Hey, there. Welcome to Chasing Life. You know, when Ozempic first hit the market in 2017, it was the start of a revolution. The medication approved to treat Type 2 diabetes was also helping people lose weight, sometimes a lot of it. And that fact did not go unnoticed. The drug seemed to usher in a paradigm shift in the field of weight management. Other GLP receptor agonists, as they are called, soon followed: Wegovy, Mounjaro, Zepbound. They help millions of people do what they've been unable to do before: lose weight, seemingly without effort. So demand for them surged, no surprise. And since their widespread use, so has our understanding of them. The landscape has changed a lot since we first reported on these drugs on Chasing Life. So today we're bringing back my friend and colleague Meg Tirrell, who has been covering them since the start. She's going to update us on what is new, what's on the horizon. And let me tell you: There's a lot to talk about. I'm CNN Chief Medical Correspondent, Dr. Sanjay Gupta, and this is Chasing Life. Welcome back to Chasing Life.

Thank you for having me.

One of my favorite guests.

Aw.

You and I, we know each other so well, we work together, but I just so respect your reporting. And I don't know if you realize this, but the last time we talked about GLP drugs was more than two years ago.

But last time we talked in the podcast. You and I talk about that constantly.

That's right. We talk about it all the time, yes. We have a lot of conversations, Meg and I. But yeah, for the podcast, for our audience two years ago, and there's a lot that has changed since then and I want to really focus on that. But I'm just curious overall, just the headline here, I think it was 2017 or so when Ozempic hit the market, like how big a deal, really, are these GLP drugs now on the market?

In terms of medicines, drugs, these are some of the biggest drugs of all time.

You're talking about in terms of money spent on them?

'In terms of money spent, but also the number of people who are taking these. I mean, there are millions of people are now on GLP-1 drugs, most of them for weight loss, also for diabetes. And increasingly, they're getting approved for other indications. They're showing they work for liver disease, chronic kidney disease, osteoarthritis, sleep apnea, preventing a second heart attack or stroke if you've already had one, heart failure. I mean, they are being tested in so many different things. So they're huge.

Does this surprise you? And I'll preface by saying you've been covering this for a long time, I think since the start, you know, here obviously, but also at CNBC. When you first started reporting on this, could you have predicted where we would be in 2026?

No, no.

What was it that gave you pause?

Well, the industry has tried this before. They've tried to develop drugs for weight loss before and they haven't been successful. They had side effects. They were dangerous to take for some people and they didn't produce very much weight loss. So they just weren't, you know, they weren't working for a lot of people. And so the industry was kind of shy to come to obesity drugs again. And then this class of diabetes drugs, and sort of tellingly, it's these huge companies in diabetes, Eli Lilly and Novo Nordisk, which have worked in insulin for almost a century, that brought these drugs to the market for obesity.

Right.

And I mean, these drugs work for both diabetes and obesity and now all of these other things as well.

The initial sort of thinking was that if you started these drugs, you're probably going to be on them for your whole life and I think there was some data a couple years ago when we were working on a documentary that showed that a pretty significant percentage of people were stopping These medications and it was either because of cost, side effects, or they sort of felt like it got them to where they wanted to be and now they were just going to use lifestyle changes to sort of maintain. What are you seeing? I mean, is there a way of contextualizing how long people stay on these medications or if they do stay on them for life?

Yeah, well, the idea is essentially that it's not changing your body, really, other than that you're losing weight. But essentially, if you stop taking these medications, your appetite does go up. We've heard from people sort of anecdotally saying like, I felt like I hadn't eaten in a year. She was like, and I guess I hadn't, you know, because she'd been taking this medicine and her appetite was so suppressed, but it just revved back up. But I think it can be different for everybody. I mean, the studies show that the majority of people, if you stopped taking one of these drugs, they do regain at least some of the weight, but not everybody does. People are different. And so I think that's really fascinating, and it probably also has to do with what happened when you were on the drug in terms of what changes you made in your own life. I mean, did you start cooking differently? Did you start exercising more, find something you enjoy and that you could keep doing? So I think those are some of the big questions. I also think, as you noted, a big reason people would stop is, I mean the cost was so high and it still is really high in a lot of ways, but it's also come down dramatically for some of these options. And I think a hope is that it'll enable people who are benefiting from the medicines to stay on them for longer.

