I was not an early prescriber of the GLP-1 agents, like Ozempic.
But after a while, it became hard to argue with success.
GLP-1 agents work, and they work for a long list of serious conditions, including obesity (43% of Americans), diabetes and pre-diabetes (about 50% of Americans), fatty liver disease, cardiovascular disease (the #1 cause of death), sleep apnea, chronic kidney disease, with probable benefits in treating substance use disorders, and emerging evidence of benefit in Parkinson’s, Alzheimer’s, and inflammatory conditions, particularly osteoarthritis and fibromyalgia.
They were originally designed to treat diabetes, which is a lifelong condition. Even if only useful in treating obesity, they’re the first weight loss medications created for long-term use.
And if they treat even half of what it looks like they do, they may be the closest thing to a cure-all silver bullet (or flaming silver sword of fire) that we’ve seen in a long time.
The main problem is cost
Insurers almost never cover the Ozempic/Wegovy or Mounjaro/Zepbound medications, unless a person has diabetes.
Cash price: about $1200/month.
This is why most insurers pass the cost on to the patient. Putting the question to AI, all the conditions listed earlier affect at least 3 out of 4 Americans. If everyone with those diagnoses took GLP-1s, health insurers would go bankrupt almost immediately; the cost of this one drug class alone would be on the order of 70% of all current U.S. healthcare spending.
But at a cost of $1200 per month to patients, GLP-1 injectables are too expensive for many, no matter how well they work.
Less pricey options exist. Zepbound is available for about $600 per month in small vials shipped directly to patients, rather than the usual preloaded auto-injector pens. Some medical practitioners will draw up compounded GLP-1s into syringes, also for about $600 per month. And Wegovy was just approved as a daily tablet, for $150 per month.
But even at $150, the price is about 30x what a generic medication for blood pressure might cost.
What about microdosing?
The jury is still out on using smaller-than-usual doses for other benefits besides weight loss.
There IS evidence that reducing the dose by stretching out the dosing interval may be helpful, from one shot per week to every 2–3 weeks, to maintain weight loss that was already achieved.
“Microdosers” may self-report feeling better. But as of Spring 2026, all current evidence for benefit is based on standard therapeutic doses, with no studies evaluating half, quarter, or other fractional doses.
How safe are they?
Not as incredibly safe as, say, creatine supplementation, but pretty safe.
There have been cases of things going badly, including death, dialysis, and blindness. The risk of these events is very low: about 0.2% for visual loss from non-arteritic anterior ischemic neuropathy (NAION), and while cases of death have been reported from bowel obstruction, GLP-1s generally reduce all-cause mortality by 13%.
The most common side effects tend to be tolerable, and occur in about 1 in 5 patients: nausea, constipation, vomiting, diarrhea and abdominal pain. About 1 in 15 patients discontinue using the medications due to these side effects (i.e., more than 90% stay on them).
Is anyone NOT supposed to take them?
The main full-stop besides cost is a personal or family history of either medullary thyroid cancer or multiple endocrine neoplasia type two (MEN 2). This is based on animal studies indicating a possible increase in these types of cancer; surveillance in humans is ongoing.
Both of these cancers occur uncommonly in the general population (0.01% prevalence of medullary thyroid cancer, and between 0.003% and 0.04% prevalence for MEN 2).
And muscle loss?
Definitely a thing; about 20% of total weight loss ends up being muscle, but an analysis of 22 randomized clinical trials found that patients lost fat and muscle proportionally, not more muscle than fat. The muscle loss appears to be no worse than what is seen in other major weight loss interventions, like surgery or very low-calorie diets.
But yes, use GLP-1 agents and you’ll lose more than just fat.
We are not suffering from an Ozempic deficiency
Put bluntly, what does it say about our food supply and modern lifestyle, that what was once a rare problem — obesity and its related metabolic conditions — has become the norm for the majority of Americans?
And that we are looking to use an expensive pharmaceutical, potentially forever, to “correct” the situation?
If you cannot lose weight no matter what and Ozempic-class meds enable you to do so, that may be the answer.
But the more profound question might be: what in your environment is stopping you and most of your fellow Americans from losing that weight?
Leave a Reply