GLP-1s for prediabetes and insulin resistance: what TikTok gets wrong

What did @amyinhalf actually say?

She made a pointed argument: people with diabetes wish they could have taken medications like Ozempic or Mounjaro before becoming diabetic, and that critics of GLP-1 use for weight loss are really just defending the belief that obesity reflects a lack of willpower. She also pushed back on the idea that people using these drugs for weight loss are "stealing" from diabetics.

The core claim is that GLP-1 receptor agonists used earlier, before someone crosses the threshold into type 2 diabetes, could have prevented the disease in people with chronic conditions that make weight loss difficult. That is a real medical argument, not a fringe one. And she is not wrong to make it.

Does the science back this up?

Largely, yes. The evidence that GLP-1 receptor agonists can meaningfully reduce progression from prediabetes or obesity to type 2 diabetes is substantial and growing.

The SURMOUNT-1 trial (Jastreboff et al., 2022, New England Journal of Medicine) showed tirzepatide produced up to 22.5% body weight reduction in adults with obesity but without diabetes, a level of weight loss associated with significant metabolic improvement. Earlier, the SCALE Obesity and Prediabetes trial (le Roux et al., 2017, The Lancet) found that liraglutide reduced the risk of progression from prediabetes to type 2 diabetes by 80% over three years compared to placebo. That is not a trivial number.

Semaglutide data from SELECT (Lincoff et al., 2023, NEJM) further reinforced that people with obesity and cardiovascular disease, but not diabetes, benefit substantially from GLP-1 treatment. The biology is clear: insulin resistance and beta cell dysfunction do not appear overnight. There is a long window where intervention could change outcomes, and GLP-1s act on that window.

What did they get wrong (or right)?

She got the core argument right. Chronic conditions, including polycystic ovary syndrome, hypothyroidism, and sleep apnea, genuinely impair weight regulation. This is not a motivational failure. Framing obesity as a willpower problem rather than a metabolic one is a documented barrier to treatment access (Rubino et al., 2020, Nature Medicine).

Where she oversimplifies: the "stealing from diabetics" framing she is reacting to is more complicated than she allows. Supply chain constraints on brand-name semaglutide were real and documented between 2022 and 2024. FDA shortage designations affected access for type 2 diabetes patients. So while she is right that preventing diabetes is a legitimate clinical goal, dismissing the access tension entirely is not entirely fair either.

She also refers to Ozempic and "menjaro" (Mounjaro) as interchangeable options. They are not the same drug. Tirzepatide is a dual GIP and GLP-1 agonist. Semaglutide is a GLP-1 agonist only. Conflating them is a minor but real inaccuracy.

What should you actually know?

GLP-1 receptor agonists are FDA-approved for different indications. Ozempic is approved for type 2 diabetes. Wegovy is approved for chronic weight management. Mounjaro is approved for type 2 diabetes. Zepbound is approved for chronic weight management. These distinctions matter clinically and legally, even if the drugs are related.

The idea of using these medications to prevent diabetes is not fringe medicine. It is increasingly where clinical guidelines are heading. The American Diabetes Association's 2024 Standards of Care recognize GLP-1 receptor agonists as options in obesity management specifically to reduce diabetes risk. Insurance coverage has not caught up with the evidence, which is a real policy problem.

If you have prediabetes or insulin resistance and you are wondering whether a GLP-1 might be appropriate for you, that is a real conversation to have with a licensed clinician, not a TikTok comment section. Eligibility depends on your BMI, existing conditions, medications, and health history. There is no one-size answer, and no video, including this fact-check, replaces a proper clinical evaluation.

Is the "willpower" critique she makes warranted?

Yes, and the research says so plainly. The idea that obesity results primarily from poor self-control has been dismantled repeatedly in peer-reviewed literature. Leibel et al. (1995, NEJM) showed that the body actively defends its weight through hormonal compensation, reducing energy expenditure as weight drops. More recently, work by Schwartz et al. (2017, Cell Metabolism) mapped the neurobiological pathways that regulate appetite and showed they are not under simple conscious control.

People with conditions like PCOS face documented hormonal resistance to weight loss independent of caloric intake. The stigma argument she makes is not just emotional. It has a measurable effect on care: weight bias among clinicians leads to delayed diagnoses and undertreated metabolic disease (Phelan et al., 2015, Obesity Reviews). She is right to name it.