With these GLP drugs, they were originally for blood sugar. And then people noticed that they were losing significant amounts of weight. And now there are all these other potential indications, seemingly unrelated, cardiovascular benefit, liver benefit. Can you talk about some of those? What else have we learned in terms of the benefits?

'Well, I think this is so interesting because a lot of those things people thought were just completely related to weight loss, you know, hey, if you lose 20% of your body weight, of course you're going to have a lower risk of having a heart attack or a stroke. And so I remember they did this huge cardiovascular outcomes trial for Wegovy, which is the GLP-1 made by Novo Nordisk. It came out a couple of years ago, 2024, it's like 17,000 people. They looked at them over four or five years, 20% reduction if you'd already had a heart attack or stroke of having the second one. And I talked to this one cardiologist who was like. You know, it's the weight, stupid, you know, like of course it's the weight, and the thing was, as they looked closer at those data, they found that regardless of how much weight people lost, or maybe even if they didn't lose weight at all, they still had the benefit in reducing a second heart attack or stroke risk. I mean, so there was something else going on. And the same thing has happened in liver disease, the same things have happened in chronic kidney disease, and the same has happened with heart failure. It's not just weight loss. The weight loss is probably helping in some ways, but so they're doing basic research on this now. Dr. Daniel Drucker up at the University of Toronto, who's one of the GLP-1 research pioneers. Just had this mouse study that came out where they essentially created these mice that don't have GLP-1 receptors in their brains and so they couldn't lose weight when given a GLP 1 drug. But what they found is that they had improved markers of this liver disease. So they found these cells in the liver that essentially, when stimulated by GLP 1, tamped down on inflammation in the livers, regardless of whether the mice lost any weight. And so they're finding that these completely weight-independent effects of these medicines and they're still trying to understand what is happening and why this is happening. Inflammation does seem to be a big hypothesis of what is going on, but then of course there's other things like addiction. I mean, and that of course is probably totally unrelated to inflammation, most likely. I mean it has to do with what's going on with the food noise and that kind of getting quieted down that we hear from a lot of people.

You know, we try and be very careful on this podcast not to be prescriptive about things, you know, or even making recommendations, but it is interesting to hear about all the known benefits now beyond just weight loss of these things and potential benefits in the future. Let me commingle two things which are in the news a lot lately. One is just peptides in general.

I know.

'And two is off-label use. So first of all, GLP, the 'P' is peptide. It is a peptide. Insulin is a peptide. These are peptides. I don't know how much you you think about this aspect of things but there's a lot of other peptides that people are talking about in the wellness community and friends of mine who say yeah, I'm definitely taking these now. It helps me they're injecting themselves with these peptides. Have you have you learned anything about these?

'It totally freaks me out. I just can't believe that this is so widespread and that like these things are not widely tested. We haven't done the safety testing. I hear so much about people who are like, we still don't know if GLP-1s are safe. It's like these have been through clinical trials and tens of thousands of people. They've been looked at so closely. The regulators are setting them in the real world all the time. And yet all these folks are taking these peptides that are completely unregulated. You don't know exactly how they're made, who's making them, what the conditions are, whether they're doing anything, whether what they say they are. Even if they are what they said they are, what are the safety risks of that? I mean, I, I just, I can't believe that people are doing this.

'I mean, one of these people who I'm talking about, one of my friends said, oh, yeah, I had a really bad reaction to taking it. They had to keep me in the office a lot longer, take my blood pressure. I felt very faint, like I was going to pass out. And I'm thinking, isn't this part of the problem? You know, like, there can be significant side effects. And a lot of times, they're taking these in non-medical settings, potentially really problematic. At the same time, though, when it comes to GLP drugs, a lot the testing has been done on very specific patient populations. Patients who have diabetes, patients who have obesity. But I think what we see is that a lot of people are taking these off label, or not for the specific indications. So how do you think about that? And what does that mean in terms of safety? Because we don't have safety data on all the populations. Like someone who's just taking it to lose a few pounds, which I hear a lot. How do you sort of frame that conversation for people?

