OnDemand: October 2025 Grand Rounds - Nothing Is More Expensive than a Missed Opportunity-Nothing Is More Expensive than a Missed Opportunity

Video Transcription

Video Summary

Dr. Donna Ryan discussed the rapid evolution of GLP-1 receptor agonists and related drugs from diabetes treatments to powerful therapies for obesity and multiple chronic diseases. She reviewed how long-acting peptide engineering turned GLP-1 physiology into pharmacology, enabling major weight loss with semaglutide and tirzepatide. She emphasized that these drugs help most patients, not just the average one, and that their benefits extend far beyond weight reduction.<br /><br />Ryan highlighted evidence that GLP-1–based medications reduce cardiovascular events, with the SELECT trial showing a 20% reduction in major adverse cardiovascular events in people with overweight or obesity without diabetes. She also described benefits in heart failure with preserved ejection fraction, obstructive sleep apnea, MASH, chronic kidney disease, osteoarthritis pain, and possibly neuroinflammatory and infectious diseases. She argued that many benefits are independent of weight loss and may involve inflammation, immunity, and brain-immune pathways.<br /><br />She closed by warning that the biggest barrier is not science but access: high cost, prior authorization, and PBM-driven pricing. Her central message was that obesity treatment is a major public health opportunity that must not be missed.

Keywords

GLP-1 receptor agonists

semaglutide

tirzepatide

obesity treatment

cardiovascular outcomes

SELECT trial

heart failure with preserved ejection fraction

chronic kidney disease

prior authorization