The GLP-1 agonist drugs you have almost certainly heard about, with such names as Wegovy and Ozempic, are the biggest wonder drugs since antibiotics. I know because I asked a couple of AI chatbots if it were true and they agreed. But, I also know the field. The time when infectious disease plagued the West has passed (COVID hysteria aside). Now it’s lifestyle diseases, which tremendously increase the chance of getting infectious diseases that will harm you or carry you off.
“Epidemic” has become almost trite, but it certainly applies to fatness in the U.S. and much of the rest of the world. For decades now, the percentage of Americans who are overweight has grown. Like a pig in a python or an aardvark in an anaconda, those who are overweight have been moving from being simply overweight to obesity to higher levels of obesity. About three-fourths of the U.S. population was overweight or obese the last time surveys were conducted. It must be worse now. During the same period, the prevalence of severe obesity increased from 4.7 percent to 9.2 percent. (READ MORE: Anthony Fauci Tells Columbia Medical Students to Lie Just Like Him)
Internationally? Believe it or not, per capita, there are countries fatter than ours; the U.S. territory of American Samoa is more than 80 percent obese. If the islands sink, don’t blame rising sea levels. It’s projected that by 2035 more than half of the world’s population will be overweight or obese. In the Philippines, where I lived for five years, I watched female obesity go from almost zero to watching rotund girls lumber by, one after another, to enter their favorite feeding ground, the 7/11.
Gym memberships, the latest diet crazes, and low-calorie drinks may have helped on an individual basis but they clearly aren’t working overall.
You can’t directly blame the food and beverage industries. Force feeding would be perceived as assault and battery in all states and territories. But yeah, they’ve figured out what we like to shove down our gullets.
And it’s clobbering us.
Obesity Is Costing Us
“It has been widely established that elevated BMI is a serious risk factor for a number of chronic diseases, including diabetes mellitus, cardiovascular disease, chronic kidney disease and musculoskeletal disorders,” noted a 2022 study. The estimated annual medical cost of obesity in the U.S. last year was over half a trillion, according to a joint Congressional report. Other costs are incalculable, and often subsidized. Theater and stadium seats are being built wider, which means fewer individuals can fit in the same area and thus higher ticket costs. (Airline seats, on the other hand, have actually been made narrower — don’t even get me started on the airlines.)
“Social media influencers” and other fat activists who call those who point out these facts “phobic fat-shamers” and insist it’s possible to be “fat but fit,” seem to have a nasty habit of dying young.
Having penned a whole book on the obesity epidemic 27 years ago (yes, we used pens back then) I’ve given up hope that anything short of pharmaceutical treatment can reverse this awful trend. Can people keep their weight under control without medication? Yes. Will they? Despite some bizarre fat activists claiming that they somehow enjoy their conditions, nobody wants to be fat and yet they are. (READ MORE: Government Health Coverage for Illegals is a Bad Idea)
I first wrote about GLP-1 agonists for The American Spectator in July last year. I noted that initially when the FDA approved them in 2005 for diabetes, researchers noted they were causing weight loss in addition to monitoring blood glucose levels. The drugs are usually self-injected weekly into the stomach (or other body parts with fatty tissue), although there are dosing variations and some come in pill form.
They are not just marginally effective. They seem to prompt a 15 percent weight loss, although clinical trials usually end after a year so we don’t know if that’s the limit. Some of the newer configurations have caused weight loss beyond that. Last June, a study using Eli Lilly’s retatrutide reported weight declines never before seen with a single drug, with patients averaging a 24 percent body weight loss in just 11 months and many in the group on the highest dose dropping more than 30 percent. That’s the same ballpark as drastic bariatric surgery, and all groups were still losing weight when the trial ended!
They have proved massive money makers for pharmaceutical companies, first for diabetes and now for fat reduction. Currently, eight different formulations are in, or have graduated, the third and usually last phase of clinical trials, with seven more for phase II, and six for phase I. All may prove safe and effective. We’ve never seen anything like this. (Meanwhile, the last full-spectrum antibiotic, ciprofloxacin (Cipro) was approved way back in 1987, and last year the FDA withdrew the label for the lowest dose 100 mg tablets because the drug is losing potency against bacteria; but that’s a different issue. A very alarming one.)
