| By Maya Goldman |
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| Illustration: Tiffany Herring/Axios |
The surging popularity of GLP-1 drugs is beginning to obscure the health consequences if people stop taking them, physicians warn.Why it matters: While many patients can shed up to 20% of their body weight using the injectables, the cost of the drugs and side effects like nausea and vomiting lead many to quit. In most of those cases, their weight returns.”A lot of people are going on these drugs and then going off, and there’s not going to be a benefit from doing that,” said Ethan Lazarus, an obesity medicine physician in Colorado.Almost half of GLP-1 users with obesity had discontinued their medication one year in, according to research published in JAMA. Other analyses show even higher discontinuation rates.Driving the news: Concern about the long-term effects of withdrawal is intensifying as more public and private insurers clamp down on coverage of GLP-1s for weight loss.Researchers have observed that people’s hunger can return voraciously when they drop off the drugs, possibly because the body’s left in a GLP-1 deficit that affects brain signaling and feelings of satiety.Between the lines: Some obesity medicine doctors are worried long-term weight loss will become more difficult for patients who cycle on and off GLP-1s.Share this2025’s obesity battle  Illustration: Sarah Grillo/Axios For all the changes in recent years in how obesity is understood and treated, 2025 is shaping up to feature familiar battles over whether the condition is a disease or the product of lifestyle choices.Why it matters: Obesity is a major public health threat in the U.S., and while new drugs have finally given doctors and patients a tool to meaningfully treat the disease, rejection of those drugs in favor of lifestyle changes at a policy or cultural level could blunt important public health progress.But high-profile skeptics of the drugs have a point: They don’t address the underlying causes of the country’s obesity epidemic.Where it stands: 2024 ended with a clash between Robert F. Kennedy Jr., President-elect Trump’s nominee for HHS secretary, and Elon Musk over GLP-1s for weight loss.”The first line of response should be lifestyle. It should be eating well, making sure you that you don’t get obese, and that those GLP drugs have a place,” Kennedy told CNBC last month.”Nothing would do more to improve the health, lifespan and quality of life for Americans than making GLP inhibitors super low cost to the public. Nothing else is even close,” Musk wrote on X around the same time.The big picture: Kennedy and Musk are emerging as influential voices in the Trump administration, each with the power to shape popular opinion as well as government policy around coverage and potentially even pricing of the drugs.Between the lines: Lifestyle and new anti-obesity medications both play a role in the obesity narrative, experts say. But they’re not substitutes for one another.Americans’ unhealthy diet and increasingly sedentary lifestyle — a product partially of changes in how we make a living — are likely behind the decades-long rise in obesity rates, and reversing those lifestyle trends could help prevent more people from developing obesity to begin with.But researchers have found that obesity causes biological changes that make lifestyle adjustments alone a poor treatment plan.”Once you have the disease of obesity and you go on a diet and you exercise and you lose weight, your body’s hormones think you’re starving to death,” said Caroline Apovian, co-director of the Center for Weight Management and Wellness at Brigham and Women’s Hospital.The body is “going to increase the hunger hormone and decrease the satiety hormones until you gain that weight back,” she added.Plus, “with no support, people will typically go back to their typical eating habits and exercise habits,” said Thomas Wadden, aprofessor of psychology at the University of Pennsylvania. “Hard work alone is not going to make people successful in the context of the current food and activity environment.”And lifestyle changes on the scale that would be necessary to make long-term dents in obesity rates are unrealistic, experts say.”Whatever is in the environment that has caused this disease is not going away,” Apovian said. “We’re not going to get rid of ultra-processed food. The cat’s out of the bag. So RFK — you’re right, yeah, but we’re never going to get there.”Details: GLP-1s work by reducing a person’s hunger levels and combating the biological changes made by obesity.Obesity rates stopped climbing this year, likely related to Ozempic use.But the drugs’ high price tag and frequent lack of insurance coverage puts them out of reach for millions of Americans who could benefit. Plus, patients have to keep taking the drugs for them to remain effective, and they can have unpleasant side effects.The bottom line: “Treating patients with drugs is the simplest way to deal with the problem at this point, but it really is sort of a moral hazard, because it doesn’t require us to change the environment that keeps creating more obese people,” Wadden said.from Endpoints News:Biopharma to raise more than 1,000 drug prices in 2025, advisory firm predictsby Nicole DeFeudisDrugmakers are expected to increase list prices on more than 1,000 medicines this year, and already raised the prices on about 250 drugs on Jan. 1, according to an analysis by the consultancy firm 3 Axis Advisors.While it’s still early, industry experts say the magnitude of those price hikes is largely in line with years prior. Most list prices increased by less than 10%, according to data first reported by Reuters. Those prices do not take into account confidential rebates and other discounts, which form a drug’s net price.”Nothing in particular looks like a material departure from business as usual,” 3 Axis president Antonio Ciaccia told Endpoints News on Thursday. However, he said the data could change as new price adjustments are announced.from STAT:drug pricingMerck is a new year outlier with its diabetes drug From STAT’s Elaine Chen: The start of the new year is traditionally a time when many drugmakers raise the price of their treatments, and this year, companies did just that with at least 250 medicines. But Merck stood out by cutting the list price of its diabetes drug Januvia by 42%.Merck cited two reasons: The first, it said, was that it wanted to align the list price more closely to the net price to benefit patients, such as those paying coinsurance. The company also cited changes in the Medicaid rebate program in 2024. Those changes allowed Medicaid to collect over 100% in rebates if companies raise drug prices by more than inflation. Merck said its Medicaid rebate rate for Januvia was over 100%, meaning it was losing money on Januvia prescriptions.This Medicaid change, experts say, was also a factor that had driven makers of insulin products — Eli Lilly, Novo Nordisk, and Sanofi — to cut list prices in 2023.As was the case with the insulin pricing, though, cutting list prices may end up actually hurting patients’ access to the drugs. After Novo cut the list price of an insulin product called Levemir, it likely wasn’t able to offer commercial pharmacy benefit managers as high rebates as it used to. Novo said it started losing access to commercial drug formularies and ultimately decided to discontinue the drug, leaving patients scrambling. There have also been shortages of other insulin products produced by Novo, leading patients to wonder if the company is de-prioritizing the production of insulin. |
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