More good news on GLP-1 meds
Ozempic, Mounjaro, Wegovy—the news just keeps getting better. A new VA study hints at an impact well beyond diabetes and heart disease. It's a brave new frontier...are we ready?
[Click for this important new study from the VA]
The US obesity epidemic started in the late 70s, in the post-WWII economic boom, when the huge wave of young Boomers hit the workplace, when ‘quick and convenient’ trumped higher prep time home-cooked meals. Boomers and McDonalds grew up together, and—for better and worse—the US is now culturally linked to fast food worldwide.
Fifty years later, more than 40% of Americans are obese, and we now know more than 30 different health problems came right along with ultra-processed foods (UPF). The metabolic mayhem of UPF diets includes costly and deadly long-term diseases like cancer, diabetes and heart disease, stressing our health system and raising already sky-rocketing health system costs but stalled outcomes.
So it’s no surprise that clinicians and the public alike have embraced new GLP-11 medications like Ozempic and Mounjaro. Right now, these drugs are only approved by the FDA to treat type 2 diabetes and reduce the risk of heart disease for adults with type 2 diabetes and cardiovascular disease but their use for weight control—at the root of both diabetes and heart disease—is well-known by clinicians and the public. Another GLP-1, higher-dose Wegovy, is FDA-approved for weight loss. Insurance coverage for GLP-1s is sketchy and often a diagnosis game, leaving the GLP-1s accessible to those who can pay cash or high co-pays, and out of the grasp of many who could benefit.
The effect on weight loss is the reason we’re hearing more from “obesity-first” proponents who urge dealing with obesity, not just the diseases it causes. It may come up quickly in the Trump administration as well; click here and here. It’s unlikely any other medications have ever had the same press coverage or generated as much discussion in such a short period of time.
We’ve long had drugs to combat diabetes and heart disease after diagnosis, but GLP-1s are the first class of drugs to show both treatment and prevention possibilities of these costly, linked diseases. Now we’ll see if we, as a nation, are willing to pay for that prevention, not just treatment, a decision at odds with our preachy history of viewing obesity as a lack of willpower, not something underwritten by genetics.
Enter this new, large VA study. The larger the study, the more we learn about both benefits and side effects, and this one is big: 2.5 million records. The Department of Veterans Affairs (VA)—with access to millions of health records—reviewed their data and found GLP-1s lowered both heart and kidney disease.
What they did not expect to find—and did—was a decrease in substance use and psychotic disorders, seizures, neurocognitive disorders (including Alzheimer’s disease and dementia), coagulation disorders, cardiometabolic disorders, infectious illnesses and several respiratory conditions. Researchers have been saying for years that obesity is behind more disease processes than just obesity; this study certainly opens that door wider. Moreover, it’s likely the study will increase VA adaptation of the GLP-1s; mental health is the top reason for military hospitalization and a significant worry in the armed services. If the VA increases use, that will put pressure on non-VA payors to do so as well.
Remember, these drugs are relatively new, and it will take more studies this size to really understand potential side effects. This study wasn’t all positive. Researchers also identified increased risk of GI problems, too-low blood pressure (hypotension) and fainting, arthritic disorders, and kidney issues. Compared to similar populations not on the GLP-1 drugs, there was also an increased incidence of drug-induced pancreatitis, not an insignificant issue.
We’re only on the frontier of drugs like these, and one of the great benefits of large studies will be the development of even better treatments in the future. For now, though, the promise of these GLP-1s is a breakthrough on understanding, not just reacting to, obesity.
This webpage is for informational purposes only and does not constitute medical advice or diagnosis. Consult a licensed clinician for medical advice applicable to your specific needs.
Technically, they are actually “GLP-1ARs”—a glucagon-like peptide-1 receptor agonist that mimics the hormone GLP-1. An agonist is a substance that binds to a receptor in a cell to produce a response, mimicking the action of a hormone or neurotransmitter.