Is microdosing the answer to costly weight loss drugs?

Doctors say lower doses of GLP-1 medicines would further cut side effects, including vomiting

Mounjaro is one of many weight loss drugs that are rising in cost. PA

Microdosing weight loss drugs, a growing global trend, could offer a new gateway solution for obesity for those priced out of the rising costs of drugs like Wegovy and Mounjaro.

Weight loss is a major contributor to reducing life-limiting diseases such as cardiovascular illness, cancer, and diabetes. According to the International Diabetes Federation, around 20 per cent of people in the UAE have diabetes, while almost 40 per cent of adults are considered overweight and 17.8 per cent clinically obese.

Delivering a pea-sized amount of semaglutide, a drug that replicates natural hormones to suppress appetite and slow digestion, could help reduce side effects and make medications more affordable while preventing the onset of related diseases.

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Glucagon-like peptide 1 (GLP-1) hormone replicas have transformed the way doctors tackle weight loss.

Semaglutide has become a significant medical tool in the obesity battle due to its weight loss properties. It was originally developed to tackle diabetes, given that the drugs send signals to the pancreas to control insulin and glucagon.

Dr Mohammad Fityan, chief medical officer and obesity medicine consultant, said that while microdosing is not scientifically tested, it can reduce side effects such as nausea and make drugs more affordable long-term. “For most people, these medications are not covered by insurance,” he said.

“So rather than taking the full 150mg dose each time, people are taking 20 per cent of that. It means the pen would last 4 or 5 times longer. However, we do not have any clinical data to support the effectiveness of this.

“In regards to safety, all the pen medications have a starting dose which should be the minimum. When we advise patients, it is based not only on our personal experience, but the clinical data.”

Rising costs

The price of GLP-1 inhibitors can vary significantly between nations. A month’s supply of Ozempic, which is used for diabetes, costs about $1,000 in the US. But if patients pay in cash directly to pharmacies rather than via insurers, costs are halved to around $499.

Meanwhile, in Denmark, where the drug is made, Ozempic is available for just $130 for a month's supply. Mounjaro, a similar tirzepatide-based drug manufactured by the US pharma company Eli Lilly, is set to rise in price by 170 per cent in the UK due to concerns over pricing inequalities around the world.

Pricing is a major factor that could push more people searching for the health benefits of weight loss towards a more radical approach, such as microdosing. A daily pill developed by Eli Lilly, currently under clinical trials, could accelerate the use of weight loss drugs even further, experts said.

Dr Mohammad Fityan, chief medical officer and consultant in obesity medicine at Burjeel Medical City. Victor Besa / The National

“Price increases for these drugs is one of the reasons why most patients are looking at microdosing,” said Dr Fityan. “The prices are just getting higher, which will add a lot of burden on patients, and it is why microdosing is getting more popular.

“The Department of Health in Abu Dhabi understands that obesity is a chronic disease that really needs to be addressed. The clinical results of an oral pill are not as good as Mounjaro, but this will be the first and only oral medication approved for weight loss. We are hoping it will be available in 2026, so it's a big development.”

Health insurers started covering obesity drugs this year, if patients fulfil certain medical criteria. Drugs are offered for obese patients, defined by a Body Mass Index of 30 or above, or 27 with at least one obesity-related comorbidity, such as hypertension, diabetes, fatty liver or sleep apnoea. Patients must also show they regularly exercise, and that is tracked via a government-supported mobile app.

Dubai test case

Experts said microdosing is a tool that can reshape early medical intervention in patients on a clear path towards diabetes and obesity. Just enough medication is administered to prevent disease from progressing in a way that’s more tolerable, more flexible, and often more affordable.

At Glucare, a specialist diabetes treatment centre in Dubai, doctors are prescribing multi-dose pens, allowing users to dial-in unnumbered clicks to achieve fractional dosing. Under guidance, doctors can escalate or taper doses at the patient’s pace, depending on any side effects that may emerge. When a target is reached, administering a lower dose can help maintain progress towards reaching a healthy weight goal.

“At GluCare, we’ve found that microdosing works best for patients who are particularly sensitive to side effects, especially those who have struggled with nausea or gastrointestinal discomfort on standard dosing,” said Dr Yousef Said, medical director of GluCare Health.

“This changes the game entirely for patients on track to getting disease, but are otherwise ineligible for the treatment. We’ve already started implementing microdosing across our weight management and diabetes programmes.”

GluCare already uses an oral semaglutide pill that has been regulated for diabetes patients. With a similar daily pill now on the horizon to treat obesity, Dr Said expects GLP-1 drugs to be more widely used across health care.

“This looks promising because it may be simpler to take and potentially broaden use even further,” he said. “While injectable GLP-1s remain the most powerful option for maximum weight and glucose outcomes, oral therapies are now firmly part of our treatment strategy, and we expect their role to expand as newer formulations become available.”