GLP-1 drug popularity is outpacing the science, Madison doctor says | Health

The Cap Times is an independent newsroom serving Madison and Wisconsin. Sign up for the Morning Update to receive news in your inbox each morning.

The explosive popularity of GLP-1 drugs like Ozempic, Wegovy and Zepbound is transforming the way Americans treat obesity, with demand soaring beyond doctors’ offices and into online marketplaces, med spas and unregulated gray-market vendors. And while the medications are helping many people lose significant weight and improve their health, one Madison doctor warns the trend is outpacing the science.

GLP-1 medications can be safe and effective when prescribed for appropriate patients and monitored by a healthcare provider, medical experts say. But growing demand, high costs and intermittent shortages have fueled a market for compounded and gray-market versions of the drugs online, raising concerns about product quality, dosing and safety.

Dr. David Harris, an assistant professor of surgery in the Division of Minimally Invasive and Metabolic Surgery at the UW School of Medicine and Public Health, said excitement surrounding the drugs has eclipsed the evidence in some cases. Researchers are continuing to study long-term effects, optimal treatment duration and which patients are most likely to benefit.

“There’s a lot of work to be done,” Harris said in an interview.

Even as new research and approvals by the U.S. Food and Drug Administration expands the drugs’ potential uses, Harris cautions the medications aren’t a one-size-fits-all solution and should be paired with medical supervision and lifestyle changes.

That’s not to say the medications aren’t useful when administered and used properly, said Harris, also director of minimally invasive surgery research at the University of Wisconsin-Madison and principal investigator at the Wisconsin Surgical Laboratory in Metabolism. He regularly works with patients who need medical intervention to lose weight that threatens their health and this family of drugs has been helpful, he said.

“I think a lot of physicians, as well as the public, would make recommendations to patients to just eat better and do some exercise, and that is really an unhelpful prescription for patients with obesity,” Harris said. “Up until now, it’s been really hard for the average physician to have a strategy that would be successful.”

Chronic problems, chronic solutions

Historically, GLP-1 medications — which mimic a natural gut hormone to regulate blood sugar, decrease appetite and slow digestion — were used primarily for patients with diabetes.

The U.S. Food and Drug Administration first approved GLP-1 medication to treat Type 2 diabetes in 2005. Sixteen years later, the FDA approved one GLP-1 medication, Wegovy, to manage weight loss. Two years after that, the agency approved another, Zepbound, for the same purpose.

The newer approvals marked a game changer for treating obesity and weight gain, which had been widely stigmatized and thought of primarily as a willpower issue, Harris said, when genetic or biological factors can cause some patients to gain weight more easily and have more difficulty losing weight.

“Obesity is a chronic problem that requires chronic solutions,” Harris said.

Got a news tip?

The Cap Times welcomes tips from readers to help us inform our community. Email tips@captimes.com or visit captimes.com/tips for more options.

As medications, Harris said, GLP-1s are incredibly effective at helping patients lose weight and avoid health complications that come with excess weight.

“The longer you carry excess weight, the more likely you are to accumulate weight-related comorbidities like hypertension, diabetes, sleep apnea, kidney disease, etc.,” Harris said.

But that success comes with caveats.

“There are some patients that do not respond, and we don’t have a good handle on why that is. We also know that weight recurrence after stopping these medications is pretty much universal,” Harris said. “In general, they’re seen as lifelong meds.”

Weight recurrence can come with psychological risks, according to Harris. That’s why, when patients receive this treatment through UW Health, the medical team often includes a mental health specialist to help patients emotionally and psychologically process notable weight fluctuations that can affect someone’s body image.

“When patients have success, and then they come off, there is a psychological damage to having weight recurrence, and I see it all the time in the clinic — patients blame themselves, get really guilty,” he said.

Other complications include the type of weight lost and potentially regained.

“When you take these medications, you lose both fat and lean mass, and when you have weight recurrence, you tend to gain fat mass back more than lean mass,” Harris said.

The risks, benefits and complications are why Harris urges patients to discuss weight management treatment with medical providers.

Inequity in healthcare access

While the FDA has approved some GLP-1 medications for weight management, others haven’t received the same stamp but still see widespread use. For example, Ozempic — arguably the GLP-1 medication with the most name recognition — hasn’t been approved by the FDA for weight loss management, nor has the medication Mounjaro.

It’s safer to get these types of medications from a trusted clinical source like a doctor or provider team than from other settings like unregulated med spas or online retailers, Harris said. While patients can face barriers to receiving prescriptions from doctors, more easily accessible options carry risks, Harris said.

“I think that there is a real lack of understanding,” Harris said. “I don’t know if the average patient needs to know the mechanism of action and where these things work in the body, but I also think they’re often prescribed in a vacuum without other considerations.”

At UW Health, the medical team usually includes psychologists, dietitians, surgeons and obesity medicine providers, Harris said.

His recommendation is complicated by knowing some patients can’t afford a clinically-approved GLP-1 medication and may turn to other options due to a lack of affordability.

“In our healthcare system, they don’t have access, and they can’t afford it, and patients are desperate,” Harris said. “This is the American healthcare system.”