"A few years ago, the term GLP-1 would have sounded like only something your science teacher would know. Now, it’s everywhere. From billboards to Super Bowl ads, they are inescapable. They have more of an influence than just advertisements, though. The economy, people, and society are all changing due to their popularity. But how is this happening? And what does GLP-1 even mean?" -- AMara Deanes, 8th Grade
The acronym GLP-1A stands for Glucagon-like peptide-1 agonists. These peptides occur naturally in your body, mainly to trigger insulin release. Another effect of GLP-1s is the slowing of digestion and the promotion of satiety for longer periods. Basically, the drug makes you feel full for longer, causing you to eat less. In those using it for diabetes, it helps with low insulin levels. GLP-1s are considered a class of drugs, since there are many different types under different names and brands.
When GLP-1s are prescribed by a doctor for weight loss, they are usually prescribed to those with a high body mass index (BMI). BMIs are calculated based on height and weight, and have been used as a health marker.
The legitimacy and importance of BMIs in healthcare have been debated in recent years. Although it is still used to diagnose people with obesity. Obesity poses health risks, which GLP-1s can help reduce when patients lose weight.
When GLP-1s are prescribed by a doctor for weight loss, they are usually prescribed to those with a high body mass index (BMI). BMIs are calculated based on height and weight, and have been used as a health marker.
The legitimacy and importance of BMIs in healthcare have been debated in recent years. Although it is still used to diagnose people with obesity. Obesity poses health risks, which GLP-1s can help reduce when patients lose weight.
A few of the GLP-1 injections that are approved for either diabetic or weight loss purposes.
Only a few forms of GLP-1 are approved by the FDA for weight loss. The most infamous and popular is semaglutide, also known as Ozempic or Wegovy, at a higher dose. These are both injections. Wegovy is also being developed into a pill, which could be prescribed as early as this year. All three drugs are owned by a Danish company called Novo Nordisk.
More recently, in 2023, tirzepatide injections, also known as Zepbound, were approved by the FDA for weight loss. Zepbound is a dual GLP-1/GIP receptor agonist, but it generally has the same effects as a standard GLP-1. The drug is owned and produced by Lily Medicine, an American drug company. Lily also makes Mounjaro, a similar injection, although it is not officially approved for weight loss, but is officially used for diabetes treatment. It can be prescribed “off-label” for weight loss purposes. Also, Lily is funding research into a stronger GLP-1, retatrutide.
These two companies are the only companies producing these drugs. The lack of broader competition drives up the cost of GLP-1s.
“The current cost of the drugs is sizeable, with the U.S. list prices for a month’s supply of Lily’s Zepbound or Novo’s Wegovy ranging from $1,079.77 to $1,349.02,” reported CNBC, “Estimates from the Jama Health Forum suggest that U.S. Medicare coverage of GLP-1s would increase net spending under the retiree health program by $47.7 billion alone over the next 10 years.”
The point of funding and spending on these drugs is to offset the overall cost of obesity related health costs. This chart from Public Medical Central shows that as the medical savings increase, so does the overall spending on GLP-1s, as well as spending from the government. If things stay on the same trajectory, Americans could spend over $60 billion on GLP-1s, including the costs covered by the government.
More recently, in 2023, tirzepatide injections, also known as Zepbound, were approved by the FDA for weight loss. Zepbound is a dual GLP-1/GIP receptor agonist, but it generally has the same effects as a standard GLP-1. The drug is owned and produced by Lily Medicine, an American drug company. Lily also makes Mounjaro, a similar injection, although it is not officially approved for weight loss, but is officially used for diabetes treatment. It can be prescribed “off-label” for weight loss purposes. Also, Lily is funding research into a stronger GLP-1, retatrutide.
These two companies are the only companies producing these drugs. The lack of broader competition drives up the cost of GLP-1s.
“The current cost of the drugs is sizeable, with the U.S. list prices for a month’s supply of Lily’s Zepbound or Novo’s Wegovy ranging from $1,079.77 to $1,349.02,” reported CNBC, “Estimates from the Jama Health Forum suggest that U.S. Medicare coverage of GLP-1s would increase net spending under the retiree health program by $47.7 billion alone over the next 10 years.”
The point of funding and spending on these drugs is to offset the overall cost of obesity related health costs. This chart from Public Medical Central shows that as the medical savings increase, so does the overall spending on GLP-1s, as well as spending from the government. If things stay on the same trajectory, Americans could spend over $60 billion on GLP-1s, including the costs covered by the government.
