Wegovy and Ozempic stars dim amid overuse concerns

What they're saying: "There is almost like a backlash kind of a sentiment going on," said Peter Antall, chief medical officer of digital chronic health company Lark.

• "I don't believe that we're having second thoughts about the power of the medication. But I think the shine is coming off how they're being used in real practice," he said. "That's where many of us are concerned."

The big picture: Millions are now taking anti-obesity prescriptions from Novo Nordisk and Eli Lilly as well as lower-cost copycats from compounding pharmacies.

• There's no denying the drugs have life-changing capabilities. But high sticker prices and uneven insurance coverage skews which patients can get them — and which patients can consistently stay on them.
• And, in many cases, patients have begun taking the drugs with unrealistic expectations and little guidance.

"Everybody just thinks it's this miracle fix," said Ethan Lazarus, an obesity medicine physician based in Colorado and former president of the Obesity Medicine Association.

• "They're not perfect, and the GLP-1s are only going to work as long as you take them, and they're expensive, and there can be side effects. Do I really want to be taking this injection for the rest of my life?"

Between the lines: Study after study shows the majority of patients drop off the drugs within two years, with many spending less than a year on them.

• The reasons most commonly cited included the cost of the brand-name drugs — Ozempic retails for nearly $1,000 a month and Wegovy for hundreds more — periodic shortages, as well as side effects like severe GI distress and, occasionally, pancreatitis.
• "The benefits of these drugs cannot be denied when they are taken as intended — meaning indefinitely. But what happens to the body and mind when these medications are discontinued? This is where the problem lies," wrote obesity specialist and gastroenterologist Christopher McGowan in MedPage Today.

Between the lines: Among the harm concerns is the impact of "weight cycling" or the effect of regaining the weight that's been lost on one's metabolic health.

• "If you're doing it in a casual fashion where you're just getting [the drugs] online whenever you can afford it, that's what's probably not going to be good for us as humans," said Angela Fitch, CEO of Knownwell.
• GLP-1s can lead to loss of muscle mass in addition to fat, and when the drugs are discontinued, it's primarily fat that returns, McGowan wrote.
• "This can leave patients worse off — with less lean mass, a lower basal metabolic rate, and greater difficulty achieving future weight loss," he wrote. "Health consequences include diminished strength, reduced bone density, and a higher risk of fractures."

The FDA has also warned about risks around unapproved versions of GLP-1s that aren't assessed for safety and effectiveness.

• And HHS Secretary-designate Robert F. Kennedy Jr. has weighed in, saying people should first consider lifestyle changes and eating healthier.

Reality check: More randomized trials are needed, for instance, to tease out potential harms associated with going on and off the GLP-1s, including whether yo-yoing on weight hurts patients, pointed out C. Michael Gibson, a cardiologist who both prescribes and takes a GLP-1.

• "It may be that there's something about people who yo-yo that is different than people who don't ... it's the difference in who they are, rather than the yo-yoing that explains the bad outcomes," Gibson said.
• There's also growing data that companies like Knownwell are compiling that show coaching and monitoring patients who are on these drugs leads to far better adherence and outcomes, Fitch said.

What to watch: This is still a massive market with a number of drug candidates under development that could make these drugs easier, cheaper and more tolerable to use.

• Demand could surge even more once there are effective oral versions that don't require injections.
• "I think these prices will come down in a couple of years, and the indications will keep expanding, and the pendulum will swing," Antall said. But for now, he said, the business is a "free-for-all in a way which is unfortunate and not good for people's health."