Losing 60K Followers, Gaining New Hope

New GLP-1 Data, Alzheimer’s Trials, and Rebuilding @OTPHQ on TikTok

Original posted at obesity.news/ on Nov 25, 2025

This Week On The Pen: Gratitude, a TikTok Gut-Punch, and the Next Wave of GLP-1 Data

This week’s On The Pen live podcast opened on an unexpectedly emotional note. During Thanksgiving week, a time Dave framed through the lens of that first, uncertain Thanksgiving; he described losing his TikTok account, a community of nearly 60,000 followers, in a single automated decision.

No human conversation. No appeal. Just an algorithm that doesn’t know his story, or yours.

And yet, what rose up for him wasn’t bitterness, but gratitude: for the work, for the mission, and for the OTP community that has walked this road with him from the very beginning.

Rebuilding After the Ban: Community as the Engine

Dave explained why he’s rebuilding TikTok instead of walking away:

• Sponsors support this work based on the reach you have helped create.

• Losing a major platform the day after going full-time with On The Pen could have been devastating. Instead, sponsors are standing by him—and the OTP community started following the new account immediately.

He asked listeners to help push the new TikTok @OTPHQ to 100,000 followers as a visible signal that the community is very much alive and still growing.

Despite the setback, there’s a lot to celebrate:

• On The Pen is now #16 in medicine podcasts in the U.S.

• It sits in the top 1% of podcasts globally.

Dave repeatedly anchored that success not in himself, but in you, community members who were tired of being blamed, dismissed, or told to “just try harder,” and instead built a patient-centered obesity medicine news hub from the ground up.

If you’d like to help us get into the top 10 medicine podcasts, click here to write a review for the podcast. If you take a screen shot of your review and email it to ann@onthepen.com, we will send you a signed copy of Dave’s book!

GLP-1s, Alzheimer’s, and a $700 Million “Lottery Ticket”

The episode then turned to major clinical news.

Novo Nordisk released data from the Evoke and Evoke Plus trials, testing oral semaglutide (Rybelsus) in patients with Alzheimer’s disease:

• The trial, estimated at roughly $700 million, was designed for an especially vulnerable population, where you don’t want dramatic weight loss.

• At lower doses, oral semaglutide improved biomarkers related to the disease.

• But crucially, it did not slow clinical progression of Alzheimer’s on the CDR-SB scale, the key measure of function and decline.

As a result, Novo Nordisk is discontinuing the extension phase of these trials.

From a medical–legal perspective, this is not a “failure” so much as a very expensive data point. Biomarkers moved; function did not. That difference will shape the next generation of trials, likely with:

• Brain-targeted GLP-1–pathway drugs that minimize weight impact, and

• Continued exploration of injectables and combination agents in neurodegenerative disease.

Dave thanked Novo Nordisk explicitly for taking that gamble on behalf of patients and for giving the field data, not just hope.

Amicretin, Tirzepatide, and Orforglipron: What the New Data Really Means

Next, Dave walked through fresh data from Novo Nordisk and Lilly in type 2 diabetes, always keeping the patient perspective front and center.

Amicretin (Novo Nordisk)

• A single-molecule GLP-1 + amylin agonist, tested in 448 adults with type 2 diabetes over 36 weeks.

• A1C drop: up to 1.8% (injectable) and 1.5% (oral), from a baseline around 7.8–8%.

• Weight loss: up to 14.5% at 36 weeks in type 2 diabetics.

• Importantly, patients were only on the top dose for a few weeks, there’s likely more runway for additional weight loss in longer phase 3 trials.

Tirzepatide (Mounjaro / Zepbound – Lilly)

• In comparable trials, tirzepatide delivered >2% A1C reduction and ~12–14% weight loss at 15 mg in type 2 diabetics, with many weeks spent at the highest dose.

• Bottom line: tirzepatide still appears stronger for A1C control, with excellent weight loss.

Orforglipron (Lilly)

• A small-molecule, once-daily oral GLP-1, not a “pill version of Mounjaro.”

• In a 72-week phase 3 trial in type 2 diabetes:

  • Placebo group: ~2.5% weight loss

  • 36 mg dose: ~9.5% weight loss

• Potent enough to matter, but clearly less powerful than tirzepatide and likely positioned as a convenient, scalable, pill-based option, especially for people who don’t want injections.

Dave framed the landscape like this:

• Tirzepatide: the “glucose crusher,” unmatched for A1C and strong weight loss.

• Amicretin: the “rocket,” poised to outperform on weight loss in type 2 diabetes, especially as dosing is optimized.

• Orforglipron: the “convenience player,” a solid, oral GLP-1 for less severe disease or injection-averse patients.

The key message: there is no single winner, only better fits for different patients, histories, and goals.

Looking Ahead: Personalized Medicine and the Long Arc of GLP-1s

In the Q&A, Dave touched on future directions that matter deeply for patients and families:

• Could GLP-1s or related agents be used prophylactically in people with strong family histories of dementia?

• How might insulin control, amyloid plaque, and cognitive decline intersect in future trials?

• Will obesity care evolve toward personalized “cocktails” of receptor agonists, guided by hormone profiles, genetics, and AI-driven models?

His view: yes, we’re heading toward more individualized obesity and metabolic medicine, though access and cost will remain major policy and legal battles for years to come.

A Note of Thanks to OTP

Threaded through every data point was something quieter but just as important: gratitude.

Gratitude for:

• The OTP community that turned a small corner of the internet into a top-20 U.S. medical podcast.

• Long-time followers who refused to accept obesity as a moral failing and insisted on seeing it as the disease it is.

• New listeners who show up, subscribe, rate, comment, share, and “train the algorithm” so that life-changing information reaches the people who need it most.

• Sponsors like Shed, Claimable, Shapa, and Integrated Peptides, who backed this work even when the largest social account vanished overnight.

And above all, gratitude, for a future not controlled by an algorithm, but by the collective will of this community, made up of patients, clinicians, and advocates who refuse to give up the fight.

Because as Dave reminded everyone: this isn’t just about weight loss. It’s about people living longer, better, and doing it together.

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