With so much polarizing chatter about the new "miracle/demon" diabetes drugs being prescribed for rapid weight loss, it can be hard to know what--and who--to believe.
From arsenic & tapeworms in the 1800s to the more refined slimming solutions of today, Americans have a love-hate relationship with weight loss medications. We love the idea of a magic thinness potion but often end up hating the real-world results, which have included some of the most deadly products in our nation's history: Meridia, Xenical, dinitrophenol (DNP), ephedra & Fen-Phen among them. (Others, like Rimonabant, were so likely to cause suicide in trials that they never made it to market in the U.S.) So why should the GLP-1 agonists be any different? And in a rare move, pharma companies are actually discouraging their use by non-diabetics due to shortages. And they do come with potentially serious and occasionally deadly side effects. But so does untreated obesity which is at pandemic levels in the U.S.. What to do?
1st things 1st: these medications are NOT for people wanting to lose 10-20 lbs of vanity weight or get back down to their "fighting weight" in time for bikini season. There's not a single Kardashian or Real Housewife of anywhere who should be taking them, nor should 85% of Hollywood celebrities. Their intended use is treating diabetes; if they're used for non-diabetic weight loss, they should be reserved for people with a BMI in the obese category (i.e. 30.0 or higher) who have not had sustained success losing weight with other methods.
It is ALWAYS preferable to lose weight the "natural" way--i.e. with healthy lifestyle changes like diet (calorie restriction) and exercise (mostly cardio + some strength training) than by using medications or surgeries, as these interventions come with serious risks and still require said lifestyle changes to work in the long term. But because we live in obesogenic environments, it can be very hard bordering on unrealistic for some people to maintain a healthy weight for the duration of their lives without help.
Enter Ozempic & the other GLP-1 agonists: Mounjaro, Saxenda, Byetta, Trulicity, Rybelsus, etc. (I refer to Ozempic the most in this article because it's the most widely prescribed for weight loss currently but most of the advice applies to all of the meds since they belong to the same class).
How & Why GLP-1 Agonists Work
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| Beneficial effects of GLP-1 meds on various body systems |
Insulin resistance is one of the most common & insidious health problems in the Western world. It is both a cause & a result of over-indulging in calorie-dense, nutrient-poor processed foods. In this state, the pancreas has to pump out much more insulin because the body's cells are not registering normal amounts. Eventually the pancreas tuckers out & you develop Type II diabetes, but insulin resistance wreaks havoc long before then (up to 10+ years before diabetes develops), causing impaired fullness signals & increased cravings for junk food like simple carbs, sweets, "comfort foods," & fried meats that drive people to eat both the wrong type & amount of food.
Over time, nerve damage in the nose & taste buds caused by elevated blood sugar (pre-diabetes or full-blown Type II diabetes) can impair the ability to fully smell & taste the more subtle flavors of your food, rendering anything that's not completely overloaded with salt, sugar, saturated/trans fat & other unhealthy additives as flavorless as cardboard. This vicious cycle makes weight loss very difficult in the long term.
And diabetes notwithstanding, insulin resistance is a health risk unto itself, increasing the risk for a host of diseases ranging from nonalcoholic fatty liver disease to cancer to Alzheimer's disease. One doctor (Mike Hansen, featured in the video below) went so far as to state that any disease that's not purely genetic (i.e. cystic fibrosis, sickle cell anemia) or contagious (influenza, COVID) can be caused or made worse by being insulin resistant. The dementia link is so strong some have suggested referring to Alzheimer's Disease as "Type III diabetes" as its pathology is so deeply intertwined with Type II diabetes, metabolic syndrome & related conditions. 🫥
Unlike stimulants & other weight loss drugs, GLP-1 agonists attack the problem at the source, delaying gastric emptying to reduce hunger & cravings that become disturbed due to insulin resistance in obese people. They mimic a hormone called glucagon-like peptide, telling the pancreas to release more insulin after a meal which helps control blood sugar in diabetics. Weight loss is merely a side effect of these drugs. Not only does your appetite decrease dramatically, it becomes almost impossible to eat large & often even normal portions, at least for a time. The result is fast & dramatic weight loss. Sounds great, right?
