Let’s face it, the weight loss industry is a multi-billion-dollar industry and so many are jumping on the train of heavy-hitting prescriptions for weight loss. The rise in diabetes and obesity in recent decades coincides with a profound shift in our environment, including dietary patterns, sedentary lifestyles, physical inactivity, and environmental toxicities. Starting weight loss medications is a significant decision that requires careful consideration beforehand.

Underlying conditions certainly can contribute to weight concerns. Hypothyroidism, diabetes, hormonal imbalances, and nutrient deficiencies can affect weight and should be at the very least identified before or while addressing weight loss. Treatment for these underlying conditions is necessary and will support a better outcome.

There are different types of medications for weight loss available. Appetite suppressants, fat absorption inhibitors, and those that affect metabolism (such as GLP-1 agonist or should I say Ozempic, Wegovy, or Semaglutide) and understanding how they work with the pros and cons of each is important. Even if you are a good candidate for a prescription, understanding which prescription approach is right for you and other valuable tools of how you might support yourself to achieve your target weight can help you not only achieve your goal but more importantly, help you maintain your goal weight.

How Can You Activate Your Own GLP-1 for weight loss?

The newest weight loss prescriptions on the market are called GLP-1, also known as glucagon-like peptide 1. This class of drugs treats type 2 diabetes and obesity. They mimic a hormone in the body that helps control blood sugar by increasing insulin levels. They can help reduce appetite and promote feelings of fullness because they make the stomach empty slower and signal the brain that you are full resulting in less cravings. The average monthly cost is around $900-1350 which is a steep price tag and often not covered by insurance especially when there are no known comorbidities. Some common side effects often remain with continued use like nausea, vomiting, bowel changes, dizziness, headaches, and indigestion. Unfortunately, some of the more serious side effects like infections, pancreatitis, gastroparesis, bowel obstruction, gallbladder concerns, and kidney injury may not be reversible.

Did you know that foods high in protein, fiber, and healthy fats (notice I said healthy fats) naturally activate GLP-1? Therefore, making breakfast your first meal of the day and including high-quality protein that delivers at least 1/3rd or more of the necessary calories for the day, along with at least 1/3rd or more (8-10 g fiber which are good carbohydrates), and healthy fat like nuts, seeds, avocado you activate GLP-1. In addition, the protein, fiber, and fat slow down stomach emptying, regulates blood sugar, supports mood, and eliminates cravings. It also is a lot cheaper than these medications and there are no downsides…except you feeling quite full but after a while you have a lot more energy and focus (bonus!).

So before jumping on the prescription train what should you know?

• Identify your weight loss goals. Set realistic expectations and achievable goals. It is not realistic for a 45-year-old female with 2 children to maintain a weight similar to when they were 20 years old. They may be able to get to that weight (maybe) but it is very unlikely that it could be maintained without severe restrictions.

• You want to understand how to maximize your metabolic rate which is the rate at which the body expends energy or burns calories. Generally, we need to burn (exercise) or not consume a total of 1000 calories a day to lose 2 pounds a week. This means if diet and exercise is the plan for weight loss it is going to take time. If you burn 300 kcals a day on the treadmill but you have a snack of 200 calories it will take 35 days to lose 1 pound (70 days for 2 pounds) assuming you are consuming only what you need. Weight loss is not just about calories in calories out. The metabolic rate is impacted by your age, sex, genetics, body composition, and hormonal balance.

• Some supplements and other factors like your nutrient status (vitamins and minerals) are important for the various functions the body needs daily. Some supplements support the GLP-1 levels like:

1. Berberine can increase GLP-1 activity resulting in better appetite and blood sugar regulation

2. Curcumin, a natural bioactive component in turmeric can stimulate GLP-1 secretion to improve glucose intolerance

3. Ginseng can stimulate GLP-1 secretion to reduce hyperglycemia

4. Fiber which is aided by fermentation by the gut microflora produces short-chain fatty acids such as butyrate, acetate, and propionate. There is some evidence that propionate stimulates GLP-1. Aim for at least 30g of fiber daily, unfortunately, the average fiber intake is less than 15g.

5. Nutrient status and utilization of these nutrients are the signaling molecules for many bodily functions. To better understand the interplay between genes and nutrients and to plan tailored weight loss, nutrigenetic testing is becoming a key approach.

• As we age, we tend to lose muscle mass, slowing our metabolic rate and making it harder to lose weight compared to our younger selves. This is known as sarcopenia and begins around 30 years of age and accelerates after age 60. We lose roughly 6-8 pounds of lean tissue every decade. Muscle tissue is metabolically active, meaning it burns more calories at rest compared to fat tissue. Essentially, less muscle leads to a lower Basal Metabolic Rate (BMR) which translates to the body burning fewer calories at rest resulting in easier weight gain. Because men typically have more muscle mass compared to women it may be easier and quicker to lose weight.

• Exercise, both cardio (aerobic exercise) and resistance training (strength training) play crucial roles in weight management, but they serve different purposes and offer unique benefits. A combination of both is often the most effective approach for achieving and maintaining a healthy weight. Resistant exercise is most important to incorporate the older we become to maintain or improve muscle.
  

• Genetics plays a significant role in weight loss by influencing factors such as metabolism, appetite regulation, fat storage, and how the body responds to diet and exercise. While you cannot change your genetic makeup there are strategies to overcome genetic influences:

1. Personalized nutrition (aka precision nutrition) to tailor dietary recommendations based on your genetic makeup (also known as nutrigenomics). This allows you to work with a provider to develop a plan considering your genetic predispositions and metabolic responses.

2. Design an exercise regimen that aligns with your genetic predisposition, preferences, and goals while tracking your progress to ensure it remains effective and enjoyable

3. Understanding your genetic hunger and fullness cues to manage appetite and prevent overeating

4. Using techniques to manage stress to reduce emotional eating and improve overall well-being.

5. Monitor health markers and adjust to your weight loss plan

• Improving body composition is key to effective and healthy weight loss. By focusing on reducing fat mass and preserving or increasing lean body mass, you can achieve a healthier body and more sustainable weight loss. Regular assessment and a comprehensive approach that includes diet, exercise, and lifestyle modifications are essential for success.

Final Thoughts

Starting weight loss medications requires a holistic approach. Always prioritize safety and long-term health over quick results. Weight loss medications certainly can have a place. Consulting with a healthcare professional is essential to ensure that weight loss medications are appropriate and used safely as part of a comprehensive weight management plan.