GLP-1 drugs for fat drunks

Investment Analysis Clubs Macro Economic Trends and Risks
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GLP-1 drugs have become blockbusters for weight loss in addition to their standard indication for diabetes.

A large recent study shows that about 1 in 10 Americans are fat drunks, a combination which synergistically increases the risk of liver disease and liver-associated deaths.

Frankly, the amount of alcohol needed to be considered a heavy drinker would put me into the hospital in a week. [National Institute on Alcohol Abuse and Alcoholism definition (for men: ≥15 drinks per week or ≥5 drinks per day; for women: ≥8 drinks per week or ≥4 drinks per day).]

In a survey of roughly 45,000 U.S. adults representing more than 257 million people, 9% said they had obesity and drank heavily over the past month, while 3.8% said they had both obesity and met criteria for alcohol use disorder (AUD) over the past year. AUD and obesity overlap was highest for men and women ages 26 to 34 (6.2% and 5.1%), people without insurance, and those on Medicaid.

Real-world data have shown lower AUD-related hospitalization rates for people on GLP-1 drugs, and the researchers pointed to early trial data showing these drugs can help people with AUD reduce their drinking.

On the one hand, GLP-1 drugs are expensive and highly profitable for the manufacturers. On the other hand, the people who need them most often can’t afford them. Insurance coverage is spotty except for specific medical conditions, such as diabetes and active cardiovascular disease.

There is a lot of flux in the pricing and coverage of GLP-1 drugs that depends on what insurance (private, corporate, Medcaid, Medicare), where the person lives, what specific conditions are being treated.

The market for GLP-1 medications is dominated by two primary pharmaceutical giants, though several other companies manufacture older versions or are racing to launch new oral alternatives in 2026.

1. Novo Nordisk

This Danish company is currently the world leader in the GLP-1 space. They produce all medications containing semaglutide and liraglutide.

  • Ozempic (Injectable for Diabetes)
  • Wegovy (Injectable for Weight Loss)
  • Rybelsus (Oral tablet for Diabetes; a high-dose weight loss version was approved in late 2025)
  • Victoza & Saxenda (Daily injectables using the older liraglutide molecule)

2. Eli Lilly and Company

The chief competitor to Novo Nordisk, this American company produces medications containing tirzepatide and the newly approved orforglipron.

  • Mounjaro (Injectable for Diabetes)
  • Zepbound (Injectable for Weight Loss)
  • Trulicity (An older, once-weekly injectable for Diabetes)
  • Foundayo (A major 2026 release; the first oral “small molecule” GLP-1 for weight loss that doesn’t have strict food/water fasting requirements)

3. Other Major Manufacturers

While Novo and Lilly hold the newest “blockbuster” drugs, other companies maintain established GLP-1 therapies:

  • AstraZeneca: Produces Byetta and Bydureon BCise (exenatide).
  • Sanofi: Produces Adlyxin (lixisenatide) and the combo drug Soliqua.
  • Boehringer Ingelheim & Zealand Pharma: These companies are currently co-developing survodutide, which is expected to seek FDA approval later in 2026 or 2027.

4. Recent Industry Moves (2025–2026)

  • Roche: Following their acquisition of Carmot Therapeutics, they are fast-tracking CT-388, a dual GLP-1/GIP agonist similar to Mounjaro.
  • Pfizer: After some early setbacks, Pfizer pivoted in 2025 by acquiring Metsera to bolster its pipeline of oral weight-loss drugs, aiming to compete with Eli Lilly’s Foundayo.
  • Amgen: They are currently in Phase 3 trials for MariTide, a unique drug that may only require monthly or even quarterly injections, which would be a significant shift from the current weekly schedule.

The demand is tremendous and that doesn’t even count the one out of ten adults who are fat drunks and are at higher risk than most.

Who is going to pay for all this? There’s a lot of political pressure for the government to force third-party payments and also for the manufacturers to cut their prices.

Which company is going to benefit most? How will the participation of other companies, like CVS and Amazon, impact the profits of the manufacturers?

Clearly there are both opportunities and risks for investors in this fast-moving space.

Wendy

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GLP-1 drugs may reduce cravings for alcohol.

DB2

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I am using a GLP-1. i am guessing I am saving more than 100 a month in junk food. Not the smaller meals, not the skipped meals, just junk food.

My nephew works at a plastics manufacturer. At Thanksgiving he was saying that his company had a layoff because their customers, junk food companies, had lost so much in sales that they had to cut back purchases of plastic.

Personally believe that GLP-1s are a miracle drug. Now watch, something important will fall off tomorrow.

Cheers
Qazulight

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Here, too, but for diabetes, made it as pre-diabetic quite a while, but the A1C was stubbornly climbing, weight difficult/impossible to take off… Mounjaro was the Doc’s choice, and over the last months it has done the trick, dropping 50+ lbs off… Biggest headache has been the insurance, in the beginning, cost was anywhere from $60 to $250 as my copay, eventually coerced it to get sorted to $150 for a 3 month supply, last month the Doc messed up, sent it in as a 30 day supply, same $150… It’s happened a few times, hopefully it’s the last time, took a but to get it made clear that the Rx was the same price whether 1 or 3 months! Silly games, hopefully done… No side effects from day one… All positives…

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And they wonder why there are assassinations.

Cheers
Qazulight

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Reminds me of so many stories in med school and residency training, get the patient to define what the “drink” is. Had one patient state they only had one glass of red wine a night, they heard red wine was good for the heart. Doesn’t sound bad. On further questioning, their one glass was close to the size of a Big Gulp (32 ounces for the unfamiliar).

