The Good and The Bad of Weight Loss Drugs

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Written by: Pratham Rao ‘27

Edited by: Yumiko Imai ‘26

If you scroll on the Times, Washington Post, or any other major newspaper outlet and make your way to the science section, you will  probably see articles about every pharmaceutical company and their attempt to take over the weight loss industry. But moving past the flashy headlines, how do these new “miracle pills” actually work and what are the positive and negative effects these drugs could have on the general public?

Weight loss drugs usually aim to “decrease appetite” and “slow down the emptying of the stomach,” [2] which helps make consumers feel less hungry and therefore eat less. Specifically, drugs such as Ozempic, Wegovy, and Saxenda are classified as GLP-1 agonists (glucagon-like-peptide-1 receptor agonists). These receptor agonists “mimic the GLP-1 hormone that is naturally released in the gastrointestinal tract in response to eating” [3]. Wegovy and Saxenda are prescribed for patients that do not have diabetes and are classified as obese/overweight, while Ozempic is used for patients with type 2 diabetes.

GLP-1 agonists are usually “injectable medications,” and the shot is given “in the fatty tissue just under your skin” [4]. Even though all three of the mentioned drugs have a lot of similarities, the differences lie in their active ingredients and to what extent they are effective. Wegovy and Ozempic both have semaglutide, an incretin mimetic that “helps the pancreas to release the right amount of insulin when blood sugar levels are high,” [5] as their active ingredient, while Saxenda has liraglutide, which is anti-diabetic but it is still only approved for obesity. While there are other active ingredients used in weight loss drugs, these are the two essential ingredients  that can be compared. The difference between Ozempic and Wegovy is that Wegovy is available in the market at higher dosage strengths than Ozempic [6]. This allows Wegovy to be prescribed for weight management purposes, while Ozempic is FDA approved for treatment of Type II diabetes.

In a study comparing semaglutide and liraglutide, Domenica M Rubino from the Washington Center for Weight Management and Research in Arlington, Virginia and other researchers discovered that patients who took weekly semaglutide injections “resulted in significantly greater weight loss at 68 weeks” [7] compared to patients who took daily liraglutide injections while accounting for diet and physical activity. There were also more side effects for those who took Wegovy (semaglutide) compared to Saxenda (liraglutide). In light of America’s obesity crisis in which more than 2 in 5 U.S. adults are obese, this study alongside many others demonstrate how valuable weight loss drugs are for diabetic and overweight populations [8].

In addition to helping people with diabetes and people lose weight, a lot of these weight loss drugs have indirect benefits to cardiovascular health and overall health because staying in a healthy weight range is one of the most effective ways to minimize risks for a heart attack, stroke, high blood pressure, sleep apnea, and more. These drugs can legitimately save a person’s life and extend their lifespan, proving that the recent prevalence of these drugs is justified and meaningful for not only the scientific community but also the use in the general population.

However, while these drugs can do a lot of good, there are a lot of negative side effects scientifically and socially. GLP-1 agonists most commonly can result in nausea, vomiting, diarrhea, dizziness, and in extreme cases, pancreatitis, sudden kidney injury, worsening diabetes related retinopathy, and medullary thyroid cancer [4]. Socially, there are a lot of ethical concerns that these drugs have raised as they have gotten more popular. Primarily, individuals that do not need these weight loss drugs are finding loopholes to obtain them, largely due to our society’s obsession to maintain a  certain physical appearance and remain “skinny.” The FDA has specifically approved weight loss drugs for obesity, which they defined as “a body mass index of 30 or greater” [9].  The cosmetic reasoning for weight loss drugs has resulted in providers “writing ‘off-label’ prescriptions for people willing to pay out of pocket for them,” which has resulted in“shortages across the country” [9]. Due to these shortages, the populations that these weight loss drugs were originally intended for are struggling to obtain the medications they need to live healthier lives, while populations that use these drugs for more cosmetic reasons continue to consume them.

Additionally, there are economic factors that control who has access to the drugs. “About 54% of adults who had taken a GLP-1 drug, including those with insurance,” [10] deemed that the drug was challenging to afford. Pharmaceutical companies such as Novo Nordisk and Eli Lilly are selling their products for around $1000/month supply, which prohibits low-income individuals from getting the prescriptions they need. This combined with the shortage of these drugs due to increased demand has resulted in apparent consumer demographic disparities, contradicting the original intent of these drugs.

While GLP-1 agonists like Ozempic, Saxenda, and Wegovy and other weight loss drugs have been instrumental in tackling serious health issues prevalent in the United States and the world, there are apparent problems with who is using these drugs and for what purpose and accessibility due to pharmaceutical companies setting incredibly high prices for them—all of which illustrates the recurring dilemma of prioritizing profits or populations.

References

1. Health V. Weight Loss Drugs 101: Benefits and risks you need to know before picking up a prescription [Internet]. Vcuhealth.org. 2024. Available from: https://www.vcuhealth.org/news/weight-loss-drugs-101-benefits-and-risks-you-need-to-know-before-picking-up-a-prescription/ 

2. McCrimmon KK. Wegovy vs. Ozempic: The truth about new “weight-loss” drugs [Internet]. UCHealth Today. 2023. Available from: https://www.uchealth.org/today/wegovy-vs-ozempic-the-truth-about-new-weight-loss-drugs/ 

3. Solan M. Understanding new weight-loss drugs [Internet]. Harvard Health. 2023. Available from: https://www.health.harvard.edu/staying-healthy/understanding-new-weight-loss-drugs 

4. Cleveland Clinic. GLP-1 Agonists [Internet]. Cleveland Clinic. 2023. Available from: https://my.clevelandclinic.org/health/treatments/13901-glp-1-agonists 

5. MedlinePlus. Semaglutide injection: MedlinePlus drug information [Internet]. medlineplus.gov. 2022. Available from: https://medlineplus.gov/druginfo/meds/a618008.html 

6. Willson A. Saxenda vs Wegovy vs Ozempic: comparing GLP-1 drugs [Internet]. Ro. 2023. Available from: https://ro.co/weight-loss/saxenda-vs-wegovy-vs-ozempic/ 

7. Rubino DM, Greenway FL, Khalid U, O’Neil PM, Rosenstock J, Sørrig R, et al. Effect of Weekly Subcutaneous Semaglutide Vs Daily Liraglutide on Body Weight in Adults with Overweight or Obesity without Diabetes. JAMA [Internet]. 2022 Jan 11;327(2):138. Available from: https://jamanetwork.com/journals/jama/fullarticle/2787907 

8. Centers for Disease Control and Prevention. Adult Obesity Facts [Internet]. CDC. 2024. Available from: https://www.cdc.gov/obesity/adult-obesity-facts/index.html 

9. Daube E. Are the New Weight Loss Drugs Too Good to Be True? [Internet]. Are the New Weight Loss Drugs Too Good to Be True? | UCSF Magazine. 2024. Available from: https://magazine.ucsf.edu/weight-loss-drugs-too-good-to-be-true 

10. Rayasam R. High Price of Popular Diabetes Drugs Deprives Low-Income People of Effective Treatment [Internet]. KFF Health News. 2024. Available from: https://kffhealthnews.org/news/article/high-prices-ozempic-mounjaro-wegovy-glp1s/