
Ozempic, Wegovy and the like, already part of our vernacular, are being touted as helpful for seemingly every condition under the sun, from heart disease to cancer, dementia, addiction, and more.
There are so many purported benefits of GLP-1 agonists beyond treating obesity that The Economist dubbed them “the everything drugs,” and declared boldly that “drugs like Ozempic will change the world.”
It’s hard to argue with that prediction.
More than 40 million Americans have already tried GLP-1 drugs, with an estimated 16 million current users. Add to that about 1.4 million Canadians, with 25,000 new prescriptions weekly in North America.
But we need to pump the brakes a bit. Despite their potential, and our great enthusiasm for them, these drugs are not cure-alls.
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Glucagonlike peptide-1 receptor agonists, GLP-1 for short, mimic a hormone the body produces to regulate hunger and blood sugar levels. They cut food cravings, slow digestion, and keep people feeling full longer. You eat less so you lose weight.
GLP-1 agonists have been used for years for treatment of Type 2 diabetes. Patients not only controlled their insulin levels, but lost weight.
More than a decade ago, GLP-1 drugs began being marketed for weight loss. Sexenda was approved in the U.S. in 2014, and Ozempic in 2017, but only for treatment of diabetes. When Wegovy was approved for weight management in 2021, things really took off.
The early research showed stunning results. People lost 14 to 20 per cent of their body weight. The testimonials were compelling. People felt reborn.
But one of the important things to remember about the landmark research is that people didn’t simply inject the drug in their stomachs once a week. They also exercised regularly and changed their diets, key elements in healthy weight loss.
The drugs alone are not a magic elixir. Used properly, they help people adopt a healthier lifestyle.
When people taking GLP-1 agonists began to lose significant amounts of weight, they saw other important health benefits.
Rates of heart attacks and strokes began to fall. They had fewer kidney problems. Their joints felt better. Some reported feeling mentally sharper.
This sparked a tidal wave of studies examining other potential benefits of GLP-1 drugs, hence the “everything drugs” moniker.
Some of that research has delivered astonishing results, especially in people with both Type 2 diabetes and kidney disease. One study found a 24-per-cent reduction in the need for dialysis and kidney transplant, and a 29 per cent lower risk of heart attack and stroke.
These kinds of numbers are life-changing.
Research is also showing notable reductions in cardiovascular risks for people who lose significant weight (which is not surprising), but also independent of weight loss (which is surprising).
The key factor seems to be that GLP-1 agonists reduce inflammation, and chronic inflammation is a factor not only in Type 2 diabetes, but cardiovascular disease, cancer, kidney disease, liver disease, autoimmune diseases and neurodegenerative conditions.
Despite early enthusiasm, however, research has not shown great benefits for conditions such as Alzheimer’s and Parkinson’s, and mixed results with various forms of cancer.
Showing promising results in a clinical trial is only part of the equation. How drugs benefit patients (or not) in the real world is what matters.
So far, GLP-1 agonists have a good track record with their indicated uses, namely Type 2 diabetes and weight management.
But some people suffer side effects, including nausea and vomiting. Significant weight loss can result in loss of muscle mass. Conditions like “Wegovy face” – sunken cheeks and wrinkles from sudden weight loss – are concerning.
Then there are the monetary aspects. GLP-1 drugs are not cheap, and not always covered by private or public health insurance. In Canada, the list price for Ozempic is $2,899 a year, and for Wegovy, $5,066.
But with the drugs going generic, those prices could fall substantially in the coming months, estimated at $1,050 annually for Ozempic, and $1,775 for Wegovy.
Soon GLP-1 drugs will also be available in pill form; no more injections required.
The big question though is: will people have to take these drugs forever to maintain weight loss (and other health benefits), or will they rebound?
And what will the long-term health effects be? Perhaps not all positive.
But a massive experiment is already under way in our weight-conscious society, one that will have potentially huge health and economic repercussions.
Stay tuned.
Editor’s note: A previous version of this article used the incorrect term GLP-1 inhibitors to describe weight-loss drugs like Ozempic and Wegovy. They are GLP-1 agonists. These drugs mimic the hormone GLP-1, they do not block it.