Only one in ten overweight or obese people currently use GLP-1 treatments, despite rising demand
Half of the people who could benefit from GLP-1 weight-loss drugs may never get them, and some of the most powerful options may strip away more muscle than rivals, according to Reuters.
Reuters reports that Eli Lilly chief executive David Ricks believes weight‑loss drugs may ultimately reach only about 50 percent of eligible overweight and obese patients, pointing to “institutional reasons in healthcare and some other complexities in managing health.”
He said that today just 1 in 10 people who are overweight or obese use GLP-1s.
Ricks compared GLP-1 uptake to low-cost statins, “the most commonly prescribed cholesterol medicines,” noting that “between 40 and 50 percent of people who should be on them, are on them,” which he sees as “maybe a ceiling.”
Reuters reported that he put 50 percent of global weight-loss drug candidates at roughly 500 million people but said “today we’re treating 21 or 22 million,” adding that “20-fold” production growth will not happen “anytime soon.”
He told Reuters there is “no real efficiency gain left,” so Lilly has to “put in more units of capacity,” and described the capex rollout as “expensive and slow.”
Price and access remain central constraints.
Obesity medicine specialists said many potential GLP-1 patients still find the drugs cost prohibitive and that self-pay prices for the lowest doses of GLP-1 pills and injectables range from US$149 to US$349 per month.
Ricks said “the history has been, it’s really been for people with means and not for people without means,” and called access “a moral imperative” and “a cost imperative,” adding that “obesity flows with poverty.”
Lilly’s new oral pill Foundayo logged 1,390 US prescriptions in its first week, while Novo Nordisk’s oral Wegovy had 3,071 prescriptions in its first four days on the US market.
Ricks said Foundayo offers convenience for people who do not want injectables, and obesity medicine specialists told Reuters that Americans are interested in GLP-1 pills as a lower-cost, needle-free alternative to injections like Lilly’s Zepbound.
On treatment effects, a new analysis found that Eli Lilly’s GLP-1 drug tirzepatide (Zepbound, Mounjaro) yields greater average weight loss than Novo Nordisk’s semaglutide (Wegovy, Ozempic), but with greater loss of muscles and connective tissues.
The study, published online ahead of peer review, looked at about 1,800 tirzepatide users and 6,200 semaglutide users and found tirzepatide was consistently associated with greater lean body mass loss, Reuters reported.
Patients on tirzepatide lost an average of 1.1 percent more lean body mass after three months and 2 percent more after 12 months of continuous use than those on semaglutide, based on an analysis by Massachusetts-based data analytics firm nference.
Patients were tracked using low-radiation scans or “smart” scales that estimate body fat, muscle mass, bone mass and other components, Reuters said.
Study leader Venky Soundararajan said the findings suggest patients should not “simplistically” pick the option that delivers the most weight loss.
The study did not explain why lean body mass loss was greater with tirzepatide, which mimics GLP-1 and GIP, than with semaglutide, which only mimics GLP-1, although both slow digestion and make patients feel full, Reuters reported.
A Novo Nordisk spokesperson did not comment on the study but said changes in muscle mass did not significantly differ between semaglutide and placebo in clinical trials and that physical function was preserved.
A Lilly spokesperson said fat loss from healthy dieting is typically accompanied by a loss of lean body mass.
They said Lilly’s late‑stage tirzepatide trial showed a similar ratio of fat‑mass to lean‑mass loss as seen in lifestyle‑based obesity treatments.
The analysis found that roughly 10 percent of tirzepatide users who lost more than 20 percent of their total body weight also lost more than 5 percent of their lean body mass, versus fewer than 7 percent of semaglutide users who lost the same share of weight.
Decreased exercise tolerance during treatment was linked with greater lean body mass loss in both groups, but more so with tirzepatide, and higher doses, longer treatment and pre-existing musculoskeletal pain were also associated with larger lean mass declines for both drugs.
Soundararajan described “a vicious cycle,” saying that starting on a drug with a higher probability of lean body mass loss and having a history of musculoskeletal disease can reduce exercise tolerance, and “if you’re not exercising when you’re on these medicines, you are essentially causing attrition of lean body mass.”
