Weight Loss Drugs – Gardner Magazine Special Report
Jump to Various Sections on this page: Public Health Briefing: The U.S. Obesity Landscape and the Rise of GLP-1 Agonist Medications —– A Learner’s Guide to FDA-Approved Weight Management Medications —– A Beginner’s Guide to Prescription Weight Loss Medications —– Beyond the Hype: 5 Surprising Truths About the Weight Loss Drug Revolution —– Obesity, GLP-1 Drugs, and Public Health in the United States, An Executive Summary.
Additional Media
A “Deep Dive” podcast on Weight Loss Medications. Listen on any device, CLICK PLAY.
A “Debate” podcast on Weight Loss Medications. Listen on any device, CLICK PLAY
An Explainer Video on 5 Surprising Truths. CLICK PLAY and video will start right here.
Public Health Briefing: The U.S. Obesity Landscape and the Rise of GLP-1 Agonist Medications
Public Health Briefing: The U.S. Obesity Landscape and the Rise of GLP-1 Agonist Medications
1. The Enduring Challenge of Adult Obesity in the United States
Obesity constitutes a formidable and deeply entrenched public health crisis in the United States, with profound implications for national health outcomes and economic productivity. As a chronic disease, its high prevalence impacts population health, healthcare system costs, and individual quality of life. A thorough understanding of the scale of the obesity epidemic and its historical trajectory is a critical foundation for evaluating the potential and the policy implications of emerging treatment strategies.
According to the most recent data (2021-23) from the Centers for Disease Control and Prevention’s (CDC) National Health and Nutrition Examination Survey, approximately 40% of U.S. adults (ages 20 and older) are classified as obese, with nearly 10% meeting the criteria for severe obesity. This represents a substantial increase over the past several decades; in the 1988-94 survey period, the adult obesity rate was 22.9%. The most recent survey did, however, show a slight decline of about two percentage points from the 42.4% rate recorded in 2017-18, marking the first time the rate has dropped by more than one point between survey periods.
The CDC’s classification system relies on the Body Mass Index (BMI), a measure calculated from an individual’s weight and height. The standard categories are:
• Overweight: BMI of 25.0 to 29.9
• Obese: BMI of 30.0 to 39.9
• Severely Obese: BMI of 40.0 or more
This stark statistical reality has catalyzed a shift in public consciousness regarding the complexities of weight management, creating fertile ground for new therapeutic interventions.
2. Public Perception of Weight Loss and New Pharmacotherapies
Public perception is a critical determinant of health policy, directly influencing patient demand, provider behavior, and the regulatory frameworks governing new therapies. Attitudes toward weight loss, willpower, and new medications like GLP-1 agonists shape the broader policy environment surrounding treatment access and insurance coverage. Understanding these perceptions is therefore essential for crafting effective public health messaging and policy.
A February 2024 Pew Research Center survey reveals a significant shift in public understanding of weight loss. A clear majority of U.S. adults (65%) believe that willpower alone is not enough for most people to lose weight and keep it off, compared to 34% who believe it is. This view, which suggests a growing recognition of the complex biological and environmental factors at play, varies across demographic groups.
| Demographic Group | Believes Willpower is NOT Enough | Believes Willpower IS Enough |
|---|---|---|
| Women | 71% | 28% |
| Men | 59% | 41% |
| Adults 65+ | 73% | 26% |
| Adults 18-29 | 55% | 44% |
This evolving perspective coincides with a high degree of public awareness of new pharmacotherapies. Surveys show that GLP-1 drugs like Ozempic and Wegovy have captured the public’s attention, but opinion on their appropriate use is nuanced.
• High Awareness: 53% of Americans report hearing or reading about these drugs “extremely or very often.”
• Conditional Approval: A majority (53%) view these drugs as good options for people with obesity or a weight-related health condition such as type 2 diabetes or high blood pressure.
• Low Approval for Cosmetic Use: In stark contrast, only 12% consider them good options for individuals who want to lose weight but do not have a related health condition.
This high level of conditional public support for new medications highlights the demand for effective, approved medical treatments for chronic weight management.
3. The Approved Pharmacotherapy Landscape for Chronic Weight Management
While GLP-1 agonists have gained significant public visibility, they are part of a broader class of medications approved by the U.S. Food and Drug Administration (FDA) for chronic weight management. It is critical to note that these drugs are intended to be used as a supplement to—not a replacement for—comprehensive lifestyle programs that include healthy eating, physical activity, and behavior changes.
The clinical criteria for prescribing these medications to an adult are specific: a BMI of 30 or greater (obesity), or a BMI of 27 or greater (overweight) in the presence of a weight-related health problem like high blood pressure or type 2 diabetes.
FDA-approved medications for chronic weight management work through several primary mechanisms:
• Helping patients feel less hungry or feel full sooner.
• Making it harder for the body to absorb fat from the foods they eat.
• Mimicking hormones, such as glucagon-like peptide-1 (GLP-1), that target areas of the brain that regulate appetite and food intake.
