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When President Trump called for fee cuts in weight-loss drugs, it was an exciting moment. Most people in America know that obesity is a major health problem, and nearly everyone knows how difficult it is to lose weight and keep it off. Here’s a summary of the President’s proposal:
President Donald Trump hailed his deal to slash the price of blockbuster weight loss drugs as a game changer, promising to make Wegovy and Zepbound more affordable for millions of Americans. But major gaps in the plan could blunt its impact, drug policy experts say: Some of the drugs the administration has promised discounts on haven’t been approved yet by the Food and Drug Administration; the lower prices for people paying out of pocket only appear to apply to the lowest doses of the drugs; and the deal doesn’t expand Medicare coverage to people seeking treatment for weight loss alone.
Although some people will be disappointed that they won’t be able to find immediate relief from weight issues, many of the questions that have come up will be resolved by the end of the year or in 2026. The cost reductions are substantial:
The agreements will cut prices of so-called GLP-1 drugs for Medicare and Medicaid beneficiaries in 2026 and offer the treatments directly to consumers at a discount on a website the Trump administration is launching in January called TrumpRx.gov. That means Medicare will start covering obesity drugs for some patients for the first time starting mid-2026, a long-awaited move that could broaden the market for the medicines and spur more private insurers to cover them. Certain Medicare patients will pay a copay of $50 per month for all approved uses of injectable and oral GLP-1 drugs, including diabetes and obesity treatment.
But some people shouldn’t ignore other issues attached to these drugs. The primary ingredient in some of the drugs is semaglutide, originally designed to treat Type 2 diabetes:
A popular weight loss drug, semaglutide, is making headlines—but not just for its widespread use. New concerns are being raised about its long-term effectiveness, safety, and what happens when people stop taking it.
Since using these drugs is so recent, there hasn’t been time to conduct long-term studies. Also, although some side effects are known, without the long-term information, the list of side effects may be incomplete:
Semaglutide is associated with a high prevalence of adverse events, and its long-term safety is unknown. In an observational study, semaglutide was associated with a more than fourfold and sevenfold risk of nonarteritic anterior ischemic optic neuropathy (an inflammation that causes sudden vision loss) in people taking semaglutide for type 2 diabetes and weight loss, respectively.
Other side effects we can liken to other prescription drugs, although some are more serious than others:
These drugs really do seem effective in causing weight loss, so much so that people have referred to Ozempic as ‘the skinny pen.’ In a study in the New England Journal of Medicine, those who took semaglutide for a little over a year lost an average of 15 percent of their body weight. This is not to say the injections are without risks, however. For Wegovy, Novo Nordisk lists ‘nausea, diarrhea, vomiting, constipation, stomach (abdomen) pain, headache, tiredness (fatigue), upset stomach, dizziness, feeling bloated, belching, gas, stomach flu, heartburn, and runny nose or sore throat’ as common side effects. More serious possible side effects include pancreatitis, gallbladder problems, hypoglycemia (low blood sugar), kidney problems, and increased heart rate.
Underlying some of the problems experienced with these medications are the emotional and psychological problems that contribute to weight gain and overeating. The following outcomes can exacerbate the problems already in place:
For many people taking semaglutide, weight loss slows over time and often stalls completely. Even after four years of use in the SELECT trial, only 12% of participants reached a healthy body weight. Most people remained either overweight or obese. And the progress doesn’t always last. When participants in the STEP-1 EXTENSION STUDY stopped taking semaglutide, they quickly regained the weight they had lost.
(The SELECT Trial was a large-scale, randomized, placebo-controlled trial designed to evaluate whether or not semaglutide, a potent GLP-1 receptor agonist, would reduce the risk of cardiovascular events among overweight patients with preexisting cardiovascular disease, but who did not have diabetes.)
Ultimately, people need to weigh the pros and cons, including the emotional and ethical issues involved:
Humans, and Americans in particular, are prone to searching for technological solutions to their problems. Weight-loss injections may seem like a much easier path to weight loss than a diet and exercise routine that requires consistency and discipline. For some, their use may be indicated and will have many benefits. For others, however, the promise of easy weight loss may deter them from developing self-control or addressing underlying personal and emotional factors that led to overeating in the first place. Thus, we should approach the use of weight-loss medications carefully, being sure that we are not substituting technology for a disciplined, healthy lifestyle.
For those who choose to use these drugs, looking at all the issues would be a wise choice.
After our experiences with the side effects of COVID-19 vaccines, we should be as informed as possible.
Discussion (22)
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They *are* miracle drugs, Susan, in that they produce miraculous results. I have many patients who have lost 50-60# on Zepbound or Ozempic, and whos diabetic control is improved. We need to learn how to manage these drugs long term and we need to learn what the rare side effects will be; both of these will come with time and experience.
Insulin was a miracle drug in 1922, but it is not without problems. Imagine the last century of treating diabetes if our concern over side effects had limited insulin use.
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If a person is treating diabetes, that's one thing; if they are trying to lose weight, that seems like a secondary consideration for taking the drug. But I get your point, Doc.
And so you're saying they've stayed on the drug for long periods and kept the weight off?
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One issue that needs to be addressed ASAP is how young women who suffer from anorexia are so easily able to find a "Dr Feelgood". That doctor then merrily whips out his or her prescription pad for the Ozempic drugs that are requested, despite how their patient's body weight is already perilously low.
Some of these woman have already died from taking them routinely.
It shouldn't be hard to make it illegal for this class of drugs to be banned from use for anyone already at a level of being 10% below the recommended weight for their height and body type. Anyone that skinny may be experiencing up to a 15% further reduction in weight, which is a deadly situation.
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Doctor Robert is right - these really are remarkable medications.
Although they're not exactly medications. These are human hormones. You have had these substances in your body for your entire life. That's one reason they're so safe.
They've been around a long time. Byetta came out 20 years ago. And remember - it wasn't new then. Every human on the planet, throughout human history, has had this substance in their blood stream for their entire lives.
We'll see how all this turns out. But the potential here is enormous...
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Susan, Have you ever been less than thin? And had real difficulty doing anything about it?
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