The Tribune

BY ALISON LOWE

DESPERATION is driving the black market demand for weight loss medication in the Bahamas where obesity is rife, an expert has warned.

The demand for GLP-1 drugs such as Ozempic and Mounjaro is “significantly and steadily increasing” because of their proven benefits, according to Dr Kristine Parker-Curling, a board-certified obesity specialist and the only full-time endocrinologist working in The Bahamas.

But a monthly price tag ranging from $250 to more than $1,500 — depending on dose and other factors — means there is a growing market for “unregulated acquisition” of this class of prescription medication despite the ‘many’ risks that injecting unregulated medicine into your body can bring, the doctor warns.

According to a 2025 Pan American Health Organization (PAHO) study, The Bahamas currently has the highest prevalence of adult obesity among countries in the Americas. More than 70 per cent of the adult population meets criteria for overweight or obesity, with approximately 40 per cent diagnosed with obesity.

GLP-1s are not covered by the national prescription drug plan, and while private insurers cover some drugs for select patients managing type 2 diabetes, this often comes with strict criteria.

Wellness Minister Dr Michael Darville has said the government intends to expand National Health Insurance coverage to include GLP-1 medications for obesity and type 2 diabetes, noting that while this would be costly for the public health system, the long-term benefits would make the investment worthwhile.

Dr Parker-Curling said the rise in demand for GLP-1s from unregulated sources personally saddens her, as it signals how far the treatments remain out of reach through conventional channels despite their benefits.

“The risks associated with use of medications not acquired through regulated channels are many,” she said. “But the fact that so many people are willing to take such risks, and to go as far as injecting substances into their body that might not necessarily meet particular standards, speaks to a degree of desperation and belief that the benefit outweighs the risks. Honestly, the price point of these medications creates a significant barrier to access that likely explains why people seek alternate means of acquiring them.”

These dangers combine the general risks of any medication with the added uncertainty of unregulated sourcing, she said, “where the chain of possession and even the chain of appropriate storage is not certain. In general, things may go according to plan most of the time, but when they do not, what recourse is there?”

Dr Parker-Curling said she is concerned by how many people are on the drugs without a proper understanding of the risks involved. “The most common side effects are gastrointestinal, including severe constipation, diarrhea, abdominal pain, bloating, nausea and vomiting,” she said.

“Some patients experience hair loss if not supplementing appropriately or maintaining adequate nutrition to support their metabolic needs. Fatigue, weakness, headaches and even mood changes and depression have been experienced in patients that I have cared for. Serious side effects like medullary thyroid cancer, bowel obstruction and pancreatitis are less common, and while they occur, I have not encountered them to date.” Severe side effects can also result from inappropriate dose escalation, she noted, and without adequate follow-up after the drug is dispensed, this too can cause serious health issues.

Despite the risks, Parker-Curling said the medications are “unquestionably useful in a growing range of clinical scenarios” beyond their original use for type 2 diabetes — one reason more local physicians are recommending them. “As far as benefits for patients navigating a weight loss journey, GLP-1 analog therapy can be an excellent add-on to their lifestyle changes,” she said. Most patients who respond well can reasonably expect to lose between 5 and 20 per cent of their body weight.

“In addition to improved weight loss, better diabetes control and improved cardiovascular risk reduction, other benefits of weight loss can be improvement in Polyendocrine Metabolic Ovarian Syndrome (PMOS, formerly PCOS), which affects a significant percentage of the Bahamian population,” she added. “Other benefits include relief from back pain, knee pain and other joint pains as a result of decreased body weight, as well as lower blood pressure and cholesterol, increased mobility, increased exercise tolerance, and decreased severity or resolution of obstructive sleep apnea.”

Perimenopausal weight gain may also be addressed through GLP-1 use, though Dr Parker-Curling noted a multidisciplinary approach — combining the medication with other interventions — is likely most effective in that scenario. There is even ongoing research into the drugs’ potential role in cancer treatment and prevention, she said.

Good candidates for GLP-1 treatment include those with a body mass index (BMI) of 30 or more, classified as obese, or a BMI of 25 or more with a chronic medical condition or complication, classified as overweight.

“Many do experience significant weight loss, but it is not a guarantee,” she said. Most patients will regain some or all of the weight if therapy is discontinued, particularly if they made no lifestyle changes while on the medication. “If the medication was the only thing you did to cause the weight loss, then it stands to reason that stopping the medications will lead to weight regain,” she said.

“The most successful patients tend to be the ones that embarked on a comprehensive lifestyle modification plan. This often enlisted the services of a multidisciplinary team involving myself, the dietician or health coach, the personal trainer, or self-motivated intentional and consistent physical activity — or sometimes enrolling in a group fitness program. The exact combination of professionals depended on the patient, their degree of motivation and sometimes budgetary boundaries.”

Patients have lost anywhere from small amounts of weight to more than 80–100 lb. with medically assisted weight loss over months of consistent follow-up, she said. Some may require ongoing therapy to maintain their results.