“What’re your thoughts on weight loss drugs?”
I’ve been asked this question by friends, family, clients and colleagues. It’s become such a hot topic! We have celebrities promoting it, patients seeking it out at med-spas, commercials normalizing its use and doctors prescribing these drugs more frequently. Weight loss drugs are being talked about so much, it’s impossible to have a presence in the world of wellness without them being mentioned. Before we move forward, I do want to acknowledge that this post includes my own personal and professional opinion and knowledge. The lens I am looking through affords me privileges. I am not a candidate for this medication, through my own health journey managing PCOS and in my career helping clients who are both overweight and obese, I’ve come to really understand what influences metabolism. There is also a lot I still do not know, as these medications are fairly new. I want to approach this topic being sensitive, empathetic and non-judgmental.
My short answer: I’m not necessarily for it nor am I fully against it. Like many medications, there is a time and a place for its use. Prescribing these drugs should be done through the lens of a practitioner taking their patients bio-individualized needs into consideration.
I cannot prescribe this medication, but clients come to me asking about my opinion after having their doctor suggest trying it. I like to evaluate the bigger picture. This is something most prescribers in conventional medicine usually are not doing, simply because our medical system does not always allot for the time for these discussions.
Important questions I'd take into consideration:
What are your current habits?
What is your relationship with food?
What is your stress level like, and how do you manage stress?
What do the quality and quantity of your sleep look like?
How well do you hydrate?
Do you have access to nutrient dense foods?
How do you eat– fast, slow, mindfully or distracted?
How often do you eat? Do you skip meals regularly?
Have you or are you willing to make any other changes alongside using the medication?
What is going on with your hormones?
How is your gut health?
How are your habits and current way of eating impacting your blood sugar?
What have you tried in the past to support your weight loss goal? Are you caught in the cycle of dieting and restricting, because dieting DOES NOT work long-term!
What do you do for physical activity, if anything?
What is your health history and what co-morbidities do you have, if any?
Of course there are patients who cannot physically do some of these things, like exercise, due to their weight. But many people seeking these medications don’t fit into that category.
With our current healthcare model, most patients aren’t given the time of day to have these lengthier, yet important conversations. I can imagine that a doctor my find it easier to go ahead and let the patient try the drug. Many patients go to their doctors with a single agenda in mind-- getting the medication so they can lose weight as quickly as they can.
My longer answer: Let’s take some time to explore these medications further. It’s helpful to understand what this does to the body and explore the bigger picture.
What is metabolism?:
Metabolism is our body’s burn rate. Similar to how the gas pedal in the car regulates the metabolism of the engine. Everyone wants a fast metabolism but that also comes with disadvantages. We should be seeking balance. Everyone talks about metabolism as if it’s strictly correlated to weight. There is truth in that, but also misinformation. How our body uses energy starts on a cellular level. It is not solely the theory of “calories in calories out”. For example, through hair tissue mineral analysis (HTMA) testing, I can better understand a client’s oxidation rate– are they metabolizing slowly or quickly. Tendencies of a slower oxidizer are weight gain, sluggish thyroid, etc. So when someone says they have a slow metabolism, it is a sign that their body is under stress. Their cells are not getting the energy efficiently, everything becomes sluggish. Diet culture tells us to eat less, but ultimately this tends to only slow down the body’s burn rate even further. Having a slow metabolism is an indicator the body is lacking cellular balance.
What is a GLP-1?:
Semaglutide, Ozempic, Monjuro, Wagovy. These are a class of medications that are considered to be GLP-1s, or glucagon-like peptide 1. GLP-1 is a hormone peptide that can reduce cravings, help regulate metabolism and improve insulin resistance. Just like any hormone, people can be deficient in GLP-1. Similarly, during peri-menopause, women can experience symptoms due to a deficiency in the hormones progesterone and estrogen. These are hormones that naturally occur in the body, just like GLP-1. These medications were originally used to treat diabetes, however they were also found to have effects on weight loss. Therefore, these medications have become FDA approved to be covered by health insurance for patients with obesity, or those who are overweight with co-morbidities such as heart disease, chronic kidney disease and insulin resistance.
What GLP-1 does:
GLP-1 is a hormone produced in the small intestine. It stimulates the pancreas to release the hormone insulin. Insulin is a vital hormone, responsible for helping the body use food for energy, clearing excess energy (sugar) from the bloodstream. Other roles include slowing gastric emptying (keeping food in the stomach longer) which can make you feel full sooner and keep you full longer. In addition, GLP-1 inhibits glucagon (a hormone released by the pancreas to raise blood sugar in response to a drop in blood sugar) in order to prevent blood glucose spikes. Most patients are injected with the medication weekly, although some use it more frequently.