The following table summarizes the key FDA-approved drugs for long-term use in chronic weight management.
| Medication (Brand Name) | Class / Primary Mechanism | Approved For |
|---|---|---|
| semaglutide (Wegovy) | GLP-1 Receptor Agonist; regulates appetite | Adults and children ages 12 and older |
| tirzepatide (Zepbound) | Dual GIP/GLP-1 Receptor Agonist; regulates appetite | Adults |
| liraglutide (Saxenda) | GLP-1 Receptor Agonist; regulates appetite | Adults and children ages 12 and older |
| naltrexone-bupropion (Contrave) | Combination (opioid antagonist/antidepressant); reduces appetite | Adults |
| phentermine-topiramate (Qsymia) | Combination (stimulant/anti-seizure); reduces appetite | Adults and children ages 12 and older |
| orlistat (Xenical/Alli) | Fat Absorption Inhibitor; reduces fat absorption from the gut | Adults and children ages 12 and older (Xenical) |
| setmelanotide (IMCIVREE) | Activates brain pathways to decrease appetite | People ages 6+ with specific rare genetic disorders |
The existence of these effective, approved medications has led to explosive market growth, which in turn has created significant challenges related to cost and patient access.
4. Market Dynamics and Patient Access Challenges
The clinical effectiveness of new weight loss drugs has fueled unprecedented market demand, creating a two-tiered system of access that policy must address. This economic boom has exposed and exacerbated significant policy challenges, primarily centered on high costs and inconsistent insurance coverage, which create substantial barriers for a large segment of the eligible patient population.
The recent growth in GLP-1 drug sales has been staggering.
• Novo Nordisk: Revenue from its semaglutide-based drugs (Ozempic, Wegovy, and Rybelsus) surged from 11.9billionin2022to∗∗31.1 billion in 2024**. The United States was the dominant market, accounting for nearly 70% of these sales in 2024.
• Eli Lilly: Sales of Mounjaro (tirzepatide) jumped to 11.5billionin2024∗∗.Initsfirstfullyearonthemarket,Zepbound(alsotirzepatide)generated∗∗4.9 billion. Together, these two drugs accounted for 37% of the company’s total 2024 revenue.
Despite this market success, inconsistent insurance coverage remains a major barrier to patient access. According to a recent KFF report, this is particularly evident in public insurance programs. Under Medicaid, a critical safety net for low-income Americans, only 13 states currently cover GLP-1 medications specifically for the treatment of obesity. The rising costs have prompted some states, including California and Pennsylvania, to stop coverage, while North Carolina briefly suspended it due to funding shortfalls.
This coverage gap exists even as Medicaid spending on GLP-1s has skyrocketed. Gross spending on this class of drugs increased from nearly 1billionin2019to∗∗8.6 billion in 2024**.
This stark disconnect between clinical demand and affordable access has inevitably fueled a shadow market, presenting an urgent and direct threat to public health that requires immediate regulatory attention.
5. FDA Regulatory Alert: Risks of Unapproved and Counterfeit GLP-1 Drugs
The high demand for GLP-1 drugs, coupled with challenges of cost and access, has fueled a dangerous shadow market for unapproved, compounded, and counterfeit versions of these medications. The FDA has issued multiple warnings regarding this trend, which poses a critical and direct threat to public health. The agency is actively working to combat the distribution of these illicit products.
Concerns with Compounded GLP-1 Drugs
While drug compounding can serve a legitimate medical need when an FDA-approved drug is unavailable, the practice carries inherent risks. The FDA has identified several specific concerns related to compounded versions of semaglutide and tirzepatide.
• Lack of FDA Review: Critically, compounded drugs are not reviewed by the FDA for safety, effectiveness, or manufacturing quality before they are marketed.
• Identified Quality and Safety Issues:
◦ Ingredient Integrity: The FDA has warned that some compounders may be using unapproved salt forms of the active ingredients, such as semaglutide sodium and semaglutide acetate. The chemical properties and safety of these salt forms are unknown.
◦ Dosing Errors: The agency has received multiple adverse event reports, some requiring hospitalization, linked to incorrect dosing. These errors have resulted from both patients miscalculating self-administered doses and health care professionals miscalculating prescriptions.
◦ Improper Storage: The FDA has received complaints of injectable compounded drugs arriving warm or without adequate refrigeration, which can compromise the drug’s quality and stability.
◦ Fraudulent Products: The agency is aware of fraudulent compounded drugs being marketed with labels from pharmacies that do not exist or from licensed pharmacies that did not actually produce them.
Through mid-2025, the FDA had logged 605 reports of adverse events associated with compounded semaglutide and 545 reports for compounded tirzepatide. Federal law does not require all compounders to submit these reports, meaning the true number of adverse events is likely much higher.
Risks of Illegally Marketed and Counterfeit Drugs
Beyond compounding, the FDA is also combating illegally marketed and outright counterfeit drugs sold directly to consumers.
• Counterfeit Ozempic: The FDA has confirmed the presence of counterfeit Ozempic in the U.S. drug supply. These fraudulent products are illegal and may contain wrong or harmful ingredients, incorrect dosages, or no active ingredient at all.
• Illegal Online Sales: The agency has issued warning letters to multiple entities to stop the illegal online distribution of unapproved semaglutide and tirzepatide.
• “Research Use” Loophole: The FDA has warned companies that are illegally selling these drugs directly to consumers under the false labels of “for research purposes” or “not for human consumption,” often with dosing instructions included.
