Yves here. While this Richard Murphy post makes a valid point about the failure to sustain weight loss after going off GLP-1 agonists, I have to take issue with his contention that fatties just need to man (or woman) up and give up their bad habits to get and keep weight off.
I went on my first diet when I was 11. This was my idea, not my parents’. My BMI was in the overweight as opposed to obese category, but I was very large for a kid those days (in height as well, another story). I got 25 lbs off, more than the average weight loss with Ozempic. It came back on over 2 years. I went on another diet, then taking off 30 lbs. It again largely came back over the next two years.
Mind you, this is as a young person when it is theoretically easier to lose weight.
The dirty secret, even with young people, is when you engage in calorie restriction (aka dieting), unless you do in in a very particular way (periodically but far from regularly eating a “normal” calorie level; exercise routines designed to generate lactic acid, which increases growth hormone and therefore raises your metabolism, can also help), your body thinks you are starving and downregulates your metabolism. So when you stop dieting, you are if anything more inclined to gain weight due to the diet-induced slowdown in your metabolism.
As an adult, I found the only way to keep weight off after my see-saw diets in my teens (there were a couple more) was to permanently restrict my intake to 1000 or so calories a day. The NIH should be paying me for being on my own long-term severe calorie restriction experiment (animal studies suggests it increases longevity). lAnd starting at age 25, I was also exercising an hour or so a day (pretty hard cardio + some calisthenics, later cardio + weight training).1
Admittedly, this is n=1. But my own experience illustrates that once you become fat, it is hard to reverse that and sustain the reduction. So I’m not keen about finger-wagging at the overweight, at least on the basis that they should be able to pull themselves up by their bootstraps. Most of the advice about getting and keeping weight off is terrible even before getting to fads. So no wonder the overweight take magic pills.
The key, as RFK, Jr.s MAHA indicates, is to improve diet and lifestyles so fewer people fall into the overweight trap, particularly young people. But neoliberalism and other practices work against that. Children no longer walk to and from school. My impression is that middle and upper class parents drive them to their play dates, rather than the kids getting their under their own power, usually bikes. Recesses are shorter than when I was young.
Neoliberalism also has resulted in less involvement by parents in community activities, like fathers playing softball, which would also serve as a model for their offspring.
Perhaps IM Doc will disagree, or some readers will say it was easy for them to shed pounds and keep them off. But I was diligent as an adult, to the extent that I did things like reading bodybuiding magazines for weight loss and supplement tips (bodybuilders are bleeding edge on weight loss methods, since they have to get “cut” for contests) and experimenting with quite a few diet and supplement fads. And I was still unable to relent on my draconian eating self-discipline, which I doubt many could maintain long-term.
By Richard Murphy, Professor of Accounting Practice at Sheffield University Management School and a director of the Corporate Accountability Network. Originally published at Funding the Future
The Guardian has reported this morning that:
People on weight loss drugs regain all the weight they have lost within a year of stopping the medication, analysis has shown.
Analysis of 11 studies of older and newer GLP-1 weight loss drugs by the University of Oxford found that patients typically lost 8kg on weight loss jabs but returned to their original weight within 10 months of stopping them.
The study, presented at the European Congress on Obesity, found that even for those taking newer, higher-dose weight loss drugs such as Wegovy and Mounjaro, people put weight back on once they stopped treatment.
Why note this? That is because what this evidence makes very clear is what I have been suggesting on this blog for a while, and that is that the purpose of these drugs is not to solve the problem of obesity. It is instead intended to create a new form of dependency, or even addiction. In this case, this dependency is on the weight loss drugs that the person becomes totally reliant upon to maintain their body image, and so their mental health, whatever the physical health side effects might be (and they can be serious, with significant potential long-term costs to the NHS).
The serious medical side effects of these drugs are ignored by most of their users. They want the dopamine hit of being slimmer without having to adjust their lifestyles, or to address the other addictions that they must shake off if they are to achieve sustainable weight loss. Those addictions are most especially to sugar and carbohydrates.
The GLP-1 drug industry is not, I suggest, interested in the side effects of its drugs. These are, as far as it is concerned, an economic externality that they can ignore as someone else (the state) will bear that cost.
And they are definitely not interested in suggesting that the other addictions that those who become dependent on their drugs might have be addressed, because if they were, then the steady flow of new sugar and carbohydrate addicts on which their business model now depends will be impacted.
Most bizarrely, the NHS, whose job it should be to see through all this and rise above it, very clearly does not do so. It has been captured by commercial interests whose only interest is in promoting addiction or dependency, at the very least.
