GLP-1 medications have transformed obesity and weight management care in the U.S. and in San Antonio. And with new GLP-1 weight loss drugs now hitting the market in pill form, local doctors expect that trend only to accelerate.
“These drugs triple, even quadruple, what we could do with prior medications in the past,” said Dr. Aaron King, a family medicine doctor with Baptist Health System. “I would classify them as revolutionary.”
Consumers know these medications under brand names Ozempic, Wegovy, Rybelsus, Mounjaro, Zepbound and Trulicity, among others.
GLP-1 drugs formulated specifically for weight loss have up until this point been administered via daily or weekly injections. In late December, the U.S. Food and Drug Administration approved the first GLP-1 pill for weight loss.
Danish pharmaceutical company Novo Nordisk announced on Dec. 22 that their once-daily weight loss pill known under brand name Wegovy had been greenlit in the U.S. A similar pill by American pharmaceutical giant Eli Lilly is also expected to be approved this year.
Dr. Alberto Chavez-Velazquez, an endocrinologist at the Texas Diabetes Institute who was involved in early primate research on GLP-1 drugs, said that although this class of medications has been on the market for decades to treat diabetes, their widespread use really took off in the last five years amid celebrity endorsements and marketing campaigns around the drugs’ weight loss benefits.
And although they’re more popularly known as weight loss drugs, researchers and doctors are uncovering a trove of health benefits that extend beyond weight management.
Some challenges, however, do persist around the drugs. The medications are expensive and often aren’t covered by insurance for weight loss, so access barriers to access persist for many in San Antonio.
Health care providers are also still grappling with misconceptions that the drugs can be used in isolation without additional lifestyle changes for brief periods to lose weight. Researchers are finding that most people who stop taking the medications regain the weight they lost, in many cases rapidly, and see other health markers return to where they were before.
“I will probably fall short from calling them ‘miracle drugs,’” Chavez-Velazquez said. “They’re fantastic drugs, but at the end of the day, I don’t see them as curative.”
GLP-1s in San Antonio
GLP-1s, short for glucagon-like peptide-1 receptor agonists, have been around since 2005, when the FDA approved Exenatide to treat type 2 diabetes. By reducing appetite, stimulating the production of insulin and slowing digestion, the drugs effectively manage blood sugar levels.
Weight loss was moderate and mostly a side effect of slower digestion and lessened appetite with the older GLP-1 drugs. They were also more niche before better formulations, research and marketing campaigns thrust them into the spotlight over the last several years.
People used to be weary about the drugs, Chavez-Velazquez said, and they often had to see an endocrinology specialist to get a prescription.
“‘I’ve been trying to put you on Ozempic for four years, but it took Elon Musk and Kim Kardashian to convince you,’” Chavez-Velazquez said with a laugh, mimicking conversations he’s had with patients over the last few years.
The Texas Diabetes Institute, owned and operated by University Health with UT Health San Antonio as its academic partner, drove early adoption of GLP-1 medications in San Antonio, mostly to treat type 2 diabetes, Chavez-Velazquez said.
Either by reducing weight or through other pathways, the drugs also benefit cardiovascular disease — reducing incidence of heart attacks and strokes — obstructive sleep apnea, fatty liver disease and slowing the progression of chronic kidney disease.
Of course, they’re most well known in the public as potent weight loss drugs. Patients can lose anywhere from 5% to 20% and more of total body weight on GLP-1 medications, but it largely depends on the drug, adherence and lifestyle changes alongside the treatment.
“It’s not rare that you see 20, 25, 30 pounds of weight loss,” Chavez-Velazquez said. “I have people that have lost 100 pounds on this medication. But it’s not the norm.”
The medications can come with side effects, mostly affecting the digestive system, like nausea, vomiting, diarrhea, constipation — among others. But local doctors say that more often than not they’re able to find a medication and dose that has minimal side effects for patients.
Providers also often encourage patients to eat enough protein and consider weight training to limit the amount of muscle mass loss, which is metabolically protective, while losing weight on GLP-1 drugs.
Another challenge for researchers and primary care providers is that the benefits from the drugs, in many cases, only seem to provide benefits for however long they’re taken.
A paper published in the BMJ in November found that most people who stopped taking weight loss management drugs like GLP-1s will regain all of the weight they lost, oftentimes rapidly, leading to researchers to caution about their short-term use.
“I think the key is for people to think about this as a long-term treatment,” said Dr. David Thomas, a bariatric surgeon with Methodist Healthcare. “A lot of patients come in the office and think, ‘I need to lose 30 or 40 pounds, and then I can get to a place where I can exercise without pain, and I can be more mindful about my diet. Those things are definitely important, but it’s all part of a long-term strategy, and shouldn’t be viewed as a ‘six-month get back on track.’”
‘Who’s going to pay for them?’
Although most major health insurers will cover the price of GLP-1 medications for diabetes, which can cost over $1,000 a month, coverage for weight loss is poor and in many cases requires other conditions to be present.
Neither Medicare nor Medicaid covers the drugs for weight loss, though they do in most cases for type 2 diabetes, cardiovascular disease and obstructive sleep apnea.
In November, the Trump Administration announced a deal with Eli Lilly and Novo Nordisk that could lower the costs of the popular drugs.
“It’s an overall expensive medicine, but maybe you’re preventing a patient from going on dialysis in five years,” said Dr. Maria Escobar-Vasco, an endocrinologist and program director of UT Health San Antonio’s Endocrinology, Diabetes and Metabolism Training program. “These medications improve your metabolic profile, we’re decreasing the incidence of diabetes in these patients, we’re decreasing cardiovascular disease, we’re decreasing kidney failure in these patients.”
According to polling by KFF, 1 in 5 adults reported having ever taken a GLP-1 agonist, including 12% who are currently taking the medication.
Most GLP-1 users reported that their insurance covered at least some of the cost; but 56% said that the drugs were difficult to afford. About a quarter of respondents reported having insurance but paying the whole cost of the medication out of pocket.
The Wegovy pill is expected to be cheaper than others, starting at $149 per month for a standard dose, according to Novo Nordisk.
“We do believe fully that these medications will essentially prevent the development of diabetes in the population,” King said. “The question really is more, who’s going to pay for them?”
