Jasmyne Cannick, a 48-year-old Los Angeles resident, started taking Ozempic five years ago, on a doctor's recommendation when she was about to be diagnosed with diabetes; and he didn't want to undergo bariatric surgery, but he also didn't want to end up like some of his relatives with amputations and horrible health conditions in their old age.

"I weighed about 250 pounds, I'm 5'6 and my health wasn't the best. At that time I didn't even know that Ozempic would become what it is now. When I started I paid about $25 a month; and with a new administration in the White House I went to paying $800 a month," Cannick said during the video conference: "Beyond Weight Loss: An Analysis of the Promises and Risks of GLP-1 Drugs Over the Lifespan," organized by American Community Media (ACoM).

The growing popularity of GLP-1 medications such as Ozempic, Wegovy, Mounjaro and Zepbound has transformed the treatment of obesity and type 2 diabetes with 29 million adults taking them, while prices for pediatric prescriptions for these drugs have skyrocketed by 700%.

The difficulties of losing weight

Dr. Jenna Shaw Tronieri, senior investigator at the Center for Weight and Eating Disorders at the University of Pennsylvania Perelman School of Medicine, said losing weight to improve health through lifestyle changes such as diet and exercise is quite difficult and requires a lot of effort.

“The body's biology is not designed to help you lose weight, and it is much better suited to prevent starvation.”

Therefore, he said that with GLP obesity medications, the idea is to reduce the effort required to lose weight by modifying some of those biological signals, as it relates to hunger.

“Instead of meticulously tracking each calorie or striving to fill up on low-calorie foods while still feeling like eating more, they simply notice that their portions are smaller, or that they snack between meals less frequently, and that, although food is still pleasurable, they no longer care as much about it.”

He specified that for patients who stop treatment, approximately two-thirds of the weight they had lost is regained in the first year after stopping taking the GLP-1 drug.

On the other hand, when people continue taking the medication, weight tends to stay relatively stable on average at peak loss up to four years later.

“There are many other reasons why patients may choose to stop treatment, such as side effects or loss of coverage or access to these medications, which is particularly problematic due to their high cost.”

Why obesity occurs

Dr. Fatima Cody Stanford, associate professor of medicine and pediatrics at Harvard Medical School, said obesity is a disease of energy regulation, not a lack of willpower.

“The body has a complex system for storing energy, and it is shaped by genetics, hormones, the appetite centers of the brain, sleep, stress, the built environment we live in, and the food environment that comes to us from birth,” he said.

He stressed that increased intake, decreased expenditure and altered storage can be driven by forces internal and external to a person's biology, in and around the environment.

“Aspects such as genetics, chronic inflammation, hormonal regulation of appetite and alteration of stress physiology remain within the balance.”

He said most people with obesity often live in an external world that is not designed with their health in mind.

“When we talk about African American women in the United States, obesity began with the chronic and sustained physiological stress of slavery itself.”

He said that thanks to decades of research, they now understand that sustained exposure to stress hormones like cortisol alters the way the body stores fat, regulates appetite and controls inflammation.

“This is not a 20th century phenomenon, but a 19th century physiological reality, imprinted on the bodies of African-American people during slavery and transmitted biologically through what we today call epigenetic and intergenerational programming, and socially through generations of economic exclusion.”

Then, he observed that today obesity in African American women is the highest of any demographic group in this country; so they must begin treating it as a predictable result of nearly two centuries of cumulative physiological stress, economic exclusion, and a food and healthcare system that was not designed with the health of Black women in mind.

The Medicare Bridge Program

He said that as of July 1 of this year, the Centers for Medicare & Medicaid Services (CMS) launched the Medicare GLP-1 bridge program.

“It is an interim solution, not a permanent one, as the program is scheduled to end on December 31, 2027 and requires prior authorization, meaning a doctor must submit an application to CMS, and it must be approved before a patient will even receive a prescription.”

“Communities with less consistent access to primary care, often the same ones burdened by two centuries of stress and structural exclusion, are the most likely to be left behind by a program that, in theory, should help them.”

The unintended consequences

Dr. Dan Cooper, distinguished professor emeritus of pediatrics at UC Irvine, said when he sees a 12-year-old boy weighing 300 pounds, he thinks about the millions of dollars being spent developing drugs to control obesity.

But also what would happen if a small part of that money had been allocated to better physical activity opportunities for minors, particularly in low-income neighborhoods, where physical fitness is much lower.

"What if there were more parks? What if physical education at school was better? Maybe I wouldn't see this 12-year-old boy who weighed 300 pounds, and I also know that if he could control his environment, the problem of obesity could be solved without medication."

Dr. Cooper said he doesn't know what the long-term consequences are, and therefore the ethical question that seems most appropriate to him is that until we understand the effects of treatment with these particular drugs, they should be very careful.

“I see 12-year-olds who weigh 300 pounds, and I know my pediatric colleagues want to be able to do something, and sometimes medication is the only option.”

How long

Cannick said he is still trying to figure out how long he will take the weight loss medication.

"I definitely don't want it to be a lifelong commitment to my wallet. I started at about 250 pounds. Now I'm about 185. I'm an African-American woman who wants to have a butt and thighs. I don't want to be skinny to the point where people ask me, 'Are you okay?'"

He clarified that while he takes his medication, he works to have healthier eating habits.

"I play tennis at least three times a week. I have changed my eating significantly since starting Ozempic. I hope I don't have to continue the medication. It's like a maintenance program, not necessarily to lose weight, but just to keep it off."

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