Side Effects & Risks
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| Example of deadly counterfeit "Ozempic" pens (right) |
As with everything in the medical world, there are no free lunches. If you fail to actually change your eating habits while enjoying this vacation from overeating, you're likely to gain all the weight back (and then some) when you quit the medication. More on this later. Non-diabetics are advised against taking GLP-1 agonists indefinitely due to the side effects & health risks, which can include pancreatitis, kidney injury, ileus resulting in death, gallstones & even serious diseases like thyroid cancer & pancreatic cancer. More common are hypoglycemia (low blood sugar), nausea, vomiting & diarrhea.
And back to that "you'll gain the weight back when you stop thing": unfortunately that's not just some loony blogger's opinion--it's been shown in study after study that weight loss patients who stopped Ozempic, Mounjaro & similar drugs gained all or most of the weight back a vast majority of the time. Some gained even more weight, putting them at a higher weight than their baseline. This is a typical effect of all weight loss drugs, and it makes it harder to lose weight in the future due to the Set Point Theory. Basically this theory states that the body fights to hold onto its all-time highest weight, hence why it's so important to avoid yo-yo dieting & trendy weight loss "hacks" that result in rapid weight loss in the first place. The rule of thumb with dieting is: the faster you lose it, the faster and more viciously it tends to come back.
And THEN there are the counterfeit versions of these medications floating around that are not FDA approved. Not only have these formulations NOT been proven safe or effective in humans, they're often mixed in compounding pharmacies, which have been shown time and again to operate in absolutely filthy conditions. Some contain ingredients apparently sourced from Alibaba & made in Chinese research chemical labs (!) where bath salts & Spice are produced. As a final wtf, because these meds are injected rather than swallowed, any impurities go directly into the bloodstream with no first-pass metabolism to filter them out, increasing their overall toxicity.
Translation: This is bad, real bad. Injectable meds from compounding pharmacies were responsible for the biggest fungal meningitis outbreak in U.S. history in 2012, resulting in over 100 deaths across multiple states & sickening over 700.
Why on Earth would anyone knowingly put this toxic sludge in their bodies under the guise of improving their health? Because it's affordable & produces results: name-brand versions are around 400% more expensive & not covered by most insurance carriers for weight loss in the absence of diabetes. But the "results" may not be what you bargained for: Americans have already dropped dead from counterfeit Ozempic pens thought to contain INSULIN instead of semaglutide. #Murica
Maintaining Your Progress After Ozempic
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| Wise words. |
What can you do to avoid this depressing fate? #1: Do NOT use the cheaper "peptides" or compounding pharmacy off-brand concoctions fraudulently labeling themselves as "Ozempic" "Mounjaro" or any other branded GLP-1 agonist no matter what your doctor, alternative medicine guru or Herbalife-slinging bestie down the street tells you. Semaglutide SODIUM or ACETATE, or semaglutide combined with B12 have NEVER been proven safe/effective in humans, which means what you're buying is a dirty knockoff from unknown sources that lacks FDA approval. It might contain the stated ingredients; it might contain cyanide & piss. Even if the ingredients are correct, it could be contaminated with dangerous bacteria, fungi, heavy metals (lead, mercury, arsenic) or other killers if it was produced anywhere other than an FDA regulated drug manufacturing facility. This does NOT include compounding pharmacies which have no real government oversight. They may be fine for buying cough syrups & the like but not costly injectables for which there's a massive demand & customer desire for cost-cutting options. There's no antidote to the ways these contaminated drugs kill you. It's a slow & painful death. Just don't.
Using the time you're on the (FDA-approved) medication to change the eating habits that caused you to gain weight in the 1st place is a great way to ensure that your progress sticks in the long run. If you merely eat LESS of the same crap (fast food, fried food, sweet drinks & other high-calorie/low-nutrient junk) while on the meds, you're guaranteed to gain it all back post-treatment when your appetite returns, maybe a little extra due to rebound hunger. You've got to use the medication to break your addiction to the processed foods that cause insulin resistance in the first place! And make no mistake: it IS an addiction. Viewing it any other way is denial. You've been warned.
