Everything You Need to Know

For those who reside in a bigger physique, typically it seems like you may’t win.

For those who don’t shed some pounds, individuals will criticize you for being “lazy,” “unhealthy,” or “missing willpower.”

However for those who take remedy that will help you, you’ll be criticized for “dishonest” or “taking the simple approach out,” even for those who’ve tried for a long time to handle your weight by means of weight loss plan, train, and way of life modifications (typically excessive ones).

On this article, we’ll be speaking a few extremely contentious group of medicines—GLP-1 receptor agonist medication akin to semaglutide (Ozempic, Wegovy, Rybelsus) or tirzepatide (Mounjaro, Zepbound).

And other people have tons of opinions about them.

However the opinion that issues most? Yours.

At PN, we’re remedy agnostic.

We’re not right here to evaluate whether or not an individual ought to or shouldn’t take remedy for weight reduction. Finally, that’s a selection left as much as you, with the steering of your major care doctor.

Both approach, we’re right here to help our purchasers and elevate their outcomes.

Whether or not you are taking remedy or not, a coach may also help you optimize diet and satiety with the appropriate meals, discover workouts that work along with your altering physique, and enable you to navigate the emotional ups and downs that come if you try and sort out an enormous, significant, long-term objective.

Nonetheless, we additionally perceive that for those who’re debating the professionals and cons of starting (or persevering with) remedy, you might need blended emotions.

For those who’re undecided if these new medicines are best for you, we now have your again. Within the following article, we’ll provide the sincere, science-backed data you could make a assured resolution.

You’ll be taught…

• Why it’s so laborious to lose (and maintain off) fats
• Why taking remedy isn’t “dishonest,” neither is it the “straightforward approach out”
• How GLP-1 medication work, and the well being advantages they’ll have (except for weight reduction)
• The way to decide for those who’re at a “wholesome weight” (it’s not nearly BMI)
• What actions you may take to decrease uncomfortable side effects and maximize long-term well being, for those who do determine to take these drugs

Let’s start.

First, why is it so laborious to lose fats?

Fats loss is laborious. Interval.

However for some individuals, it’s tougher nonetheless—due to environmental, genetic, physiological, social, cultural, and/or behavioral elements that work towards them.

Listed below are just a few of the contributing elements that may make fats loss so difficult.

We reside in an surroundings that encourages a caloric surplus.

Think about life 150 years in the past, earlier than automobiles and public transit have been invented. To get from level A to level B, you needed to stroll, pedal a bicycle, or experience a horse.

Meals was typically in brief provide, too. You needed to expend energy to get it, and meals would simply fulfill you (however not depart you “full”).

As we speak, nevertheless…

“We reside in an obesogenic surroundings that’s stuffed with low cost, highly-palatable, energy-dense meals [that make overeating calories easy, often unconsciously],” says Karl Nadolsky, MD, an endocrinologist and weight reduction specialist at Holland Hospital and co-host of the Docs Who Lift podcast.

“We even have numerous conveniences that scale back our bodily exercise.”

After all, even in such an surroundings, we now have individuals in lean our bodies, simply as we now have individuals who wrestle to cease the dimensions from repeatedly creeping up.

Why?

Genetically, some individuals are extra predisposed to weight problems.

Some genes can result in extreme weight problems at a really early age. Nonetheless, these are fairly uncommon.

Way more widespread is polygenic weight problems—when two or extra genes work collectively to predispose you to weight acquire, particularly if you’re uncovered to the obesogenic surroundings talked about earlier.

Individuals who inherit a number of of those so-called weight problems genes are likely to have significantly persistent “I’m hungry” and “I’m not full but” indicators, says Dr. Nadolsky.

Weight problems genes additionally appear to trigger some individuals to expertise what’s colloquially often known as “meals noise.”

They really feel obsessive about meals, regularly pondering, “What am I going to eat subsequent? When is my subsequent meal? Can I eat now?”

Physiologically, our bodies have a tendency to withstand fats loss.

For those who acquire a number of fats, the hormones in your intestine, fats cells, and mind can change the way you expertise starvation and fullness.

“It’s like a thermostat in a home, however now it’s damaged,” says Dr. Nadolsky. “So when individuals lower energy and weight goes down, these physiologic elements work towards them.”

After shedding weight, your intestine might regularly ship out the “I’m hungry” sign, even for those who’ve just lately eaten, and even if in case you have greater than sufficient physique fats to function a calorie reserve. It additionally would possibly take extra meals so that you can really feel full than, say, another person who’s by no means been at the next weight.

Being in a bigger physique typically means being the recipient of fats stigma and discriminatory remedy.

Till you’ve lived in a bigger physique, it’s laborious to consider how totally different the world would possibly deal with you.

Our purchasers have informed us tales about being bullied on the health club, brazenly judged or lectured on the grocery retailer, and in any other case being subjected to innumerable feedback and assumptions about their physique form, well being, and even value.

Even in medical settings, individuals with weight problems usually tend to obtain poor remedy.^{1, 2} Healthcare suppliers might overlook or downplay signs, attributing well being considerations solely to weight. This may result in delayed- or missed diagnoses or simply plain outdated insufficient care.

