As GLP-1 drugs gain popularity as a near cure-all for dieting, a study has found that as many as 20 percent of patients may not see sufficient weight-loss effects. That raises the question of what solutions are available.

On April 15 local time, Medical News Today (MNT) cited a recently published review paper as saying combination therapy that adds the naltrexone-bupropion (NB-ER) product Contrave could be an alternative.

GLP-1 receptor agonists have spread rapidly in recent years, driven by demand not only for type 2 diabetes treatment but also for obesity care and weight loss. A recent KFF survey found that 12 percent of U.S. adults, about 1 in 8, are taking GLP-1 drugs such as Wegovy or Zepbound (Mounjaro) for weight loss or to treat chronic disease. Previous studies have reported many cases in which patients lost 5 to 15 percent of their starting weight over 1 year of use.

The effect does not appear the same in all patients. A recent study published in Nature found that an individual's genetic traits may influence how well they respond to GLP-1 treatment. That has led to criticism that a single-drug approach has limits in obesity treatment.

A research team proposed combining Contrave with GLP-1 drugs. The team explained that while GLP-1 focuses on making people feel full sooner and reducing hunger, Contrave has strengths in lowering food cravings. Muzamil Hussain (무자밀 후세인), a clinical research fellow at Ulster University in Britain, said the combination acts on dopamine pathways and the hypothalamus and mesolimbic system to increase satiety and reduce food cravings.

Hussain cited the possibility of combination use particularly for patients with strong reward circuits for fatty or sugary foods. He said the combination could reduce satisfaction from such foods and lessen urges for so-called comfort eating. He also said it could have potential uses for patients who fail to lose more than 5 percent of their weight on GLP-1 monotherapy.

The researchers stressed that obesity treatment cannot be solved with a single answer. Hussain said many patients do not respond sufficiently to GLP-1 treatment and may not achieve enough weight loss to reduce the risk of obesity-related conditions such as diabetes or heart disease. He said the scientific community should continue to look for alternative and adjunct therapies for these patients.

Clinicians have reached similar conclusions. Mir Ali (미르 알리), an obesity and metabolic surgery specialist who did not take part in the study, said patients who received combination drug treatment often had better outcomes. He said obesity is a chronic and wide-ranging health problem and there is no single treatment that works for every patient.

Endocrinologist Jennifer Chung (제니퍼 청) also said weight loss is an area where multiple factors work together. She said in clinical practice many patients experience major frustration when they fail to achieve expected results even with consistent medication use. She added it is not always possible to predict who will respond well to treatment and who will not.

Chung also stressed the importance of identifying causes of low response more quickly. She said confirming the cause allows a rapid switch to other or combination treatments and lets personalised care begin earlier.

The findings again showed that a single drug is unlikely to meet all patient needs in obesity treatment. An approach that targets different pathways together, such as satiety and desire for food, could support wider options in real-world treatment strategies.