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Similar story…one of my patients as a resident and answered a question on alcohol frequency on his medical history from with “occasionally”. Well, he was actually Irish so I asked exactly what “occasionally” meant to an Irishman. He didn’t miss a beat and replied, “On the occasions of the sun coming up and going down…and the clock striking every hour in between”

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Seven days in a week, when I was drinking for pain and depression believe me, I did not miss those two days. Started lying to docs as 1) they didn’t believe my pain ratings, and 2) they judged my attempts to deal with life.

Moving to Vermont gave me MUCH better alternative to alcohol for pain and allowing me to sleep at night.

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Agreed…on the value of these meds. I’m doubtful that something novel will show up…at least, nothing to rival what’s known about excess body fat as a pathologic condition.

I suspect that, as more and more folk start to use it appropriately at an earlier stage in the development of obesity…the so called “vanity” pounds stage (or the early pathology stage as I call it)… its use will be recognised as one of the prevention strategies availableto head off many of the sequelae that are recognised as consequences of metabolic dysfunction.

My daughter asked my husband if he’d prescribe Ozempic…“but don’t tell mummy”. Of course he did (prescribe it and tell me) … and I tackled her on it. I was a bit miffed that she thought I wouldn’t support her efforts to lose the 20 odd pounds (I thought) that had built up during the last year or so with the Lump of Foul Deformity…and not an ounce of it due to junk food, either. She was working so hard with a personal trainer and on managing her diet but the glass of wine or two at the end of a stressful day, and the subsequent overeating undid her best efforts.

In less than a week on .25 mg (lowest starter dose) the food noise had stopped along with the need for any ethanol as a relaxer. First call from her was “I feel like myself again!”.

After about 9 months, she’s lost 30 lbs, revealed the muscle that she’d built up in the previous 18 months…and added some more. Of course, most folk wouldn’t get these results without the same circumstances (never been a fat person, didn’t have long enough in the “overweight” category to become one) and although the stress is still there, the dysfunctional coping mechanisms haven’t returned.

Interestingly, her pre and post weight loss bloodwork hasn’t changed dramatically per the standard metabolic panel, but I’ll wager that the one thing that isn’t generally measured, even when the index of suspicion ought to be high with the amount of belly fat she was hefting around… circulating insulin/HOMA-IR…would’ve shown how early on insulin resistance begins.

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VeeEnn,

I have managed to obtain a triple agonist. My wife takes a double agonist. She is experiencing no side effects.

I need to lose about a third of my body weight. From 240 to 170. Once I got to the effective dose of about 4 mg a week, (The phase 3 trails have the participants on 9 and 12 mg) I started experiencing sleepless nights. The only good cure is significant almost daily weight training.

So not sure if that is a side effect or a desired outcome. For people like my wife who have over the years had the diet culture and have lowered their metabolism I am thinking that the triple agonist MIGHT MAYBE, restore some resting metabolic rate.

As we are old now, mid 60’s, HITT and Crossfit are not really a good fit, but she has found that chair yoga and picking up seashells is helpful.

Cheers
Qazulight (Of course my sweety has been in Texas and the cat has not helped with sleeping either.)

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Saw one concerning report, that some people are losing muscle mass as well as body fat. Didn’t dig into the study to see if they differentiated between people only taking the drug and people taking the drug and exercising.

Those taking GLP-1s for “vanity reasons”, this is a bad outcome. Those that are morbidly obese, benefit probably outweighs the risk.

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Ideally you lose visceral fat.

The Captain

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Indeed, @ JLC …loss of muscle mass with caloric deficit is a well observed and documented phenomenon with long term successful dieting and without the forethought of appropriate exercise and dietary composition. The case, I imagine, long before that lab colleague of my husband …John Eng…got cracking studying Gila Monster saliva. It’s the deficit not the drug. Likewise the problem with gallstones.

Why does it appear to be such a problem…at least per articles without appropriate discussion in media outlets? Nothing else has the track record of success in helping folk lose such large amounts of weight, so consistently and in such large numbers.

For a take on the merits of these medications, look to the folk who are doing it right and utilizing the drugs in an intelligent and rational fashion, not the folk who’re doing it wrong …regardless of how many of them there are.

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Yes indeed. Unfortunately, it’s not readily visible and not everso easy to measure…although the fancy DEXA scan or the more up to date bio-impedence scales do a good enough job to give you a heads-up.

Like insulin resistance, it’s apparently an early phenomenon in those first departures from healthy homeostasis. The best heads-up before the spit really hits the fan…those so called vanity pounds (or early pathology pounds) that you can see have taken up residence around the belly when you look in the bathroom mirror of a morning.

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Earnings up 170%, YoY.

Eli Lilly Shares Jump On Guidance Boost, Earnings Above Expectations
https://www.marketwatch.com/story/eli-lilly-shares-jump-on-guidance-boost-earnings-above-expectations-321ed382?mod=mw_quote_news
Earnings surged to $8.26 a share, up from $3.06 a share the year prior. Adjusted earnings were $8.55 a share, blowing past Wall Street’s forecast of $6.97 a share, according to FactSet. Revenue rose 56% to $19.8 billion, fueled by growth for the company’s GLP-1 drugs Mounjaro and Zepbound.

Lilly is now selling $12.9 billion of GLP-1 drugs every three months and expects to sell even more
https://www.marketwatch.com/story/lillys-stock-rallies-as-sales-of-glp-1-drugs-nearly-double-09c01977?mod=mw_quote_news_topstories

DB2

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