The confluence of immense medical promise and significant regulatory risk presents a complex and urgent challenge for public health governance.
6. Conclusion: Navigating the New Era of Obesity Treatment
This briefing highlights the complex interplay of public health needs, clinical innovation, economic forces, and regulatory challenges defining the current landscape of obesity treatment in the United States. For health policy analysts and public health officials, several core tensions emerge.
The persistently high prevalence of obesity provides the fundamental context for the intense public demand for new and more effective treatments. The emergence of GLP-1 agonists represents a significant therapeutic advancement, offering substantial benefits for many individuals with obesity. However, the high cost of these medications and inconsistent insurance coverage have created profound inequities, limiting access for many who could benefit.
This gap between high demand and limited, affordable access has fueled a dangerous unregulated market. The risks posed by unapproved, counterfeit, and improperly compounded drugs present a serious and immediate threat to patient safety. The core imperative for policymakers is therefore to forge a regulatory and reimbursement framework that can reconcile these tensions—one that expands access to breakthrough therapies without compromising patient safety or exacerbating health inequities.
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A Learner’s Guide to FDA-Approved Weight Management Medications
A Learner’s Guide to FDA-Approved Weight Management Medications
1. Introduction: More Than Just a Pill
Welcome to this guide on FDA-approved medications for weight management. If you’re curious about how these drugs work, this guide will break down the different types and their mechanisms in simple, clear terms.
First, it’s important to understand the context. Obesity is a chronic disease that affects more than 4 in 10 adults in the United States. While diet and exercise are fundamental, there’s a growing understanding that for many, success requires more than willpower. In fact, a 2024 Pew Research Center survey found that 65% of Americans believe willpower alone is not enough for most people to lose weight and keep it off. FDA-approved medications can be a valuable tool, but they are not a magic bullet. Studies show that these medications work best when they are combined with a comprehensive lifestyle program that includes a healthy eating plan and regular physical activity.
To understand how these different drugs work, let’s first look at their main strategies for managing weight.
2. The Two Main Approaches to Medication-Assisted Weight Management
FDA-approved weight management medications generally work in one of two primary ways to help a person lose weight and maintain that loss.
• Affecting Appetite and Fullness: Some drugs work on the brain to make you feel less hungry or to help you feel full sooner after eating. By targeting the body’s appetite-regulating systems, these medications help reduce overall calorie intake.
• Reducing Fat Absorption: Other drugs work directly in your gut. Their goal is to make it harder for your body to absorb the fat from the foods you eat, meaning fewer fat calories are taken in.
Now, let’s explore the specific categories of medications and see which approach they use.
3. Understanding the Different Classes of Medications
3.1. The “Fullness Signal” Drugs: GLP-1 and GIP/GLP-1 Agonists
This popular class of drugs works by mimicking natural hormones in your body, like glucagon-like peptide-1 (GLP-1). These hormones target areas of the brain that regulate appetite and food intake, essentially “signaling fullness.” Some drugs in this class also slow down how quickly the stomach empties, which helps you feel full for a longer period after a meal.
The GLP-1 Agonist drugs include:
• Wegovy (semaglutide) – A weekly injection.
• Saxenda (liraglutide) – A daily injection.
A newer type of medication, the dual-agonist, takes this approach a step further. Zepbound (tirzepatide) is unique because it mimics two hormones—glucose-dependent insulinotropic polypeptide (GIP) and GLP-1—to regulate appetite. It is also administered as a weekly injection.
3.2. The “Appetite Control” Drugs: Combination Medications
This class of medication works by combining two different existing drugs into a single pill to help reduce appetite and make you feel full sooner.
• Contrave (naltrexone-bupropion) – Combines a drug used to treat addiction (naltrexone) with an antidepressant (bupropion).
• Qsymia (phentermine-topiramate) – Combines a stimulant that reduces appetite (phentermine) with a drug used to treat seizures or migraines (topiramate).
3.3. The “Fat Blocking” Drug: Fat Absorption Inhibitors
This type of medication has a distinct mechanism that doesn’t involve the brain’s appetite centers. Instead, it works directly in your gut to reduce the amount of dietary fat your body absorbs from food.
The drug in this class is Orlistat. It is available in two forms:
• By prescription as Xenical.
• In a lower dose, over-the-counter version called Alli.
3.4. A Specialized Drug for Rare Genetic Conditions
One medication is approved only for a very specific and small group of people. Imcivree (setmelanotide) is approved for individuals aged 6 and older who have obesity caused by certain rare genetic disorders. These conditions must be confirmed by genetic testing before the drug can be prescribed.
To help you see all of these options side-by-side, the following table provides a clear summary.
