Weight loss with GLP-1 inhibitors is for treating obesity
GLP-1 inhibitors, more commonly known under brand names like Ozempic and Wegovy, are weight loss drugs that slow down gastric emptying. It affects the brain and the gut to help people feel fuller for longer, decreasing their appetite.
These drugs have been circulating in the media, with a lot of buzz around celebrity usage. But as Dr. Michelle Cardel makes clear, “These medications are for the chronic condition of obesity, and they’re not meant to be used as a jumpstart or to lose a small amount of weight.”
“These medications are for the chronic condition of obesity, and they’re not meant to be used as a jumpstart or to lose a small amount of weight.”
Originally developed to treat type 2 diabetes, it became clear that another side effect was significant weight loss – about 15 to 21 percent body weight loss over a one year timeframe. (With behavioral weight management, we see the loss of 5 to 8 percent of body weight over one year.) “When people are getting access to these medications, it often changes their experiences around food, and it’s helping patients recognize that it’s not about willpower, but it’s about addressing these biological contributors to obesity,” explains Dr. Cardel. “We’re all really excited about the opportunity to see our patients create this more neutral feeling towards food and attenuate cravings.”
These drugs are recommended for long-term use by the FDA. Data shows that once you stop taking the medication, patients are gaining about two-thirds of the weight back. “We now recognize that obesity is a very complex, multifactorial disease,” says Dr. Cardel. “It’s a chronic condition. And like other chronic conditions, it requires long-term care and treatment… The medications are only going to work as long as you take them.”
For the first time, medication is getting close to the weight loss seen with bariatric surgery, where patients lose 25 to 30 percent of body weight. “It’s great that we’re expanding the tools in the toolbox so that way we can provide more evidence-based care and reach more patients who need it,” says Dr. Cardel, noting behavioral weight management, pharmacotherapy, surgery, and devices as the treatment options for obesity.
Behavioral weight management and lifestyle change are still important factors
“Behavioral weight management is going to be the foundation across all treatment modalities,” Dr. Cardel says, referring to any weight loss strategy. The FDA recommends pairing GLP-1 medications with holistic and healthy lifestyle modifications. “There is no medication that’s going to improve our overall diet quality or get us to move more, sleep better, or shift to a more positive mindset… We want to develop these healthy habits for the long term, whether you continue these medications over the course of your life (which is what the FDA recommends), or… in case you ever stop the medications.” (Dr. Cardel notes that stopping these medications should be discussed with your healthcare provider, and is often linked with a lack of insurance coverage.)
“There is no medication that’s going to improve our overall diet quality or get us to move more, sleep better, or shift to a more positive mindset… We want to develop these healthy habits for the long term.”
Sticking to regular meal times – even if they’re smaller meals – can help curb side effects
Common side effects on GLP-1s are nausea, vomiting, constipation (due to a lack of hydration), and hair loss (brought on by stress on the body). Dr. Cardel emphasizes sticking to normal meal times to curb some of these effects. Patients may feel inclined to skip meals because they’re not hungry, “but in order to both establish those long-term healthy habits and to ensure adequate nutrition and calorie intake while you’re on these GLP-1s, I do recommend that people continue to eat a regular meal schedule,” says Dr. Cardel.
She suggests lower fat foods (higher fat foods can prompt some of the GI symptoms like nausea), and getting enough fiber and hydration. ”And if you’re continuing to eat on somewhat regular meal timings – even if they’re smaller meals – that can help prevent some of those components like the hair loss, for example.”
Like any weight loss strategy, patients may experience a plateau
Studies show that people’s weight loss may begin to plateau between nine and 12 months. At that point, Dr. Cardel says, people should switch from a weight loss mindset to a weight management mindset. Continuing to stay active and eat balanced meals are part of that plan.
But there’s a third component that Dr. Cardel emphasizes, and that’s “remembering that it’s not just about a number on the scale.” Checking in on improved energy levels, the increased ability to be active with your kids or grandkids, and coming off other medications are just a few examples of related milestones worth celebrating beyond your weight.
Kids don’t want to talk about their weight
Research indicates that discussing weight with children often elicits feelings of shame and embarrassment. Instead, children appreciate when their parents prioritize discussions about overall health, leading by example through healthy behaviors. To achieve health goals, families can work together to incorporate more fruits and vegetables into their meals, take walks together after dinner, or even walk the dog as a unit. As Dr. Cardel states, “At the end of the day, no matter what our weight is, we can all be healthier, we can all improve our diet.”
“At the end of the day, no matter what our weight is, we can all be healthier, we can all improve our diet.”
Healthy lifestyle habits are just one part of long-term health
“I think a component that’s so often left out of the conversation is the importance of community and social supports,” says Dr. Cardel. When it comes to longevity, “it’s about the quality of those life years.” Holistic healthy living includes diet, physical activity, sleep, and stress. And we also need to be “engaging with our friends and our neighbors and our families and our loved ones and building up our support networks, because those are also going to be a key component for long-term health.”