'Yeah, I mean, I think the most important thing probably is that you're doing it under the supervision of a trusted medical professional. And that's, I take a real concern is that we're hearing more and more about folks who are like, yeah, I just decided I'm gonna microdose this thing and I got it through this website and I started taking it. And, you know, it frightens me a little how easy it is to do that. And that, you're with a telemedicine doctor, you see once for five minutes over your phone, you never see that person again, they never check back in on you. They will prescribe you something maybe, but I don't know, I just think that's, what do you do then if you have a problem? You're not, you go to the ER, I guess. So that scares me a little. I do think the idea of like, how do these drugs work in folks who don't have weight to lose is something that's very interesting, especially as we start to look at them for things like addiction or Alzheimer's. I mean, there's a lot of different indications where these could be used that have nothing to do with weight. You don't wanna lose weight, especially in an elderly person, maybe you're not trying to lose more weight. And so I think that's very interesting. And the companies when you think about it for sort of these cosmetic purposes -- you know, just have a few pounds to lose -- they've really stayed away from that. I mean that is even though it is a huge market and probably a huge number of people who are taking these medicines, they haven't tested that it's just not where they are. And so we don't really know, other than the real world use of it. But I've also been hearing from doctors, they're getting really worried about people getting too thin on these medicines. And I even talked to one doctor who was just saying, even looking at some folks in Hollywood, I mean, looking at the modeling world, like thin seems to be having this resurgence, this extreme thinness. And I think that is worrying to a lot of people.

'When I interviewed some of the scientists at Novo Nordisk in Denmark, one of the things they said to me, interestingly, was that they sort of slow rolled the idea of using these medications for weight loss initially, and they were very specific about it. They just didn't think people would inject themselves for weight-loss. Diabetics do, you know, for insulin, but the idea that it would become as widespread as it has, that surprised them when I was interviewing them in retrospect. But even at that time, there was a desire to say, hey, look, could we potentially turn this into a pill? And they've done that now. And this is something you've been reporting on a lot. First of all, why was that so challenging?

'Well, as you noted, GLP-1 is a peptide, and so it is sort of this larger molecule. And so, you know, we can't swallow insulin, for example, because it doesn't get, you know, broken down in a way that we can metabolize it in our bodies. And it's the same problem for GLP1. And so-

So it gets churned up by your gastric acids and everything in your stomach in your stomach.

'Yeah, it doesn't have time essentially to act in the ways that it needs to in our body as a medicine. So Novonordisk had to essentially develop a technology to enable it to be swallowed and so that our body could actually take it up as a medication. Interestingly, the technology is called SNAC. Oh, I didn't know that, really? Yeah, that's like S-N-A-C, yeah. I cannot remember what it stands for. But it essentially sort of buffers it and enables it to get into ourselves in a way that, you know, it gets metabolized. But for that reason, the Wegovy pill that they just got approved, you know essentially at the end of 2025 and went on the market in January, you have to take it first thing in the morning, 30 minutes before eating or drinking much water. You can have like four ounces of water with it and you have wait before taking other medicines because it just changes the sort of metabolism of everything. So that was sort of tricky, and I think they're very proud of the fact that they engineered this to be able to work as a pill. But then you have Eli Lilly, which developed a small molecule version of GLP-1, orforglipron.

These names, they're crazy.

Now it has a brand name, Foundayo. And so that just got approved. And we haven't seen yet how many people are taking it, but with the Wegovy pill, it was the fastest drug launch of all time. I mean, hundreds of thousands of people, if you believe these Wall Street estimates, which have been coming out, are taking the Wegovy pill already. And so I'm really interested to see how quickly the Foundayo pill gets taken up as well.

Calling it the Wegovy pill for a second, how does it compare to the injection in terms of how well it works and side effects?

