12/23/2025
Ask Dr. Gordon-- GLP-1 Drugs
Our first topic is a doozy! I have been asked to speak about GLP-1 shots and the various other injectable and oral weight loss medications that are offered today. This is a great opportunity for me to introduce you to the politics, controversies, and economics of the new wave of medicines that have been introduced to the market for the treatment of "chronic" disease. It is a way for me to highlight healthcare decision-making based on common sense, functional measures that we all thought we were training for when we got into this business in the first place!
Let's define the topic:
Which medications are we talking about? In a broad sense, we are discussing all medications that are associated with weight loss. In a strict sense, we are most concerned with glucagon-like peptide-1 receptor agonists (GLP-1s) and related incretin-based therapies (GIPs).
What is the population that is affected? Today, approximately 42% of all adults are clinically obese, meaning that they have a Body Mass Index (BMI) of 30 or higher. Additionally, another 30 to 40% of Americans have a BMI greater than 27 and at least one weight-related health risk condition (like diabetes, hypertension, or abnormal cholesterol levels). This means that today as many as 70% of adults in the U.S. are possible candidates for GLP-1 or GIP therapy for weight control.
Historical Background (or how we got here):
Prior to 1960, there are no specific sources of information detailing the exact percentage of Americans that were obese. However, retrospective nutritional studies, economic information, agricultural records, and the health statistics that were available to review would indicate that a maximum of about 10 to 12% of the population prior to 1960 were obese. I would add that this statistic is reinforced by evidence from anthropological and archeological studies covering the history of human civilization. In 1980 obesity prevalence had risen to around 15%. In 2000, obesity was estimated to affect approximately 30% of the adult population. Since then a rapid rise has taken place and we have arrived at the currently level of 42%.
The vast majority of human obesity is caused by wealth or an abundance of available calories. In 1970 the U.S. produced approximately 3200 to 3300 calories per day per person, but today this country produces between 3800 and 4000 calories per capita per day. While calorie production alone cannot explain obesity, understand that an extra 500 calories per day will result in a 1 lb weight gain per week! The other cause of diet-related obesity is the composition of our diet. Prior to 1980, Americans ate a higher fat, lower refined carbohydrate diet. We ate more whole foods with higher fiber content, high nutrient content, and higher water content than today. We also ate at different times, with larger morning meals, few snacks, and more time between meals. In truth, the introduction of the Food Pyramid guidelines, dominated by highly refined, grain-based carbohydrates, in 1987 set off an epidemic of childhood obesity that persisted into adulthood.
By the year 2000, adult obesity and weight-related health conditions, such as Type II diabetes, had become the dominant driver of mortality. Diabetes research led to the introduction of Byetta, the first of the GLP-1 drugs, for the treatment of severe diabetes in 2005. A "side effect" of Byetta was weight reduction through appetite regulation, delayed gastric emptying, and enhanced satiety signaling. Severe diabetes who were obese reported substantial weight loss in many cases. You can almost see the medical industry begin to salivate!
The Hidden Policy "Precondition":
Now that a potential weight loss drug was discovered, only one issue needed to be resolved. Obesity was not considered a disease. This was a necessary precondition for clinical justification, insurance coverage, and fundraising for research and development. In June of 2013 the American Medical Association House of Delegates overrode their own Council on Science and Public Health and adopted a policy recognizing obesity as a disease. Instead of highlighting the failure of our agricultural industry and nutritional institutions, the AMA just reclassified obesity as a chronic disease opening the door to the massive commercialization of an off-label use of a diabetes medication.
Formal entry into obesity treatment:
Following the lead of the AMA, the FDA approved the first modern GLP-1 specifically for chronic weight management, Saxenda (liraglutide), at the end of 2014. Further drug trials, called the STEP program showed that GLP-1 drugs could decrease weight by an average of 15% when used as an adjunct to a reduced calorie diet and increased physical activity. Furthermore these trials showed that discontinuing the drug lead to regain of lost weight and proved the need for continuous maintenance doses to sustain weight loss over time.
The introduction of Wegovy (semaglutide) in 2021 ushered in a new era of pharmaceutical weight loss intervention. Zepbound (tirzepatide) was approved in 2023 with indications that it produced larger than average weight loss compared to semaglutide.
Propaganda and "Mission Creep":
Central to the marketing of any successful drug are the claims that the health benefits of using the drug go far beyond the actual verified claims. In 2024, the FDA approved Wegovy to reduce cardiovascular risk in adults. Later that year Zepbound was approved to treat moderate to severe obstructive sleep apnea in adults with obesity. So now these drugs have shifted from "obesity management" to "whole-body health optimization" drugs.