4. At-a-Glance Comparison of Weight Management Medications
This table summarizes the FDA-approved drugs for chronic weight management discussed above.
| Medication Class | Brand Name (Generic Name) | Primary Mechanism of Action | How It’s Taken |
|---|---|---|---|
| GLP-1 Agonist | Wegovy (semaglutide) | Mimics the GLP-1 hormone to regulate appetite in the brain. | Weekly Injection |
| GLP-1 Agonist | Saxenda (liraglutide) | Mimics the GLP-1 hormone to regulate appetite in the brain. | Daily Injection |
| Dual GIP/GLP-1 Agonist | Zepbound (tirzepatide) | Mimics two hormones (GIP and GLP-1) to regulate appetite in the brain. | Weekly Injection |
| Combination Medication | Contrave (naltrexone-bupropion) | Combines two drugs to reduce appetite and increase feelings of fullness. | Oral Pill |
| Combination Medication | Qsymia (phentermine-topiramate) | Combines two drugs to reduce appetite and increase feelings of fullness. | Oral Pill |
| Fat Absorption Inhibitor | Xenical / Alli (orlistat) | Works in the gut to reduce the body’s absorption of dietary fat. | Oral Pill |
5. Essential Takeaways for the Informed Learner
As you learn about these medications, it’s crucial to understand these guiding principles before starting a conversation with your healthcare provider.
1. A Tool, Not a Cure Obesity is a chronic disease, and these medications are designed to manage it for the long term. Just like medications for other chronic conditions like high blood pressure or diabetes, these drugs are designed to manage an ongoing disease, not provide a short-term fix. They are most effective when paired with sustained diet and exercise. If you stop taking the medication, it is probable that you will regain some of the weight you lost.
2. Prescribed for Specific Needs These drugs are not for everyone who wants to lose a few pounds. They are intended for adults who have health problems related to their weight. A healthcare professional will typically prescribe them for individuals with a Body Mass Index (BMI) of 30 or greater, or a BMI of 27 or greater if the person also has a weight-related health condition, such as type 2 diabetes or high blood pressure.
3. Safety First: The Importance of a Legitimate Source To ensure your safety, you must obtain these medications with a prescription from a licensed health care provider and fill it only at a state-licensed pharmacy. The FDA has issued serious warnings about the risks of unapproved, counterfeit, and improperly compounded versions of these drugs. These illegal and dangerous products could contain the wrong ingredients, no active ingredient at all, incorrect dosages, or other harmful substances. The FDA also warns that some unapproved versions are sold with false labeling or require refrigeration but are shipped improperly, which can ruin the drug’s quality and safety. –
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A Beginner’s Guide to Prescription Weight Loss Medications
A Beginner’s Guide to Prescription Weight Loss Medications
Introduction: A New Tool for a Complex Journey
For many people, managing weight is a significant and often frustrating challenge. It’s a journey that involves much more than simple choices. A 2024 Pew Research Center survey found that 65% of U.S. adults believe willpower alone is usually not enough for most people to lose weight and keep it off. This widespread understanding highlights the complex nature of weight management. For individuals who qualify, prescription weight loss medications are emerging as a valuable tool, intended to be used alongside healthy eating, physical activity, and other lifestyle changes to support long-term health.
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1. What Are Weight Loss Medications and Who Are They For?
Prescription weight loss medications are designed for a specific purpose: to help people who have health problems related to their weight. They are not intended for cosmetic weight loss but are a medical treatment for a chronic disease.
1.1. Defining Overweight and Obesity
Healthcare professionals use a measure called the Body Mass Index (BMI)—which relates weight to height—to define these conditions.
• Overweight: A BMI between 25.0 and 29.9.
• Obesity: A BMI of 30.0 or greater.
1.2. Identifying Potential Candidates
A healthcare professional may prescribe a weight management medication for an adult who meets one of two primary criteria:
Having a BMI of 30 or greater.
Having a BMI of 27 or greater with a weight-related health problem. This includes conditions such as type 2 diabetes or high blood pressure.
Ultimately, the decision to use these medications is a collaborative one, made between a patient and their healthcare professional after considering the individual’s health history and goals.
Understanding who these medications are for is the first step; the next is understanding how they actually work inside the body to help manage weight.
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2. How Do These Medications Work?
Weight loss medications are not all the same; they function through several different biological mechanisms. The primary ways these drugs help manage weight include:
• Making you feel less hungry or full sooner.
• Making it harder for your body to absorb fat from the food you eat.
• Mimicking hormones that target areas of the brain that regulate appetite and food intake.
2.1. Common Types of Medications
Many of today’s most effective weight loss drugs, known as GLP-1 agonists, were first developed to treat type 2 diabetes. Their effectiveness in promoting weight loss led to their approval for chronic weight management. The following table summarizes the main classes of FDA-approved drugs.
| Medication Type | How It Works | Example Drugs (Brand Names) |
|---|---|---|
| GLP-1 and GIP/GLP-1 Agonists | Mimic natural hormones (like GLP-1 and GIP) to target areas of the brain that regulate appetite, making you feel full longer so you eat less. | Wegovy (semaglutide), Saxenda (liraglutide), Zepbound (tirzepatide) |
| Combination Medications | Blends different drugs to lessen appetite, increase feelings of fullness, and in some cases, help burn more calories. | Qsymia (phentermine-topiramate), Contrave (naltrexone-bupropion) |
| Fat Absorption Inhibitors | Work directly in the gut to reduce the amount of dietary fat your body absorbs from food. | Orlistat (Xenical, Alli) |
While these mechanisms are powerful, they are designed to work in partnership with fundamental lifestyle habits, not as a replacement for them.
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3. The Most Important Partnership: Medication and Lifestyle
It is crucial to understand that medications do not replace physical activity or healthy eating habits. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) states clearly: “Studies show that weight management medications work best when combined with a lifestyle program.”