In that previous TAS article, I defended GLP drugs against allegations that they might cause thyroid cancer (the FDA has required a warning label) and pancreatic cancer. I noted that, with a cure rate of nearly 100 percent, thyroid malignancies barely qualify as cancer. This year a British Medical Journal study comprising GLP users in three Scandinavian countries has found no relationship to thyroid carcinomas. The FDA warning needs to disappear.
As to pancreatic cancer, that was always a tenuous link, and a study released in January that followed half a million GLP users over seven years found no increased pancreatic cancer risk. Mind, many adult cancers can take years to manifest but that falls along a bell curve with some developing relatively quickly. In a cohort that large, you’d find them. They didn’t.
As more and more people use the drugs, we can expect to find more people with unwanted side effects like nausea, vomiting, diarrhea, and constipation. Worst case scenario: Stop, reduce dosage, or switch to another formulation.
Meanwhile, a risk-risk analysis would note that, since obesity has been linked to almost countless cancers, even if it did increase the risk of any single one, that would be irrelevant.
As it happens, the GLP leader, Danish Novo Nordisk, has just released the results from a four-year study; the results are pretty spectacular. It comprised more than 17,000 non-diabetic patients from over 40 countries and found Wegovy indefinitely reduced weight for the full period, as well as reducing deaths and illness from heart disease.
Don’t like needles? Novo, along with Lilly, is in late-stage testing of pills that have caused 15 percent weight reductions in less than a year. Other research is focused on stretching out time between dosing.
GLP-1s Will Be in Short Supply for a While
Before you rush off to your physician, there are a few things you should know. One is that the drugs are in short supply and will remain so until at least next year. As soon as they roll off the production line, they’re scarfed up as quickly as the protagonist in the nauseating (in more ways than one) movie The Whale scarfed down those pizzas. There have been almost desperate campaigns to get doctors to reserve the diabetic-level drugs for diabetics.
However, non-obese people will seek out the drugs for some good reasons. One is the harmful effects of too much fat don’t begin at what we call obesity. That’s essentially an arbitrary line. It’s why articles on fat-related health problems usually lump them together. Anything linked to obesity is still bad at what we call overweight, which helps explain the “over,” and is worse at what we call extreme obesity. Yes, carrying the weight near the abdominal region is worst but unfortunately, we can’t pick and choose. At my most overweight I’ve had a big belly but absolutely nothing goes to my appendages. Boo-hoo for me.
Plus, yeah, it’s nifty to fit into the same jeans at 60 that you did at 20. Apparently, a lot of women do like “dad bods,” but men almost always prefer lean at any age. So it could be a long time before there’s enough medicine to match demand.
Another problem with getting the meds is that given all the health benefits of the GLP1s you might think that your private health insurance plan plus Medicaid and Medicare would cover them. You would probably be wrong. For diabetes, yes. But Medicare has traditionally not covered weight-loss drugs because, in the past, they didn’t work. Now suddenly they do we have been caught off-guard. About a quarter of U.S. corporate insurers cover GLPs for obesity, but if you don’t get insurance through your employer forget it.
State Medicaid plans make their own rules regarding everything, with many plans refusing to cover vision and dental — something nobody claims is unnecessary or the realm of scammers. A 2023 survey found that 16 states’ Medicaid systems provided some sort of coverage, but generally with tight rules. North Carolina did cover them, but as of April 1, it no longer does, explaining “The cost of these medications was projected to exceed $170 million in 2024, jumping to more than $1 billion over the next six years. This exceeds the amount the State Health Plan spends on cancer, rheumatoid arthritis, and chemotherapy medications.”
As for Medicare, the importance of establishing that the drugs have health benefits beyond those attributable to weight loss allows an end run around the rule. Indeed, Medicare does now cover some of the drugs for which it’s found sound evidence that they reduce heart disease and stroke, again independently of the impact of lowering fat levels.
But it’s threatening to break the bank. In 2022, Medicare Part D spending on GLPs reached $5.7 billion, up from just $57 million in 2018. Ozempic alone came in at 6th place among top-selling Part D drugs in 2022.
Which connects us to our next problem. If you’re thinking of paying out of pocket, you’ll run into why Medicaid is balking. Price gouging. But only for Americans. Yes, wave that big green foam “We’re Number One!”
