Wegovy has been hailed as a “major breakthrough” for its effectiveness in reducing body weight. However, the high cost of the injection drug makes it inaccessible for many, leading to rebound weight gain when people can no longer afford it.
From TikTok influencers to celebrities, drugs like Wegovy and Ozempic are being promoted as weight-loss miracles. However, these drugs are not intended for cosmetic weight loss. Ozempic is approved for diabetes, and Wegovy is for people with obesity who have weight-related conditions such as high blood pressure or high cholesterol, affecting millions of Americans. Evidence shows that these new drugs are far more effective than previous obesity medications. A landmark clinical trial published in The New England Journal of Medicine in 2021 found that the drug led to a 15% reduction in body weight on average.
The demand for these drugs has surged, leading to a shortage of semaglutide, the active ingredient. Novo Nordisk, the manufacturer, is prioritizing stable supplies. However, at a cost of about $1,400 a month, many people can’t afford to stay on the medication long-term. When people stop taking it, they often experience rebound weight gain, with a study showing that most people regain most of the weight within a year of stopping the medicine.
Yolanda Hamilton from South Holland, Ill., experienced this firsthand. Her doctor prescribed Wegovy due to her elevated BMI, high blood pressure, and elevated blood sugar. She lost 60 pounds and felt much better, with more energy and reduced cravings for sugar. However, after changing jobs and losing insurance coverage, she gained back 20 pounds within a few months of stopping the drug. Hamilton is frustrated by the rapid weight regain and is worried about the impact on her blood pressure and blood sugar.
The rebound weight gain is not surprising given how the medication works. Wegovy’s active ingredient, semaglutide, is a GLP-1, or glucagon-like peptide-1, which mimics the GLP-1 satiety hormone in our bodies. This hormone signals the brain to stop eating. When people stop taking the medicine, they start to feel hungrier. Hamilton’s appetite has increased, and she no longer feels satisfied with small meals, losing energy as the weight comes back.
Dr. Robert Kushner of Northwestern University, who treats Hamilton, explains that the pharmaceutical companies have restructured this naturally occurring hormone into a drug. When people stop taking it, they start to feel hungrier. Kushner’s office is helping Hamilton appeal the insurance denial, but she is worried about the impact on her health.
Dr. Karla Robinson, a family physician and medical editor at GoodRx, notes that many patients experience rebound weight gain, which can be devastating. There is no generic version of semaglutide, and the drug is subject to the manufacturer’s pricing. Novo Nordisk offers a $500 coupon for Wegovy, but the lowest price among all retailers is still $1,304 per month, which is out of reach for most people.
Hamilton believes Wegovy is revolutionary but cannot afford it. Robinson points out that people with low incomes experience obesity at disproportionately higher rates, making this a significant health equity issue. Black and Hispanic adults have higher rates of obesity, according to the CDC.
Since Wegovy was approved by the FDA in 2021, some insurance plans have begun to cover the medication for people who meet the clinical prescribing guidelines. However, insurance coverage is spotty, and Medicare does not cover Wegovy or other weight loss drugs. There is increasing pressure to change this, with organizations like the Moffitt Cancer Center and the NAACP lobbying for legislation to allow Medicare to pay for obesity drugs.
The American Academy of Pediatrics has also recommended that pediatricians offer weight loss drugs to adolescents 12 and older with obesity as an adjunct to behavior change and lifestyle interventions. However, the need for long-term use of Wegovy to maintain weight loss raises concerns about side effects, including GI symptoms and a black box warning for thyroid tumors in rodent studies.
Despite these concerns, doctors emphasize the risks of leaving obesity untreated, as heart disease is the leading cause of death in the U.S., and obesity and weight-related conditions are top risk factors. Exercise and diet modification are still the first strategies to try, but given the high rates of overweight and obesity in the U.S., there is an urgent need for more interventions.
Dr. Marcus Schabacker, CEO of ECRI, argues that these drugs can help destigmatize obesity by treating it like any other disease. He emphasizes that exercise and diet are key components of tackling obesity, but medications that have proven to be effective should also be part of the treatment.
In a significant development, an experimental drug from Eli Lilly, retatrutide, has shown even greater weight loss benefits than any drug currently on the market. In a mid-stage clinical trial, retatrutide helped people lose, on average, about 24% of their body weight, equivalent to about 58 pounds. If confirmed in a larger phase 3 clinical trial, retatrutide could surpass other weight loss drugs, including tirzepatide, which is expected to become the best-selling drug of all time.
Dr. Shauna Levy, a specialist in obesity medicine, describes the new findings as “mind-blowing,” noting that the drug’s effectiveness is approaching that of bariatric surgery. The rapid development of new treatments for weight loss, including GLP-1 agonists like semaglutide, has been transformative, giving many people hope in the fight against obesity.
Retatrutide mimics GLP-1, GIP, and glucagon, which may explain its more effective weight loss. Dr. Holly Lofton, director of the weight management program at NYU Langone Health, notes that the combination of these hormones helps improve how the body breaks down sugar, reduces appetite, and enhances metabolism.
Dr. Dan Skovronsky, Eli Lilly’s chief scientific and medical officer, explains that retatrutide harnesses the body’s own mechanisms to metabolize food and signal when to stop eating. The phase 2 trial of retatrutide involved 338 adults who were obese or overweight, showing promising results.
As the development of new weight loss drugs continues, the potential for greater accessibility and effectiveness offers hope for millions of people struggling with obesity. The ongoing research and trials will determine the future of these treatments and their impact on public health.
Source: NPR, NBC News, The New England Journal of Medicine
