GLP-1 Drugs Like Wegovy: Revolution or Risk?

Medications such as Wegovy (semaglutide) and other GLP-1 receptor agonists have quickly become household names. They’re hailed as breakthrough treatments for obesity, offering people who’ve struggled with weight loss a new tool that finally works. Demand is skyrocketing, waiting lists are long, and for many, these drugs have delivered real results.

And as with any “miracle drug,” the story needs deeper evaluation. GLP-1 medications may revolutionize obesity treatment and metabolic health, but they also carry risks—financial, medical, and physical. If we’re not careful, they could become another short-term fix rather than a long-term solution.

The Promise

GLP-1’s work by mimicking a hormone that slows gastric emptying, reduces appetite, and improves insulin sensitivity. For many, the effect is dramatic: weight loss of 15% or more, better blood sugar control, and improvements in metabolic markers such as blood pressure and triglycerides (Wilding et al., 2021).

For people with obesity and related conditions such as type 2 diabetes, these drugs can be life-changing. They provide hope where traditional advice—“eat less, move more”—has consistently fallen short.

The Price Tag

Yet the promise comes with a price. Literally. Even with proposed price changes, Wegovy and other GLP1s are still pricey for the average American, and insurance coverage is patchy at best. For the vast majority of people, this is unsustainable long term.

Even when cost isn’t a barrier, there’s another problem: only about a third of patients remain on the drug at one year, and people often regain much of the weight when they stop taking the drug (Gleason et al., 2024, Rubino et al., 2021). Some stop due to cost, but many find the common side effects eventually intolerable. 

This raises the question: are we really solving obesity, or just renting a solution as long as the prescription lasts?

The Risk of Muscle Loss

Another concern is what kind of weight people are losing. Studies show that GLP-1 drugs reduce both fat mass and lean body mass. In some cases, up to 40% of weight lost may come from muscle and other lean tissue (Prado 2024).

That matters because muscle is critical for strength, vitality, and preventing sarcopenia, the medical term for concerning muscle loss with aging. It’s also critical for metabolic health. Muscle tissue improves insulin sensitivity, supports mobility, and helps maintain long-term weight stability. Losing too much lean mass may leave people thinner but metabolically weaker.A diet higher in protein, with resistance training, can help preserve lean mass during weight loss (Leidy et al., 2015). But if GLP-1 drugs are used without dietary guidance, people may find themselves in a worse position metabolically, even if the number on the scale improves.

The Lifestyle Blind Spot

Perhaps the biggest risk is that these medications allow us to ignore lifestyle therapies that target the root causes of obesity and metabolic dysfunction. 

If GLP-1 drugs become a stand-alone solution, we risk sidelining the proven benefits of lifestyle interventions—nutrient-dense diets, regular exercise, quality sleep, and stress management. These don’t just help with weight; they improve overall health, preserve muscle, and build resilience.

A diet higher in protein and healthy fats, in particular, has been shown to improve satiety, stabilize blood sugar, and support lean mass—all outcomes that GLP-1 drugs can’t deliver on their own (Ludwig & Ebbeling, 2018).In addition, ketogenic diets have shown better maintenance of lean mass compared to low-fat diets, and published clinical experience demonstrates ketogenic diets are effective at helping people discontinue GLP1s while still maintaining their weight loss (Camajani et al 2022, Mckenzie et al 2024).

The Case for Stewardship

The right response is not to reject these medications. They are powerful tools, and for some people, they may be life-saving. But tools must be used wisely.

We need a policy of stewardship—ensuring GLP-1 drugs are prescribed and used in a way that maximizes benefits while minimizing harms. That means:

• Pairing medication with lifestyle guidance. GLP-1 drugs should be combined with dietary strategies, especially lower carb, higher protein and higher fat diets, and resistance training to preserve lean mass.
  
• Using them selectively. These medications should be reserved for those who truly need them—individuals with obesity and metabolic dysfunction who haven’t succeeded with lifestyle interventions alone, including attempts at a ketogenic diet.
  
• Prioritizing long-term health, not just short-term weight loss. The goal isn’t just a smaller body; it’s better metabolic health, improved body composition, and sustainable well-being.
  
• Addressing the food environment. Drugs may suppress appetite, but they don’t change the fact that ultra-processed foods dominate store shelves. Policy should also focus on making whole, nutrient-dense foods more accessible and affordable.
  

The Bottom Line

GLP-1 weight loss medications may mark a turning point in the fight against obesity and metabolic disease. They are powerful, effective, and in some cases, life-changing. But they are not magic. They are expensive, often temporary, and come with risks—including muscle loss, side effects, and the temptation to ignore lifestyle factors.

We should embrace these medications where appropriate—but do so with caution, responsibility, and respect for the bigger picture. That means combining them with proven lifestyle interventions, supporting long-term metabolic health, and re-shaping our food environment.

Because in the end, drugs alone can’t solve the obesity and metabolic health crisis. But with stewardship, they can become part of a smarter, more holistic solution.