When drugmakers released the weight loss drug Phen-Phen in 1997, my mother was devastated. No because the FDA has warned that the drug may His heart was severely damaged or Maybe even kill himBut because she was trying to lose weight she was body conscious, and the only thing that worked was getting ripped off.
This is an extreme reaction. My mom would rather take a potentially fatal drug than face life without it shows how frustrating it can be to be told that you have to lose weight over and over again, try your best to do it, but find it absolutely impossible.
For decades, the prescription for weight loss was to eat better and move more — make lifestyle changes. But these changes were extremely difficult to sustain long-term. Even when people keep them for years, they often produce marginal results. A small number of people were treated with drugs. Opted for even less surgical intervention.
Now GLP-1 drugs like Ozempic and Mounjaro have entered the fray. And they completely changed the game — how doctors talk to and think about patients. How we think about ourselves and what can be achieved. And why we’ve been stuck in a “medical” cycle that has been so depressing to so many for so long Obesity rates continue to rise.
Why diet and exercise?
In the mid-90s, public health experts were looking for ways to reduce rising obesity rates, largely because obesity was linked to diseases such as type 2 diabetes and certain types of cancer.
D The NIH initiated a study in 1996 that would largely define clinical thinking about medical advances. The researchers looked at how the type 2 diabetes paradigms were affected by better eating and more. They found that lifestyle changes, including weight loss, had a big impact on preventing type 2 diabetes. Participants who met their goal of losing just 5 percent of their body weight reduced their incidence of type 2 diabetes by 58 percent. To put this in perspective, if a person weighs 300 pounds, they need to lose about 15 pounds. These were not The biggest loser Weigh-in these were supposed to be achievable outcomes.
Issued by government officials A call to action. Doctors had real evidence that lifestyle changes mattered. Diet and exercise are done D Prescriptions for weight management.
“I spent 20 years selling the benefits of 5 percent weight loss,” says Dr. Dan Bessen, an endocrinologist and director CU Anschutz Health and Wellness Center at the University of Colorado. “It seems like a small change in weight, and yet it had dramatic benefits.”
Diet and exercise restrictions
Culture, of course, took these findings and quickly reworked them to fit existing beauty standards and narratives of personal responsibility. No more arguments. Lose weight little by little and stay healthy. Instead, it became, If a person with obesity can control themselves, they can achieve their goals.
But biology is more complicated than that.
“The body has its own idea of what weight it wants to weigh,” Bessen said. Weight loss triggers all sorts of biological responses that reduce damage. We get increasingly hungry and our bodies store energy (aka fat). It was helpful when we lived in caves. Now that we’ve domesticated wolves and work from home in soft pants, not so much.
And so the miracle cure itself becomes a disease.
“Doctors in particular have this idea that, ‘Well, Mrs. Jones, you should be able to manage [losing weight] On your own,'” Bessen said. “We don’t do that with diabetes or high blood pressure.”
And maybe we’re about to stop doing that with obesity.
The Olympic Revolution
Medicines have been available to treat obesity for decades. But nothing has proven as effective or as culturally appealing as the idea of just eating well and exercising. Until the Olympics.
Ozempic is a brand name of a series of drugs GLP-1 agonists which has exploded in popularity in the past few years. These injectables mimic hormones that slow digestion and trigger satiety, meaning you eat less and want Assuming you eat less, you lose a lot of weight – The average is about 15 percent. And, much like cholesterol or arthritis drugs, they don’t rely on willpower to achieve the desired results.
Which means the conversation has shifted. Patients come in asking for brand-name GLP-1, something that doesn’t happen with other conditions, Bessen told me. And doctors can quickly write prescriptions instead of allowing a person to self-flagellate for months or years before considering medical intervention.
The existence of an effective drug seems to have relegated obesity from a perceived personal failing to the category of curable disease.
Here’s an irony worth mentioning: People who take GLP-1 drugs Report often Aversion to over-processed foods and a preference for fresh fruits and vegetables. And weight loss can help people move more freely. These medications do not replace lifestyle changes. They seem to make them possible.
Uncertain future
Not everyone who lives with a large body needs to lose weight. And the body positivity movement has helped many people break through their own inner fatphobia and break out of the prison created by unattainable beauty standards.
But some people feel the need to make changes to prevent type 2 diabetes or manage other health conditions. If they take GLP-1 drugs, there are some challenges and pitfalls.
Side effects can be extreme: people have reported debilitating constipation and vomiting. There are also medicines Cosmologically expensive And most insurances don’t cover them for obesity treatment. And there’s another aspect of taking these drugs that worries him: the emotional toll they can take.
Eating is often a social activity, so radically changing your relationship with food can also change your human relationships. Significant weight loss can lead to uncomfortable conversations about a person’s personal health choices that are difficult to navigate. And those who have worked hard to embrace their weight may feel deeply conflicted about being able to change the body they grew to love.
“When one of us goes in for bariatric surgery, we prepare them for that,” Bessen said. “They see a psychologist; They see a nutritionist. They talk to other people who have had surgery and say, ‘How was it for you?’ Medicines are going to reduce that kind of weight. But we are not preparing people for this.”
A new era of thinking about obesity and treatment may help solve some of the problems of the last era. But there are plenty of new ones to consider now that we’re here.
Prices are expected to drop as more companies pump more GLP-1 drugs into the market. And finally there is a compelling case for insurance companies to cover the drugs. Treating type 2 diabetes and cancer is expensive. Preventing these diseases can save money in the long run. It is a little less clear when we develop systems to manage the psychological effects of changing one’s physical body. But as more people take this route, we will learn more about the unintended consequences of this treatment.
