Over the past couple of years, a lot of people have heard about GLP-1s and the weight loss that can occur when people take these medications. While this class of drugs began as a treatment for diabetes, doctors realized that they also led to weight loss. Fast forward to today, and recent survey data shows that nearly one in five people in America have taken a GLP-1 for the purpose of weight loss.
When I first started to hear about GLP-1s in 2023, I was unsure what to think. As someone who specializes in eating-related therapy, I have seen a lot of trends in weight loss come and go; medications, liquid diets, fasting, paleo, keto, to name just a few, have risen and fallen in popularity, with very few people sustaining long-term weight loss with any approach. The behavioral science when it comes to dieting is clear: diets don’t work long-term for most people. Even when we lose weight, within months or years, we will likely gain it back, and often go up higher on the scale than the number we started with before the diet began.
Our bodies developed biological mechanisms over millennia to defend against weight loss. This biology has kept us alive since the days of our early ancestors, but now in a time of plenty, that same biology makes it nearly impossible for many of us to lose weight and keep it off. Our bodies were not made for an environment in which we work and play in front of screens and have ready access to tasty foods. There is a mismatch between the design of our bodies and the environment we live in. The diseases we are developing tell the story: heart disease, high blood pressure, and diabetes are often directly tied to what we are eating and the amount of extra body fat we are carrying. The bottom line is that losing excess weight and keeping it off is good for our health, but extremely hard for most people, which is why the successes that are being reported with GLP-1s are so noteworthy.
What I’m seeing in my practice is amazing—people who have battled their weight since childhood are losing 50, 100, or 200+ pounds to live at healthy weights they could have never attained/sustained before. On a GLP-1, some people lose more quickly than others, and some people have more side effects than others, but everyone I have in my practice who is taking a GLP-1 has lost weight when they take the medicine and do the recommended things. What are the recommended things? It’s important to eat enough protein when on a GLP-1. This lets a person keep muscle while their body is losing fat. Regular exercise, including resistance/strength training, is also key to muscle preservation. Eating enough, focusing on healthy foods, and getting enough water are also important components of a successful game plan. There’s a dramatic difference in how people will look after weight loss if they have done these things vs if they haven’t.
Prior to the advent of GLP-1s, many people needing to lose 50 pounds or more found this nearly impossible through diet alone. Some turned to gastric surgery. While gastric surgery can lead to initial substantial weight loss, most people plateau in their weight loss and then gain some of the weight back. These days, I often see people in my practice who have had a gastric surgery in the past, and who are now using a GLP-1 to help maintain their weight and lose even more weight than they had been able to lose through the surgery alone. Having GLP-1s in the arsenal of weight loss approaches now gives people more options to choose from. One of the observations/criticisms of the GLP-1s is that people may need to stay on them at a lower dose indefinitely to maintain their weight loss. Once the medication is removed, people tend to gain the weight back. It will be interesting to see where medical science goes with this. I suspect that low dosing or micro-dosing of GLP-1s will become commonplace for weight maintenance for many people.
Science is increasingly revealing that brain genetics play an important role in determining our weight range. For too long, society has seen weight control as a matter of self-discipline, rather than the complex interplay of brain-wiring, hormones, and genetics that it actually is. For example, GLP-1s have revealed to us that some people have a constant chatter going on in their brains about food. This chatter seems impossible to turn off with willpower alone. Prior to the emergence of GLP-1s, I had never heard the term “food noise,“ which is the term that has emerged in the past few years to describe this internal chatter. For all the time I have worked in the areas of eating, bingeing, and weight control, no one had ever described this to me before in such specific terms. Once GLP-1’s started to turn down the volume on food noise, we understood that this phenomenon existed. I hope that discoveries like this create greater compassion between people. Being overweight in American society is a common but stigmatizing condition. Beginning to focus on the biological factors rather than assuming only psychological factors could be a great start in making our society less judgmental and more informed on this topic.
Research on GLP-1s is exploding, and new medications are advancing in clinical trials and coming to market at a fast pace. There is interesting research coming out leading us to believe that GLP-1s likely have independent positive effects on the health of some of our individual organs regardless of weight loss. Some people are wondering if GLP-1s may help with aging and could become part of standard preventative treatment for many people. Science is working to get answers to these questions. I’m hopeful that GLP-1s will become more affordable. We have seen prices come down to some extent since these medicines first came out, and as competition brings more drug choices and older drugs come off their patents, the options should get cheaper. Right now, many insurance carriers will not pay for GLP-1s for weight loss alone, but I am hopeful this will gradually change with time.
If you are on a GLP-1 or considering taking one, I would be happy to work with you. However, if this kind of intervention is not for you, or you and your doctor have decided that a GLP-1 would not be good for you, I am equally happy to work with you! This is a very individual decision, and only you and your doctor can decide if a GLP-1 would be right for you.