We all know you can't just get rid of bad habits without replacing them with better ones, so here are some things to work on while taking the meds. I advise not waiting until your last few months on the medication to try and cram all this hard work in or you're destined to fail:
1.) Reacclimate your taste buds to an unprocessed, balanced diet packed with healthy foods. Complex carbs (whole grains, beans, lentils, nuts, seeds), lean protein sources, healthy fats (mono- and poly-unsaturated) & high-fiber foods (fruits/veggies) plus plenty of ice cold water. The rule of thumb is, if it has a commercial it's not real food. Flaming Hot Cheetos & Oreos, I'm looking at you.
2.) Pay attention to how your food is prepared: avoid frying & stick to sauteeing, boiling, broiling, baking & other low-grease methods, as oils contribute massive amounts of hidden calories & unhealthy fats to your meals--the kind of fat that clogs arteries & causes heart attack & stroke over time. Add lots of yummy herbs/spices to make it tasty. Dried herb mixes = generally okay; rich sauces & dressings = use in extreme moderation.
3.) Get used to counting calories (not carbs, fat or anything else unless you're diabetic) & knowing how many you should be eating per day. A TDEE calculator can figure that out for you. And count ALL your calories--don't overlook things like sweet drinks, cooking oils, sauces/dressings & other sneaky sources.
4.) ALWAYS be sipping water. This both reduces cravings & keeps you hydrated, which prevents UTI & improves mood/cognition among other vital functions. Add some ice + a twist of lemon, lime or orange if it's too "plain" by itself.
5.) Learn to identify your "triggers" & avoid them when possible: If binge-watching your fave Netflix series or hanging out in certain places (the state fair, the mall, etc) makes you crave Auntie Anne's pretzels or funnel cake, AVOID THOSE PLACES. When triggering situations are unavoidable, fill up on healthier options before attending. And get real comfortable saying 'no' to people who pressure you to "just try" a bite of this or that at get-togethers. It's not rude to turn down food, alcohol or anything else, but it IS rude to not take no for an answer.
A healthy relationship with food is about eating to live, not living to eat. Eating should not be an orgasmic experience that you plan your life around nor the centerpiece of social gatherings, and you should never feel tired or uncomfortably full after a meal. If you do, you're eating too much & likely the wrong things. Food is merely fuel that gives you energy to do the activities you want to do in life. If it's stealing your energy & joy, it's time to put it back in its place. 💚
Remember: Weight loss is 85% diet and 15% exercise, if that. You can't outrun the giant portions & ridiculously gluttonous junk in the typical American diet, so don't delude yourself into thinking that a gym membership will sustain your progress or allow you to eat more. Cardio exercise is vital for heart & lung fitness but it's unlikely to cause you to drop weight. Strength training can help build muscle which increases your metabolism so you burn fat at rest, but unless you do it at bodybuilder levels it's unlikely to have noticeable effects on your physique. Sorry.
Sleep is as important as exercise, if not more so. Poor sleep can cause impaired satiety (fullness) signals by reducing leptin & increasing ghrelin--2 chemicals vital for appetite regulation. If you suspect insomnia or another sleep disorder, have a sleep study done and get it treated as you'll never get a handle on your weight until it's managed (and obesity dramatically worsens sleep apnea, often to dangerous levels & causing another one of those "vicious cycles"). Aim for 8 hours of uninterrupted sleep per night and remember: you can't "catch up" on lost sleep the next day or on weekends. It has to be consecutive uninterrupted sleep to achieve the deep NREM state that restores brain & immune function. Again, sorry. I don't make the rules.
And I can't write an article about weight management without mentioning mental illness. People with untreated depression, anxiety disorders, personality disorders & other mental health conditions are generally much more likely to be obese than mentally well people, so strive to make mental health a top priority. And the relationship is bi-directional: obesity also appears to CAUSE or worsen mental health conditions like depression, eating disorders, anxiety & substance abuse. This association is stronger in females for unknown reasons. To further complicate the issue, some psychiatric medications can cause weight gain such as anti-psychotics & some older mood stabilizers. Talk to your prescriber if this is a concern for you. Dose adjustments or med changes can help greatly but never attempt this on your own.
