Have you ever heard of a drug called Ozempic? Just kidding. As we all know, this medicine and numerous related drugs are the rage. It is classified as a GLP-1 drug. The percentage of my patients who are taking these drugs is steadily rising. Of course, initially, Ozempic’s purpose was in diabetic management. Once it was discovered that weight loss was a “side-effect,” a new therapeutic mission was discovered. Indeed, public demand to use this medicine off-label for weight loss has risen sharply. Currently, there are two GLP-1 agonist medicines that the FDA (Food and Drug Administration) has approved for obesity treatment. I can promise you that pharmaceutical R & D on similar and next-generation weight loss pharmaceuticals is supercharged. Why the interest?

• There is an obesity epidemic in America.
• The medical, financial, and societal consequences of obesity are staggering.
• Diet and exercise options are insufficiently effective for most individuals.
• Prior weight loss medications were only modestly effective and had some concerning adverse reaction potential.
• The market for effective weight loss treatments is monumental. The market expands as new medical uses or treatment targets develop. To illustrate, if you lower the normal level of cholesterol or blood pressure, then more folks will need drugs. If these drugs are found to provide medical benefits for other conditions, then drug usage will rise.

Bariatric surgery, including gastric bypass and related procedures, is obviously a less attractive option than an effective pill or a weekly injection. Indeed, bariatric surgeons may find that they have more free time these days than they used to.

GLP-1 medicines and those that will follow appear to be game-changers. Curiously, we do not fully understand how they work. They do seem to curb appetite and slow down the digestive system making users feel full sooner.

Of course, there are side effects, such as nausea, vomiting, and abdominal pain. But might there be unknown long-term effects of these drugs which must be taken indefinitely? Will we look back years from now and wonder why so many of us enthusiastically drank the Kool-Aid? I am just speculating here, but it does seem to me that there has been a collective rush to judgment before the facts have come in. Risk-benefit analysis should assume greater importance for a medicine that may be taken for several decades, particularly when we do not fully grasp how it works.

What do you think? Are these patients riding smoothly on the Ozempic Express, or might they be on board a lumbering runaway train?

Michael Kirsch is a gastroenterologist.