Something that our society still gets wrong about weight loss is the “calorie in, calorie out” model. This oversimplifies the process of how our body uses and stores energy. If it were that simple, we wouldn’t have an obesity epidemic in the first place. Our hunger and fullness cues are influenced by so many factors unrelated to the quantity of food we eat and how much we exercise.
Photo retrieved from: https://www.nbcnews.com/tech/internet/ozempic-weight-loss-drug-ads-instagram-wegovy-semaglutide-rcna88602
What impacts hunger and fullness hormones:
-The amount of food we eat. Both overeating and under-eating can contribute to weight gain because the body is getting mixed signals. Most diets are filled with ultra processed foods and calorie restriction– where people are eating roughly the amount a toddler should consume daily ( ~1200 calories or less…) This adds stress to the body, signaling to store fat for protection and safety.
-Over exercising to the point of burnout and exhaustion will increase stress hormones like cortisol in the body, which contributes to weight gain. Focusing mostly on cardio without building muscle mass can also wreck the metabolism.
-Poor sleep directly contributes to increased hunger (higher levels of Ghrelin, the hunger hormone) the next day. Under-eating is one common cause of poor sleep too. It can be a vicious cycle.
-Unmanaged stress contributes to craving more carbohydrates and sugar for a quick source of energy. When the body is working hard to combat stress, it won’t want to work to break down nutrient-dense foods like protein, fats and fiber.
-Your environment can cause temptations and food-related triggers. Do you have a cookie jar on the counter? Are you watching TV in your free time watching commercials of ultra-processed foods? Does anyone else recognize how outrageous it is that every shopping line sells candy and soda– Best Buy sells electronics, so why are Skittles, KitKats and Mountain Dew hanging out in the check-out aisle?
-Your gut microbiome is made up of trillions of bacteria that play a pivotal role in regulating appetite. For example, Short-Chain-Fatty-Acids (SCFA’s) in the large intestine signal fullness. The majority of people are not eating enough fiber (fruit, vegetables, whole grains, nuts, seeds, beans) to promote a diverse array of SCFA’s.
-Digestive capacity – digestion is more than eating food and then pooping. Depending on how well our digestive organs are doing their job, you can be eating food but not actually absorbing nutrients, causing you to still feel hungry. Having Hypochlorydria (low stomach acid) is extremely common (I see this in almost all of my clients!). Stomach acid is influenced by stress, medications and diet. Learn more here! One symptom of low stomach acid is having an excessive appetite.
-Imbalanced hormones and blood sugar dysregulation can cause people to experience frequent hunger. Many people ride the rollercoaster of blood sugar highs and lows throughout the day. Every time blood sugar spikes, insulin helps to clear the sugar from our bloodstream. Oftentimes our insulin response can overshoot, causing low blood sugar. It’s when our blood sugar is low that we start to crave more food, in particular sugar and carbohydrates.
Benefits of GLP-1 medications:
I started this article by saying it is important to look at your own bio-individual needs to determine if this medication is right for you. When prescribed responsibly and under the right circumstances, people are doing really well and their health is greatly improving. Benefits of the medication include:
-Improvement in blood sugar in those with Type II diabetes.
-Fat loss.
-Cardiovascular benefits, such as reduced risk for cardiovascular disease and stroke.
-Reduced mortality rates in people with a diagnosis of cardiovascular disease and diabetes.
-More control around food, less binging.
I’ve learned that if something is too good to be true, it usually is. This concept can definitely apply towards using the medication solely for weight loss purposes too. People have tunnel vision. As a Functional Nutritionist, I wouldn’t be doing my job without considering whether or not this medication is the best outcome for your health. Does it work for weight loss? Absolutely. But how realistic is this approach for the long-term? It’s important to understand the consequences and concerns.
Reported side effects (so far):
-Injection site reactions
-Severe GI symptoms like vomiting, nausea, gallstones, diarrhea and constipation
-Headaches and migraines
-Irreversible gallbladder disease
-Thyroid cancer
-Pancreatic cancer
-Pancreatitis
-Acute kidney injury
-Nasopharyngitis (inflammation of the nose and throat)
Additional concerns to consider:
-Unrealistic expectations: During a natural weight loss journey it is normal for the scale to fluctuate and for progress on the scale to plateau from time to time. It’s not normal to lose every single day or week. When working with clients on weight loss naturally, I always explain how their current low weight will one day be their high weight. It can be a gradual process because the body is trying to protect you as your metabolism adjusts. This is when patience and consistency in healthy habits is most important!