All the GLP-1 drugs have done is add another drug on which people can become dependent, quite possibly for life, to the vast array that the NHS already spends a fortune on to keep the medical-pharmaceutical industry in the extraordinary level of profits to which it has become accustomed, without ever actually solving almost any of our real health problems, to all of which it turns a blind eye, as to address them would reduce their future earnings.
There is a sickness at the heart of the NHS in the form of drug companies, who are fleecing us all.
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1 I am now weirdly able to eat more but still less than a normal person since moving to Thailand; I attribute it to being in >80 degree temperatures nearly all the time.
The key to a normal weight is proper nutrition which is nearly impossible to achieve these days due to work-life balance. It requires an enormous effort not only on the part of an individual but the whole family.
I found the following book insightful, it put together lots of things I already new in a broad picture I could comprehend:
https://www.penguin.co.uk/books/464609/what-your-doctor-eats-by-stokholm-dr-camilla/9781785045431
Its about what you cut our or don’t eat e.g. metabolism killing stuff. After that its about intermittent exorcise and not 1 hr hectic gym sessions e.g. treadmills are hamster wheels in more than one way and pumping weights for big muscle for aesthetics is marketing ploy since antiquity.
Yet at the end of the day genetics always is in play …
You likely were never fat.
One you become fat, it takes virtually no calories to maintain it. It is extremely difficult to shed and keep off. There is actually a lot of evidence that supports the existence of that problem. Merely creating a calorie deficit (undereating and/or exercising) downregulates the metabolism (unless you follow particular protocols so as to avoid that). You have to stay at the lower level of intake to keep the weight off.
I know you mean to help, but please do not sell simplistic solutions. As a former fattie who struggled for over a decade to get it under control and then has had to treat food as an enemy for the rest of my life (and yes, has also tried many diet fads, all of which were based on “healthy foods” before getting to their claimed special wrinkle), you are insulting just everyone who has had a long-standing issue with weight control and labored earnestly to try to combat it. And that’s before considering another big (in both senses of the word) group, post menopausal women.
I know tons of people in NYC, where it is easy to buy prepared healthy foods, and who are also at an affluent enough level to be able to afford to take time to exercise (on top of normal NYC walking, which is a lot) to disprove your contention. They were obsessively careful and either could not lose the weight or would lose it and have it come back in a year or two.
I even heard one man talking to his daughter (who I inferred was a regular at various fat loss/health oriented residential program): “So how much did it cost you for each pound you lost this time? $1,000?” And I could further infer that she was moaning about how careful she was about following nutritionist advice between her fat loss retreats.
Yes, eating “bad” food causes problems, including often packing on pounds. But if you are overweight, the idea that “eating healthy” is a magic weight loss remedy is a canard.
The most effective diet approach, keto, (by using a metabolic trick, putting your body into ketosis), is almost certain to be unhealthy on a long-term basis, since the restrictions on eating carbs amount to restriction on eating fruit and veg, which contain many micronutrients.
And what is healthy food?
Pasta was good for you before being bad for you.
Coffee was bad for you before now being OK for you.
Beef was bad for you but now is OK or maybe even good for you if grass fed.
Kale was good for you but now maybe isn’t due to heavy metals: https://www.delish.com/food/a43162/kale-poison-thallium/
Low fat was good for you but now maybe isn’t.
Red wine was good for you in moderation but now is bad because any alcohol is now bad.
The jury has long been out on soy products like tofu
Whole eggs were bad for you because cholesterol in the yolk but eggs increasing blood cholesterol is deemed not to be true so eggs are OK.
Tea seems to be ever and always OK but you can’t live on that.
So I just started on one of the GLP-1s. In my mid-50s, certainly not obese but definitely tilting into overweight. I have some problematic arthritis, which the weight was not helping, and my cholesterol was starting to tick up to unhealthy levels. Plus some family members with diabetes and didn’t want to go that route.
I’ve done the diet thing before, successfully, and kept the weight off for extended periods (over a year). But it does take a lot of mental energy (for me anyway, I definitely have a sweet tooth.) Being under stress tends to undermine the ability to keep weight off, and life is exceptionally stressful right now as a matter of course. I exercise reasonably regularly but my experience has been that weight is 90% diet and 10% exercise. Exercise for me is about being fit in cardiovascular and strength terms and has little impact on how I tip the scale.