This shift focuses on reframing these drugs as cardiometabolic protectants and expanding usage from carefully selected higher-risk patients to broad population use. It is not uncommon today to see people taking Wegovy or Ozembic so that they can lose 20 lbs to fit into their prom dress! Doctors don't expect patients to actually comply with the requirement that GLP-1 therapy be combined with a reduced-calorie diet and increased physical activity. This also means that weight gain is considered a "relapse" rather than "noncompliance". In other words, personal responsibility flies right out the window!
This same tactic has been utilized by pharmaceutical companies for the commercialization of antidepressants, statin drugs, and acid reflux medications to name just a few. Identify a niche population (mild anxiety or depression, slightly higher than normal LDL cholesterol, or heartburn after unhealthy meals); then create a disease, like seasonal affective disorder, mixed dyslipidemia, or GERD; then put 40% of the population or more on a drug that requires continuous maintenance instead of highlighting and treating the underlying dysfunction of poor diet, sedentary lifestyle, and stress.
What is the cost of these drugs?
Retail cost of Wegovy is $1349 for a 28 day supply. Self-pay programs can vary from $299 to $450 per month. Over a 30 year period of time this means that Wegovy would cost over $526,000 at retail price (in other words, insurance cost), or approximately $136,000 for the person willing, and able, to pay cash for the drug.
When we allow the pharmaceutical medical disease care model to diagnose and treat "chronic illness" instead of adopting common sense public health policies, the financial burden to the public becomes unbearable in a very short period of time!
What is the real Benefit of GLP-1/GIP Drugs?
For HIGH RISK patients who are obese, diabetic, and have one or more other weight-related co-morbidities, the main benefit is a reduction in adverse cardiovascular events and a reduction in obstructive sleep apnea. (It should be noted that these benefits are associated with weight loss and not a benefit of the drug itself.)
For Type II diabetics or those with chronic kidney disease, there is reasonable evidence that GLP-1 drugs reduce the risk of kidney failure or kidney damage. (While clinically important, these outcomes should not be applied to the general population.)
Expected metabolic improvements would include lower blood pressure, better control of blood glucose levels, lower triglycerides, and lower levels of inflammatory markers. However, these frequently observed benefits are due to weight loss and reduced caloric intake rather than the pharmacologic benefits of the drug. Anyone losing weight can expect the same improvements.
What are the Risks of these drugs?
Common adverse effects and risks of GLP-1 and GIP drugs include nausea, vomiting, diarrhea, constipation, abdominal pain, and decreased appetite. These side effects are minimized culturally because "nausea" sounds tolerable -- until it isn't.
Serious complication can arise from taking these drugs including gallbladder and biliary disease, pancreatitis, acute kidney injury due to dehydration, and thyroid C-cell tumors.
In 2025, another potential side effect of sudden loss of vision in one eye was identified for semaglutide medicines such as Ozempic, Rybelsus, and Wegovy. While many of these more serious side effects are considered rare for individuals, they add up when exposure becomes massive. Emergency room visits attributed to adverse events from semaglutide drug use climbed to almost 25,000 in 2023. Between 2018 and 2023, prescriptions for GLP-1 type drugs rose over 400%. As of September 2025, GLP-1 prescriptions accounted for 6.5 out of every 100 prescriptions in the U.S. In non-diabetic patients, 80% of the prescriptions were for women.
Another problem with GLP-1 type drugs are their likely derogatory long-term effects. While not proven, because long term studies have not been performed, there are risks associated with long-term widespread use. These include loss of lean body mass, sarcopenia, and "metabolic fragility". Over time, the loss of muscle and strength can worsen the risk of falls, broken bones, and disability.
Persistent alterations in gastric motility are another concern for long-term users. Stomach and bowel motility are vital for health and nutrient absorption. Again, at this time there is not enough evidence to make conclusions.
Lastly, we know that patients regain weight after stopping these drugs, but we know nothing about the consequences of intermittent usage. What is the cumulative adverse event risk? What is the cumulative cost burden to the individual, the insurance companies, and the taxpayer? More important, what is the risk associated with the "cosmetic use" population that do not fall into strongest risk vs. benefit category? Drug trials are designed for approval, not to determine long-term societal benefits.
Summary:
When GLP-1 drugs first hit the market, I was excited for Type II diabetes who were severely overweight and at high risk of serious illness or death from associated weight-related co-morbidities. This was a potential treatment that could legitimately save lives. But the economic incentives have corrupted the market and the agencies that are supposed to safeguard Americans and promote public health. This is part of a broader strategy of medicalizing all aspects of our lives, which fosters dependence on medical interventions and discourages any sense of personal responsibility. I would urge people who consider using GLP-1 and GIP weight loss drugs to consider all of the potential risks and benefits before beginning care. I would also like for people to understand that any weight loss therapy is designed to be a part of a comprehensive lifestyle change which involves dietary regulation, regular exercise, and stress management.