All of this mixed can add as much as an extremely pervasive and ongoing supply of stress.

This stress—along with being socially isolating and psychologically damaging—can additional contribute to elevated urge for food and pleasure from high-calorie meals, decreased exercise, and poorer sleep high quality.³

Which is why…

Taking remedy isn’t an “straightforward approach out.”

In 2013, the American Medical Affiliation categorized weight problems as a illness.

And but, many individuals nonetheless don’t deal with it as such, and reasonably contemplate weight problems as a willpower drawback, and the consequence of merely consuming an excessive amount of and shifting too little. (The treatment: “Simply strive tougher.”)

In actuality, individuals with weight problems have as a lot willpower as anybody else.

Nonetheless, for them, fats loss is tougher—for all the explanations talked about above, and extra.

So, identical to chemotherapy or insulin isn’t “the simple approach out” of most cancers or kind 1 diabetes, remedy isn’t “the simple approach out” of weight problems.

Somewhat, remedy is a device, ideally used alongside wholesome way of life behaviors, that may assist offset among the genetic and physiological variances that individuals with weight problems might have, and have little particular person management over in any other case.

What you could learn about GLP-1 medication

In 2017, semaglutide (a synthentic GLP-1 agonist) was authorised within the US as an antidiabetic and anti-obesity remedy.

With the emergence of this class of medicine, science provided individuals with weight problems a comparatively protected and accessible strategy to shed some pounds long-term, as long as they continued the remedy.

How Ozempic and different weight problems medicines work

Present weight reduction drugs work primarily by mimicking the perform of glucagon-like peptide 1 (GLP-1), a hormone that performs a number of features:

• Within the pancreas, it triggers insulin secretion, which helps regulate blood sugar (and in addition helps you’re feeling full).
• Within the intestine, it slows gastric emptying, affecting your sensation of fullness.
• Within the mind, it reduces cravings (the will for particular meals) and meals noise (intrusive ideas about meals).

In individuals with weight problems, the physique rapidly breaks down endogenous (pure) GLP-1, making it much less efficient. Consequently, it takes longer to really feel full, meals supply much less endurance, and meals noise turns into a near-constant companion, says Dr. Nadolsky.

Semaglutide and comparable medicines flood the physique with synthetically made GLP-1 that lasts for much longer than the GLP-1 the physique produces. This long-lasting impact helps enhance emotions of fullness, scale back between-meal starvation, and muffle cravings and meals noise.

Curiously, by calming down the mind’s reward middle (the a part of the mind that drives cravings and even addictions), these medicines may additionally assist individuals scale back addictive behaviors like compulsive ingesting and playing, says Dr. Nadolsky.

Notice: Newer weight reduction medicines, for instance tirzepatide, mimic not solely GLP-1, but in addition one other hormone referred to as gastric inhibitory polypeptide (GIP). Like GLP-1, GIP additionally stimulates post-meal insulin secretion and reduces urge for food, partly by reducing gastrointestinal exercise. Different medication quickly to come back available on the market, like retatrutide, mimic a 3rd hormone, glucagon.

How efficient are GLP-1 medication?

Researchers measure a weight reduction drugs’s success primarily based on the proportion of people that attain key weight reduction milestones of 5, 10, 15, or 20 p.c of their weight.

These medicines are nonetheless evolving, however to this point, they’ve proven to be fairly efficient:

About 86 p.c of people that take GLP-1 medication like Ozempic, Rybelsus, and Wegovy lose not less than 5 p.c of their physique weight, with a few third of them dropping greater than 20 p.c of their physique weight.^{4, 5}

And newer technology variations of those drugs—akin to tirzepatide, and the not-yet-FDA-approved retatrutide—are solely getting higher, with as much as 57 p.c of individuals dropping greater than 20 p.c of their physique weight.^{6, 7}

How do weight reduction drugs examine to way of life interventions?

Prior to now, weight reduction interventions have targeted on way of life modifications like calorie or macronutrient manipulation, train, and typically counseling.

Somewhat than pitting way of life modifications towards weight reduction medicines or surgical procedure, it’s extra useful to consider all of them as appropriate gamers.

With way of life modifications and training, the typical individual can anticipate to lose about 5 to 13 p.c of their physique weight.

Once you add FDA-approved variations of GLP-1 and different weight-loss medication to way of life and training, common weight reduction jumps up one other ten p.c or extra. ^{8, 9, 10, 11}

Fats loss typically comes with highly effective well being advantages

For years, the medical neighborhood has informed people that dropping 5 to 10 p.c of their physique weight was ok.

Partly, this message was designed to right-set individuals’s expectations, as few lose rather more than that (and maintain it off) with way of life modifications alone.