-Dosage: Prescribers are starting people off on doses far too high, often causing symptoms such as nausea, vomiting and lack of appetite. This is not normal or healthy. The goal is not to rid your appetite or ability to eat. Oftentimes this is not the prescriber’s first choice, yet patients come back asking for more when it “stops working”.
-Muscle wasting: What you see on the scale tells us very little information about what contributes to that number. Most people fixate on wanting to see a low number, not realizing it is made up of fat, bone mass, water weight, inflammation and muscle mass. One of the biggest drivers of a healthy metabolism is muscle mass. When losing weight, the goal should be losing fat and reducing inflammation, while preserving lean muscle mass. When losing weight at a rapid rate, without properly supporting muscle by eating enough protein and doing strength training, your weight loss will reflect a substantial amount of muscle loss. This contributes to many metabolic disadvantages such as loss in strength and mobility, suppressed immune function, blood sugar dysregulation, hormone imbalance and a slowed metabolism.
-Malnourishment: Human beings need to eat real food. Due to side effects of the medications, many people are severely under-eating. Starvation for weight loss is not only dangerous for long-term health, it causes a lot of stress on the body. It’s like trying to drive your car without stopping for gas. We need fuel! In addition to under-eating, people are not changing what they are eating- continuing to rely on highly processed foods. Without incorporating nutrient-dense foods, in addition to not eating enough, people are becoming malnourished, lacking nutrients their body needs.
-Female reproductive health: Women’s bodies need protein, fat, fiber and micronutrients in order to have a healthy cycle. Under-eating and lack of proper nourishment are common contributors for hormone imbalance, unhealthy menstrual cycles and infertility.
-Losing weight too fast: Research suggests losing 5% of weight within 6 months is a realistic and healthy rate of weight loss. Some are losing that amount in less than one month…
-Eating disorders and misconstrued expectations around weight loss.
-Long-term: It is important to consider if this is a medication you will need to be taking for the rest of your life to maintain your weight loss. We know through restrictive yo-yo dieting approaches that every time you gain the weight back it is harder to lose again. Oftentimes, gaining even more than you set off to lose in the first place. Humans love instant results, it’s gratifying. But what’s in it for the long-term?
My experience working with clients using these medications that have been big red flags:
-Medication shortages: I have witnessed people suddenly losing access to their medications due to insurance complications or shortages. Not only does this create stress, anxiety and fear, but it disempowers the individual. They are solely relying on this medication to have success with their weight loss.
-Nausea and aversions to food: “Everything repulses me, I just can’t eat”, said one client.
“I barely ate for almost two weeks but now I am starting to get my appetite back. I might need to increase my dosage again”, said another. People actually believe that having an appetite is unhealthy.
-Constipation: The same client who barely ate for two weeks proceeded to tell me she had not had a bowel movement in ten days… TEN days! Not only must she feel like sh*t, but her poor hormones and gut microbiome are getting slammed right now.
-Increasing dosage: Whether someone feels hungry again (we are supposed to get hungry if we are alive!) or if their weight stalls on the scale, they immediately go to their prescriber wanting a higher dose. I overheard a patient tell her prescriber, “My appetite is starting to come back. I think I need a higher dose”. The prescriber responded, “Are you working out?” The patient replied, “I am going to the gym for an hour a day”. The prescriber then said, “okay, we can try upping the dose”. My mind was blown. This poor lady’s body is under SO much stress– exercising an hour a day without barely eating? No wonder she isn’t losing weight… and the prescriber just went along with it without educating the patient. Does the prescriber even understand how weight loss works? You can imagine I was taking lots of deep breaths to regulate my own reaction while listening to this conversation.
-Loss of period: One of my PCOS clients is 29 years old and stopped getting her period after losing 32 pounds in three months. Her doctor did not seem concerned, and told her if she goes 90 days without a period she can come get medication to start her period. Oh lord!
-Hair falling out: Rapid weight loss puts stress on the body. Additionally, lack of nutrients puts stress on the body. If the body is not getting enough nutrients and is under too much stress, non-critical parts of the body (like hair) won’t be prioritized in obtaining the few nutrients the body is receiving.
-Low energy: Two other clients using the medication told me they cannot exercise right now because they have low energy and feel too weak.
People are losing weight but how do they feel? Constipated? Bloated? Weak? Tired? That doesn’t sound enjoyable or healthy either.