The chart featured in Public Medical Central detailing GLP-1 spending and savings.
When it comes to a person-to-person basis, the use of GLP-1s is extremely cost-ineffective. Both Ozempic/Wegovy (semaglutide) and Zepbound (tirzepatide) saw high increases in quality-adjusted life-years in this study. This means that they reduced weight-related health problems in the long run. Although for these benefits to be substantial, users would have to spend upwards of $400,000 at current prices. Despite high costs, users are also saving on other spending factors, such as food and retail shopping.
“A 2024 Cornell University study found that households with at least one GLP-1 user cut their grocery spend by 5.3% within six months of adoption, with that rate rising to 8.2% among higher-income households,” wrote CNBC. Specific processed foods, such as sweets and snacks, saw the biggest decrease. So at the end of the day they’re not buying healthier foods, just less of them overall.
Spending is becoming health-focused. This means a spending decrease of over a billion dollars in fast food and snack spending. Gym memberships and protein foods are booming. Companies such as Coca-Cola and PepsiCo are investing millions of dollars in health forward versions of their famous products. Since GLP-1s also affect the brain’s reward system, spending reflects that.
“I would say that the high costs are definitely not worth it since these drugs are definitely not costing that much to manufacture,” said 7th-grade Literary Arts student Alice Stewart. “The companies selling them know people will pay that much for these weight loss drugs, so they're overcharging them.”
A 2024 study in JAMA Network Open estimated that the manufacturing cost of these drugs per month could be anywhere from $0.75 to $71.49. This is vastly different from the market prices today, and causes low-income users to conserve their medication. More on that later.
Despite high costs, many GLP-1 users are willing to pay out of pocket for their medication monthly. “If my insurance [through work] doesn’t cover the cost of medication, I am going to get another job offer so I can ask my boss to pay the difference. Or get a new job,” said one respondee in a study about the effects of GLP-1 use on social behavior.
This particular study examined users using it for weight loss purposes. This desperation for weight loss shows a shift in the priorities of consumers after the release of these drugs.
“Based on early signals, GLP-1s may be catalyzing a behavioral and economic shift that’s on par with major technological breakthroughs,” explains Harvard Business Review, “A transformation that begins with biology is now cascading across categories once siloed from healthcare, potentially blurring the lines between industries like food, wellness, beauty, retail, and travel.”
According to a chart in the Harvard Business Review, consumer interest in Ozempic skyrocketed nearly 400% in less than 3 years. Curiosity and interest in GLP-1s are on par with that of social media and other technological advances. When sites such as Facebook and Instagram were released, they saw similar jumps in interest. This kind of popularity has never been seen before in a medication.
“A 2024 Cornell University study found that households with at least one GLP-1 user cut their grocery spend by 5.3% within six months of adoption, with that rate rising to 8.2% among higher-income households,” wrote CNBC. Specific processed foods, such as sweets and snacks, saw the biggest decrease. So at the end of the day they’re not buying healthier foods, just less of them overall.
Spending is becoming health-focused. This means a spending decrease of over a billion dollars in fast food and snack spending. Gym memberships and protein foods are booming. Companies such as Coca-Cola and PepsiCo are investing millions of dollars in health forward versions of their famous products. Since GLP-1s also affect the brain’s reward system, spending reflects that.
“I would say that the high costs are definitely not worth it since these drugs are definitely not costing that much to manufacture,” said 7th-grade Literary Arts student Alice Stewart. “The companies selling them know people will pay that much for these weight loss drugs, so they're overcharging them.”
A 2024 study in JAMA Network Open estimated that the manufacturing cost of these drugs per month could be anywhere from $0.75 to $71.49. This is vastly different from the market prices today, and causes low-income users to conserve their medication. More on that later.
Despite high costs, many GLP-1 users are willing to pay out of pocket for their medication monthly. “If my insurance [through work] doesn’t cover the cost of medication, I am going to get another job offer so I can ask my boss to pay the difference. Or get a new job,” said one respondee in a study about the effects of GLP-1 use on social behavior.
This particular study examined users using it for weight loss purposes. This desperation for weight loss shows a shift in the priorities of consumers after the release of these drugs.
“Based on early signals, GLP-1s may be catalyzing a behavioral and economic shift that’s on par with major technological breakthroughs,” explains Harvard Business Review, “A transformation that begins with biology is now cascading across categories once siloed from healthcare, potentially blurring the lines between industries like food, wellness, beauty, retail, and travel.”