'It's actually pretty similar in terms of, I think, both of those things. We'll have to see how it actually shakes out in their real world, but it doesn't appear to be significantly different. When you look at the Lily pill, Foundayo, it is not as effective, at least in clinical trials, certainly not as tirzepatide, which is a Zepbound, but it also seems not to be as effective if you just compare, and it's not apples to apples because they weren't head-on compared in a clinical trial together. But it doesn't look like it's as effective as the Wegovy pill in terms of its clinical trial results. And we're gonna have to see what the side effect profile ends up being for it.

And we'll have much more on the evolving landscape of GLPs with my colleague, Meg Tirrell, right after this short break. Let's talk about cost and even before comparing the pill to the injection, we heard about the, uh, president Trump plan to reduce costs. Like how has that sort of played out for the average consumer?

That actually did something. Often these things come out of different administrations and you're just like, what's this really gonna do? And in general, the TrumpRx idea, they have this new website where you can buy drugs directly from drug companies and TrumpRx sort of lists them on its website. They're not selling drugs, but they say they have a role in negotiating the discounts. There are questions about how broadly helpful that is going to be for for drugs generally, but for the GOP1 drug class, it actually has played a part in bringing costs down really significantly. And there may have been a price war anyway, because when you've got two companies that are competing so directly, sometimes you do see costs come down in this way. And that's when like competition is great. And it works for the consumer. Sometimes that doesn't happen in the drug industry, because you've gotten the middlemen with insurers and PBMs. And sometimes you actually see costs go up, which is horrible. But anyway, in this situation, they came down. And so the Trump administration negotiated a price of about $150 a month.

And what was it before that? Like, what was the average price?

The list price of these drugs was about $1,000 a month or more.

So a significant drop.

'Significant drop and a lot of folks don't have good insurance coverage of these drugs. A lot of insurance companies, even now, they're dropping coverage for weight loss of these medications. And now you're hearing a lot examples of basically, like PBMs or insurers, saying just buy it directly from the company, use cash pay. So it's interesting that there's all these new ways of sort of paying for these drugs, but $150 a month out of pocket, but it's only for the lowest doses of the medicines. So most people start on this low dose, but then move up over time. And so you're gonna be paying more over time, I think the highest price is around $350 a month, which is not insignificant. It's a huge amount to be paying out of-pocket, but it is a lot lower than a thousand dollars.

Oh, less than when it was. So were Eli Lilly and Novo Nordisk, were they good with this plan? Where does the shortfall of money come from? Who's paying the gap?

'Yeah, I mean, I think what is cool about this is it can be seen as a trade-off between volume or the number of people you're helping. Volume is the Wall Street word. The number of people who can get access to these medicines versus how much each person is paying. If these are really so helpful, which the data suggests they are, then it's great that more people can get access to them and the companies can still make a ton of money. I mean, they brought in like $36 billion each last year from these drugs.

Wow. From these drugs alone?

Yeah.

Amazing.

Yeah. It's huge. And only getting bigger and bigger.

That's worldwide data? Yeah.

Yeah. I know. I know, and what's cool is hopefully, and we see this, I mean, they're plowing a lot of that back into research. And so that will, you know, hopefully improve medicines in this category and in others going forward.

Right. Are there big research questions that they're still trying to answer, like the oral formulation, taking this as a pill seemed like a big one. Like, we want to be able to provide this in a way where people don't have to inject themselves. What do you sort of see coming down the pike? What are the big questions they're trying to ask or developments they're trying to achieve?

Well, in the nearest term, they're trying to maximize weight loss. So this is the Retatrutides of the world, the triple G's. And Novo has its own answers to that as well. I think some companies, as we noted, are trying to work on so you can take it less frequently. So the opposite direction of the daily pill. But then also trying to make them more tolerable, because a lot of people do experience these GI side effects with the medicines. I hear from doctors, maybe five to 10 percent of patients find these side effects so severe that they just don't want to take the drugs. I mean, so that's something that companies are trying to work on as well. We've also heard when people lose a lot of weight particularly very quickly, and if they're not doing weight training along with it, and depending on what their diets are, they can lose a lots of lean muscle mass, too. They lose their muscle. And this happens when people loose weight in any way. You lose a a lot weight quickly on a diet, you might also lose a lot lean muscle too.

Right.

