The arrival of Ozempic and other GLP-1 drugs have been hailed as a silver bullet by those who see it as the solution to our obesity problems, while others are concerned that its widespread use is potentially putting people at risk of other significant health problems that won’t be so easy to fix.
Let’s start by looking at where Ozempic came from and what it is.
Our body naturally produces the GLP-1 hormone in the gut in response to the presence of food. Its function is to help regulate our blood sugar. It also works to suppress appetite and slows digestion. If you’ve got food in your belly, you don’t need to refuel again now.
The Glucagon-like peptide-1 receptor agonists, or GLP-1s as they’ve come to be known, are medications formulated to be used in helping patients with type 2 diabetes and or obesity (BMI>30) manage their condition.
As with many medications, side effects are not uncommon and these include headache, nausea, vomiting, constipation, diarrhoea, indigestion or dizziness. The side effects are often quite mild and usually settle.
Not everyone with type 2 diabetes requires treatment with a GLP-1 or is eligible for one.
Some of the issues surrounding these drugs has the been the hype about them being the miracle weight-loss treatment, and many celebrities have shared their journey on social media.
And to be fair, we do know the treatments are extremely effective in assisting with weight loss. The amount of weight lost depends on the particular drug used and so varies, but studies suggest a 10 to 20% drop in body weight by 6 months is achievable.
When specifically used for this reason, the benefits of losing excess weight are not insignificant: it reduces your risk for developing heart disease or stroke, reduces your risk of developing certain cancers, reduces liver fat and inflammation and can assist those individuals living with moderate to severe sleep apnoea.
The burden of obesity is not insignificant.
Another area of considerable interest is whether these drugs may have a neuroprotective effect to protect us from conditions such as Alzheimer’s disease.
We know it works, so what’s the issue?
The issue from a lifestyle medicine perspective is that being prescribed a GLP-1 drug is not without risk.
Reports of some patients experiencing pancreatitis, bowel obstruction, gastroparesis or gall-bladder issues have been highlighted.
- The biggest risk, particularly for older adults and especially women, is the associated lean muscle mass loss and reduced bone density, increasing your risk for frailty and falls. Studies indicate muscle loss can account for 25-39% of the total weight loss achieved.
We all lose some muscle mass as we get older, around 8% per decade between the ages of 40 and 70. This is sarcopenia. But the GLP-1 induced muscle loss is far greater, and it’s really hard to rebuild that muscle once it’s gone.
Without enough muscle and strength, it’s going to get harder to:
- Get yourself out of a chair or to walk without an aid
- Open a jar
- Carry your groceries
- Climb stairs
- Save yourself from falling if you lose your balance
- Because it induces a loss of appetite, not feeling hungry can lead to nutritional deficits. More cases of scurvy are being diagnosed, that’s the deficiency caused by lack of intake of vitamin C.
Starvation is not a good way to address our weight problems, even if you’re not experiencing hunger. Hunger is a signal telling us we need to eat. The problem being that many of us never experience hunger because of our tendency to graze or snack across the day.
If you’re using a GLP-1 medication, it’s essential you receive the appropriate nutritional advice and support to switch to those foods that will best support your nutritional requirements.
Signs you could be suffering from a nutritional deficit can include:
- Feeling low on energy or chronically fatigued
- Dry skin and hair loss
- Bleeding gums
- It can reduce the desire to eat or drink alcohol.
You might be thinking is that such a problem?
Well, it is, if it means you no longer gain any pleasure from socialising with others. One of the important aspects of eating food is that it builds connection with others. We break bread together for a reason.
While many more people today are choosing to drink less alcohol or stop altogether, not being able to enjoy being with friends or family to celebrate a birthday, significant event, or being on holiday impacts not just the person using the GLP-1 but others around them.
At a recent dinner party, I noticed one person take a miniscule portion of food and then spend most of the time pushing it around the plate, not actually eating. A mouse would have gone home hungry.
The hostess then produced a magnificent dessert, and the person took two tiny mouthfuls with a teaspoon before leaving the rest.
Was she sick?
There was no evidence to suggest that was the case.Was she fussy or intolerant of the food being served?
She was a long-standing friend of the hostess who would have known her food preferences, so this is doubtful.Was she using a GLP-1 medication?
I don’t know. But I wouldn’t be surprised if this was the case.Food is a connector and a social activity.
Are we denying ourselves the simple pleasures of life, in the pursuit of thinness?
What’s my beef?
I’m sharing my thoughts because I am deeply concerned that in the rush to obtain these medications, we are overlooking the fundamentals required for good health.
Primum no nocere. First do no harm.
As a Lifestyle Medicine Physician, I believe it is imperative these drugs should only be prescribed with adequate supervision of the person’s unique nutritional requirements and support for behavioural change as needed, along with advice on physical activity and strength exercises.
The best person to support you is someone who has been trained in Lifestyle Medicine, this could be a medical practitioner, nutritionist, physiotherapist, exercise physiologist or metabolic health specialist.
Unfortunately, this doesn’t appear to be happening much.
Am I being overly cautious? I don’t think so.
If you are taking a GLP-1 medication, are you keeping your future health safe?
What’s been your experience of using or seeing others use these drugs?
Refs:
https://www.thelancet.com/journals/landia/article/PIIS2213-8587(24)00272-9/abstract
Ghusn W, De la Rosa A, Sacoto D, et al. Weight Loss Outcomes Associated With Semaglutide Treatment for Patients With Overweight or Obesity. JAMA Netw Open. 2022;5(9):e2231982. doi:10.1001/jamanetworkopen.2022.31982