ADHD is often overlooked when discussing mental illnesses but its connection to addiction & obesity is particularly strong. Patients with untreated ADHD have a tendency to see things as all-or-nothing ventures, getting extremely motivated in the beginning and then losing interest after a single slip-up or when dramatic results are not forthcoming. Working for delayed rewards is extremely hard for these folks (of which I am one) due to low dopamine--the brain's reward chemical. We need gratification NOW and that's not how weight management works--it's a lifelong marathon, not a 50 yard dash. Gradual, sometimes painfully slow but sustainable changes win the weight loss race. Read that again, ADHD'ers. And then read this. Got it? And when you're ready, this.
While it may seem unrelated, stress is directly linked to weight gain--particularly in women. If you notice yourself eating mindlessly when worried or under acute stress, you can thank cortisol--the body's stress hormone (one of several). If this is you, swap your stress snacks with something low- or no-calorie like baby carrots or celery sticks (mmm, cronchy!) but more importantly: make an effort to reduce your daily stress levels. Self-care is not just bubble baths & spa days, it's creating a life you don't need to escape from. Practice saying 'no' to over-committing to non-essential (i.e. unpaid) tasks; cut toxic people out of your life & put yourself first. Look around: are you pulling more weight than your peers, partner, family members or co-workers? If you are, it's time to ask yourself why you expect more from yourself than others, whether you're being taken advantage of and how you can lighten your load. Busy-ness is not a virtue & it could be sabotaging your weight loss efforts or even shortening your life.
On a final note: a lot of people use the "I don't have time to meal prep or buy groceries" excuse but when you examine their daily lives, it's ALWAYS a choice. Life is about priorities. You do have the time but you're not currently devoting it to your diet. The good news is that can change. (See above: "drop unpaid/unnecessary tasks & make time for you" section). It's not so much a "time" problem as a motivation/focus/time management problem. Fast food & other highly processed convenience eats might be fast & available on every corner, but they're both expensive in the moment & the long term. Good health is priceless & worth the effort. 💚
Conclusion
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None of this is EASY, mind you, but nothing worth doing ever is. We don't become clinically obese overnight or for no reason--there are are many pathologies and maladaptive behaviors that go into it. And there will be just as many positive life changes required to dig ourselves out. If you're waiting on a magic pill or potion to do the heavy lifting for you, here's your sign to stop--it's not coming. It's on you to educate yourself about good nutrition (which I've made easy by linking to examples of "good" foods in each of the major food groups above), to slow down & give your health the same attention you give everything else in your life. GLP-1 agonists are merely a tool that hits 'pause' on the clock while you recalibrate your lifestyle in a healthy way... or not. Your long-term outlook is entirely dependent on what you do with that time & whether you remain dedicated to avoiding the highly addictive foods that made you sick to begin with.
Whew.
So to answer the question of whether Ozempic & other GLP-1 agonists are miracle or demon drugs for weight loss in non-diabetics, I'd say they're neither. They are probably the best weight loss aids that have ever existed due to their specificity in treating insulin resistance & lack of addictive potential like stimulants. That said, they can be misused and already are being overprescribed to non-obese patients & even people with eating disorders like bulimia who know how to manipulate doctors & drug-seek. And as with all medications, they have side effects that can be serious for some people. All patients should educate themselves on what those are and stop them at the 1st signs of possible complications. Managing your expectations & using them properly--in the lowest effective dose for the shortest time possible while you make healthy dietary changes--will result in the best outcomes. They're safer than invasive bariatric surgery for sure but doctors must do a better job of saying NO to non-obese patients & not prescribing the counterfeit knockoffs.
There's no such thing as a miracle drug OR a demon drug, by the way--it's all in the dose & how it's used. That goes for everything from baby aspirin to Ozempic to fentanyl. They all have their place. It's pharma/doctor greed & patient ignorance that is the problem. These are my opinions and you can do with them as you please. 🛐 🧻
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