GLP-1 has high price tags and major side effects. Can microscopy be the answer?

GLP-1 has been shown to be very effective against obesity, but is very expensive, and often produces serious side effects such as nausea, vomiting, dizziness and fatigue.

That's why digital weight loss company Noom has launched a microdosage of GLP-1. The company's plan involves starting at very low doses and gradually increasing to 25% of the standard maintenance dose, with the goal of finding the lowest effective dose to support weight loss while minimizing side effects and reducing costs.

The product starts at $119 per month and uses composite GLP-1s, which are customized through composite pharmacies and contain the same active ingredients in the brand GLP-1. Compound GLP-1 is controversial because they are not FDA-approved, and many doctors believe that the compound version will harm patients, but they are cheap alternatives to branded drugs. When GLP-1 was lacking, the composite version became very popular, although now some companies like Hims & her are facing Novo Nordisk scrutiny due to the sale of composite GLP-1. Novo Nordisk recently terminated his partnership with Hims & her as she continues to prescribe these drugs.

Currently, if it is not medically suitable for treating patients, doctors can prescribe compound medications. However, Hims & hers did not provide microdosing for GLP-1, the company confirmed to Medcity News.

Is this microdosage plan safe and effective? NOOM said that due to the smaller dose, patients reduce the risk and intensity of side effects. The company also provides clinical supervision to ensure safety.

However, at least one obesity medicine expert is not sure that Noom's microdosage products are safe. Moreover, when smaller doses are specified, you have little concern, but use of complex GLP-1 because they are not FDA-approved.

“Microdosage itself is not necessarily a problem. Equivalent [compared to branded GLP-1s]? ” Dr. Disha Narang, an endocrinologist and director of obesity medicine at Endeavor Health, argued.

She noted that the only brand GLP-1 that can be microscopic is Ozempic because it takes a click pen as a click and must be done outside the label. The others are only used once.

NOOM program

To comply with NOOM's Microdose GLP-1 program, the patient's body mass index must be 25 or higher. They began with the intake survey, where they shared medical history and weight loss goals. If the clinician believes that the patient is clinically appropriate, the results are reviewed and a prescription is provided.

The patient's dose is 0.2 mg, which can be gradually adjusted to a maximum of 0.6 mg if required. NOOM clinicians evaluate progress every two weeks and determine whether the dose should remain the same, slightly increase or decrease. Typical doses of Half Loopid are .25 mg to 2.4 mg.

“NOOM never represents elevating people to the highest dose they may tolerate. We don't think this is the right dose method, but the minimum dose can help patients achieve their health goals,” said Geoff, the company's CEO.

In addition to prescriptions, patients can also access NOOM’s GLP-1 partner education program, 24/7 messaging with clinicians and nursing coordinators, and one-on-one health coaches.

The company notes several studies showing the effectiveness of this microdosage approach. For example, a study published by Novo Nordisk in the New England Journal of Medicine found that patients lost about 20% and 40% of the full dose. In addition, preliminary data on Noom's microdose program found that 70% of patients had no side effects at all.

What others think of the plan

Dr. Narang, who strives to be healthy, is not the only one who is skeptical about the composite microscopy program, as it is not approved by the FDA.

“While taking lower doses is not wrong or harmful (as long as you use FDA-approved versions instead of compound versions) they may not be worth it, and therefore may not be worth it. We do not know the safety or efficacy of compound GLP-1 drugs, and at any dose/benefit risk is more likely to be the risk of these drugs than benefits for welfare.” Fitch is also a former president of the Obesity Medicine Association.

Narang, who strives to be healthy, emphasizes that when it comes to complex GLP-1, it is difficult to know that it is actually caused in people. She feels that the GLP-1 market has become very unregulated and there is little data to support the microscopic of composite GLP-1.

Meanwhile, Noom stressed that it has taken all the necessary measures to ensure safety. The company only works with state-licensed, U.S.-compatible compound pharmacies. It procures its ingredients from FDA-registered facilities, each batch tested by a third party. Patients can also request a certificate of analysis from their care coordination team, which indicates that the drug meets regulatory requirements.

“Compounding has been around since or before, and has been a tool for doctors and patients,” said Noom Chief Medical Officer. “So it’s just leveraging a tool that allows us to give people what they really need and help them find the lowest effective dose, rather than undoubtedly going through a less efficient process and leading to less success.”

It is worth noting that although physicians and pharmaceutical companies are concerned about the safety of composite GLP-1, ironically, the lawsuit is related to the safety of branded GLP-1 drugs. Cases have been filed against Novo Nordisk and Eli Lilly, claiming they have failed to warn consumers of dangerous side effects of weight loss medications, such as sudden blindness and persistent vomiting leading to hospitalization. This includes popular Ozempic, Wegovy and Mounjaro drugs.

Although Narang and Fitch have reservations about Noom's microscopy plan, other company executives believe this shows hope. These include Dr. Jennifer Peña, chief medical officer of WISP, a linear sexual and reproductive health company that also provides weight care.

“Such a program that supports the microscopic drug of GLP-1 drugs may be a smart, safer alternative for some, especially if higher doses can cause adverse side effects or achieve meaningful effects,” Peña said.

She added that WISP does not currently offer microdose methods, but it will be considered if supported by strong research and clinical guidelines.

Peña's comment was responded by Dr. Rishi Khakhkhar, a company that provides on-demand medical advice.

“From a safety perspective, one of the main reasons patients prevent GLP-1 is gastrointestinal side effects,” Khakhkhar said. “Microdoses may be a strategy to help reduce these problems and improve compliance. Evidence is still emerging, and patients with microdoses should be monitored by a responsible care team as much as the patient's full dose.”

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