Glucagon-like peptide-1 receptor agonists — GLP-1 RAs — have in the space of five years become the most consequential development in obesity medicine since bariatric surgery. Semaglutide, marketed as Ozempic for type 2 diabetes and Wegovy for obesity, has produced weight loss results in clinical trials that were previously achievable only through surgery: reductions of 15–22% of total body weight over 68 weeks in the STEP clinical trial programme. These are not modest results. They represent a genuine pharmacological breakthrough. But they are also accompanied by significant questions — about long-term safety, about what happens when the medication is stopped, about the cardiovascular, gastrointestinal, and psychological effects, and about what they mean for our understanding of obesity as a disease. This article provides a rigorous examination of the GLP-1 research literature, drawing on the STEP, LEADER, and SUSTAIN trial data; the SELECT cardiovascular outcomes trial (which demonstrated a 20% reduction in major cardiovascular events); emerging research on GLP-1 receptor agonists for non-alcoholic fatty liver disease and neurological conditions; and the significant concerns raised about muscle mass loss, gastrointestinal side effects, the rebound effect on cessation, and the medicalisation of a condition with complex socio-economic determinants. The article also examines what Ayurvedic medicine understands about metabolic imbalance — Kapha excess and Agni dysfunction — and whether any of the mechanisms through which GLP-1 works (reducing appetite, slowing gastric emptying, modulating reward circuitry) have historical analogues in traditional medicine. The conclusion argues for informed, evidence-guided use rather than either uncritical enthusiasm or reflexive dismissal.
Narayan Rout (Thu,) studied this question.
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