It’s a classic Catch-22

In 1961, Joseph Heller’s novel Catch-22, a paradoxical situation is the focus, and in our culture, the phrase has become synonymous with no-win situations. It’s my intention to write encouraging — not discouraging Health columns as long as they’re based on facts, not on my opinions. This column is going to be about the hottest new drug being touted as THE panacea for the number one preventable health issue of the last 50 years.

The annual cost of obesity (defined as a 35-inch waist for women/a 40-inch waist for men) is $1.4 trillion (projected to reach $3 trillion by 2030) which currently includes direct medical costs between $173 billion and $261 billion. Those direct costs are largely paid by insurance and are more than double the expense of non-obese citizens. We all share the insurance rates though, so we all are sharing in supporting those who are dangerously overweight.

While chronic diseases (heart disease and cancer) are still the leading causes of death in the U.S., we have the highest rates of obesity and diabetes in the developed world! When obesity triggers metabolic syndrome diagnosis, this increases risk of many types of cancer, type 2 diabetes and heart disease, along with the costly associated conditions of high blood pressure, high blood sugar, low HDL (good) cholesterol, high triglycerides, sleep apnea and more. Directly linked to poor nutritional habits and physical inactivity, these are preventable conditions.

Now, about that Catch-22: Enter GLP-1 drugs into consideration. They suppress appetite which dramatically reduces daily calorie intake, forcing the body to burn stored fat for energy. Sounds like a positive step. Some of the people turning to this new drug are significantly obese, have excessive amounts of visceral (deep) fat, and their overall health is in serious jeopardy so something has to be done.

So where’s the no-win paradox? Glad you asked. It’s right here in no particular order of priority:

  • Long-term safety of this drug beyond two years is unknown
  • When drug is stopped, most weight is regained in 12-18 months so it requires a lifetime commitment
  • An estimated 25 percent to 39 percent of the “weight” lost is lean muscle tissue, making the focused building of muscle essential as a partner to this drug
  • Reduced overall fitness
  • Increased possibility of falls
  • Bone density loss and increased possibility of fractures in falls
  • Potential nutritional deficiencies due to reduced consumption
  • Sagging and wrinkling of facial skin and of breast tissue due to rapid loss of body weight
  • Dangerous problems with compounding prescriptions.

Compounding prescriptions began in 2022 as the overwhelming popularity caused shortages of semaglutide and tirzepatide. (I’m staying away from brand names because I’m not wealthy and can’t handle lawsuits). The supply of these ingredients stabilized in 2025 but many weight loss clinics and spas have kept selling compounded drugs containing additives, inconsistent sterilization, toxic ingredients, incorrect dosages and more potential problems.

So, if we are objective about it, because we all are paying for this, we all will celebrate this new popular approach to fat loss and not concern ourselves about the problems listed. But, I am concerned because I see folks every day who choose a more responsible path to improve their body composition. I’m hoping this column will encourage at least one person to choose that path.

Simply, it requires eating better and being more physically active. That’s not an oversimplification. You can do it.