Two years on, are GLP-1 drugs such as Ozempic and Mounjaro here to stay?

In January 2023, the world was abuzz with stories of a revolutionary weight-loss drug – a simple, self-administered injection that promised to transform the lives of those struggling with obesity. The click-baity headlines surrounding Ozempic, including “the skinny jab” and “Hollywood's best-kept secret”, came thick and fast.

For many, it seemed too good to be true, but for Dubai resident Sarah Nicole Rice, the rise of Ozempic and its counterpart Mounjaro was the start of a transformation she never thought possible. “Mounjaro was an absolute game-changer for my life,” she tells The National.

“My weight dropped steadily, and I've lost 25 per cent of my body weight since I started my journey two years ago. I struggled for years with every diet, every exercise, every calorie counted. You name it and I've tried it all.”

Rice is only one of millions of people who have turned to GLP-1 receptor agonists, a class of drugs that includes semaglutide (Ozempic and Wegovy) and tirzepatide (Mounjaro), to not only shed kilos, but also redefine their relationship with food, health and self-worth.

What began as a promising treatment for diabetes, has seemingly become a doctor-prescribed cornerstone in the battle against global obesity.

At the heart of these drugs lies glucagon-like peptide-1 (GLP-1), a hormone that is secreted in the intestines after eating, and has several functions, such as enhancing insulin secretion, slowing gastric emptying and increasing feelings of fullness by sending signals to the brain.

For Rice, the biggest effect of taking Mounjaro was “turning off the food noise and the constant chatter of what to eat”.

“It keeps me at bay when it come to eating. It's like now my brain knows better when I don't want any food and when to stop eating. There are still times when I have cravings, but I'd only want to have a tiny bit of it because I'm not really hungry.”

The science behind the hype

Large-scale clinical studies have produced compelling results, too. Early research published in The New England of Journal of Medicine in 2021 found that participants using semaglutide lost, on average, 15 per cent of their body weight over 68 weeks, which is a little more than a year.

For context, most conventional weight-loss interventions, including intensive lifestyle changes, yield average losses of five to 10 per cent.

The numbers were so compelling that in the same year, the US Food and Drug Administration approved Wegovy specifically for chronic weight management, with similar approvals following in other regions.

A more recent study by Eli Lilly and Company, the producer of Mounjaro, showed that tirzepatide demonstrated a sustained average weight loss of 22.9 per cent through a three-year treatment period.

There's been growing interest in exploring the broader effects of GLP-1 drugs beyond their use in diabetes and weight loss, too. In December, the FDA approved Zepbound (which has tirzepatide) as a treatment for moderate to severe obstructive sleep apnoea following successful clinical trials.

Another Dubai resident, Ananda Shakespeare, says she has lost about 30kg in the past 12 months that she's been on Mounjaro, with manageable side effects of nausea and occasional feelings of tiredness. Another resident, who didn't want to be named, says the drug has helped ease her struggle with polycystic ovary syndrome, and she took it based on her gynaecologist's prescription.

While the promise of these medications becomes clearer with time, the spotlight remains on their profound ability to treat obesity, a public health challenge that has long been viewed through a lens of personal responsibility, but is now understood as a complex condition.

The dangers of irresponsible use of GLP-1 drugs

While GLP-1 drugs have changed some lives for the better, their rapid rise in popularity has also exposed troubling trends in how they are prescribed. Some doctors, eager to meet patient demand, or capitalise on the buzz, now dole out these medications with minimal oversight. Some pharmacies, too, readily sell GLP-1 drugs over the counter with no doctor's prescription required.

“The problem we see in the market right now is that some people who are being prescribed these drugs have a simple goal of losing weight. While this is a primary biomarker, it can't be the only one,” says Dr Ihsan Almarzooqi, co-founder of diabetes centre GluCare in Dubai.

Potential side effects can include: nausea, diarrhoea or constipation, feeling weak or tired and vomiting. Less common but more severe effects include pancreatitis and bowel obstruction.

Lean muscle mass loss, too, has been associated with the use of GLP-1, for example, and the Dubai doctor says it's crucial to understand weight loss beyond the scales. “The average lean muscle loss on a patient being prescribed GLP-1 without lifestyle modifications can go up to 35 per cent – meaning this much of their weight loss is coming from muscle instead of fat, which can be dangerous,” he notes.

