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Evaluating the Efficacy and Ethical Implications of Semaglutide and GLP-1 Receptor Agonists for Weight Management in Obesity
No full textObesity is a global public health crisis, with more than 890 million adults living with obesity as of 2022.¹ Traditional weight management strategies, such as lifestyle modification, often yield only transient results, creating the need for effective pharmacotherapeutic options.² The advent of glucagon-like peptide-1 receptor agonists (GLP-1 RAs), particularly semaglutide, has transformed obesity care, offering superior efficacy compared with older anti-obesity drugs.³ This paper evaluates semaglutide and related GLP-1 RAs in terms of clinical effectiveness, socioeconomic impact, and ethical concerns.
Clinical trials highlight the potential of semaglutide. In the STEP 1 trial, participants lost a mean of 14.9% of their body weight, compared to 2.4% with the placebo, at 68 weeks.³ Similarly, Rubino et al demonstrated that continued semaglutide use allowed patients to maintain 89.5% of weight lost, while discontinuation led to significant regain.⁴ Tirzepatide, a dual GLP-1/GIP agonist, has shown even greater weight loss (21% at 72 weeks), reflecting rapid pharmacologic progress.⁵⁻⁶ Meta-analyses confirm semaglutide’s efficacy in non-diabetic populations (mean reduction of 11.85%), though gastrointestinal adverse effects and discontinuation risks remain concerns.⁷
Despite efficacy, GLP-1 RAs pose socioeconomic and ethical challenges. Cost is prohibitive, with prescriptions for semaglutide and tirzepatide rising 5.3% annually, driven by high demand and aggressive marketing.⁸ While these drugs reduce cardiometabolic risk, their long-term outcomes and cost-effectiveness remain uncertain, straining healthcare systems.⁹ Ethical issues include inequitable access and industry practices prioritizing profit over equitable distribution.¹º Lower-cost medications such as phentermine remain widely used among low-income populations despite inferior efficacy, exacerbating disparities.⁸
This manuscript advocates for a balanced approach, integrating GLP-1 RAs into obesity treatment while addressing affordability, access, and ethical prescribing considerations. Policy measures such as price regulation, insurance expansion, and clinician education are essential to mitigate disparities.⁹ Future research must explore sustainable financing models and long-term health outcomes to optimize the public health impact of these therapies.
Balancing Weight Loss and Muscle Preservation During GLP-1-Based Therapy for Type 2 Diabetes and Obesity: A Clinical Review
No full textABSTRACT
This review examines skeletal muscle loss associated with GLP-1RAs and dual GLP-1/GIP-RAs, widely used therapies for T2DM and obesity. While these agents demonstrate robust efficacy in glycemic control and weight loss, evidence indicates that approximately 20% to 30% of the weight reduction may result from loss of lean body mass, with skeletal muscle representing a critical component. This has important implications for metabolic health, physical function, and sustainability of weight management. The review synthesizes clinical trial data to clarify the extent and clinical relevance of muscle loss, addressing misconceptions fueled by media reports that may overstate the risk. Variability in assessment methods, including DEXA and MRI, is discussed to contextualize findings and highlight methodological limitations. Potential mitigation strategies are explored, such as resistance exercise and emerging pharmacologic combinations like GLP-1RAs with amylin analogs, which show promise in promoting fat loss while preserving muscle mass. Despite limitations in current research, such as small sample sizes and inconsistent body composition measures, ongoing studies are expected to refine understanding and support treatment paradigms that emphasize not just weight loss but also optimized body composition and functional health. This review provides evidence-based insights to help clinicians optimize GLP-1–based therapies by balancing the benefits of weight loss with strategies to preserve skeletal muscle and improve long-term outcomes in T2DM and obesity
Integrating Non-Invasive Tests into Primary Care: A Practical Approach to Early Detection of Advanced Fibrosis in Metabolic Dysfunction–Associated Steatohepatitis (MASH)
No full textABSTRACT
Metabolic dysfunction-associated steatohepatitis (MASH), formerly known as nonalcoholic steatohepatitis (NASH), is a liver disease that is progressive over time. Populations with past medical history of obesity, type 2 diabetes mellitus or have other aspects of metabolic syndrome have an increased risk of MASH. MASH is a major cause of liver-related morbidity and mortality, and it is also a major cause of progressive liver fibrosis. Despite its growing prevalence, MASH remains underdiagnosed and underprioritized. This is especially true in primary care settings, where high-risk individuals are often treated. The biggest setback with diagnosis of MASH is the need of proper diagnostic tools. While historically the gold standard, liver biopsy is invasive, costly, and impractical for broad population screening. Due to the issue of proper diagnosis, it is rather difficult to discover patients who would benefit from early intervention and specialized care and treatment. This study evaluates whether non-invasive tests (NITs) can replace biopsy-based screening for patients at risk of advanced fibrosis. The Fibrosis-4 (FIB-4) index is the primary tool that is being evaluated in this paper. It focuses on how well it works as a diagnostic tool, how effective it is in the clinic, and how it is used in the real world. The review also evaluates how vibration-controlled transient elastography (VCTE) can help sort patients with moderate or high-risk FIB-4 scores into groups based on their risk stratification. Sequential application of these tools offers a real-world, evidence-based, and practical approach to early identification and risk stratification, minimizing unnecessary referrals and invasive procedures. The findings support a scalable model for integrating NITs into primary care workflows, emphasizing training, EMR integration, and standardized protocols. Adopting this approach aligns with current clinical guidelines and facilitates a proactive, population health-based strategy to address MASH-related liver disease. This article provides primary care providers with evidence-based strategies for identifying and managing patients at risk of MASH complications
An Analysis of the Key Components of WAR in Baseball
