The introduction of glucagon-like peptide-1 (GLP-1) receptor agonists, such as semaglutide (Ozempic and Wegovy) is a breakthrough in the management of obesity. These medications have proven to be very effective in promoting weight loss and improving blood sugar levels.
While a lot of people may think that I have something against GLP-1s – whether because they’re ‘competition’ for my practice (they aren’t), or that maybe I don’t agree with using pharmaceuticals over diet for weight loss. I wrote all about that here.
I believe the new class of weight loss medications are incredible tools that will help to change people’s lives for the better. But they aren’t the entire puzzle; they’re only just a piece, and there are some very real limitations to their use.
Recent research suggests that obesity rates in the US have dropped very slightly – from 46% in 2022 to 45.6% in 2023. There has been a 700% increase in the use of GLP-1 agonist medications between 2019 and 2023.
Although even a 0.04% change in obesity rates may indicate a general downward trend that may be attributed in part to GLP-1 medications, there are good reasons to believe that these drugs will not drastically reduce the prevalence of obesity…at least, not now. But why?
The answer to this question is multifaceted and complicated.
Limitations of GLP-1 Medications in Addressing Population-Wide Epidemic
Cost and Accessibility: These medications are super expensive – as in, over $15,000 a year in some cases. This is a huge barrier for people who can’t afford to pay out of pocket, or who don’t have private insurance coverage. Even for those with private insurance, companies often cap spending or duration for GLP-1 medications. While some people qualify for GLP-1 meds through Medicare or Medicaid, many do not.
A recent hearing of the US Senate Committee on Health, Education, Labor, and Pensions revealed that Ozempic costs 15x more in the United States than in Germany. Data on patient discontinuation of GLP-1 receptor agonist medications is inconclusive, but numbers range from around 50% within 3 months to 75% by the 2 year mark. The reasons for going off the meds include cost, side effects, or slow weight loss.
In other words, so many people who would likely benefit greatly from these medications, just can’t access them at all, or for long enough. Access is lower for people in certain racial and ethnic groups, which are also the groups that have the highest rates of obesity (and the lowest access to healthcare overall).
The patents for several of these medications are up in March, 2026, meaning that less expensive generic versions of semaglutide will likely be on the market shortly after that. Will they be much more affordable? Only time will tell.
Sustainability of Effects: While GLP-1 medications are effective for weight loss, research suggests that these medications are probably a long-term commitment. For many people, their benefits are contingent on continued use. A study from the STEP 1 trial highlighted that two-thirds of the weight lost using semaglutide was regained within a year after treatment discontinuation. As the numbers indicate, some weight regain is likely, but that’s not necessarily true for everyone.
When I work with clients who are on GLP-1 agonist medications, we focus not only on food, but also on relationship with food and with lifestyle changes such as increasing physical activity.
Limitations on Efficacy of GLP-1 Agonist Medications: According to Dr. Spencer Nadolsky, D.O. and Obesity and Lipid Specialist, these meds do have their limits.
Right now, the average is around 20% weight loss with Tizepatide (Mounjaro). For a 400 pound person, that would mean 80 pounds lost. That person still has obesity.
In addition to this, Dr. Nadolsky reinforced the fact that not everyone responds to these medications.
Root Causes of Obesity: Obesity is driven by complex factors, including socioeconomic disparities, food system issues, and sedentary lifestyles. Conversely, GLP-1 medications primarily target processes such as appetite regulation and insulin sensitivity. These are obviously important, but to really effect change on obesity rates, there should be a comprehensive focus not only on pharmacology, but also public health interventions. A 2023 review in Nature Medicine proposed that initiatives to address this issue that have four parts: informing the public about nutrition, enabling them to make health-promoting choices, motivating them to make changes to their routines and habits, and influencing behaviour via social norms and other methods.
The review suggested increasing active transport, increasing healthcare payor incentives, improving access to and affordability of healthy foods, limiting availability and media marketing of high-calorie foods, improving food labeling, reformulating food products to be more healthful, and increasing access to weight management programs and bariatric surgery.
Side Effects and Contraindications: Common side effects of GLP-1 medications, such as nausea, vomiting, and gastrointestinal discomfort, can deter adherence. Additionally, these drugs are contraindicated for individuals with certain conditions, such as kidney disease, certain cancers, and a history of pancreatitis.
The Role of Dietary Interventions
GLP-1 medications are effective for most people, but changes in diet do need to be part of their use. Dietary strategies can enhance the efficacy of treatment while supporting long-term health.
Here are some tips for eating while on a GLP-1 medications:
Prioritize Protein and Fiber: GLP-1 medications slow gastric emptying, promoting early satiety. This means that most meals and snacks should be nutrient-dense to avoid nutrient deficiencies and promote overall health. A diet rich in lean proteins (e.g., meat and fish, tofu, eggs, Greek yogurt and ricotta, beans and lentils) helps to maintain muscle mass. Getting ~25+ grams of fiber per day from vegetables, whole grains, and fruits, helps sustain fullness and supports blood sugar control. Don’t sleep on beans or soy foods as a way to get high-quality protein and fibre in one place!
Minimize Ultra-Processed Foods: Processed foods high in refined carbohydrates, added sugars, and unhealthy fats can counteract the benefits of GLP-1 medications. I recommend focusing on whole, minimally processed foods to improve overall metabolic health. That also means minimizing alcohol and other lower-quality foods to help maximize nutrients in your diet.
Hydration and Small, Frequent Meals: People on GLP-1 medications often experience nausea, which can be mitigated by staying hydrated and eating smaller, more frequent meals. On nauseous days, incorporating foods that are gentle on the stomach, such as soups and smoothies, can help.
Mindful Eating Practices: GLP-1 medications reduce appetite, creating an opportunity to practice mindful eating. Slowing down during meals, savoring food, and listening to hunger cues can help reinforce healthy eating behaviors.
Emerging Weight Loss Medications
In addition to existing GLP-1 receptor agonists, several promising weight loss medications are under development or awaiting approval:
- Orforglipron Eli Lilly is developing Orforglipron, an oral GLP-1 receptor agonist. This medication could provide an alternative for patients who prefer not to use injectables.
- CagriSema (Cagrilintide/Semaglutide Combination) Novo Nordisk is advancing this combination therapy, showing significant weight loss effects in early trials.
- Retatrutide Retatrutide is a triple-hormone receptor agonist, with early studies reporting substantial weight reduction.
- VK2735 Viking Therapeutics is exploring VK2735, an oral therapy with promising preliminary results.
Conclusion
GLP-1 medications offer significant benefits for individuals struggling with obesity, but they are not a panacea for the broader epidemics. Addressing these complex, multifactorial challenges requires a comprehensive approach that combines medical innovation with robust public health efforts. By integrating dietary strategies, promoting equitable access to care, and tackling systemic issues, we can make meaningful progress toward reversing the trends in obesity.
Are you looking for help with your nutrition? I’m taking new clients in my 1:1 practice. Get more information and book a session here.
Did you know? I also have an online course for nutrition in perimenopause and menopause called Don’t Sweat It. Get more information and sign up here.
