Did Ozempic end the era of diet and exercise?

My mother was shocked when pharmaceutical companies took the weight-loss drug fen-phen off the market in 1997. Not because the FDA warned that the drug was dangerous. seriously damage her heart or could even kill herbut she's been trying to lose weight ever since she realized she had a body, and the only thing that's worked so far has been getting ripped out of her hands.

This is an extreme reaction. The fact that my mother chose to take a deadly drug rather than live her life without it meant that she was told over and over again that she needed to lose weight, and that no matter how hard she tried, it would never fail. It just goes to show you how frustrating it is to know something is possible.

For decades, the go-to prescription for weight loss has been to eat better and move more – lifestyle changes. However, maintaining these changes over the long term has been extremely difficult. Even if people continued to do them for years, they often got only marginal results. Few were treated with drugs. Even fewer chose surgical intervention.

GLP-1 drugs such as Ozempic and Munjaro are now joining the conversation. And they have completely changed the landscape of how doctors talk to and think about their patients. How we think about ourselves and what we can achieve. And why have we been stuck in a “treatment” cycle that has frustrated so many for so long? Obesity rates continue to rise.

In the mid-'90s, public health experts were looking for ways to alleviate rising obesity rates. The main reason for this was that obesity is associated with diseases such as type 2 diabetes and certain types of cancer.

of NIH begins research In 1996, this would largely define clinical thinking regarding future treatments. Researchers looked at how eating better and getting more exercise affected cases of type 2 diabetes. They found that lifestyle changes that resulted in even small amounts of weight loss had a big impact on preventing type 2 diabetes. Participants who achieved the goal of losing just over 5 percent of their body weight reduced their incidence of type 2 diabetes by 58 percent. To put this into perspective, if you weigh 300 pounds, you need to lose about 15 pounds. These were not the biggest loser Weighing. These were supposed to be achievable results.

issued by a government official call to action. Doctors had real evidence that lifestyle changes were important. I started eating and exercising of A prescription for weight management.

“I've been trying to sell the benefits of 5% weight loss for 20 years,” said Dr. Dan Bessesen, an endocrinologist and president of the society. CU Anschutz Health and Wellness Center at the University of Colorado. “The change in weight may seem small, but it had a dramatic effect.”

Limits of diet and exercise

Of course, cultures quickly took these discoveries and reworked them to fit existing beauty standards and narratives about personal responsibility. The discussion is over, Lose some weight and become healthier. Instead, it looked like this: If obese people can control themselves, they will be able to achieve their goals.

But biology is more complicated than that.

“The body has its own idea of ​​what it wants to weigh,” Bessesen says. Losing weight triggers all sorts of biological responses that prevent weight loss. We become hungrier and hungrier, and our bodies store energy (aka fat). This came in handy when we lived in caves. Not so much now that I've tamed wolves and started working from home in soft pants.

And the miracle cure itself became a kind of disease.

“Physicians in particular have this mindset of, 'Mrs. Jones, you're going to be able to handle this.' [losing weight] Do it yourself,” Bessesen said. “You don't do that for diabetes or high blood pressure.”

And maybe we're going to stop doing that when it comes to obesity.

Drugs to treat obesity have been around for decades. But nothing is more effective or culturally appealing than the idea of ​​simply eating well and exercising. Until then Ozempic.

Ozempic is one of the brand names for a group of drugs called. GLP-1 agonist It has become explosively popular in the last few years. These injections mimic hormones that slow digestion and cause a feeling of fullness, so you eat less and want Eat less. As expected, you will lose a lot of weight. On average about 15%. And, like with cholesterol or arthritis medications, you don't rely on willpower to achieve the desired results.

In other words, the conversation has shifted. Patients ask for GLP-1 by brand name, but this doesn't happen for most other conditions, Bessesen said. Doctors can also write simple prescriptions instead of letting patients flog themselves for months or years before considering medical intervention.

The existence of effective therapeutic drugs appears to have switched obesity from a perceived personal failure to a category of treatable disease.

There's an irony worth mentioning here: People who take GLP-1 drugs report well I hate ultra-processed foods and prefer fresh fruits and vegetables. And losing weight allows people to move around more freely. These medications are not a substitute for lifestyle changes. They seem to be enabling them.

Not everyone living with a large body needs to lose weight. And the body positivity movement has helped many people dismantle their internalized fatphobia and escape 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. There are some challenges and drawbacks if you choose to take GLP-1 drugs.

Side effects can be bothersome. Debilitating constipation and vomiting have been reported. Medicine is also cosmically expensive And most insurance policies do not cover obesity treatment. But there's another aspect of taking these drugs that he's concerned about: the mental toll.

Eating is often a social act, so drastically changing your relationship with food can also change your relationships with others. Significant weight loss can lead to difficult and uncomfortable conversations about personal health choices. And those who have gone to great lengths to accept their weight may feel deeply conflicted about being able to change the body they've come to love so much.

“When we send someone for bariatric surgery, we prepare them for it,” Bessesen said. “They're seeing a psychologist. They're seeing a nutritionist. They ask other people who've had surgery, 'How was your surgery?' Taking the drug will cause you to lose a lot of weight. But we're not preparing people for that. ”

A new era that focuses on obesity and treatment may help solve some of the problems from the previous era. But now we have a lot of new things to consider.

Prices are expected to level off as more companies bring more GLP-1 drugs to market. And there is a strong argument that insurance companies will ultimately cover the drug. Treatment for type 2 diabetes and cancer is expensive. Preventing these diseases can potentially save you money in the long run. It's a little unclear when systems will be developed to deal with the psychological effects of altering one's body. But as more people take this path, we will learn more about the unintended consequences of this treatment.