GLP-1s Are Cheaper, but There’s Just 1 Problem

One clinician says patients may be measuring the wrong thing.

IM Imagery/GETTY IMAGES

A new Medicare pilot limits GLP-1 costs to $50 a month. Lower-cost access sounds good: more patients who need help can afford these drugs. However, expanding access raises a separate question: Does everyone benefit equally?

Dr. Sean O'Mara, a performance-optimizing physician who uses MRI imaging to track changes in patients’ body composition and a medical consultant to some White House staff members, says the number on the scale may be the least useful way to know if the drug is working.

What GLP-1s Are Really Changing

“We pay more attention to the success of a drug rather than the potential consequences,” O'Mara told The Epoch Times.

O'Mara’s clinical worry, in short: “When you step on the bathroom scale, you may be celebrating loss of health, not gain.”

Patients may assume weight loss and fat loss are the same thing, and that fat loss always means better health.

Weight loss on a GLP-1 could include loss of muscle, nutritional reserve and, in some cases, loss of heart muscle tissue  (myocardium), creating a risk of a different problem.

That is especially important for older adults and anyone already at risk of low appetite, undernutrition, or sarcopenia—an age-related loss of muscle mass and strength.

People on GLP-1s can quietly fall short on protein, fiber, B vitamins, minerals, and total energy. Over time, that can affect muscle mass, energy, immune function, and recovery. In other words, the medication may help reduce body size while simultaneously eroding some of the body’s important tissue reserves.

As a clinical nutritionist, I’ve seen this hundreds of times—losing weight is not always the same as improving health. If a patient loses a substantial amount of lean muscle, that can affect metabolism, strength, balance, and long-term function. In a review published in April of 7,965 people using GLP-1 drugs, about 1 in 10 people who lost more than 20 percent of their body weight also lost more than 5 percent of their lean mass.

O'Mara’s proposed solution is more systematic monitoring.

He uses MRI imaging to distinguish between visceral fat, which wraps around organs and drives disease risk, and subcutaneous fat, which sits under the skin and can be comparatively protective. He recommends patients ask about imaging if they want a clearer picture of what’s changing internally, potentially repeating scans every six months. The scan can be expensive if billed through insurance, often costing about $3,500, but cash-pay options may cost closer to $290.

It’s Always On

GLP-1 is a natural peptide—a hormone—that’s produced in the small intestine from the metabolites (byproducts) of your gut microbiome.

In its natural form, GLP-1 lasts only seconds to a couple of minutes, operating in pulses rather than as a constant signal.

“The real benefit may come from this biological peptide being pulsed short durations, and then you stop, while GLP-1 medicines, by contrast, are always on,” said O'Mara.

That distinction matters, he noted, because human biology runs on cycles. We alternate between fasting and feasting, stress and recovery, wakefulness and sleep. “Never before has our body been exposed to this peptide for such long-term activation.” O’Mara asked, “What happens when we bypass the body’s regulatory constraints?”

He attributes many common side effects—nausea, vomiting, constipation, muscle and bone loss, and dehydration—to that prolonged signaling rather than to the drug class being inherently harmful.

That does not mean the drugs have no role, but it does mean they should be used carefully with a clinician’s support and a clear long-term strategy. Many patients may not realize that reduced hunger can make it harder to eat enough protein, fiber, and micronutrients to sustain healthy tissue over time.

The Long-Term Strategy

The GLP-1 drugs may act as a temporary patch rather than fixing the root causes, according to O'Mara.

He points to the composition of the gut microbiome as a major driver of cravings, eating patterns, and, therefore, food choices. “The behavior change is going to come from the bacteria changing.”

His approach emphasizes eating fermented foods, using targeted probiotics, getting adequate protein, and cutting out ultra-processed foods. “There is real utility and value to getting to leverage what your body produces under the correct circumstances,” he said. “Lab-made molecules cannot duplicate that elegance.”

However, that doesn’t diminish the benefits of GLP-1 drugs, especially for patients who need them.

Emerging research finds GLP-1 drugs have broader effects than weight loss and blood sugar control. One large observational study published in 2025 found a lower overall cancer risk in adults with obesity taking GLP-1s, including lower risks of endometrial, ovarian and meningioma cancers, though it also flagged a possible kidney cancer signal that needs longer follow-up. Early research is also exploring whether these drugs may affect depression and brain health, including dementia-related pathways, but those findings remain preliminary.

O'Mara’s broader point is that GLP-1 is not a substitute for food quality, adequate protein, or behavior change but should support a broader plan that can eventually stand on its own.

“When you stop taking GLP-1 meds, what do you always see happen? Weight comes flying back in,” O'Mara said. In his view, that rebound suggests the body’s deeper drivers have not been addressed.

For that reason, the real story is not just about access to a new medication. It is about how society defines health in the first place.

The expanding use of GLP-1s may help many people, but are we treating disease, or just moving the scale? If you’re struggling to find answers for weight concerns, you deserve a more honest answer than a lower number on a bathroom scale.

Views expressed in this article are the opinions of the author and do not necessarily reflect the views of The Epoch Times. Epoch Health welcomes professional discussion and friendly debate. To submit an opinion piece, please follow these guidelines and submit through our form here.