How I work with clients taking the medications:
It is critical to view weight loss medication as ONE tool in addition to having other healthful habits in the toolbox. The medication is not the end all be all, so it should be complementary to other lifestyle changes. I have had clients experience great success using the medication as one piece to their wellness puzzle. By taking a holistic approach they also support their health for the long term. A few approaches that have worked well in practice include:
-Eating smaller meals more frequently throughout the day. This could look like having breakfast, snack, lunch, snack, dinner, and snack.
-Prioritizing whole foods to ensure they are eating adequate protein, fiber, healthy fat and micronutrients like vitamins and minerals. This could look like lean sources or protein, veggies, fruit, nuts, seeds and whole grains.
-Implementing stress management practices like yoga, meditation, journaling and Therapy.
-Using a hunger-fullness scale to build mindful awareness when eating.
-Strength training at least two times per week to prioritize building muscle mass.
-Working on your sleep hygiene to improve quality and quantity of sleep.
Wrapping up…
The medications are not necessarily the problem; it’s the mindset of the consumers and the lack of education from prescribers. Our healthcare system may be viewing this as a win-win situation; it’s a quick fix for weight loss, making patients happy, while also making Big Pharma money. But what is this doing to your health? How is this impacting the relationship to your body and your perception of health? Too many people equate health to the number on the scale and that cannot be further from the truth. Maybe this stems from the media, celebrities, and even doctors.
It’s always important to get clarity around your goals:
How will reaching your weight loss goal improve your life?
How do you want to feel?
What may you be doing differently if you reach your goal?
So many people are chasing the number that they weighed in High School. Our bodies naturally change and that does not mean lack of health.
As a practitioner who is passionate about spreading knowledge around how to support your health, this approach feels inharmonious to my soul. It feels like a quick fix, deterring people from making decisions from a place of intention and mindful awareness. This approach may create more of a disconnect from your intuition, getting you further away from a place of empowerment. It’s nearly impossible to understand how your food choices impact your own hunger and fullness cues when you take medication that delays gastric emptying to such an extent that you may not feel hungry at all because food repulses and nauseates you, or worse, makes you vomit.
One of my biggest frustrations within the world of nutrition is how much noise there is when it comes to weight loss. Food is our fuel, our nourishment. It creates culture, community, pleasure and for me, cooking is an outlet of my creativity. Food is not just calories. By treating this medication as the solution for weight loss, our society is further cementing the ideas that health and weight are synonymous.
Will losing drastic amounts of weight quickly really equate to health?
How can we talk about weight without addressing your nervous system, habits and routines?
Is this going to help someone’s health in the long-run?
When we forget to factor other foundations of health (stress, sleep, community, nutrients, hydration, movement, blood sugar balance and gut health) into the equation, we lose important influences that contribute to the quality of your life off of the scale.
This topic can create debate. Remember, I am just one individual with my own knowledge, education and experience. I am not here to judge anyone or deter you from taking this medication. I want you to understand the full picture and look at the long-term implications of how this impacts people both physically and mentally so you can feel equipped to successfully support your health.
References:
Hyman, Mark. "The Shocking Truth About Ozempic & The Effects It Has On the Body" The Doctor's Farmacy. April 17, 2024.
Kindelan, Katie. New Study Focuses on What Happens If you Stay on Weight Loss Drug Wegovy for Years. https://abcnews.go.com/GMA/Wellness/new-study-focuses-stay-weight-loss-drug-wegovy/story?id=110401021. May 20, 2024.
Lemons, Katie. Ozemp-ick? Wrestling the Weight Loss Injectable as a HAES Provider. The Lemonade Stand. August 7, 2023.
My Thoughts on Ozempic, Mounjaro and Wegovy as a Functional Medicine Expert. (Retrieved on June 25, 2024 from: https://drwillcole.com/functional-medicine/my-thoughts-on-ozempic-mounjaro-and-wegovy-as-a-functional-medicine-expert)
Moore, Tanya. "Ozempic Done Right". The Dr. Tyna Show. September 28, 2023.
Nutritional Therapy Association. (2020). Blood Sugar Regulation. Retrieved from https://nutritionaltherapy.instructure.com/courses/217/pages/mb-%7C-core- videos?module_item_id=15145
Testdontguess.org HTMA Course Notes.
Suran M. As Ozempic’s Popularity Soars, Here’s What to Know About Semaglutide and Weight Loss. JAMA. 2023;329(19):1627–1629. doi:10.1001/jama.2023.2438
Comments