Because obesity is a chronic disease, lasting success requires a long-term commitment. This involves making sustainable changes to eating patterns, increasing physical activity, and addressing other behaviors that contribute to weight gain.
When this partnership between medication and lifestyle is successful, individuals can experience significant and measurable health benefits.
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4. Realistic Benefits and Potential Side Effects
When taking these medications as prescribed within a comprehensive lifestyle program, a person can expect a range of outcomes.
4.1. Expected Health Benefits
1. Significant Weight Loss: On average, after one year, adults taking prescription medications as part of a lifestyle program lose 3% to 12% more of their starting body weight than people in a lifestyle program without medication. Research shows that some people lose 10% or more of their starting weight, with certain medications helping over half of users achieve this goal.
2. Improved Health Markers: A weight loss of just 5% to 10% can lead to major health improvements, including lower blood sugar, blood pressure, and triglyceride levels.
3. Relief from Other Conditions: Losing weight can also improve other health problems related to excess weight, such as joint pain and sleep apnea.
4.2. Common Side Effects and Concerns
Like any medication, these drugs have potential side effects. The most common are often related to the digestive system and include:
• Nausea
• Diarrhea
• Vomiting
• Constipation
• Abdominal pain
While most of these side effects are mild, more serious side effects (like pancreatitis or gallstones) can occur, underscoring the importance of ongoing medical supervision. It is also important to know that a person will likely regain some weight after stopping the medication. This reinforces the necessity of building and maintaining healthy lifestyle habits for long-term success.
While approved medications have known and manageable side effects, the dangers associated with unapproved and counterfeit drugs are far more severe.
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5. CRITICAL SAFETY WARNING: Be Aware of Unapproved and Counterfeit Drugs
The U.S. Food and Drug Administration (FDA) has issued serious warnings about the risks of using unapproved versions of popular weight loss drugs.
5.1. Key Dangers to Know
• Compounded Drugs: These are custom-mixed drugs, often used when the approved version is in shortage, but they are not FDA-approved. The agency does not review them for safety, effectiveness, or quality before they are sold.
• Counterfeit Drugs: These fraudulent products claim to be authentic but can contain the wrong ingredients, no active ingredient, or even harmful substances.
• Illegal Online Sales: Drugs sold online without a prescription from a state-licensed pharmacy may be fraudulent, unapproved, or unsafe.
• Improper Dosing: The FDA has received reports of serious adverse events, some requiring hospitalization, due to dosing errors with compounded products.
5.2. How to Protect Yourself
The FDA provides simple, actionable steps to ensure you are getting safe and authentic medication:
1. Only obtain a prescription from a licensed healthcare provider.
2. Only fill your prescription at a state-licensed pharmacy.
3. Never use medications falsely labeled “for research purposes” or “not for human consumption.”
4. Talk to your doctor if you have any questions or concerns about your medicine.
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6. Conclusion: A Considered Decision for Your Health
Prescription weight loss medications are a serious medical treatment, not a quick fix or a cosmetic solution. They represent a significant advancement in treating obesity, a complex, chronic disease. The decision to begin is deeply personal and must be made in close partnership with a healthcare provider who understands your complete health profile. When used as one part of a comprehensive plan that includes nutrition, physical activity, and behavioral changes, these medications can be a powerful tool for improving long-term health and well-being.
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Beyond the Hype: 5 Surprising Truths About the Weight Loss Drug Revolution
Beyond the Hype: 5 Surprising Truths About the Weight Loss Drug Revolution
Introduction
The media buzz around new weight loss drugs like Ozempic and Wegovy is inescapable. According to the Pew Research Center, about half of all Americans (53%) report hearing about these medications “extremely or very often.” The headlines are dominated by stories of dramatic weight loss, celebrity use, and potential side effects. But beyond this surface-level narrative, a more complex and surprising story is unfolding—one that intersects with science, economics, and public health.
This new class of medications is reshaping not only how we treat obesity but also how society thinks about it. To understand the full picture, it’s essential to look past the hype. Here are five of the most impactful and often overlooked facts about this new era of weight management.
1. It’s Not About Willpower—and a Majority of Americans Now Agree
For decades, the prevailing belief was that weight loss was purely a matter of personal discipline. That perception is undergoing a dramatic shift. A survey by the Pew Research Center found that about two-thirds of U.S. adults (65%) now believe willpower alone is not enough for most people to lose weight and keep it off. This view is even more common among women (71%) and becomes more prevalent with age, held by 71% of adults aged 50-64 and 73% of those 65 and older.
This change in public opinion aligns with the medical community’s framing of obesity as a chronic disease. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), these new drugs are intended to treat a complex medical condition, not a personal failing. They are a tool to be used as part of a comprehensive health plan, not a substitute for it.
Medications don’t replace physical activity or healthy eating habits as a way to lose weight. Studies show that weight management medications work best when combined with a lifestyle program.
2. The Sales are Astronomical, But Access is a Maze of Contradiction
The financial success of these drugs is staggering. In 2024 alone, Novo Nordisk’s revenue from Ozempic, Wegovy, and Rybelsus reached $31.1 billion. Similarly, Eli Lilly’s Mounjaro and Zepbound accounted for around 37% of the company’s entire 2024 revenue.
