The complex puzzle of weight loss
The extremely popular and recent use of the drugs known as glucagon-like peptide 1 receptor agonists (GLP-1 RAs), for weight loss is still a controversial area.
GLP-1 (glucagon-like peptide 1) agonists are used for diabetes management, but also for weight loss. Semaglutide is a GLP-1 receptor agonist and is the generic name of the active substance in the medications Ozempic®, Wegovy®, and Rybelsus®. Ozempic® and Wegovy® are given as injections and Rybelsus® is offered as an oral medication.
GLP-1 agonists stimulate receptors for the hormone glucagon-like peptide 1, which increases insulin production from the pancreas. These drugs also slow the movement of food from the stomach into the small intestine and thus you feel full quicker and for longer, so you eat a smaller amount of food. The best known GLP-1 RA drug is Ozempic.
Let’s look at some pros and cons to give you clarity which is helpful if you are struggling with a stubborn weight problem.
Perhaps you have tried everything you could think of such as changing your diet, consulting a dietician and/or counsellor, exercise, protein powders and supplements etc? After all this time, effort and expense, you may still be overweight – how frustrating!
You may very well give up and accept the excess weight or worse you may start overeating the wrong comfort foods again and put on more weight. I advise you not to give up as you don’t have to live the rest of your life overweight.
Being overweight is not good for your health and is associated with higher risk of diabetes, heart disease, high blood pressure, arthritis and cancer. Obesity increases inflammation which ages you faster.
The reasons that a person becomes and stays overweight is not due to one factor alone and can be very complex. There are often hidden metabolic and hormonal imbalances that must be addressed to make weight loss possible and sustainable.
For example, did you know that your blood tests for thyroid function may look normal but if you have a fatty liver or poor gut health you can make the wrong shape thyroid hormone? This means you will have underactive thyroid metabolism and will find it impossible to lose weight. I bet you did not know that liver and gut health affect your thyroid function! Poor thyroid function can also lead to polycystic ovaries and low progesterone which further exacerbates weight gain.
Weight loss detective program
To provide a holistic approach for weight loss I have designed the Weight Loss Detective Program which offers support and guidance. The detectives are professional nutritionists or naturopaths and analyse an in-depth questionnaire to uncover hidden issues that could be sabotaging your weight loss. Visit www.sandracabot.com if you want to try our quizzes to see if you may have hidden metabolic and/or hormonal imbalances slowing down your weight loss.
A healthy lifestyle and eating natural unprocessed foods remain the foundation for the management of obesity, and doctors should guide patients to make positive choices regarding their diet, exercise, mental health, and sleep. However, for many people, lifestyle changes alone are rarely sufficient to obtain a goal of sustained weight loss. This is especially true when there is high stress in a person’s life.
GLP-1 agonist drugs versus lifestyle
A meta-analysis of clinical trials testing lifestyle interventions alone to lose weight among overweight adults found that the relative reduction in body weight in the intervention versus control cohorts was -3.63 kg at 1 year and -2.45 kg at 3 years. A significant percentage of people do not adhere to weight loss interventions such as diet and exercise. This study found that patients had better results from programs supervising attendance, giving social support, and diet advice than interventions not supervising attendance, and without social support.
Another study in 2022 looked at 175 overweight or obese patients who were administered weekly injections of semaglutides (with doses ranging from 1.7mg – 2.4mg). They achieved a total body weight loss of 5.9% after 3 months of treatment and 10.9% after 6 months of treatment.
This is why doctors and patients have been looking for effective drugs to create better results among adults with obesity. In a national survey of 1479 US adults, 12% reported having used a GLP-1 RA drug. Diabetes was the most common reason (43%), followed by heart disease (26%) and overweight/obesity (22%).
The high cost of GLP-1 RA therapy was a major barrier to wider use. Some 54% of participants said that it was difficult to afford GLP-1 RA therapy. Having health insurance did not change these statistics significantly.
In March 2024, the US Food and Drug Administration approved semaglutide to reduce the risk for cardiovascular disease among patients with overweight and obesity and existing cardiovascular disease. It appears that Medicare will cover semaglutide for that indication, which bucks a trend of more than 20 years during which Medicare Part D would not cover drug therapy for weight loss.
