GLP-1s: the drug was never the hard part

The GLP-1 drugs are a genuine scientific triumph, and a preview of a mistake public health keeps making. We treat the molecule as the finish line. It isn't. It's the starting gun for the part that actually decides outcomes: whether people keep going.

The number under the hype

Only about 12%¹ of American adults are on a GLP-1, and a large share of those who start will stop within a year, cost, side effects, coverage gaps, and the simple grind of a daily behavior all pull them off. When they quit, much of the weight comes back. So the headline "miracle drug" runs straight into the oldest wall in public health: biology is solvable in a lab; behavior is solvable only in someone's real life.

I've spent a career on the second half

The half that decides outcomes, adherence, coaching, habit, friction, is exactly the work I've done at scale. When we printed a health hotline on the market-leading soap in Bangladesh, doctors took roughly 3,000 calls a day, because we met people where they already were instead of asking them to travel to a clinic. That's the same muscle a GLP-1 program needs: not another warning about consequences, but a lower-friction path to the next dose, the next check-in, the next small win. Pharma builds the tool. Someone still has to build the behavior around it.

The dual-market stakes are enormous

In the US, GLP-1s are an access-and-adherence story playing out at a $-heavy scale. In Bangladesh, which carries one of the world's heaviest diabetes burdens, on the order of 13 million²-plus adults, the drugs are largely out of reach, which makes the behavioral lever not optional but the *only* scalable one available. Diet, movement, early detection, adherence to cheap existing medicines: unglamorous, and the highest-return public-health work in the country. Same disease, two markets, one conclusion, the intervention that scales is behavioral.

What "whole-person" actually requires

"Whole-person care" is a phrase everyone uses and few resource. In practice it means segmenting who's likely to discontinue and why, coaching through the side-effect window instead of leaving people alone in it, and designing the follow-up so continuing is easier than quitting. It's communication and support design, done deliberately, the difference between a drug that works in a trial and a drug that works in a life.

The short version

• Only ~12% of Americans take a GLP-1, and most who start will stop, the drug isn't the hard part.
• Biology is solved in a lab; behavior is solved only in someone's real life.
• I've built the behavioral half at scale, a ~3,000-calls/day hotline that met people where they were.
• In Bangladesh's 13M+ diabetes burden, behavior isn't a nice-to-have, it's the only scalable lever.

If the medicine is no longer the bottleneck, who is designing the behavior around it, and are we resourcing them?

Md Shafaat Ali Choyon (MPH, CHES®, MBA, MCIM) is a growth, marketing and public-health strategist who builds and runs AI in production, with 17 years across telecom, fintech, e-commerce, consumer tech and healthcare in the US and Bangladesh. See the essays or the portfolio.