So, opted to try GLP-1s. Basically my experience is they just make sticking to a lower calorie diet much much easier. My animal brain’s messages to go have a snack, or clean my plate, have been quieted. So my higher brain doesn’t have to play bad cop and can focus on other things. Have experienced zero side effects which is great.
The current plan is to be on them for about six months, get down to my target weight, then get off and see how it goes. Being on the GLP-1 has made it far easier to change my eating routine to be healthier so the plan is to stick to that routine. It’s much easier to keep a routine than it is to start a new one, so I’m optimistic that the weight won’t come zooming back.
You indirectly confirm the issue. You got the weight off but it came back. This is the not-acknowledged problem, that creating a calorie deficit (unless you diet in a particular way to avoid that, and I did not know to do that when young) = downregulation of metabolism = even greater propensity to gain weight once you stop dieting.
I have found it a loosing battle with weight. It’s always 3 pounds off – 5 pounds on; uptrend since I hit 40. Low/slow metabolism people have a very tough life weight wise.
All natural diets where we literally make everything at home from raw natural ingredients is possible with a bunch of planning and effort. What I have found is that calories are still calories when it comes to keeping weight off for me.
What’s astonishing and astounding is the cost of these meds. A family of 4 can buy all natural ingredients, fruits and veggies for the cost of what it takes 1 adult to be on these drugs in the US!
I wish we had common sense health policy where we give folks like me time/access to affordable trainers/dietician’s/therapists as needed AND subsidize fresh fruit/veggies/wholesome food instead of burning money on these meds.
Do note, that I am just referring to folks for whom these drugs are a choice not a requirement for medical reasons.
Why are we collectively less smart as humanity, as opposed to having individual intelligence amplified for good outcomes?
This is another example of a medication for something that creates dependency when there are alternatives (albeit with their own costs…. apart from an increasing number of specific areas of cancer, medicines are often a zero sum game).
I started thinking about this when I had to fly to Sydney. Dad and I suffered chronic insomnia from childhood but of course while a GP will give you a “classic” sleeping pill (7-10 days worth in UK) to reset your sleep schedule, they won’t give you more because of dependency and trust you’ll just go away.
I discovered by chance that sub-clinical dose of amitriptyline cured my insomnia. I had been given it for neuropathic pain. GP happy to leave me on it and all was well for 10 years. Then the weird “doing stuff in my sleep” started (long before people like Roseanne blamed adderall etc for night time inflammatory tweets!). Psychiatrist instantly said some people have this reaction and I’m never ever to touch it again. But gave me subclinical dose of quetiapine instead which has worked now for 15 years.
Returning to my core point, out of the box thinking is required. There ARE medications for other things that have known high degree of appetite suppression. They come with a whole host of caveats (why most doctors hate them) but we have had them since 1970s and they work a treat.
Caffeine and stimulants generally are appetite suppressants.
But again at risk of oversharing, I am never hungry. Maybe once in 18 months I’ll get a weird gnawing sensation in my stomach and realize, “Oh, THAT must be what hunger is like.”
Not having any body signals at all as to when to eat (save getting in a bad mood or a headache and realizing it’s low blood sugar) is a problem.
Wellie, if anyone needs a long term lab rat for Tirzepatide (Zepbound) I’m your huckleberry. I intend to take it until the day there is sad singing, slow driving, and (maybe?) women crying. In 18 months, I am down from 285 to 210, with another 20 or 25 to go. My doctor says my bloodwork has never been better. I would like to hit 185, because among other reasons, that was the weight class I had to wrestle in as an 8th grader when I was 13 years old. I yo-yo dieted and regained my actual bodyweight at least 3 times over the long life.
I started with the less expensive compound pharmacy version for most of the weight loss, but recently was approved by my Medicare supplement plan for the Big Pharma version due to sleep apnea. I am eating clean and am much more active than I was previously. Yes, I am making the requisite lifestyle changes. No, this isn’t a vanity project.
Perhaps I should be more concerned about long term ramifications, but at 71 yo I am chronologiclly running out of runway to begin with. It’s want to be able to walk that ruway without stopping every 50 feet to catch my breath!
Faced with endocrine disruptors added to processed foods and food packaging, crop varieties bred and treated for mechanization/shelf life rather than nutrition, and concentrated feedlot, junk food/endocrine disruptor fed meats, dairy and eggs, the challenges are major. Lack of inexpensive addiction treatment and better foods doesn’t help, while commodity crops are subsidized. Higher PFAS levels in our water is not the answer.
Be kind to yourself and others