Yet, this commercial boom stands in stark contrast to the reality of patient access. According to a KFF report cited by Pew Research Center, only 13 states cover these GLP-1 medications for obesity treatment under Medicaid. The gap between what is medically available and what is financially accessible is widening. Rising costs have even forced some states, like North Carolina, to briefly suspend coverage altogether, highlighting a growing crisis of affordability and equity.
3. The “Quick Fix” Has a Lifelong Catch
A common misconception is that these medications offer a short-term cure for excess weight. However, because medical experts classify obesity as a chronic disease, treatment must often be ongoing to be effective. The NIDDK is direct on this point, stating, “You probably will regain some weight after you stop taking weight management medication.”
This reframes the drugs as a long-term management tool, similar to medications used to control high blood pressure or cholesterol, rather than a one-time fix. If a patient responds well and does not experience serious side effects, health professionals may advise them to stay on the medication indefinitely to maintain its health benefits.
4. The Biggest Danger Might Not Be a Listed Side Effect
While the official side effects of FDA-approved drugs are well-documented, a more immediate danger may lie in the unregulated market that has emerged to meet overwhelming demand. The U.S. Food and Drug Administration (FDA) has issued multiple warnings about unapproved and “compounded” versions of these drugs, which do not undergo any FDA review for safety, effectiveness, or quality.
The FDA has identified several specific and alarming risks associated with these products, including:
• Dosing errors: The FDA has received numerous reports of adverse events, with some requiring hospitalization, due to patients and even health professionals miscalculating doses of compounded products.
• Fraudulent products: Some compounded drugs have been found with labels from pharmacies that either do not exist or did not actually make the product.
• Unknown ingredients: The FDA has expressed concern that some compounders may be using different active ingredients, such as semaglutide salt forms, whose safety and effectiveness are completely unknown.
• Counterfeits and illegal sales: The agency has also warned consumers about counterfeit Ozempic and drugs sold online that are falsely labeled “for research purposes.”
As of July 31, 2025, the FDA had received 605 reports of adverse events for compounded semaglutide and 545 for compounded tirzepatide, noting that these numbers are likely significant undercounts.
5. Americans See a Clear Line Between Medicine and Vanity
Public opinion on these drugs is far more nuanced than media portrayals often suggest. A Pew Research Center survey reveals a clear distinction in how Americans view their appropriate use. A majority (53%) believe the drugs are good options for people with obesity or a weight-related health condition like type 2 diabetes or high blood pressure.
However, support plummets when the drugs are considered for cosmetic purposes. Only 12% of Americans view them as a good option for people who want to lose weight but do not have a related health condition, while 62% say they are not a good option in that scenario. This public sentiment aligns directly with guidance from medical experts.
For this reason, never take a weight management medication only to improve the way you look.
Conclusion
The story of modern weight loss medication is far more complex than a simple tale of a scientific breakthrough. It is a story that forces us to confront profound questions about the nature of chronic disease, the challenges of healthcare inequality, and the serious dangers of an unregulated market. The conversation is no longer just about losing weight; it’s about public health, patient safety, and societal values.
As these powerful new tools change how we treat a chronic disease, how do we ensure the benefits are both safe and accessible to everyone who needs them?
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Obesity, GLP-1 Drugs, and Public Health in the United States
Obesity, GLP-1 Drugs, and Public Health in the United States
Executive Summary
The United States is grappling with high rates of obesity, a chronic disease affecting approximately four in ten adults. In response, a new class of medications known as glucagon-like peptide-1 (GLP-1) receptor agonists has surged in popularity, fundamentally altering the landscape of weight management. Public awareness of drugs like Ozempic and Wegovy is high, with a majority of Americans viewing them as appropriate treatment for individuals with obesity or related health conditions, but not for cosmetic weight loss. This demand has fueled explosive revenue growth for pharmaceutical companies, with sales reaching tens ofbillions of dollars annually, predominantly within the U.S. market.
However, this rapid adoption is accompanied by significant challenges. The U.S. Food and Drug Administration (FDA) has issued multiple warnings about the risks associated with unapproved, compounded, and counterfeit versions of these drugs, which do not undergo federal review for safety, quality, or effectiveness. Reported issues include dosing errors leading to hospitalization, improper storage, fraudulent labeling, and the use of unapproved chemical forms.
Clinically, these medications are intended for long-term use as part of a comprehensive lifestyle program that includes diet and exercise, not as a standalone solution. While they can lead to significant weight loss—an average of 3% to 12% more than lifestyle changes alone—weight regain is likely upon discontinuation. Access remains a critical issue, as inconsistent insurance coverage and rising costs have led some state Medicaid programs to restrict or eliminate coverage, creating barriers for patients who could benefit from these treatments.
The U.S. Obesity Landscape
Prevalence and Historical Trends
Obesity remains a major public health issue in the United States. According to the most recent age-adjusted estimates from the Centers for Disease Control and Prevention (CDC) for 2021-2023, approximately 40% of American adults aged 20 and older are considered obese, with nearly 10% classified as severely obese. This represents a significant increase over recent decades; in the 1988-1994 survey period, 22.9% of adults were obese and 2.8% were severely obese. A slight decline of around 2 percentage points in the obesity rate was observed between the 2017-2018 and 2021-2023 survey periods, marking the first time the rate has fallen by more than one point between surveys.