Dr Almarzooqi explains how it's important for people to seek continuous guidance when on such medications. “Doing it under no supervision or with a doctor who has no experience with it can cause quite dramatic loss in muscle, which you will find extremely difficult to regain if you're not doing the lifestyle changes in tandem.”

The irresponsible prescription and use of GLP-1 drugs not only undermines their intended purpose, but also raises concerns on shortages for the patients who rely on them.

Dubai resident Renil Cheriyan Thomas says: “There are many people who need it to keep their diabetes under control, but fail to procure a dose because they were being stockpiled by others for weight loss. There were times I had to wait up to a month to get it."

For Thomas, using GLP-1 was never about its weight-loss promise, given his latent autoimmune diabetes in adults diagnosis. In addition to insulin medication, Thomas was prescribed Mounjaro to manage his blood sugar – and he has found greater success with the combination.

The burning question: Is GLP-1 weight loss sustainable?

People using GLP-1 drugs for weight loss often transition off the medication at some point. In the US, only one in four who were prescribed Wegovy or Ozempic for weight loss were still taking them two years later, according to a Reuters report citing wide-scale analysis of pharmacy claims in the country.

While details on why patients quit aren't immediately clear (some say the onerous side effects, others the cost), Almarzooqi says it's crucial to ensure the weight loss, along with other supposed results, are sustained with long-term lifestyle changes. At GluCare, patients prescribed GLP-1 drugs are enrolled in a months-long programme that includes unlimited consultations and regular body composition analysis.

Almarzooqi says this allows them to increase compliance among patients, as well as guide them in monitoring other health markers such as muscle mass retention, liver function and cholesterol levels to deliver holistic care.

“The compliance rate is generally high, at over 80 per cent, with this data-driven approach,” he says. More often than not, people who self-medicate are likely to reverse the positive results of GLP-1 drug use.

Ali Hashemi, the co-founder of GluCare and one of the early patients of his own clinic, says he learnt this the hard way. “ The danger is people are seeing these injections as like a magic needle. It's simply not that. You still have to do the hard work, as I learnt. The first time I was on Mounjaro, I got off it too quickly after hitting my goals – which means I just mistakenly dropped the drug from a high dose to nothing,” he says.

“We hadn't learnt yet at the time that the curve is important,” Hashemi adds, explaining how “the risk and rewards of these drugs change based on how long you can keep the effect. If you regain the weight after, then you've gained nothing.”

At Wellth, the integrative medicine spin-off of Aster DM Healthcare, Dr Karima Arroud emphasises that lifestyle changes "remain foundational" when it comes to weight management, and that weight loss drugs are just “tools to enhance sustainable health strategies, and are not stand-alone solutions”.

“Sustainable results depend on integrating balanced nutrition, physical activity and stress management,” she explains. “I counsel patients on adopting anti-inflammatory diets, engaging in enjoyable and consistent physical activity, and addressing psycho-social factors. This integrated approach transforms short-term success into long-term health.”

The future of GLP-1 drugs

The GLP-1 revolution seems only to have begun, with researchers and manufacturers exploring new formulations, including oral versions and combination therapies that promise even greater efficacy. There are other important questions too, such as how these drugs can be made more affordable on a global scale.

Hashemi posits that cost could be one of the biggest deterrents against the use of GLP-1 drugs. Presently in the UAE, medical insurance companies don't cover such prescriptions for weight loss, and a dose can cost up to Dh2,000 a month.

“Maybe competition will bring down the cost soon, but we don't know that for sure. What we know is that it helps in many ways, and if doctors follow the evidence and couple it with responsible prescription and supervision, it can really be a game-changer.”

At the end of the day, the real impact of GLP-1 medications isn’t just measured in clinical trials or lofty promises of future breakthroughs. Two years into her GLP-1 journey, Rice doesn't see herself discontinuing the drug anytime soon.

“My transformation so far has given me so much confidence in things like applying for a job, for example. I used to feel that people were just judging me wrongly because I was overweight, and I never want to be in that position again.”

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