“Has Ozempic Usurped the Fitness Revolution?”

When pharmaceutical companies removed the weight-loss medication fen-phen from the market in 1997, my mother was heartbroken. Not due to the FDA’s warning that the medication could greatly harm her heart or potentially even result in her death, but because she had been striving to shed pounds ever since she realized she had a body, and the only solution that had ever been effective was taken away.

This is an intense response. The fact that my mother would prefer to take a potentially lethal drug rather than confront life without it demonstrates just how maddening it can be to be repeatedly told you need to lose weight, endeavor to do so, yet find it utterly unachievable.

For many years, the standard prescription for weight loss was to improve diet and increase physical activity — enact lifestyle modifications. However, these changes were profoundly challenging to maintain over time. Even if individuals persisted for years, the results were often minimal. Few individuals were treated with pharmaceuticals. Even fewer selected surgical options.

Presently, GLP-1 medications such as Ozempic and Mounjaro have entered the discussion. They have entirely transformed the approach — how medical professionals communicate with and consider patients. How we perceive ourselves and what is feasible. And why we have been trapped in a “treatment” cycle that has brought frustration to so many for an extended period, all while obesity levels have continued to rise.

In the mid-1990s, public health specialists sought ways to address escalating obesity rates, primarily due to the association of obesity with conditions like Type 2 diabetes and specific types of cancer.

The NIH initiated a study in 1996 that would largely shape clinical perspectives on treatment henceforth. Researchers examined how improved diet and increased physical activity influenced occurrences of Type 2 diabetes. They discovered that lifestyle modifications leading to even a slight weight loss had a significant effect on Type 2 diabetes prevention. Participants who achieved the goal of losing just over 5 percent of their body weight decreased the incidence of Type 2 diabetes by 58 percent. To illustrate, if someone weighed 300 pounds, they would need to shed approximately 15 pounds. These were not The Biggest Loser weigh-ins. They were intended to be realistic outcomes.

Government representatives issued calls to action. Medical professionals had compelling evidence that lifestyle modifications were impactful. Diet and physical activity became the recommended method for managing weight.

“I’ve dedicated 20 years trying to advocate for the advantages of a 5 percent weight reduction,” stated Dr. Dan Bessesen, an endocrinologist and head of the CU Anschutz Health and Wellness Center at the University of Colorado. “It appears to be a minor adjustment in weight, yet it produced remarkable benefits.”

The limitations of diet and exercise

Society, of course, took these discoveries and swiftly adapted them to align with prevailing beauty standards and narratives regarding personal accountability. The narrative shifted from Lose a little bit of weight to become a lot healthier. It evolved into If only an individual with obesity could exercise self-control, they could reach their objective.

However, biology is more intricate than that.

“The body has its own perception of what it wishes to weigh,” Bessesen mentioned. Weight reduction triggers various biological reactions that complicate the loss. We tend to feel more hungry, and our bodies conserve energy (a.k.a. fat). This was once beneficial when we lived in caves. Now that we’ve tamed wolves and work from home in comfortable clothing, it’s not as advantageous.

Thus, the miraculous solution has turned into something of an affliction in itself.

“Doctors particularly hold this notion that, ‘Well, Mrs. Jones, you should be able to manage [losing weight] independently,’” Bessesen remarked. “We don’t apply that approach to diabetes or hypertension.”

And perhaps we are on the verge of ceasing this with obesity.

Medications to address obesity have existed for years. Yet, none have demonstrated to be as effective or culturally enticing as the notion of merely improving diet and physical activity. Until Ozempic.

Ozempic is one brand name among a series of medications calledGLP-1 agonists that have surged in acceptance over the past few years. These injectable treatments imitate hormones that decelerate digestion and induce a sense of fullness, resulting in reduced food intake and desire to consume less. As anticipated, this leads to significant weight loss — approximately 15 percent on average. Similar to medications used for cholesterol or arthritis, they don’t depend on willpower for achieving the intended effects.

This shift has transformed the discourse. Patients arrive requesting GLP-1s by brand, unlike most other health issues, Bessesen shared with me. Moreover, physicians can rapidly issue a prescription rather than having someone endure self-punishment for months or years before contemplating medical treatment.

The availability of a potent medication appears to have reframed obesity from being seen as a personal shortcoming into a manageable health condition.

It’s notable to mention an irony here: Individuals utilizing GLP-1 medications frequently express a dislike for highly processed foods and favor fresh produce. Additionally, weight loss can enable individuals to move more freely. These drugs do not substitute for lifestyle adjustments; rather, they appear to facilitate them.

Not every individual inhabiting a larger body needs to shed pounds. Furthermore, the body positivity movement has assisted numerous individuals in dismantling their internalized fatphobia and escaping the confines of unattainable beauty ideals.

However, some individuals do perceive the necessity to implement changes to avert Type 2 diabetes or manage other health issues. If they choose to utilize GLP-1 medications, certain challenges and disadvantages arise.

Adverse effects can be severe: Individuals have reported incapacitating constipation and nausea. These medications are also astronomically expensive, and most insurance plans do not cover them for obesity treatment. There’s another element of taking these medications that worries him: the emotional strain they may impose.

Dining often serves as a social engagement, thus a profound alteration in one’s relationship with food can also affect personal relationships. Noticeable weight reduction can lead to awkward discussions surrounding a person’s private health decisions that can be challenging to manage. Additionally, individuals who have invested considerable effort in accepting their weight may feel significant internal conflict regarding the ability to alter the body they have grown to cherish.

“When someone undergoes bariatric surgery, we prepare them for that,” Bessesen noted. “They meet with a psychologist; they consult a nutritionist. They converse with others who have undergone the procedure and ask, ‘What was that like for you?’ Medications can facilitate that degree of weight loss, yet we are not preparing individuals for it.”

A new perspective regarding obesity and its treatment might be addressing some of the challenges faced in previous approaches. Nevertheless, numerous new aspects must be considered now that we have arrived here.

Prices are anticipated to stabilize as more companies introduce a greater supply of GLP-1 medications into the marketplace. Moreover, there is a strong argument for insurance providers to ultimately cover these drugs. Treating Type 2 diabetes and cancer incurs substantial expenses. Preventing these diseases could yield financial savings over time. The timeline for developing systems to address the psychological repercussions of transforming one’s body remains somewhat uncertain. However, as more individuals pursue this avenue, we shall acquire additional insights into the unforeseen effects of this treatment.