GLP-1 for Everyone?

Immunity against Cravings in the Abundance Society

Resistance is futile!

As a Trekkie in the 90s, this phrase first captured my attention when rooting for Captain Picard fighting the Borg collective that aimed to assimilate the entire Alpha Quadrant. Years later, living in a similar abundance environment to the Utopian Federation, my hunter-gatherer instincts realized it’s futile to resist three-course luncheons and five-course dinners – with (nearly) fatal consequences for my health.

A hypothetical time machine from a science-fiction 24th-century setting to mythological Greece would elicit a similar story: The constant offerings of high-calorie food, the one drink for the road, or a little bit more of doomscrolling require the strength of Odysseus tied to the mast of his galley to withstand all these temptations.

As humans, we are forced to engage maximum willpower spent just to be healthy. It often makes us miserable. Diets and dry Januaries are fleeting and short. They're usually followed up by extended Summer splurges that often last until Christmas. 

The good news, to fellow Trekkies or not, is that ingenious scientists have delivered us solutions. GLP-1 drugs like Wegovy and Mounjaro are basically the vaccine against Borg nanoprobes and the constant silencer of Siren voices.

The health revolution at the tip of a pen

Too often, people treat GLP-1 users (or patients) as failures and cheaters. “You can’t just hit the gym?” and “You don’t have sufficient self-discipline and need a drug for a diet?” are common judgments.

While preventive cardiovascular medications such as statins are now normalized, metabolic health is still seen as something one has to achieve on one's own to demonstrate mental strength. The collateral damage of this is frequently underappreciated for those who've never tried: less time and energy to cultivate hobbies, not being as present with friends and family, and waking up filled with self-loathing. Dieting is hard.

Moral judgments on weight and appearance are plenty, but maybe pure evidence will help us normalize the ‘health hack’ and make our lives longer and better.

According to Gallup, US obesity rates dropped from 40% in 2022 to 36.4% in 2026. In absolute numbers, that means there are eight million fewer obese people in the United States. Not only is this a massive personal victory for everyone, but it's also a massive societal benefit. Given that one in nine adult Americans uses GLP-1s, the impact can easily be attributed to the decline in obesity rates.

Beyond just weight, we're learning that these drugs also have positive impact on our overall health. GLP-1 users have a 20% lower incidence of major cardiovascular events. Kidney disease risk is even 24% lower compared to those who don't take them. Semaglutide promises to reduce alcohol consumption by 40%. Recent reports show that more and more physicians also prescribe these drugs off-label for indications such as Crohn’s disease.

Beyond this long list of potential health benefits, clear economic benefits are also evident in widespread societal use of GLP-1. Together with Dr. Panzaru, I argue in this peer-reviewed paper that many health insurance systems merely see the pharmacy bill of GLP-1s but neglect the societal cost savings from avoided dialysis, heart attacks, disability, absenteeism, and the drink-driving crash that never happens.

Industry has already reacted to the large interest of consumers to obtain these drugs beyond insurance coverage and rolled out direct-to-consumer sales channels with large discounts. Governments seem to be following the wide demand (and a partial understanding of the net-positive impact on society) by rolling out programs such as the GLP-1 bridge in Medicare Part D.

Beyond the prescription

But there are still barriers to overcome. Despite a very solid safety record and side effects that can also be observed in many over-the-counter drugs, GLP-1s are still prescription-only medicines requiring a doctor visit or a telehealth consultation. Conversely, many countries allow over-the-counter statins and emergency contraceptives. Given that oral GLP-1s have arrived and we have data from tens of millions of patients, it might be time to think about how to cut out even more middlemen in the game to make us all healthier.

Consumer demand is already here, and additional barriers to access might push even more patients into less-safe or dangerous black- and grey-market offerings from some questionable compounding pharmacies.

Let adults choose

Adults are trusted and allowed to buy alcohol, nicotine, and sugar without a prescription, and that’s a good thing. What is hard to understand is that GLP-1s still require a regular physician visit. All other wellness products and drugs are readily accessible. Perhaps it's time for a pivot.

Let’s accept that we live in abundance. And that allocating a large portion of our energy to resist the call to consume is not fun at all. We have the biotechnology to enjoy long and healthy lives. Let's aim toward the future and normalize technology-driven solutions to overconsumption. A healthy step!