Harvard experts weigh GLP-1 priorities after 1-in-8 uptake

Caroline Apovian said on Harvard’s “Harvard Thinking” podcast published Oct. 21 that GLP-1 prescribing should prioritize the highest-risk patients as nearly one in eight American adults used the drugs for weight loss last year.

Evidence grade: Claim (no study cited). The episode was an expert discussion, not a trial or guideline, and it matters because GLP-1s moved from Type 2 diabetes treatment into weight management while obesity affects 42 percent of the U.S. population, according to Apovian.

“I think what we’re not talking about adequately enough is: Who are they for?” said Apovian, co-inaugural director of the Integrated Mass General Brigham Center for Weight Management and Wellness and a professor of medicine at Harvard Medical School.

Apovian argued that medical guidance should put higher-risk patients first even as the drugs are sold more broadly. “If you take a GLP-1 to lose 10 pounds, you don’t have the disease of obesity,” she said, adding that stopping treatment could be followed by weight regain and a new problem.

The episode, hosted by Samantha Laine Perfas, also featured Daniel Lieberman, professor of human evolutionary biology at Harvard University, and Fatima Cody Stanford, an obesity medicine physician-scientist at Mass General Brigham and an associate professor at Harvard Medical School.

Prioritizing highest risk

GLP-1s were first developed for Type 2 diabetes and are now used for weight management. The podcast framed the rise in use as a reason to clarify which patients are most likely to benefit and which may face avoidable risks.

Cody Stanford said she pushes back on describing the medicines as “game changer” or “magical,” but said they changed public understanding of obesity. “People are beginning to realize that [obesity] is beyond this idea of willpower and self-control, that there is actual biology behind this disease,” she said.

She said the drugs have produced total body weight changes of 15 percent or 22 percent, and that a “triple agonist” is getting closer to 30 percent total body weight loss. The transcript did not provide trial names, duration, comparison groups or absolute health outcomes for those figures.

Apovian said the drugs are hormone analogs that affect the brain and other organs. She said patients often describe reduced “food noise,” feeling full and making different choices around food and exercise.

Lieberman put the discussion in evolutionary terms. He said humans did not evolve to lose weight easily, and that weight loss activates signals that make people hungry, making sustained loss difficult for many people.

Cautions behind access

The podcast also raised concerns that GLP-1s could divert attention from broader drivers associated with obesity. Lieberman pointed to food environments, ultra-processed foods, stress and other factors, while Cody Stanford emphasized chronic stress and allostatic load among Black women in the U.S.

The podcast disclosed that Apovian and Cody Stanford have worked with pharmaceutical companies, including GLP-1 makers. Apovian was described as a former consultant, Cody Stanford as a current consultant who has also received industry funding for research.

The podcast cannot show who should take GLP-1s, because it did not present new clinical data, a formal prescribing guideline or patient-level risk thresholds. It also did not quantify muscle loss risk, though the host identified muscle loss as a downstream concern that may particularly affect older adults.

The discussion applies most directly to U.S. adults considering or prescribed GLP-1s for Type 2 diabetes or weight management.

Source: podcast transcript, Harvard Health Publishing / Harvard Medical School, Oct. 21, 2026.

Atlas360 reports health research and does not provide medical advice.