Nutrition: some thoughts on weight loss drugs
Nutrition: some thoughts on weight loss drugs
You probably know the drugs I’m talking about, because they have been everywhere lately. This was a particularly interesting article. I wrote about my thoughts on weight loss drugs for teens not too long ago, but wanted to go a bit further here on adults.
Let’s do a comparison
If you’ve been here for a while, you know I’m not about weight loss diets in any way (in fact, I don’t focus on weight loss in my practice). There is literally no research showing they work in the long term, and they can be incredibly harmful both physically and mentally. Here are some characteristics of weight loss diets:
Often involve strict rules, plans or other methods designed to restrict calories
Primary goal is weight loss, as opposed to certain biomarkers or healthy behavior change
Have a start and end point
Do not address behaviors around food or relationship with food
Cookie cutter - the same diets are meant to work for everyone without taking the individual into account
Result in regain of lost weight, and usually more, once diet is stopped the vast majority of the time
Now let’s think about weight loss drugs* (Ozempic, Wegovy, Mounjaro) and their characteristics:
Is a specific drug whose mechanism is designed to restrict calories by reducing appetite
Primary goal for their use is weight loss, as opposed to healthy behavior change
Have a start and end point (I’ll discuss more in a second)
Do not address behaviors around food or relationship with food
Cookie cutter - the drugs (nor those prescribing) do not take the individual into account
Result in regain of lost weight, usually more, once the drug is stopped
Are weight loss drugs no better than a diet?
Well, if you ask me, not really. And that’s because there is no long-term game plan. Because the drugs are fairly new, there are no long-term studies on safety nor the use of them for years and years for the purpose of weight maintenance after the initial loss. Right now, the cost is prohibitive for most individuals to be using long-term. And what’s more, what is known is that once people go off these drugs, they gain the weight they lost back. Can you even imagine doctors prescribing a new cancer drug with a known side effect of a cancer recurrence once the drug is stopped? Why does the medical community have such huge blinders on when it comes to these weight loss drugs (and honestly, calorie restricted diets. why are you still recommending these??)? A treatment for “obesity” (in quotes here because I think this is a stigmatizing term) doesn’t “work” if it causes patients to regain lost weight once they stop it. This is of course also why diets don’t work.
Nutrition counseling and weight loss drugs
I believe the standard of care when prescribing weight loss drugs is that they are recommended in tandem with “a healthy diet and lifestyle.” This has and always will be a terrible recommendation without specifics - referral to a dietitian? PT? Therapist? I can speak to personal experience in that when I was working at a hospital a year ago, several of my patients were beginning to be prescribed these drugs with nary a referral to me for nutrition education and guidance. This is a HUGE missing piece! Meaningful and individual recommendations are crucial to long-term healthy behavior changes around food and lifestyle. Period, the end, and I will die on this hill.
The thin ideal
What’s making this whole situation worse is the vast amount of media coverage celebrities are getting for becoming noticeably thinner overnight, thanks to these drugs. It seems like the body diversity movement, which has gotten so much traction in recent years, is taking a back seat to this reemphasis on thinness. What these weight loss drugs are helping reinforce is that there is only one type of acceptable body, and that “health” means being within a narrow weight range (i.e., BMI). Nevermind that weight range has been calculated using an antiquated formula never designed to be a measure of health in the first place.
If you can’t tell, this topic does get me a bit fired up, and this probably won’t be the last time I write about it. I’d love to hear your (respectful) thoughts in the comments!
*note I’m not speaking about their use as diabetes medications here