Shot at weight-loss: At what cost?

GLP-1 weight-loss drugs offer real benefits but carry risks, high costs and sustainability concerns, requiring careful medical guidance.

WALK into any social gathering these days and there is a reasonable chance someone will bring up Mounjaro, Ozempic or simply “the jab”.

A colleague quietly loses 10kg. A relative swears it changed their life. Someone on Instagram claims it is the answer no one told them about. The conversation has moved from specialist clinics into group chats, and that shift deserves a serious look. So what is actually going on here?

Behind the hype

These drugs – known collectively as GLP-1 receptor agonists, with newer versions targeting both GLP-1 and GIP receptors – were originally developed to treat type 2 diabetes.

Tirzepatide, marketed as Mounjaro, works by mimicking hormones that regulate appetite and blood sugar. Clinical trials showed it could produce weight loss of up to 20% of body weight in some participants. That is not modest. For comparison, most lifestyle interventions produce between 3% and 8%. The scientific community sat up and paid attention. Then the public did too.

Why it is suddenly everywhere

Partly because it works – at least for some people, under some conditions. But also because social media compressed what used to be a slow clinical adoption curve into months. When results are visible and testimonials are abundant, demand moves faster than supply chains, regulatory frameworks or the evidence base. Malaysia has seen a sharp rise in inquiries at private clinics.

Globally, shortages have affected diabetic patients who depend on these drugs first and foremost. It is worth pausing on that. People with type 2 diabetes who were already on semaglutide faced supply disruptions because demand from the weight-loss market outstripped production. That tension is not a footnote; it is a real consequence of hype outrunning planning.

Who may benefit, who may not

Clinically, these medications are approved for adults with obesity (BMI =30) or those with a BMI =27 alongside a weight-related condition such as hypertension or type 2 diabetes.

In the right patient, with proper medical supervision, they can reduce cardiovascular risk and improve metabolic health considerably. But “the right patient” matters more than most social media posts acknowledge.

The medication is a tool, not a verdict on whether someone deserves to lose weight. The clinical picture has to come first. People with certain thyroid conditions, a history of pancreatitis, gallbladder disease or who are pregnant should not be on these drugs. That conversation has to happen with a doctor, not on a comment section.

There is also the question of why someone wants to lose weight. Not all weight loss is clinically necessary, and starting a prescription medication to meet a social standard is a very different conversation from managing a chronic disease.

Problem of sustainability

Here is what the brochure versions leave out: most of the benefit disappears when the medication stops. Studies show that within a year of discontinuing these drugs, patients regain the majority of lost weight. That is not a character flaw; it is pharmacology.

These medications suppress appetite through a biological mechanism and when the mechanism is removed, appetite returns. This raises a difficult question that clinicians and health economists are still working through.

If effective use requires long-term, possibly lifelong, administration – who can actually afford that? In Malaysia, these injections are not subsidised under the public health system and cost several hundred ringgit per month at private clinics. The gap between who benefits and who can sustain treatment is wide, and it mostly follows income lines.

Safety concerns and what we still do not know

Side effects are real. Nausea, vomiting, diarrhoea and constipation are commonly reported, especially in the early weeks.

More serious concerns include pancreatitis, gallbladder disease and – flagged in animal studies, though not yet confirmed in humans – potential thyroid effects. Muscle mass loss alongside fat loss is another emerging concern, particularly without adequate protein intake and structured exercise routines.

Most clinical trials on these drugs run between one and three years. We simply do not have robust data on decade-long use for weight management specifically. Patients deserve to know that.

Informed consent is not just a form; it is a conversation. None of this means these drugs are dangerous for everyone. It means full information is not optional.

Fake products and growing black market

This is where things get genuinely alarming. Unverified versions of semaglutide and tirzepatide are circulating through online marketplaces, unregulated channels and direct-to-consumer sellers with no prescription required.

The National Pharmaceutical Regulatory Agency has issued warnings.

Counterfeit injectables carry risks ranging from bacterial contamination to incorrect dosing to entirely unknown compounds.

A person self-injecting an unverified substance based on a social media tutorial is not replicating what clinical trial participants did. The circumstances are not comparable and the risks are not either.

The pressure to access something “everyone is doing” creates conditions for harm. It is an old public health story in new packaging.

Weight is shaped by genetics, hormones, environment, sleep, stress, food systems and economic conditions.

A medication that addresses one part of that picture can be genuinely useful. It cannot address all of it.

Patients who use these medications alongside structured lifestyle support consistently do better than those who rely on the injection alone. That finding is not incidental.

Turning point

These drugs represent a real advance in obesity medicine. For patients who have struggled with weight-related illness despite sustained effort, having an effective pharmacological option matters and it should not be dismissed. But effective tools used without proper guidance and sourced from unverified sellers without realistic expectations can carry their own costs.

Before anyone starts, they should be asking their doctor four questions: Does this apply to my situation? What are the realistic outcomes? What happens when I stop? And where exactly is this product coming from? Those are not difficult questions; they are the right ones.

Public health does not ask people to avoid progress. It asks people to reach for it carefully, with both eyes open.

Dr Helmy Sajali and Dr Chin Ri Wei Andrew are Doctor of Public Health (DrPH) candidates at Universiti Malaysia Sabah. Comments: letters@thesundaily.com