But some companies are working on ways to try to preserve lean muscle mass while you lose your fat mass. I had one R&D executive say, 'we're going to make everybody hot' because they were working on preserving muscle.

Thin and strong.

Yeah.

I mean, it is fascinating. And I find it feels a little dystopian at times because you and I are both medical reporters and look, eating right, exercising, living a healthy life, that should always be the right answer. At the same time, we realize it doesn't work for everybody. So these drugs can play a role, but they've probably taken an outsized role in all this. I'll share with you just quickly, you know, it was fascinating talking about muscle mass loss because I visited this, this lab in Oshkosh, Wisconsin, uh, where they're studying these 13 line squirrels.

Oh, yes. I love this story.

It was amazing to me. And this, this researcher says to me almost as an offhanded comment that bears when they hibernate and they can hibernate for months at a time, they're not eating, they are not moving. And when they come out of hibernation, oftentimes they have as much, if not more muscle mass than when they went in.

Huh.

Huh, right?

Yeah.

It's fascinating. And the whole reason this has gotten a lot of attention recently is because they're thinking about this for NASA. Like, could humans hibernate as they're going towards Mars?

Whoa.

It solves a lot problems. One is that you're hibernating so you don't get bored. Boredom and isolation is a big concern. Two is you don't have to take as much food and water up because they're not eating or drinking anything at the time that they're hibernating. And three is this issue of humans, if you don't move for even a few days, you lose muscle mass. They may be sort of in that state for months where they're moving much. Hibernation could solve a lot of problems. So it's gotten all this funding recently, but then she said, it could be actually something beneficial for people who are taking GLP drugs as well. This has been one of the big questions. I want to lose weight. I don't want to lose muscle.

Right. Oh, I think that is so fascinating. I didn't know that about the NASA going to Mars. I mean, it's like Austin Powers.

I know right. Well, yeah, and then even back here on Earth, the idea, like you're saying, like, I want to lose weight, but I don't want to lose muscle mass. I don't want to loose bone density and things like that. By the way, I'm getting my bone density checked again. I think we talked about this last time. It's been about a year. So I'll let you know how that turns out.

Oh, OK.

'Last time we talked about this topic, I wrote this down, you made sort of an interesting comment related to the stigma associated with taking these pills, or taking these injections at that time, now pills. You know being being sort of criticized for like you're just using a shortcut here you know there's there's non-medication ways non-expensive medication ways to achieve these. Where do you think we are culturally now compared to a couple years ago?

'I think there are still a lot of folks who feel that way. I mean, we just did a video this week about some findings on these medicines and I was looking at some of the comments. And you know, there were a number of people who were just like, well, just eat right, avoid ultra-processed foods and you know. And so I think that there is still a lotta that. But I do think, I mean there's also a growing appreciation for what these medicines can do. And so, I think that is changing. But I still think, I mean, people love to speculate who's taking a GLP-1, why did their body change so much? And it's something that, you know, we all do it, we're all gossipy. It's like how we are as humans. But, I think the issue is the pressures that people might feel to look certain ways and that that pressure is probably increasing as it becomes easier to look at certain ways that are maybe not realistic and maybe not healthy for a lot of people. I think that can be problematic.

The potential side effects that you talked about, GI, people feeling nauseated, having constipation. In part, that's a little bit how these drugs work because they're slowing down the motility of your gut. Do they find that for most people, these side effects go away after a time? Is this like something people develop a tolerance to?

Yeah, and then the tolerance idea is totally fascinating too, which is something that I've talked to addiction researchers about, because they're wondering, do you reach a level of tolerance of these medications that you need to keep taking them in order to keep staving off your addictions? I think it's fascinating. So there's, you do have to titrate up on the medicines over time, mainly to try to ensure the tolerability is manageable. So you start at the slow dose, after a month, typically you go to the next dose. And you know, sometimes people can stay at a certain dose and that works for them. Some people have to get to the highest dose and stay there. We do see that there typically is a plateau. People stop losing weight at a certain point with these medications. They don't just lose and lose and lose.

They can't just wither away to nothing, right? Yeah.