There is support in the US Congress to further increase Medicare coverage of GLP-1 RA drugs for obesity. GLP-1 RA drugs are associated with greater average weight loss than either lifestyle interventions alone or that associated with previous weight loss medications.
Side Effects of GLP-1 RA drugs
Ozempic can cause a loss of fat from the face and for some users can lead to an aged, wrinkled appearance, known as ‘Ozempic face’. Risks of taking GLP-1 RA drugs include nausea, constipation, indigestion, reflux, rashes and itching. When you stop taking Ozempic or other GLP-1 RA drugs, the weight usually comes back on. All GLP-1 agonist drugs (except dulaglutide) promote weight loss, with the greatest effect found with the drug tirzepatide.
Two thirds of users of GLP-1 RA drugs stop using them within a year. This could be due to high cost, or side effects and also because they find the drugs are not working as they plateau at a new body weight.
How to reduce weight loss from your face
Many people who want to lose weight are afraid of losing too much fat from their face and looking older. It’s a realistic concern because as we age we do lose fat from our face and that contributes to sagging of the skin on the face.
An effective way to remedy this is to chew more tough food. This can increase the muscle mass and bone density on your face, helping to support the skin on your face for longer.
The majority of the modern diet is comprised of soft foods: porridge, smoothies, sandwiches, eggs, pasta, potato chips and soup are all soft foods. They require very little work from your jaw and facial muscles.
Studies have shown that intentionally increasing the amount of tough foods in your diet can actually increase both the bone density and muscle mass in your face. This means the skin on your face will sag much later in life. Examples of tough foods to chew include tough cuts of meat with fat and gristle attached, raw nuts and raw vegetables. Some people take it a step further and chew mastic gum or purchase a jaw strengthening device. You can find more information on this topic in the fascinating book Breath: The New Science of a Lost Art.
It is essential to keep the muscles on your face strong and active in order to reduce an aging facial appearance. When on a GLP-1 RA drug you may find that your appetite for protein is reduced. This is because the movement of the stomach is slowed down, and meat is harder to digest. Animal protein contains the full complement of essential amino acids, especially leucine. Leucine is the amino acid most important for stimulating muscle synthesis.
Hydroxymethylbutyrate (HMB) is a substance that is made when the body breaks down leucine. Studies have shown taking HMB supplements can increase exercise performance, reduce muscle breakdown and increase muscle growth. This even occurs in people who don’t exercise and in elderly individuals.
Branched chain amino acids are leucine, isoleucine and valine. Branched chain amino acids are the specific types of protein that stimulate increased muscle growth, reduce muscle breakdown and reduce muscle soreness after exercise.
Glutamine helps promote muscle growth and it is needed by the cells that line your gastrointestinal tract. Sixty percent of your muscles are made of glutamine.
Ultimate Muscle Food powder is a blend of glutamine, branched chain amino acids and HMB in a delicious all natural and vegan lime flavoured powder. It is an excellent supplement for people who are not maintaining muscle protein when taking GLP-1 RA drugs such as Ozempic.
How much weight can you lose with GLP-1?
In a 91 kilogram (200-pound) person, average weight loss is ½ to 1 kilogram (1 to 2 pounds) per week. In a 136 kilogram (300-pound) person, average weight loss is 0.7 to 1.4 kilograms (1.5 to 3 pounds) per week. In clinical trials, most people on liraglutide lost over 5% of their body weight over 56 weeks. For semaglutide, there was an average weight loss of almost 15% of their body weight over 68 weeks.
After 20 years of clinical experience in medicine with GLP-1 RA drugs it appears that the benefits of these drugs outweigh risk in the correctly matched patient. With correct guidance by doctors, GLP-1 RA drug therapy can have a positive effect on increasing weight loss in an individual.
My book titled I Can’t Lose Weight and I Don’t Know Why can explain why you never need to give up in your quest to be a healthy weight. It can make the complex factors that cause obesity much easier to understand and make your journey easier.
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