According to a chart in the Harvard Business Review, consumer interest in Ozempic skyrocketed nearly 400% in less than 3 years. Curiosity and interest in GLP-1s are on par with that of social media and other technological advances. When sites such as Facebook and Instagram were released, they saw similar jumps in interest. This kind of popularity has never been seen before in a medication.
The graphs originally shown in Harvard Business Review
Social media made a deep shift in the way we view each other and communicate. Over half the global population uses social media. GLP-1s could have the same effect on society because of its abilities.
“An increasing number of people with a ‘healthy’ BMI are now using off-label, low-dose GLP-1s to maintain weight or lose a few pounds,” wrote Marie Claire. The accessibility and popularity of GLP-1s could have a role in this. You see ads for them everywhere you go, and suddenly it doesn’t seem like such a bad idea for a beach vacation or wedding.
Of course, this casual use comes at a monetary cost, a cost that insurance companies will spend millions trying to cover.
“I think it depends on the circumstances whether insurance companies should cover them. If someone really needs them, they should be treated like a necessity,” said Stewart, “but if someone doesn't really need to lose weight, then they should be treated more like plastic surgery, which I believe insurance doesn't cover.”
If users can’t afford GLP-1s at the sticker price, they resort to other methods of obtaining the medication. “Users are purchasing medication (which may be out of date or counterfeit) through their own social networks, at pop-up ‘weight loss’ clinics, via local peer-to-peer online selling, or from international online vendors,” wrote PLOS Global Health.
Along with this self-medication, lower-income users are experimenting with the doses to conserve their medication for the month.
When using the injection form of GLP-1s, the pen makes a clicking sound as the medication goes in. Depending on the dosage of the medication, there’s a certain number of clicks that the pen makes. Some users are “counting clicks” to conserve doses. Some low-income users using GLP-1s for diabetes are forced to use this method to save money.
Counting clicks is especially prevalent among men taking it for bodybuilding purposes. Some men are “cycling” between drugs and taking mixes of medications. The use of these drugs is turning into a way of body engineering and tinkering to obtain the ideal body.
This is only one of the ways people change their doses. Some users are sharing medications or jumping to higher doses without allowing their bodies to adjust. This can cause extreme adverse effects, including a GLP-1 overdose. Overdoses can cause extremely low blood sugar, stomach problems, injection site reactions, and more.
Of course, side effects are possible with any medication, but straying from recommended usage and doses can only make them worse. Users are willing to brave high costs and side effects for the weight loss benefits.
Another adverse effect of GLP-1 use is loose skin. This is where terms like “ozempic-face” come from. The loose skin gained from rapid weight loss is a marker of Ozempic use, especially in those who had a high starting weight. An increase in people with loose skin is changing the procedures plastic surgeons are performing. This is yet another way that GLP-1s are changing the world.
“An increasing number of people with a ‘healthy’ BMI are now using off-label, low-dose GLP-1s to maintain weight or lose a few pounds,” wrote Marie Claire. The accessibility and popularity of GLP-1s could have a role in this. You see ads for them everywhere you go, and suddenly it doesn’t seem like such a bad idea for a beach vacation or wedding.
Of course, this casual use comes at a monetary cost, a cost that insurance companies will spend millions trying to cover.
“I think it depends on the circumstances whether insurance companies should cover them. If someone really needs them, they should be treated like a necessity,” said Stewart, “but if someone doesn't really need to lose weight, then they should be treated more like plastic surgery, which I believe insurance doesn't cover.”
If users can’t afford GLP-1s at the sticker price, they resort to other methods of obtaining the medication. “Users are purchasing medication (which may be out of date or counterfeit) through their own social networks, at pop-up ‘weight loss’ clinics, via local peer-to-peer online selling, or from international online vendors,” wrote PLOS Global Health.
Along with this self-medication, lower-income users are experimenting with the doses to conserve their medication for the month.
When using the injection form of GLP-1s, the pen makes a clicking sound as the medication goes in. Depending on the dosage of the medication, there’s a certain number of clicks that the pen makes. Some users are “counting clicks” to conserve doses. Some low-income users using GLP-1s for diabetes are forced to use this method to save money.
Counting clicks is especially prevalent among men taking it for bodybuilding purposes. Some men are “cycling” between drugs and taking mixes of medications. The use of these drugs is turning into a way of body engineering and tinkering to obtain the ideal body.
