Popular weight-loss drugs known as GLP-1s could soon become more affordable for Americans.
On Thursday, the Trump Administration and two major drugmakers announced an agreement to drastically reduce the cost of the drugs for people enrolled in Medicare and Medicaid, as well as for cash buyers.
Currently, the injectable drugs can retail for up to $1,000 a month. Drugmakers Eli Lilly and Novo Nordisk are developing oral versions of their GLP-1 medications, which could dramatically lower costs. If approved by the Food and Drug Administration, the pills are expected to range from $149 to $350 a month. President Donald Trump said the deal will expand access to millions of people and “equalize the world.”
University of Virginia associate professor Siddhartha Angadi says it’s important to understand that “these drugs are for life.”
“There’s good data to show that once … you come off the drugs, the weight comes back,” he said. There is also limited information about how taking medications like semaglutide and tirzepatide affects the human body over the long term.
Angadi, a cardiovascular exercise physiologist in the Department of Kinesiology in UVA’s School of Education and Human Development, said weight loss is not synonymous with good health.
While there are short-term benefits, including better blood sugar control and lower blood pressure and inflammation, “It is important to recognize the value of things like physical activity, aerobic exercise, strength training and so on,” he said. “If you’re obese and fit, actually (the) risk of death is half of that of someone (who) is normal weight but unfit. So, fitness matters a lot.”
Siddhartha Angadi:
More importantly, what I would say is we need to stop this sort of myopic focus just on weight and fat.
What we ought to be looking at is not just the change in what the person looks like — their body composition and their weight — but we ought to be looking at changes in function over time. Because function is a tremendously useful predictor of the risk of death.
There are multiple ways of looking at function. So, you can look at cardiorespiratory fitness, and the reason why we care about cardiorespiratory fitness primarily is because it’s a far better predictor of the risk of all-cause death and death from cardiovascular causes than just knowing whether someone is fat or not.
So that’s one way of looking at it. The other thing you can look at is muscular strength. Muscular strength also predicts the risk of death, survival and so on. So that is what I mean by function.
And some studies have looked at function in these patients that have been given these drugs. They’ve typically looked at change in something called six-minute walk distance, which is the distance walked in about six minutes. But the change there has been minuscule.
So, we’re looking at people that have lost maybe 10 to 25% body weight, but the improvement in the six-minute walk distance was only about 10 meters, which is 33 feet. That’s not a lot in six minutes. And that was about 5% in these studies, so it’s quite small.
So, you know, the presumption is, the cultural presumption often is that if you’re no longer fat, you must be getting fitter. That’s not true.
Preserving muscle mass is also important. “Now, how much of that you’ll preserve? At this point, genuinely, it is an unknown with these high-efficacy drugs like semaglutide and tirzepatide,” Angadi said. “The hope is in the next five or six years, we start getting some answers.”
Recent research, co-written by Angadi, UVA Dr. Zhenqi Liu and former UVA graduate student Nathan Weeldreyer, found about 40% of the weight people lose using brand-name drugs like Wegovy or Zepbound comes from something called fat-free mass, which is everything in your body that is not fat. Up to 50% of that can be muscle.
For the researchers, this finding raised questions about implications for aging, frailty and fitness in the long term. “We just don’t know the answer to that,” Angadi said. “So, these are some things we really need to study now.
“The other thing that we also talk about is that people (who) are obese already are prone to not being fit,” he said. “So, when you lose all this fat-free mass where you’ve got a lot of muscle in there, is that going to, in the long term, cause serious issues? So, again, a lot of unknowns.”
