Glucagon-like peptide-1 agonism - GLP-1, common in obesity medicines - is not essential to weight management, according to preclinical research led by Richard DiMarchi and Matthias Tschöp, with funding from their startup company Bluewater Biosciences.
One criticism of this analysis (which I think is mostly spot on) those GLP drugs help people change their lifestyle by turning off the ‘food noise’. They don’t, by themselves, make anyone lose weight. They help people who overeat be not hungry all the time so that they can eat better and work out more - it’s the eating better and working out more that is causing the weight loss.
I don’t think it’s the criticism you think it is but it’s okay because I think it’s the same point I’m making.
People would rather take a pill (or an injection in this case) than do a better job of regulating their own eating. I understand that GLP helps increase the “fullness” hormone but there are foods that will help with that but people choose not to eat them.
Kale is great roughage and it fills your stomach quickly. But people won’t eat it because they would rather eat a cheeseburger.
I want to be super clear: we (Americans) didn’t get where we are by ourselves. There is an obesity epidemic that is due to a combination policy decisions and terrible personal choices. And I’m not going to lecture lower-class people because they are effectively in food deserts because grocery stores can’t profit off of them the same way they can with middle class people. And I know first hand that food like kale may not be accessible to those people and even if they were, preparing it takes time and resources they may not have.
But as a whole, the USA has a “let me take a pill so I can ignore everything else” epidemic as well. People who are taking GLP-1 could probably make better choices if they desired to. They could order the salad instead of the steak but they don’t.
I want to thread this needle carefully: I’m not shaming anyone for using GLP-1. Or Atkins or Weight Watchers or whatever. The fact you want to make a change is worth celebrating!! If it works for you, fantastic. Sometimes it’s what people need to motivate them to make better choices.
What I am saying is that GLP-1 works to help you lose weight the same way every weight loss program does: decreasing your caloric intake. If you want to lose weight but don’t want to pay for GLP-1 (or any other program), reducing your portion size will work just as well.
Because I will near guarantee that if you lose weight using GLP and don’t do anything else, you will lose weight but you will gain it back within a year.
I have never struggled with weight. Or not in the direction of overweight anyway. When I am full I don’t want food. When emotionally upset, I REALLY don’t want food. I don’t need willpower or a big bowl of kale before every meal.
If someone can live the life I get to have, with a drug, that is awesome. The GLPs have some good side effects, they have been used long enough now that there’s increasing evidence they reduce the risk of dementia, heart attack, and stroke (even in diabetics of normal weight, not using it to lose weight) - not all the side effects are bad, and if it is well tolerated it’s a reasonable drug to just stay on.
I do agree that lifestyle comes first. And think most people do enjoy a healthy lifestyle if they try it. But I don’t think someone should have to do more than I do, just to get to the same place.
This whole conversation reminds me of getting migraine treatment - the doctors would say oh try avoiding food triggers. What food triggers? Every single food, oh and also fasting. Heat, cold, sex, no sex, stress, relaxation , caffeine , no caffeine. The list of migraine triggers was “life”.
I got them with my period though, not something I could avoid, and even though I’m sure the doctor was trying to make me feel empowered to do something about it, it always felt like they were blaming me for getting the migraines.
I have had them managed with emergency med imitrex by injection for 30 years, once a month and now less often with menopause plus estrogen and progesterone daily. Would I rather have had to take extreme lifestyle measures just to avoid crippling headaches? No. The drugs worked so much better.
There is no inherent virtue in avoiding drugs. They are tools, in the same toolkit that holds a good diet and physical activity and meditation.