A recent survey found Ozempic (injectable), Rybelsus (pill form), and Wegovy, all from Novo, cost between $936 and $1,349 for a month’s supply. A bar graph shows for Ozempic shows a one-month U.S. supply at $936 is over five times higher than the cost in Japan ($169), the second-highest price point for the drug. The lowest price point for Ozempic is $83 in France. Right. It’s over 10 times the price in the States. They weren’t cherry-picking; I randomly chose Spain and it was on the high side for Europe but still only $141.
Personally, I could afford these drugs almost anywhere but in the U.S., especially given understandable evidence that GLP users are lowering their grocery bills. An analysis found a 6 to 9 percent decrease in grocery spending, particularly among snacks, pastries, and ice cream, while sales of vegetable snacks, fish, and yogurt increased. Sacre bleu! In France, the drugs could more than pay for themselves. (We writers prefer “sacre bleu” over the more common “Mon Dieu” because “My God!” is universal though still literally taking the Lord’s name in vain, while who the heck singles out a color?)
Other financial side benefits to users would be decreased use of medicines and delaying, perhaps forever, joint surgery. But upfront costs indicate no medication, for me and most Americans. And sorry to say that writing a book on overweight and obesity, as I have, is not talismanic. Granted, I’m getting on in years, still suffering a leg problem that inhibits exercise, and my Sunday 5-hour bike rides have been replaced by nothing.
Pharmaceutical Companies Are Making Plenty On GLP-1s
Naturally, though, these drugs are very expensive to make! Wrong! Er, mistaken, gentle reader. While GLPs are not complex biologics that could be produced and sold at a profit for as little as 89 cents a month, according to a study published in the Journal of the American Medical Association (JAMA) Network Open, the retail prices can be almost 400 times higher than the estimated cost of production.
The drug companies always claim production costs are of little relevance, that what counts is cost savings from problems averted. Plus they have to recoup their losses on all the drugs that fail, which is the great majority. Both are valid points. But even that low French price ensures a substantial profit and the real question, with pharmaceuticals generally, is why are Americans always footing the darned bill?
The answer is that they have a literal (not figurative) conspiracy between the AMA, Big Pharma, and insurance companies that manifests itself in all areas of health care, and because the U.S. government subsidizes health insurance paid by employers, which is fine if you qualify but otherwise it sucks.
Mind, Medicare negotiates with pharmaceutical companies. At this point, I have no answer as to why it allows itself to be gouged. On our behalf, of course.
Finally, there is a cap on GLP usage by some of those who need it most. Psychological.
Overeating is often, perhaps usually, self-medication. Many of us will gladly forgo it for the benefits of weight loss. Others will not. Or cannot? You can watch anti-GLP vloggers become hysterical before your eyes because GLPs have taken away their fix. Many list a panoply of symptoms allegedly caused by one of the drugs that have no substantiation in the medical literature. In one video, a YouTuber admits she’s hysterical and “not a very balanced person” but has no idea how hysterical she is, nor that she’s a hypochondriac.
The protagonist in The Whale did most of his scarfing during panic attacks. Mind, often the stressor in fat people is being fat. Both directly and from all the bad things that being overweight causes. But if food is your therapy, you’ll have to find another one.
So perhaps the “perfect” weight loss drug allows the consumption of more food. That was the promise of stimulant drugs like amphetamines and Orlistat (Xenical), which keep about a third of consumed fat from being absorbed but can have nasty side effects. Metabolism boosters, including caffeine, appear to have some effect but too much causes shakiness, hallucinations, and other nasties. Is perceiving your hair to be full of spiders worth it? You can’t have your cake and eat it, too. (Which, yes, is better stated in reverse.)
The GLP-1 agonists we have now have proved stunningly effective initially for diabetes, then weight loss, then various serious diseases independently of weight loss, and just keep improving. The supplies must go up, and the prices for Americans must come down. We’re literally dying for it.
Michael Fumento is an attorney, author, journalist, and former paratrooper who has written for National Review, the Weekly Standard, Commentary, The American Spectator, Human Events, Forbes, Reason, Policy Review, the Spectator (London), the Sunday Times of London, the Wall Street Journal op-ed page, and many other publications.
