Millions of people are taking a new class of medication for weight loss. That medication is, of course, the class of medication known as GLP-1 receptor agonists. One of the most widely used versions is a product called Ozempic.
Even just a few years ago, I saw just a handful of folks on it. That has changed dramatically. In some circles, it may seem like all your friends are on it. In others, you can hardly find anyone on it. More on that later.
Type 2 Diabetes (T2DM) is a horrible metabolic health disorder. It elevates low-density lipoprotein (LDL) levels, which is linked to heart disease. It increases the risk of dementia, stroke, heart attacks, blindness, kidney failure, cancer, atherosclerosis, osteoarthritis, tendon injuries ( I had to tie this to orthopedics somehow), and more. We are learning more and more about the many ways that T2DM leads to poor health.
While many have argued—including in some bestselling books—that this is mostly about sugar, it's not that simple. As this graph shows, sugar has soared in recent decades, but it has also begun falling again on a per capita basis, but obesity (a common cause of T2DM) has not fallen with it.
According to the Centers for Disease Control and Prevention (CDC), an estimated 96 million Americans, or 38% of the adult population, had pre-diabetes in 2019. In 2019, an estimated 37.3 million Americans, or 11.3% of the adult population, had type 2 diabetes. In 2001, about 60% of adults were not physically active enough. This number has increased to 80% in 2020.
These are staggering numbers. Not only with respect to the health of the affected individual, but it has consequences for the entire family if a wage earner is unable to work, because of the many complications of diabetes. Those risks extend further, leading to disappearance from the workforce, early mortality, and what the economist Angus Deaton has called "deaths of despair".
The GLP-1 medications were initially developed for T2DM. After the studies were completed, however, it became clear that most people on the GLP1s were losing considerable weight. Wegovy was born out of that "side effect": it had the first FDA indication for weight loss. It was at this time that the use of GLP-1s started to explode.
Prior to the arrival of GLP-1 medications (and related SGLT-2 (sodium-glucose cotransporter-2) medications, most T2DM medications didn't really improve a patient's chances of having fewer complications from T2DM. But that has all changed. As more and more people use these products we are finding out their effects on decreasing a host of health risks, including cardiovascular disease.