These classifications are based on the Body Mass Index (BMI), a measure of weight relative to height.
• Overweight: BMI of 25.0 to 29.9
• Obese: BMI of 30.0 to 39.9
• Severely Obese: BMI of 40.0 or more
While widely used as a screening tool, many medical professionals advise that BMI alone is insufficient for assessing individual health risks, as it does not account for factors like genetics or body composition.
Public Perceptions of Weight Loss
There is a broad public consensus that weight management involves more than individual resolve. A February 2024 Pew Research Center survey found that 65% of U.S. adults believe willpower alone is generally not enough for most people to lose weight and keep it off, compared to 34% who believe it is sufficient.
This perspective varies across demographics:
• Gender: 71% of women believe willpower is not enough, compared to 59% of men.
• Age: The belief that willpower is insufficient increases with age, from 55% of adults aged 18-29 to 73% of those 65 and older.
• Race/Ethnicity: 68% of White and 70% of Black adults hold this view, compared to 55% of Hispanic and 54% of Asian adults.
When asked about factors that impact a person’s weight “a great deal,” Americans identified diet (57%) and exercise habits (43%) as the most significant, though over one-fifth also pointed to stress, genetics, and access to grocery stores.
The Rise of GLP-1 Weight Loss Medications
Public Awareness and Views
GLP-1 medications have become a prominent topic in public discourse. As of early 2025, 53% of Americans reported hearing or reading about drugs like Ozempic and Wegovy “extremely or very often.” Women are more likely than men to report high exposure (59% vs. 47%), with awareness being particularly high among women aged 50 and older (68% for ages 50-64 and 63% for ages 65+).
Public opinion distinguishes between medical necessity and elective use. Among those aware of the drugs, a majority (53%) said they are good weight loss options for people with obesity or a weight-related health condition. In contrast, only 12% considered them a good option for individuals who want to lose weight but do not have a related health condition; 62% stated they are not good options for this group.
Explosive Market Growth
The demand for GLP-1 drugs has translated into extraordinary financial growth for the pharmaceutical companies that produce them. The United States is the largest market by a significant margin.
• Novo Nordisk: The Danish manufacturer of Ozempic, Wegovy, and Rybelsus (all based on the active ingredient semaglutide) saw combined revenues from these three drugs soar from $276.6 million in 2018 to $31.1 billion in 2024. These drugs accounted for 70% of the company’s entire 2024 revenue. In 2024, nearly 70% of these sales occurred in the U.S. alone.
| Year | Combined Annual Sales (Ozempic, Wegovy, Rybelsus) | U.S. Sales |
|---|---|---|
| 2018 | $276,584,000 | $251,636,000 |
| 2019 | $1,738,198,000 | $1,485,946,000 |
| 2020 | $3,554,936,000 | $2,845,304,000 |
| 2021 | $6,149,066,000 | $4,434,738,000 |
| 2022 | $11,894,498,000 | $8,145,830,000 |
| 2023 | $22,454,894,000 | $15,939,000,000 |
| 2024 | $31,084,746,000 | $21,677,964,000 |
• Eli Lilly: The U.S. company produces Mounjaro and Zepbound (based on the active ingredient tirzepatide). After Mounjaro’s approval in mid-2022 and Zepbound’s in late 2023, their combined sales reached $16.5 billion in 2024, accounting for approximately 37% of Eli Lilly’s total revenue that year. In 2024, 84% of their combined sales were in the U.S.
| Year | Combined Annual Sales (Mounjaro and Zepbound) | Total Company Revenue |
|---|---|---|
| 2022 | $482,500,000 | $28,541,400,000 |
| 2023 | $5,338,900,000 | $34,124,100,000 |
| 2024 | $16,465,800,000 | $45,042,700,000 |
Clinical Guidelines and Treatment Considerations
Indications for Use
Weight management medications are intended for individuals with health problems related to their weight. Healthcare professionals may prescribe them for adults with:
• A BMI of 30 or greater.
• A BMI of 27 or greater, coupled with a weight-related health condition like type 2 diabetes or high blood pressure.
Four medications—orlistat, liraglutide, phentermine-topiramate, and semaglutide—are FDA-approved for use in children aged 12 and older. A fifth, setmelanotide, is approved for children aged 6 and older with specific rare genetic disorders that cause obesity.
Efficacy and Role in Treatment
These medications are designed to supplement, not replace, lifestyle modifications. Studies demonstrate they are most effective when combined with a program of healthy eating and increased physical activity. On average, adults taking these medications as part of a lifestyle program lose 3% to 12% more of their starting body weight after one year than those relying on lifestyle changes alone. A weight loss of 5% to 10% is considered clinically significant and can lead to improvements in blood sugar, blood pressure, and triglyceride levels.
Treatment as a Chronic Care Model
Obesity is a chronic disease, and treatment may need to be indefinite. If a medication is effective and does not cause serious side effects, a healthcare provider may recommend staying on it long-term. If a patient does not lose at least 5% of their starting weight after 12 weeks on the full dose, the provider will likely recommend stopping the medication and considering other options. Because of the chronic nature of obesity, individuals will likely regain some weight after discontinuing the medication.
