Dr. John Whyte
Prescription weight loss drugs, known as GLP-1s, are sweeping the country. The drugs, which include blockbuster medications like Ozempic and Wegovy, have helped millions of Americans quickly shed excess pounds. About 1 in 8 U.S. adults say they’ve taken one.
But as a doctor, I must caution that these drugs might not be the miracle they seem to be.
In fact, GLP-1s might be making it harder for physicians to guide patients toward lifestyle changes − the real key to long-term health − and for patients to adopt them.
Issues surrounding the medications are especially relevant now that President Joe Biden has proposed that Medicare and Medicaid cover weight loss drugs for millions of Americans.
GLP-1s work by mimicking a hormone that tells the brain that the stomach is full. They also slow the speed at which food exits the stomach, leaving patients feeling satisfied for longer. As a result, patients eat less and lose excess weight.
Medications can lead to rapid weight loss
After only four months, patients typically lose between 5% and 10% of total body weight. By a year, it’s around 15%.
This rapid weight loss can feel liberating, especially after years of failed attempts. But there’s no such thing as a magic pill − or shot − and taking GLP-1s for the rest of one’s life is no substitute for a healthy lifestyle.
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I’ve noticed a troubling shift in people’s mindsets. One patient recently came into my office 20 pounds lighter than she was a few months earlier. When I asked what she had done differently − what diet changes or exercise habits she had incorporated − her answer was blunt: “Honestly, Doc, I didn’t do anything, I just took the drug. I just eat less of what I was eating.”
She’s far from an outlier. I’ve had many patients who lead a sedentary lifestyle and eat mostly unhealthy foods lose weight with GLP-1s. They feel healthier, and by some metrics, they are healthier: In addition to reducing weight, GLP-1s can lower blood pressure, blood sugar and cholesterol levels.
These positive data points make it harder for doctors to convince patients taking GLP-1s that they also need to adopt a healthier lifestyle. After all, what’s the point of going to the gym or eating a balanced diet if your blood work looks good and you appear fit?
It’s a valid question. And that’s why it now takes more time with patients to revisit the role of diet and exercise. These life habits aren’t just about looking good − or even feeling good. They’re about keeping our bodies as healthy as possible and preventing disease.
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And GLP-1s are not − and never will be − the sole solution for achieving that goal.
In many cases, they provide a false sense of security and make it easy to oversimplify the impact of weight on overall health.
Importance of healthy diet goes beyond weight
Food really is medicine. A balanced diet that includes the right amount of fruits, vegetables, carbohydrates, fats and proteins isn’t just about weight management − it’s about fueling every cell in our bodies.
Nutrition is so important for our long-term health that switching from an unhealthy diet to a healthy diet can add a full decade to someone’s life expectancy.
Health isn’t just a matter of what we put into our bodies, but what we do with them. As we enter our 50s and 60s, we naturally lose muscle mass, which can cause fatigue and make us more vulnerable to injuries. Strength training is essential to counteracting this, especially for people taking GLP-1s.
While we need more research, there’s concern that these medications might accelerate muscle loss, especially in the elderly. That impacts your daily activities. Thin and weak is not a combination anyone should strive for.
Let’s not forget bone health. Weight-bearing exercises like walking and running are your best defense against osteoporosis, the loss of bone mass that can come with aging.
Weight loss medicines can help kickstart a healthier lifestyle. When muscles and joints bear less weight, it’s easier to start exercising. Feeling full more quickly can make choosing a salad for lunch more appealing. But patients should think of these drugs as a helpful tool, not a cure-all.
At least one study has found that when people stopped taking a GLP-1, they regained two-thirds of the lost weight. That’s often because they did not change their behavior. There are plenty of reasons people may stop taking these weight loss drugs, including pregnancy and breastfeeding, unpleasant side effects or interactions with other treatments like chemotherapy.
Finally, we need to ask why many patients struggle to make healthy lifestyle changes in the first place. Often, patients who turn to GLP-1s feel like they already tried lifestyle changes and they didn’t work. But in reality, they didn’t have the right tools and adequate support to be in a position to succeed.
Doctors bear a fair amount of the responsibility for this − we aren’t always the best at giving practical, empathetic health advice. Too often, we say “Go to the gym” or “Eat healthier” without providing realistic, specific instructions.
We can’t ignore the role that societal factors play, either. Healthy foods are often more expensive, and many communities lack safe spaces for physical activity. If we truly want people to embrace lifestyle changes – whether they’re on GLP-1s or not − we need policies that make the healthier choice the easier choice.
GLP-1s have an important role in modern medicine. But any doctor will tell you that a number on the scale should never be the sole measure of health. A lifestyle that includes a nutritious diet, regular exercise and other healthy habits is equally important.Dr. John Whyte is chief medical officer of WebMD.
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