This is only one of the ways people change their doses. Some users are sharing medications or jumping to higher doses without allowing their bodies to adjust. This can cause extreme adverse effects, including a GLP-1 overdose. Overdoses can cause extremely low blood sugar, stomach problems, injection site reactions, and more.
Of course, side effects are possible with any medication, but straying from recommended usage and doses can only make them worse. Users are willing to brave high costs and side effects for the weight loss benefits.
Another adverse effect of GLP-1 use is loose skin. This is where terms like “ozempic-face” come from. The loose skin gained from rapid weight loss is a marker of Ozempic use, especially in those who had a high starting weight. An increase in people with loose skin is changing the procedures plastic surgeons are performing. This is yet another way that GLP-1s are changing the world.
“As people started looking for ways to get rid of the excess skin, surgical body-contouring procedures became more popular, with liposuction, butt lifts, arm lifts, and thigh lifts having the greatest growth, according to the American Society of Plastic Surgeons (ASPS),” wrote Allure. These kinds of procedures are only expected to get more popular as GLP-1s become more accessible with oral medications.
In the past, surgical weight interventions have been more popular among those looking to lose weight. GLP-1s might seem like a way to lose weight without surgery, but some users with higher starting weights end up with loose skin. Thus, plastic surgeons are only changing the way they perform weight loss procedures, not cutting them out altogether.
Body standards are changing post-GLP-1 release. In 2023, after Ozempic and Zepbound were approved for weight loss, the American Society of Plastic Surgeons (ASPS) reported an increase in procedures relating to a “ballet body.”
“The use of semaglutide medications like Ozempic® has enabled patients to achieve leaner torsos, leading many, especially women, to seek breast implant reductions and other procedures to create a balanced body shape,” wrote the ASPS. This, paired with the return of 2000s-style low-rise jeans, shows a change in body ideals from the body positivity movement of the 2010s. The popularity of activities such as pilates pair well with the ideal body.
In the past, surgical weight interventions have been more popular among those looking to lose weight. GLP-1s might seem like a way to lose weight without surgery, but some users with higher starting weights end up with loose skin. Thus, plastic surgeons are only changing the way they perform weight loss procedures, not cutting them out altogether.
Body standards are changing post-GLP-1 release. In 2023, after Ozempic and Zepbound were approved for weight loss, the American Society of Plastic Surgeons (ASPS) reported an increase in procedures relating to a “ballet body.”
“The use of semaglutide medications like Ozempic® has enabled patients to achieve leaner torsos, leading many, especially women, to seek breast implant reductions and other procedures to create a balanced body shape,” wrote the ASPS. This, paired with the return of 2000s-style low-rise jeans, shows a change in body ideals from the body positivity movement of the 2010s. The popularity of activities such as pilates pair well with the ideal body.
“In a cultural moment already marked by the resurgence of ultra-thin ideals, from banned #skinnytok content to pulled fashion campaigns, GLP-1s risk becoming both accelerant and alibi,” wrote Marie Claire. “The danger isn’t the medication itself, but what happens when a powerful medical tool is absorbed into a beauty economy that has long profited from bodily dissatisfaction.”
“I don't think weight loss drugs will solve [weight stigma] because people are already obsessed with trying to lose weight and be skinny,” said Riley Bishop Martinez, an 8th-grade Literary Arts student, “so I think giving someone medication that makes someone lose weight is not going to help.”
Stigma around weight is only changing to a medical problem from a social one. Weight stigma will not be reduced by GLP-1s; it will only amplify an economic and social gap between race and class. Obesity is already unevenly distributed between lower wages, higher wages, and people of color. Higher body weights will be seen as a medical problem that only the rich can solve.
GLP-1s are changing the world as we know it, and this is only the beginning.
“I don't think weight loss drugs will solve [weight stigma] because people are already obsessed with trying to lose weight and be skinny,” said Riley Bishop Martinez, an 8th-grade Literary Arts student, “so I think giving someone medication that makes someone lose weight is not going to help.”
Stigma around weight is only changing to a medical problem from a social one. Weight stigma will not be reduced by GLP-1s; it will only amplify an economic and social gap between race and class. Obesity is already unevenly distributed between lower wages, higher wages, and people of color. Higher body weights will be seen as a medical problem that only the rich can solve.
GLP-1s are changing the world as we know it, and this is only the beginning.
