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Alternatives to Semaglutide Other GLP-1 receptor agonists include: Liraglutide Dulaglutide Exenatide Other diabetes treatment options: Metformin SGLT2 inhibitors DPP-4 inhibitors Insulin Treatment changes must be guided by a licensed medical specialist

So to answer your question directly, there are some people who probably don't have that thrifty gene, but just the fact of how their lifestyle is they're not physically active, they're eating a lot of highly processed food and so forth they're gaining weight, but that can change quickly depending upon change in their behavior and in their environment