Side Effects and Risks
Patients may experience a range of side effects. Common issues include nausea, vomiting, diarrhea, stomach cramps, and headaches. More serious but rare side effects can include pancreatitis, gallstones, kidney injury, intestinal obstruction, and vision loss. These medications are considered harmful during pregnancy and should not be taken by those who are pregnant, trying to become pregnant, or breastfeeding.
FDA Safety Warnings and Regulatory Concerns
The FDA has raised significant concerns about the safety of GLP-1 drugs obtained outside of approved channels. The agency explicitly warns that patients should only use medications obtained with a prescription from a licensed provider and filled at a state-licensed pharmacy.
Unapproved and Compounded Drugs
Compounded drugs are not FDA-approved and do not undergo the agency’s review for safety, effectiveness, or quality. Key concerns identified by the FDA include:
• Improper Storage: Injectable GLP-1s require refrigeration. The FDA has received complaints of compounded drugs arriving warm, which can affect their quality.
• Fraudulent Products: The agency is aware of fraudulent compounded drugs with labels that list non-existent pharmacies or licensed pharmacies that did not produce the product.
• Dosing Errors: Multiple adverse events, some requiring hospitalization, have been linked to patients or healthcare professionals miscalculating and administering incorrect doses of compounded semaglutide.
• Unapproved Ingredients: Some compounders may be using salt forms of semaglutide (semaglutide sodium and semaglutide acetate), which are different active ingredients than those in the approved drugs. The FDA is not aware of any lawful basis for their use.
• Illegal Substances: The substances retatrutide and cagrilintide are not components of any FDA-approved drug and cannot be legally used in compounding.
Counterfeit and Illegally Marketed Products
The FDA is actively monitoring and taking action against illegally sold products:
• Counterfeit Ozempic: The agency is aware of counterfeit Ozempic being marketed in the U.S. and warns that such products can contain incorrect or harmful ingredients.
• Illegal Online Sales: Warning letters have been issued to stop the distribution of illegally marketed semaglutide and tirzepatide online.
• “Research Use” Products: The agency has warned companies selling unapproved drugs falsely labeled “for research purposes” or “not for human consumption” directly to consumers.
Adverse Event Data
As of July 31, 2025, the FDA had received 605 reports of adverse events associated with compounded semaglutide and 545 reports for compounded tirzepatide. The agency notes this is likely an undercount, as federal law does not require all state-licensed pharmacies to report such events.
Access, Cost, and Insurance Coverage
Medicaid Coverage
Access to GLP-1s for obesity through Medicaid is inconsistent across the country. As of a January 2026 KFF report:
• 13 states cover one or more GLP-1s for obesity treatment under Medicaid.
• 7 states cover some weight loss drugs but exclude GLP-1s.
• The remaining states do not cover these medications for obesity.
The rising cost has strained state budgets. North Carolina briefly suspended coverage due to funding shortfalls, while California, New Hampshire, Pennsylvania, and South Carolina stopped covering GLP-1s for weight loss as of January 1, 2026.
Spending Trends
The financial impact on public insurance programs is substantial.
• Medicaid prescriptions for GLP-1s grew from 1.3 million in 2019 to 8.4 million in 2024.
• Medicaid gross spending on these drugs increased from nearly 1billionin2019to∗∗8.6 billion in 2024**.
For private insurance, coverage varies significantly by plan, and cost remains a major factor for many patients.
Appendix: FDA-Approved Chronic Weight Management Medications
The following table summarizes prescription drugs approved by the FDA for long-term use in treating overweight and obesity.
| Medication (Brand/Generic Name) | Approved For | How It Works | Key Contraindications |
|---|---|---|---|
| orlistat (Xenical, Alli) | Adults and children 12+ | Works in the gut to reduce the amount of fat absorbed from food. | Problems absorbing nutrients; cholestasis. |
| phentermine-topiramate (Qsymia) | Adults and children 12+ | A combination of an appetite suppressant (phentermine) and an anti-seizure/migraine drug (topiramate). | Glaucoma; hyperthyroidism; use of MAOI antidepressants in the last 14 days. |
| naltrexone-bupropion (Contrave) | Adults | A combination of an addiction treatment drug (naltrexone) and an antidepressant (bupropion). May reduce hunger or increase fullness. | Uncontrolled high blood pressure; seizures; anorexia/bulimia; opioid use; use of MAOIs. |
| liraglutide (Saxenda) | Adults and children 12+ | Mimics the GLP-1 hormone to target brain areas that regulate appetite and food intake. | Personal or family history of medullary thyroid cancer (MTC) or multiple endocrine neoplasia syndrome type 2 (MEN 2). |
| semaglutide (Wegovy) | Adults and children 12+ | Mimics the GLP-1 hormone to target brain areas that regulate appetite and food intake. | Personal or family history of MTC or MEN 2. |
| tirzepatide (Zepbound) | Adults | Mimics two hormones (GIP and GLP-1) to target brain areas that regulate appetite and food intake. | Personal or family history of MTC or MEN 2. |
| setmelanotide (Imcivree) | People 6+ with specific rare genetic disorders. | Activates brain pathways to decrease appetite and increase calories burned. | Not specified for general use. |
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