No full textIn this project we will be exploring Wins Above Replacement (WAR) as an important metric of player performance evaluation in baseball and also as a means for combining various player contributions into a single numerical value. This project is inspired by the limitations and discrepancies within existing WAR models. The project explores past research on WAR in order to develop a new model utilizing the multiple linear regression technique in order to assess its efficiency compared to the current models. The focus of this project primarily pertains to the offensive aspect of war, commonly known as oWAR. This project explores the existing WAR structures and identifies key components and methods used for their establishment. The new WAR model is constructed based on analysis and pre-established methodologies developed by Baseball-Reference and FanGraphs WAR models. By applying advanced statistical analysis techniques a WAR model is created, integrating multiple variables relating to offensive statistics and also accounting for contextual adjustments for various game conditions. The methodology includes a detailed data collection and analysis as well as model construction, while utilizing historical data regarding player statistics and performance for the 2022 Major League Baseball (MLB) season. The regression analysis will help determine the quality of the proposed model that aims to assign a numerical value to player contribution and determine if there is a more accurate and comprehensive way of determining WAR, while taking into account the limitations and biases. Statistical tests will be used to determine the model’s accuracy and utility in determining player value. The implications of this research aim to extend the knowledge of baseball analytics and offer insights regarding the methodologies of player performance metrics and their applications
Contributions to Violence: Male Serial Killers and Social Bonds
No full textThis research analyzes the often-questioned contributions to violence of male serial killers. The sole purpose of this research is to conclude whether weak social bonds and negative childhood experiences contributed to the level of violence in the futures of 15 male serial killers convicted between 1970-1980. The strength of their social bonds, measured by the amount of weak social bonds exhibited or experienced in childhood, and the level of violence were used as variables in this research. Their weak social bonds were measured in the aspects of child abuse or neglect experienced in the home, drug or alcohol abuse in the home, antisocial behavior, animal cruelty, and first offenses if they occurred, as well as the age at the time of their first offense. Their murder methods were measured and categorized as more violent and less violent. More violent murder methods were recognized as more intimate acts of violence, and less violent murder methods were recognized as less intimate acts of violence. Their weak social bond factors that applied were then tallied up and compared to the level of violence portrayed by each of the 15 serial killers. This concluded that over half of the male serial killers that had higher levels of violence experienced many of the weak social bond factors measured and presented that there is a correlation present between weak social bond factors of these serial killers’ childhoods and the higher levels of violence that many portrayed in their futures
SHARE Greater Lynchburg Giving Tuesday Campaign
No full textThe purpose of this project was to bring the community of nonprofit partners and community members together in celebration of and in preparation for this past Giving Tuesday. In my partnership with SHARE Greater Lynchburg we created a campaign called #GiveGood LYHGives that served to educate the community about various nonprofits in Lynchburg and how the community can give back to those organizations, either with time or money. Community members could nominate Give Good ambassadors who were given purple beanies and encouraged to wear them around town and especially when doing service. I learned about the process of working with sponsor partners and contractors to assist in the campaign. I wrote weekly article features that detailed a different nonprofits mission and needs for Giving Tuesday and led a presentation to 30 plus partners on how they could execute their own Give Good campaigns through social media strategy techniques and provided graphics to take more of the work out of launching a campaign on a smaller scale. We partnered with ABC13, WNRN radio, News & Advance and other partners to publicize the campaign and hosted weekly Tuesday Days of Giving at different partner locations leading up to Giving Tuesday. On the day of, we hosted a pancake breakfast in partnership with a local restaurant for over 40 ambassadors and nonprofit partners
Short term effects of manual therapy to the hip on dynamic balance and hip abductor strength
No full textStudy design: Randomized Controlled laboratory study.
Background: The brain’s sensorimotor system is constantly converting acquired sensory stimuli from the body and its environment into transmittable signals that elicit a response in the brain, allowing the body to unconsciously control many homeostatic processes, including balance. Mechanoreceptors found in joints communicate with the motor division of the brain to understand where it is located in space through a process called proprioception. This allows for subtle changes in posture that help one remain upright when attempting to balance all their weight on one limb.
Objective: To assess the strength and proprioceptive response through high velocity low amplitude joint manipulation of the hip observed through changes in dynamic balance and hip abductor strength.
Method: __ healthy individuals were randomly assigned to a group receiving a thrust manipulation of the hip (n=__), or a sham manipulator (n=__). Before and after intervention, participants completed the star excursion balance test (SEBT) as well as a measurement of hip abductor strength.
Discussion: ________
Conclusion: _______
Key Words: Proprioception, dynamic balance, mechanoreceptors, hip strength, hip abductors, SEB
Home-Based Exercise Program Increased Mobility and Physical Fitness in Older Adults
No full textDecreased mobility and physical fitness along with increased sedentary time is associated with loss of independence for older adults; regular exercise may be beneficial. However, travel and cost may be barriers to regular exercise. The purpose of this study was to determine the effects of a home-based endurance, strength, and balance exercise program on mobility and physical fitness in independent older adults. Older adults were recruited from the community to participate in a home-based University of Lynchburg Active Aging Program (ULAAP) for 8-weeks. Endurance, strength, and balance exercises were prescribed using National Institute of Aging’s Exercise & Physical Activity Guidelines and ULAAP’s target: 150-minutes endurance, 8 strength, 8 balance exercises. Participants reported weekly progress. Physical activity assessed with International Physical Activity Questionnaire (MET). Dynamic stability was tested with 4 square test (4Sq), Mobility was tested with 30s chair stand (30s) and timed up and go (TUG). Exercise capacity assessed with a 6 minute walk test (6M). Strength assessed with left/right handgrip test (LHS, RHS). Each test was completed pre and post with anthropometrics. Pre and post differences were assessed using paired samples T-tests (
