New Drugs for Obesity: GLP-1s and Their Potential

Can New Drugs Help Millions of Americans with Obesity? More than 100 million Americans struggle with obesity, but one drug is poised to change the weight-loss landscape---not only by shrinking waistlines, but reshaping how physicians approach chronic disease. Ozempic (semaglutide) and other GLP-1s...

Can New Drugs Help Millions of Americans with Obesity? More than 100 million Americans struggle with obesity, but one drug is poised to change the weight-loss landscape---not only by shrinking waistlines, but reshaping how physicians approach chronic disease. Ozempic (semaglutide) and other GLP-1s agonists are now at the center of a growing medical revolution. Originally developed to mimic the hormone GLP-1---regulating glucose levels and suppressing appetite---these drugs have been used for more than a decade to treat diabetes. Lately, however, they've become known for a different purpose: weight loss. Clinical trials suggest that GLP-1s may do more than manage weight and metabolism. They show promise for treating a range of conditions, from cardiovascular disease to neurodegenerative disorders such as Alzheimer's and Parkinson's. At the [2024 World Medical Innovation Forum](https://worldmedicalinnovation.org/) in Boston, where industry leaders and experts from Mass General Brigham's Harvard faculty gathered from September 23 to 25, GLP-1 drugs were a focal point of the discussions---with medical professionals, investors, and innovators debating their future applications, costs, and accessibility. **Beyond Diabetes and Obesity: GLP-1's Role in the Brain** New research is beginning to illuminate a surprising connection between GLP-1 agonists and brain health. Early clinical trials suggest that these drugs may do more than regulate appetite---they could also protect neurons, reduce inflammation, and promote survival of brain cells in conditions such as Alzheimer's and Parkinson's. GLP-1 receptor agonists may slow neurodegenerative disease progression, said HMS associate professor of medicine and pediatrics [Fatima Cody Stanford](https://hms.harvard.edu/faculty-staff/fatima-cody-stanford), a physician-scientist at Massachusetts General. That's a tantalizing prospect for conditions that, until now, have had few effective treatments. While this research is still in its infancy, the promise of a drug that could address both metabolic and cognitive decline is a vision of the future that excites many in the medical community. But the potential cognitive benefits don't stop at neurodegeneration. Emerging studies hint at another intriguing application: addiction treatment. By modulating dopamine release in the brain's reward system, GLP-1 drugs could help regulate cravings, reducing compulsive behaviors such as overeating and even excessive drinking. Their impact on the gut-brain axis may even help improve mental health and reduce the risk of relapse. The ability to curb addiction and improve mental health using a drug designed for metabolism hints at the holistic health impact these GLP-1 medications might have. **A Multi-Condition Breakthrough---But Who Can Afford It?** Although the enthusiasm around GLP-1 drugs continues to build, so do concerns about their accessibility. The obesity treatment market is projected to balloon to \$70 billion by 2030. "If Big Pharma puts all their eggs in this basket," says Stanford, "they'll probably do very well." But as she and other experts acknowledge, the success of these companies doesn't guarantee that patients---especially low-income individuals living with obesity---will benefit. Already, many diabetes patients find themselves competing for access to a medication that was originally intended to treat their condition. One solution might lie in oral formulations of GLP-1 drugs. Stanford suggested that pills, rather than injections, could ease production bottlenecks and reduce costs, making the medication more accessible to a wider range of patients. **Medicare Coverage Gaps** GLP-1s are currently covered by Medicare (Part D) when prescribed for type-II diabetes---obesity is an exclusion, forcing patients to pay out of pocket or navigate inconsistent private insurance policies. Efforts to address this gap include the Treat and Reduce Obesity Act, which aims to expand Medicare's coverage of FDA-approved obesity medications. This bipartisan bill, introduced in 2012 and reintroduced in 2023, is gaining momentum with support from both sides of the aisle. As the debate continues, experts argue that obesity management should be integrated into primary care, rather than limited to specialized clinics. [With nearly 42 percent of Americans classified as obese](https://www.harvardmagazine.com/node/86623) and fewer than 10 percent receiving metabolic drug treatments, this break in care reflects a broader failure of the healthcare system to address a growing epidemic. **How GLP-1 Drugs Could Transform the Food and Restaurant Industries** The potential reach of GLP-1 drugs extends beyond the doctor's office, touching industries like food and dining. As more people use these medications to manage their weight, consumer shopping habits are likely to shift. [Paul LaViolette](https://www.massgeneralbrigham.org/en/research-and-innovation/innovation/about/team/paul-laviolette), managing partner at venture capital and private equity firm SV Health Investors suggested that restaurants and food brands could feel the impact as customers become more health-conscious, seeking to maximize the [benefits of their treatment through eating habits.](https://www.harvardmagazine.com/2024/02/cancer-prevention-nutrition) Fast food chains that rely on high-volume sales may see a decline in traffic, while upscale dining establishments offering quality, portion-controlled meals might experience a boost. Professor of medicine [Caroline Apovian](https://nutrition.hms.harvard.edu/people/caroline-m-apovian), director of the Center for Weight Management and Wellness at Brigham and Women's Hospital, emphasized that high-protein diets and resistance training are essential to prevent muscle loss, a common side effect of significant weight loss. Restaurants that cater to these needs could find new opportunities in a health-conscious market. Similarly, supermarkets may see increased demand for [specialty diets like ketogenic or Mediterranean plans](https://www.harvardmagazine.com/node/86103), as consumers on GLP-1 medications look to optimize their health. This could push food brands to innovate and expand their offerings to meet the needs of this growing segment. **A New Era for GLP-1s in Healthcare?** The growing use of GLP-1s could play a pivotal role in addressing America's obesity crisis. As Stanford put it, obesity is "the most significant chronic disease in human history." And GLP-1s have the potential to tackle a range of interconnected health issues, including high blood sugar, cardiovascular risks, and brain diseases. The question remains whether America's patchwork healthcare system can become aligned. If GLP-1 medications are made more affordable and accessible, they could help reduce the burden of chronic conditions that drive up healthcare costs nationally. But with that potential comes the challenge of marrying and navigating a set of industries---pharmaceuticals, insurance, and healthcare---which aren't always set up to deliver cutting-edge treatments to those who need them most.