How Weight Loss Drugs Affect US Health Care and Food. Plus, the Biggest Problem With GLP1s.

Today’s episode is our second in a series on the weight loss medicine revolution of the last two years.

On Tuesday, we spoke with endocrinologist Beverly Tchang about the science of glucagon, such as peptide 1 receptor agonists also known as GLP1s, also known as Ozempic, Wegovy, Moujargo, and Zepbound. If you haven’t listened to that show, I think you’re safe and entertained within the confines of this episode. But if you want to know more about how these drugs work, their effect on insulin and glucose and the brains reward center, or the questions they raise about obesity and the nature of willpower and free will, I encourage you to queue up that show. Today, in Part 2, we have two guests: Zach Reitano is the CEO and cofounder of the telehealth platform Ro. He is here for a reason. He has a birds-eye view of the GLP1 marketplace, increasing demand, the supply chain, the economics of pricing, and insurance. He also wrote several revealing essays, drawing on research from think tanks, medical experts, and investment banks, that helped shape my understanding of these drugs and their impact. it’s population and economy. Our second guest is Dr. Robert Lustig, an endocrinologist who spent many years as a pediatrician and researcher at the University of California San Francisco. As you will hear, he is not very optimistic about the ability of these drugs to revolutionize obesity medicine in America.

If you have questions, observations, or ideas for future episodes, email us at PlainEnglish@Spotify.com.


In the following excerpt, Derek talks about the implications of the weight loss drug revolution in the United States.

Derek Thompson: Today’s episode is the second in our series on the weight loss drug revolution in recent years. On Tuesday, we spoke with endocrinologist Beverly Tchang about the science of glucagon-like peptide-1 receptor agonists, also known as GLP-1s, more commonly known as Ozempic, or Wegovy, or Mounjaro, or Zepbound. If you haven’t listened to that show, I think you’re still safe and entertained within the confines of this episode. But if you want to know more about how these drugs work, their effect on insulin and glucose and the brains reward center, or the questions they raise about obesity and the nature of willpower, I strongly encourage you to queue up that show.

Today, in Part 2, we have two guests. First, Zach Reitano is the CEO and cofounder of the telehealth platform Ro. He’s here for a reason. First, he has a bird’s-eye view of the GLP-1 marketplace, increasing demand, the supply chain, the economics of pricing, and insurance. He also wrote several revealing essays, drawing on research from think tanks and medical experts and investment banks, that did much to shape my understanding of these drugs and their impact on population and economy.

Our second guest is Robert Lustig. Dr. Lustig is an endocrinologist who spent many years as a pediatrician and researcher at the University of California San Francisco. And as you will hear, he will offer a kind of counterpoint to my optimism. He’s not sure these drugs will revolutionize obesity medicine in America, and it’s my view that, as optimistic as I am that they will, the only way to be optimistic is to be an educated optimist. Otherwise, I’m just plain ignorant. So were going to hear out Dr. Lustigs case against the greatest possible effect of GLP-1 drugs, although he has some belief that they will play a big role for obese people.

So first, in this episode, to level set our understanding of the GLP-1 market, I want to say a few words about the size of the market for these drugs. Morgan Stanley estimates that about 5 million people in the US take GLP-1 drugs, these weight-loss drugs. Four million take them for type 2 diabetes, and about 1 million take them for weight loss. Now, that’s not big, you might say, but here’s a way to imagine how big this market could get if patients decide if, I want to be clear if patients decide that these drugs are worth should stay.

In the 1980s, 40 years ago, about 10 percent of people diagnosed with high blood pressure were taking medication for high blood pressure. But over the past half century, with advances in ACE inhibitors and other drugs, that number has risen. Today, tens of millions of Americans use blood pressure medication, and this has dramatically contributed to the decrease in cardiovascular deaths.

If GLP-1s follow a similar trajectory, the number of Americans on these drugs could easily triple over the next decade. And the implications for health are one thing. Lower obesity will obviously reduce many chronic diseases and pain. But what about other industries? How does it affect food?

Morgan Stanley research and survey data suggest that patients on GLP-1 drugs reduce calorie intake by 20 to 30 percent, and that’s not even a 20 percent reduction in all food categories. Consumption of candy, sugary drinks, and cookies decreased by 60 percent for patients on GLP-1. Alcohol consumption decreased.

So if you work in packaged food and beverages, or in restaurants, or in grocery stores, and you believe that a high proportion of your clients are likely to continue and remain on these drugs for the next decade, these drugs, which are probably , essentially, an anti-snacking drug, how does that change your menu, your supply chain, your procurement strategy?

We cannot answer every implication of GLP-1 today; the ripples are too wide. But these are the kinds of questions that interest me. And then, because I like to check my optimism every once in a while, these are the kinds of predictions I’m excited to ask Dr. Lustig. I’m Derek Thompson. This is Simple English.

This excerpt has been edited for clarity. Listen to the rest of the episode here and follow the Simple English feed on Spotify.

Host: Derek Thompson
Guests: Zach Reitano and Robert Lustig
Producer: Devon Baroldi

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