Weight Loss Drugs: Solving the Symptom, Not the Problem?

Many folks have asked me about the new injectable weight loss drugs and what I think.  It’s worth looking at several pieces in the New York Times that give perspectives about weight loss and weight loss drugs. 

Do they work? 

Yes, people do indeed seem to lose weight on these medications.  Deese, Gruber and Cummings in the March 4th edition opine that while the new GLP-1 drugs may be effective, they cost ten times here what they do in other countries and that if given to everyone who needed them, would cost $1 trillion at current prices. 

OK, so they work. But – we are not addressing an underlying problem.

Johann Hari on May 7th writes that with almost 70 percent of Americans being obese, the big issue at stake is satiety – the ability to eat and feel full.  He notes that research shows that the current American diet (two thirds ultra-processed foods) subvert the body’s ability to feel sated.  

“One scientific experiment — which I have nicknamed Cheesecake Park — seemed to me to crystallize this effect. Paul Kenny, a neuroscientist at Mount Sinai Hospital in New York, grew up in Ireland. After he moved in 2000 to the United States, when he was in his 20s, he gained 30 pounds in two years. He began to wonder if the American diet has some kind of strange effect on our brains and our cravings, so he designed an experiment to test it. He and his colleague Paul Johnson raised a group of rats in a cage and gave them an abundant supply of healthy, balanced rat chow made out of the kind of food rats had been eating for a very long time. The rats would eat it when they were hungry, and then they seemed to feel sated and stopped. They did not become fat. 

But then Dr. Kenny and his colleague exposed the rats to an American diet: fried bacon, Snickers bars, cheesecake and other treats. They went crazy for it. The rats would hurl themselves into the cheesecake, gorge themselves and emerge with their faces and whiskers totally slicked with it. They quickly lost almost all interest in the healthy food, and the restraint they used to show around healthy food disappeared. Within six weeks, their obesity rates soared. 

After this change, Dr. Kenny and his colleague tweaked the experiment again (in a way that seems cruel to me, a former KFC addict). They took all the processed food away and gave the rats their old healthy diet. Dr. Kenny was confident that they would eat more of it, proving that processed food had expanded their appetites. But something stranger happened. It was as though the rats no longer recognized healthy food as food at all, and they barely ate it. Only when they were starving did they reluctantly start to consume it again.” *

Seems like our American diet stacks the cards against us.

Is the question really about our own ability to “control ourselves?”  Or is it about a system that has built itself on cheap poor food that causes our bodies to eat more and get fat?   

My own recent experience was puzzlement at my own recent weight gain. I’ve always eaten foods that I learned were healthy.  Lots of veggies and fruit, not a lot of processed foods, yogurt – though I have a weakness for bread and butter and fresh pasta.  I was a vegetarian and then a pescatarian for many years, so I was adding nuts and seeds everywhere for healthy proteins and fats. 

Recently I enrolled in a weight loss app recommended by a practitioner and some friends.  The key feature is that it makes estimating calorie intake easy.  What struck me was the number of calories in the foods and how delicious they are. I love Trader Joe’s blister peanuts—a ¼ cup (a small handful) is 170 calories.  In a weight loss diet of 1600-1800 calories a day, that’s 10% right there.   I could eat easily a whole meal’s worth.   It also brough home how much exercise it takes to balance the calories of junk food. I had not been paying attention to how many calories were in the food.   

Just being conscious of the calories and exercising more has helped me drop 13 lbs.  Going further is difficult, though, and I’m realizing that the reason is in fact this question of satiety.  Portion sizes play a huge part: when I was younger, my body simply burned off the extra calories, and I ate as much as I wanted, not what I needed.  The food tasted good, so I’d eat more.  Plus, restaurants serve ridiculously huge portions, easily enough for two most of the time.  I’d gotten out of practice of eating slowly and small amounts, then paying attention to feeling full. 

In a world where so many people are hungry, it’s a good problem to have to have too much food.  However, the kind of food that you have available can be problematic. In my neighborhood, I am lucky: I have so many grocery stores and farmers markets near me.  Within a two-mile radius I have over eight grocery stores – that carry fresh, healthy food – and several farmers markets each week.  A more common reality is the one in larger areas of Chicago: not only are there “food deserts” – no nearby grocery stores whatsoever – but also when there are small stores nearby, they stock mostly expensive, poor quality, ultra-processed foods.   

No food. Bad food. High calorie food. Food designed for craving, not satiety.

And here we are – literally carrying the weight of that world.

So, what do I think about the new weight loss drugs?  I think there are some people who need them.  I’m intrigued by what I see my patients doing with them – and some are having good success.  I think it can be an interesting jumpstart to re-teaching our bodies how to not constantly crave high calorie foods.  If obesity is a serious enough problem, especially with other health issues – it can be a good idea. 

I am worried about these programs that sell compounded versions of the drugs.  They are not recommended now – it is not clear that the ingredients used in them are safe and effective for the long term.  Some of them may be fine, but how do you know? 

What are the alternatives?

I’m not a fan of intermittent fasting when people have mental health issues – I think we need real food and fuel in the body regularly.  I’m not a fan of supplements – they are not regulated, and we don’t know what’s in the bottle.  I believe that if you need more of a particular nutrient, eat real foods with those nutrients.  Don’t take fish oil – eat fish.  Don’t take Vitamin C, eat foods with it.  Lastly, I am not a fan of Atkins, Keto or any of these diets that promise that you can eat mostly protein and fat to lose weight.   

Consider instead programs that help us become conscious and offer support about what we are putting in our bodies.  I have had experience with weight loss programs Weight Watchers and Noom.  They both seem to be okay, though I recommend you not get caught up in all the other things they want to sell you.  There’s the 12-step program Overeaters Anonymous.  And there are programs that specialize in obesity medicine that can get you good help, and advice that’s as up to date as we have.

What works for me?

Michael Pollin, author of “In Defense of Food” summarized it in eight words “Eat food.  Not too much.  Mostly plants.”  Makes sense to me.   

* Recommended article: A Year on Ozempic Taught Me We’re Thinking About Obesity All Wrong, by Johann Hari:  https://www.nytimes.com/2024/05/07/opinion/ozempic-weight-loss-drugs.html?unlocked_article_code=1.3k0.FQ2x.VZb1GReVuxiW&smid=url-share