Welcome to Running: A FEVER. This is a show about fitness, diet, and medicine. I’m Michael Davis, and my goal is to live a long, healthy, happy, active life right up to the very end. And I do that by loving my life enough to make it last as long as possible.
On June 4, 2021, the FDA approved Wegovy for the treatment of chronic obesity and overweight individuals. Dr. John Sharretts, deputy director of the Division of Diabetes, Lipid Disorders, and Obesity in the FDA’s Center for Drug Evaluation and Research, said, “Today’s approval offers adults with obesity or overweight a beneficial new treatment option to incorporate into a weight management program. FDA remains committed to facilitating the development and approval of additional safe and effective therapies for adults with obesity or overweight.”
One weekly injection makes people feel satiated for longer by slowing hunger signals to the brain and the rate at which a person’s stomach empties.
Wegovy is one of a group of drugs called GLP-1 receptor agonists. GLP stands for Glucagon-like peptide-1. They have been around since 2005. Some other GLP-1 drugs are
Bydureon, from AstraZeneca
Saxenda, from Novo Nordisk
Tanzeum, by GlaxoSmithKline
Trulicity, from Eli Lilly
Adlyxin from Sanofi
Zepbound, from Eli Lilly
Some of these have other names for the brands marketed as treatment for type 2 diabetes.
GLP-1 is a naturally occurring hormone. GLP-1 receptor agonists are medications that mimic the actions of GLP-1 by binding to and activating the GLP-1 receptor, ultimately leading to improved blood sugar control and other benefits.
The story of GLP-1 drugs goes back over 100 years. In 1902, the first insulin-stimulating hormone was discovered. It is called secretin. Then, gastrin was discovered in 1905. But it wasn’t until 1984 that the first GLP-1 hormone was discovered by scientists at the Massachusetts General Hospital in Boston, Massachusetts. GLP-1 itself is a hormone that plays a role in regulating blood sugar levels. It is produced in the intestines when food is consumed.
At the same time, Jean-Pierre Raufman at the National Institutes of Health became interested in studying Gila monster venom because the Gila monster, the only venomous lizard native to the United States, eats only once or twice a year. His research led to the isolation of a substance in the venom called exendin-4, which was similar to GLP-1 but had a longer half-life, making it more feasible as a drug. GLP-1 has a half-life of only two minutes. Eli Lilly and Amylin Pharmaceuticals marketed the drug as exenatide and obtained FDA approval in 2005 for its use in treating diabetes. Saxenda was approved in 2010, followed by Tanzeum and Trulicity in 2014.
The increase in use of GLP-1 drugs for weight loss has been amazing. Between 2018 and 2023, prescriptions for these drugs increased by a staggering 300%. They are “all the rage.” Wegovy and Ozempic have made Novo Nordisk more valuable by market capitalization than the entire economy of its home country of Denmark. By October 2024, Zepbound and Mounjaro had made Eli Lilly the most valuable drug company in the world, with a market capitalization of $842 billion, the highest ever achieved by a drug company.
The popularity of the drugs for weight loss has created a gray market for unauthorized products claimed to be GLP-1s. People without insurance or unable to obtain a prescription because their proposed use is cosmetic, seek other alternatives to get the drugs. An estimated 95% of online pharmacies offering these products operate illegally in the United States. This presents a risk of buyers obtaining substandard or counterfeit drugs.
Another reason for this is the cost. Without insurance, the drugs can cost between $100 and $1500 per month. With insurance, the cost is still between $100 and $1000. Some specific examples:
Ozempic or Wegovy – up to $1349 per month
Saxenda or Victoza – up to $936 per month.
Of course, these costs vary depending on the brand, your insurance, and the specific pharmacy you use. And not all insurance plans cover the use of GLP-1s for use against obesity alone.
Why are these drugs so popular? 70% of American adults are either obese or overweight. This is a hazardous condition that can lead to some of the top causes of death, including heart disease, stroke, diabetes, and is even linked to certain types of cancer. I have struggled with my weight all of my adult life, with short-lived or limited success from dieting and exercise alone. Losing 5% to 10% of body weight through diet and exercise has been associated with a reduced risk of cardiovascular disease.
What’s it like? People have reported feeling fuller sooner and for longer, leading to a reduction in appetite and food cravings. Unfortunately, the downside is a list of side effects that can make eating difficult, including nausea, constipation, diarrhea, loss of appetite, and vomiting. Some other downside effects reported are weight gain, headaches, and additional weight gain after stopping the treatment.
Some quotes:
“I didn’t even think of (food)…Looking at a bag of Doritos was kind of like looking at a pair of socks.”
“No matter how little I seem to eat in that sitting … I would get nauseous or I would throw it up.”
“I definitely ate less…it just didn’t feel good. Even just drinking water would kind of upset my stomach and make me feel a little nauseous.”
Are they safe? All of the drugs I’ve listed are FDA-approved. They are not recommended for people with acute pancreatitis. There is a risk of thyroid tumors, and the drugs are contraindicated for people with a history of thyroid cancer. There is an increased risk of gallstones. As of March 2024, there are 58 personal injury lawsuits for gastroparesis (ineffective muscular contractions of the stomach), ileus (disruption of the propulsive ability of the intestines), and intestinal blockage or obstruction. One study found that GLP-1 agonists may result in hypotension (low blood pressure), fainting, arthritic disorders, kidney stones, and pancreatitis. It’s easy to get scared when you start looking into the adverse effects of drugs.
Most of these drugs are available only as injections, and usually are sold as drug-device combination products. This is essentially a pen similar to those used for the relief of anaphylactic shock in individuals with severe allergic reactions. The pen is stored refrigerated like insulin. You clean the area with alcohol, press the end of the pen to your stomach or thigh, press a button, and wait for a click; it can take up to 20 seconds.
Personal thoughts? Well, I generally think you should only take medication if you need it, and in this case, I probably don’t need it. I could be wrong, though. I’m trying diet and exercise again, this time mixing in some prayer as well. But I’ve had plenty of failures in the past, so I’m keeping my mind open. I’m not even sure if it’s available to me, and I wouldn’t invest outside of an insurance plan. I’m also a bit concerned about the side effects, especially weight gain after stopping the medication. If I have any problems with other side effects, I’ll need to stop, and then I’ll be back to square one, and perhaps even worse off than when I started. So I’m being very conservative and cautious at this point, and I sure hope I don’t have to use GLP-1s. But that’s just my personal opinion. What do you think? Please share your experience or thoughts in the comments.
I hope this episode has provided some insight into the benefits, drawbacks, and history of these new and very popular drugs. Remember, if you’ve got the fever, keep it burning, and if you don’t, catch the fever. And I will see you next time, on Running: A FEVER.
https://en.wikipedia.org/wiki/GLP-1_receptor_agonist
https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/expert-answers/byetta/faq-20057955
https://my.clevelandclinic.org/health/treatments/13901-glp-1-agonists
https://ro.co/weight-loss/injections-cost/
https://www.today.com/health/diet-fitness/what-does-taking-ozempic-feel-like-rcna70774
https://www.mountsinai.org/health-library/special-topic/insulin-and-syringes-s