And sometimes that might happen before somebody's lost as much weight as they want to lose. I also hear from doctors that some people wanna lose an unhealthy amount of weight. And so then the doctors are having these conversations like, hey, I know you weighed 105 pounds in college or whatever, but that doesn't mean you should weigh that now. And so trying to have those conversations too about what's healthy and what's not. But, yeah, people typically do seem to get used to these side effects and then you go up again and you might experience them again.

Are there other things that doctors are concerned about?

Yeah, I mean, there can be other side effects, like people sometimes have hair loss, and in the Retatrutide trials, we saw large numbers of people with this sort of prickling skin condition that they felt when they were taking the medicine. There's also a very rare eye condition called NAION, and it can be kind of like a sudden vision loss in one of your eyes. And so it's very rare, but it is something that can happen. People worry about the thyroid, and so that's something to monitor. And then of course, there have been things like gastroparesis, so this sort of like, you know.

Paralyzed gut.

Exactly. And so, you now, these are drugs. I think about possible side effects when I take ibuprofen. So I think people need to be cautious.

'Just, you know, again, people should always be mindful if they're putting anything into their bodies. So what are you hearing in your just own circles of friends and just being out there as a reporter? The sort of reaction to these medications -- Are they just now part of regular culture here in the United States?

'I think in some ways they are and in some way they're not. I mean, an increasing number of people who I know are taking them, people who might have been resistant to taking them before. I have older people in my life whose doctors felt like the drugs hadn't been studied for long enough, even just a couple of years ago, whose doctors now are saying, okay, they're fine. You would benefit from being on this. And I like to see, to hear about how people are taking them, you know. A number of people I know have said either their doctor has required that they start weight training before they go on these medicines so that they establish that pattern. They know that they can do it while they're doing it. I think that's really great. Other people I've heard even just by themselves, they wanted to take these medicines and they're like, I'm going to start weight training before I take the medicines so that I establish that sort of pattern, and I know that I can do it. And I think, that's so healthy and great. I mean, I even think about it for myself. I'm like, these medicines have so many different benefits. Should I be micro-dosing a GLP-1?

What do you think?

I don't know, but I also think my diet isn't perfect, my exercise isn't perfect. Not that it needs to be perfect, but I also need to take a page out of those folks' books and get to a point where I'm really consistent with those kinds of things and assess where I am. And if I still feel like I need help or I could benefit in some way, talk to a doctor about it.

I'm the same way and it's funny the the I think a lot of people just just sort of look at the cardiovascular benefits. You know, I have a strong family history of heart disease. You know, I worry about dementia. I have dementia my family. And, so I'm not taking these medications, but there's a part of me that wonders if I'm missing out now because of these. Like, will I look back ten years from now and say gosh I could have maybe helped if not prevent, at least stall, you know, the onset of some of these diseases? I feel like that's an increasingly big part of the conversation.

Yeah, and the problem is, like, we don't know until we know.

Right.

'And even though these drugs have been around for a long time, they're pretty well understood, it doesn't mean that they're completely benign. And, you know, would we find if a certain population is taking them that, you, know, could something bad happen if you were taking them? So it's not, like a only one direction, you there is a risk-benefit, and so, you know.

Two years from now, what do you think this market looks like?

I hope we have a lot more information about what these drugs are doing. The big companies are finally running the trials in alcohol addiction and nicotine and opioids and cannabis. From the business perspective, that's a market. Drug companies are like, we don't really do that. You know, it just hasn't been financially successful for us, and so we're not touching it. Now they're in it. They're running these big clinical trials. And could this possibly really help people? That would be wonderful. So I hope we see that. I hope that we see good results in the brain health space. So I'm hoping we see benefits there. But yeah, just hope we keep learning about these and that, I mean, we have enough doctors and enough people overseeing care that people can do it in a way that's safe.

I love your reporting. I always appreciate the chance to talk to you and I think the entire audience always learns something. So thank you.

Oh, well, likewise, thank you.

Appreciate it. That's our show for today. I hope you learned something, I certainly did. I know I got a lot out of it. And a big thanks again to my colleague here at CNN, Meg Tirrell. Please join us next week.