This is my third time writing about the use of GLP-1 drugs for weight loss – you know them as Ozempic and Wegovy. Why am I revisiting this subject? Because the longer this class of drug is around, the more we come to know about it.

The mainstream health headlines claim that Ozempic is found to help with improved cardiovascular and renal health, has potential neuroprotective effects, positive impacts on behavioral and substance use outcomes, and can help prevent some cancers.

Okay, those are the headlines – but it’s time to set the record straight. These are drugs that bring phenomenal profits to the drug companies that manufacture them, but what about the long-term results? I think we are being misled – and that, in turn, is causing great long-term damage to our health.

Every drug has a benefit and a risk. And if the benefit doesn’t outweigh the risk, a drug should never come to market. But this is a business, and sometimes short-term data can bring drugs to market that might even be called “miracle” drugs or the solution to a medical problem. I don’t remember as much hype about a drug in my lifetime as we have seen with Ozempic and Wegovy. I’m afraid that the air is coming out of the balloon, and we the public are being misinformed.

Let’s review

In my first two articles (“Drugs are not a shortcut to weight loss,” June 13, 2023, and “Is there such a thing as a ‘shortcut’ in weight loss?” September 8, 2024), I spoke about how the drug works and its side effects. In my first article, I wrote that pancreatitis, kidney problems, nausea, diarrhea, gallbladder disease, “Ozempic face,” and an increase in the risk of thyroid cancer are the side effects.
Boxes of Ozempic, a semaglutide injection drug used for treating type 2 diabetes made by Novo Nordisk, is seen at a Rock Canyon Pharmacy in Provo, Utah, U.S. March 29, 2023. (credit: REUTERS/GEORGE FREY)
Boxes of Ozempic, a semaglutide injection drug used for treating type 2 diabetes made by Novo Nordisk, is seen at a Rock Canyon Pharmacy in Provo, Utah, U.S. March 29, 2023. (credit: REUTERS/GEORGE FREY)
The article I presented 15 months later added stomach paralysis, blurred vision, and more emergency departments reporting more cases of hypoglycemia from over-dosages or usage in combination with other drugs that lower blood glucose. We are now about 18 months since that writing and this category of drug has been around long enough to begin drawing better conclusions based on better data.

The problem

Let’s reexamine the problem of overweight and obesity. In the United States, which has a very large sample size and where data is readily available, a shocking 32% of adults are overweight and another 42% are obese – seriously overweight. If we go back to the early 1960s, 14% of people in the US were obese – just a third as many.

As opposed to what drug companies would like you to think, this is not a genetic phenomenon. Genes don’t change in the population in 50-60 years. This is a problem of what we eat and how much we eat. For the sake of public health and for our pocket books, the need to deal with this is indisputable. But as I wrote previously, drugs are not the answer. They never have been.

To review, these GLP-1 agonists (catalysts) suppress appetite and delay gastric emptying – and are very expensive! The retail price is about $1,600 a month. Even if your insurance will cover part of it, one way or another, you’re paying for it.

And there are now more side effects to add to this growing list. Severe constipation has been reported, high levels of lipase, which will damage the pancreas, and now we have them contributing to two eye diseases that can lead to partial blindness. Non-arteritic anterior ischemic optic neuropathy (NAION) was discovered as a side effect last July, and just this past month, a link between Ozempic-Wegovy has been seen regarding macular degeneration in older adults. And we don’t know all the negative side effects yet of GLP-1s. Scary!

What the new data says

The JAMA Cardiology journal recently published an article on the potential use of GLP-1. Dr. Vanita Rahman responded in a letter using data NOT from the pharmaceutical companies. In that letter and in a subsequent interview with Chuck Carrol, she cited a study called the Select Trial that analyzes four years of using the drug.

Here are some of the conclusions she pointed out. There is big weight loss for the first 15 months (65 weeks), but then there is a plateau, regardless of the need to lose more weight. At the two-year mark, only 12% had a normal BMI, 44% remained overweight and another 43% were still obese. When the medication is stopped, the weight is back to baseline less than two years later. Any health gains made (lower blood pressure, lower sugar, resolved fatty liver for example) all disappear.

Another thing that Dr. Rahman reported is that 65% of people discontinue using the medication within a year and another 19% within two years, for a total of 84%.

Perhaps the biggest frustration is the impression that has been created that drugs or surgery are the only answers to obesity. As anyone who has studied weight loss understands, sustainability is the name of the game.

There is a way to achieve similar results and much better long-term ones for a mere fraction of the price. In a 12 month study, people going on a plant-based diet had lost an average of 12.1 kg. by the one-year mark. Their cholesterol dropped 19.3 points, LDL cholesterol dropped more than 23 points, and they lowered their A1C by 0.5%. Half of American adults say they know eating a plant-based diet can improve their health and help prevent chronic diseases, according to a recent Physicians Committee/Morning Consult survey. Yet just 1 in 5 primary care practitioners discuss this lifesaving message with patients. This needs to change.

The risk and the benefit

Given all of the information we now have on GLP-1 agonist drugs, what is the risk-benefit ratio? Yes, Ozempic will lower blood sugar and help people lose weight. Yes, the benefits that come from weight loss, like lower blood pressure and reduced cancer risk, also happen. And yes, this drug is bringing ridiculous profits to big pharma.

But there are better and cheaper ways to achieve the intended goals of taking this drug. That means incorporating lifestyle medicine into one’s life with an emphasis on a whole-food, plant-based diet. It is far more sustainable, far less expensive and there is more than sufficient data that it works for almost everyone.

Does this drug have a potential practical use? Yes, it does. Use it to stabilize the patient and then work hard on behaviors and nutrition education. That’s what we do in The Wellness Clinic. We work on teaching what healthy living is and help our clients get lasting results. I’ve personally seen amazing results over many years. I think that modern medicine, at least in this area, has truly lost its way. Don’t be persuaded by the abundance of propaganda you see in ads, newspapers, magazines, TV, and the Internet. There is no magic fix! There are better ways to “Add hours to your days, days to your years, and years to your lives.”

The writer is a wellness coach and personal trainer with over 25 years professional experience. He is a graduate of the eCornell University Certificate course on Plant Based Nutrition and a member of the international council of the True Health Initiative, and of the board of Kosher Plant Based, as well as director of The Wellness Clinic. alan@alanfitness.com and www.alanfitness.com