Losing that last 15 pounds: Is Ozempic or a simple diet tweak better?
Many people want to lose 5, 10, or 15 pounds. Some want to lose even more. Many have made efforts in the past that didn’t work. When they hear that Ozempic and other GLP-1 receptor agonists are all the rage in Hollywood, they start asking questions.
But first, here is the question I want everyone to ask before starting any new medicine or adjusting their lifestyle: Could I continue this for the rest of my life? Any plan that requires you to be hungry, invest a ton of time and money that you don’t have, or eat things that you don’t like or don’t satisfy you WILL NOT WORK.
What are the biggest downsides of Ozempic and similar drugs?
The three major downsides are significant. First, most insurance will not cover them. That means they cost at least $1000 per month. Second, once you go on these medicines, it currently appears that you need to stay on them for life or you will gain the weight that you lost back.
The third downside is a huge enthusiasm killer for many: the research indicates that you lose A LOT of muscle when you go on these medicines. For example, in a subgroup analysis of the STEP-1 trial data, patients lost an average of 38 pounds on Ozempic during the study, but 40% of the weight they lost on Ozempic was lean muscle!! I am very concerned that patients who decide to stop taking these drugs will regain the fat they lost but not the muscle!
How do these medicines work?
GLP-1 receptor antagonists change some hunger hormone levels and slow down how quickly your gut digests and excretes food, reducing hunger significantly. They trigger insulin release and block glucagon release, which help lower blood sugar levels.
What is the benefit?
These medications help diabetics control their blood sugar and they help everyone who takes them eat less. Other important benefits that most people aren’t aware of include lowering cholesterol and triglyceride levels, lowering blood pressure, as well as reducing the risk of fatty liver disease and heart disease.
What are the risks?
GLP-1 receptor antagonists cause loss of appetite, of course. They may also cause other intestinal issues like nausea, vomiting, indigestion, constipation or diarrhea. In some cases, the nausea and vomiting can be extreme and last for weeks or months. Less commonly, patients can get severe reactions like pancreatitis (inflammation of the pancreas), medullary thyroid cancer, serious allergic reactions, and other major health problems.
What is an alternative?
My patients are getting excellent results with managing their weight on a complete health optimization plan, but that requires DNA analysis, labs, and lifestyle analysis. Without knowing more about a patient, there are two simple things that have been proven to really facilitate weight management in most people. And they don’t require you to be hungry.
Increase your protein intake a lot, to the range of 0.75 gram per pound of body weight. This works best if you are active and getting exercise. Several clinical trials have found that consuming more protein than the recommended dietary allowance - without reducing your caloric intake - not only reduces body weight, but also enhances body composition by decreasing fat mass.
Increase fiber supplementation. In combination with a high protein diet, increasing your fiber supplementation by sprinkling 1 tbsp of organic whole psyllium husk over each meal helps you feel more satisfied by your meal and helps change your gut bacteria (microbiome) in ways that can help you lose weight.
My recommendations
Once I know a patient’s genetics and what types of fuel and nutrients their body is craving, I can give them a precision nutrition and exercise plan that helps them feel much better, manage their weight, and improve their health. But, even if we don’t know your specific genetic needs, most people find that making the simple changes listed above helps them reduce their hunger and improve their body mass composition. If someone needs Ozempic because their situation is serious, I am happy to prescribe it. They just need to know the drawbacks and alternatives first.