As well as, this modest weight reduction additionally results in measurable well being enhancements. Lose 5 to 10 p.c of your complete weight, and also you’ll begin to see blood sugar, ldl cholesterol, and stress drop.¹²

Nonetheless, dropping 15 to twenty p.c of your weight, as individuals are likely to do after they mix way of life modifications with second-generation GLP-1s, and also you do rather more than enhance your well being. You may go into remission for a number of well being issues, together with:

• Hypertension
• Diabetes
• Fatty liver illness
• Sleep apnea

Meaning, by taking a GLP-1 drugs, you would possibly give you the chance finally to cease taking a number of different medication, says Dr. Nadolsky.

Consultants suspect GLP-1s might enhance well being even when no weight reduction happens.

“The medicines appear to supply additive advantages past simply weight discount,” says Dr. Nadolsky.

Analysis signifies that GLP-1s might scale back the chance of main cardiovascular occasions (coronary heart assaults and strokes) in individuals with diabetes or coronary heart illness.^{13, 14, 15} In individuals with diabetes, they appear to enhance kidney perform, too.¹⁶

The idea is that organs all through the physique have GLP-1 receptors on their cells. When the GLP-1s connect to those receptors within the kidneys and coronary heart, they appear to guard these organs from injury.

For that reason, in 2023, the American Heart Association listed GLP-1 receptor agonists as one of many yr’s high advances in heart problems.

7 methods to make weight reduction medicines simpler—and enhance long-term well being

Right here’s what we consider:

Weight reduction medicines don’t render way of life modifications out of date; they make them extra vital.

When GLP-1 medicines muffle meals noise and starvation, many discover it simpler to prioritize lean protein, fruits and veggies, complete grains, and different minimally processed meals. Equally, as the dimensions goes down, individuals typically really feel higher, in order that they’re extra more likely to embrace weight lifting and different types of train.

Certainly, based on a 2024 shopper traits survey, 41 p.c of GLP-1 drugs customers reported that their train frequency elevated since occurring the remedy. The vast majority of them additionally reported an enchancment in weight loss plan high quality, selecting to eat extra protein, in addition to fruit and veggies.¹⁷

That is nice information, as a result of it additional reinforces the concept that remedy isn’t merely “the simple approach out.”

(After all, typically medication are used as “the simple approach out”; After occurring remedy, individuals can proceed to eat poor high quality meals—simply much less of it. This will increase the chance of dropping vital muscle and bone, and dropping much less—and even no—physique fats.)

When used accurately, weight reduction remedy is a device that, as talked about above, could make wholesome way of life modifications simpler to perform, making each the medication and the life-style modifications simpler, and enhancing each short- and long-term success.

For those who do determine to take weight reduction medication, use these methods to get essentially the most out of them—and protect your long-term well being.

Technique #1: Discover methods to eat nutritiously regardless of uncomfortable side effects.

The slowed abdomen emptying attributable to GLP-1 medication can set off nausea and constipation.

Fortuitously, for most individuals, these GI woes are likely to resolve inside a number of weeks.

Nonetheless, for those who’re experiencing a number of nausea, you’re not going going to welcome salads into your life with open arms. (Consider how you’re feeling when you’ve the abdomen flu. A bowl of roughage doesn’t seem to be it’ll “go down straightforward.”)

So, attempt to discover extra palatable methods to eat nutritious meals. (For instance, fruit and veggies within the type of a smoothie or pureed soup may be simpler.)

Dr. Nadolsky additionally suggests individuals keep away from the next widespread offenders:

• Massive parts of any variety
• Greasy, fatty meals
• Extremely processed meals
• Any robust meals smells that set off your gag reflex
• Sugar alcohols (like xylitol, erythritol, maltitol, and sorbitol, typically present in weight loss plan sodas, chewing gum, and low-sugar protein bars), which may set off diarrhea in some

Technique #2: Prioritize energy coaching.

When individuals take GLP-1 weight reduction medicines, about 30 to 40 p.c of the burden they lose can come from lean mass.^{18, 19, 20}

Put one other approach: For each 10 kilos somebody loses, about six to seven come from fats and three to 4 from muscle, bone, and different non-fat tissues.

Nonetheless, there’s two essential caveats to this statistic:

1. Folks with extreme weight problems typically have extra muscle and bone mass than others. (Carrying round an additional 100+ kilos of physique weight means muscle tissues must adapt by getting larger and stronger.)

2. Muscle and bone loss aren’t inevitable. (As Dr. Nadolsky places it, “Muscle loss isn’t a cause to keep away from treating weight problems [with medication]. It’s a cause to do extra train.”)

To protect muscle and bone mass, intention for not less than two full-body resistance coaching classes per week.

As well as, transfer round as a lot as you may. Strolling and different types of bodily exercise are important for conserving metabolism wholesome—and may also help to maneuver meals by means of the intestine to ease digestion.^{21, 22}

(Want inspiration for energy coaching? Take a look at our free exercise video library.)

Technique #3: Lean into lean protein.

Along with energy coaching, adequate protein consumption is important for serving to to guard muscle mass.

You should use our free macros calculator to find out the correct quantity of protein for you. (Spoiler: Most individuals will want 1 to 2 palm-sized protein parts per meal, or about 0.5 to 1 gram of protein per pound of physique weight per day.)

Technique #4: Fill your plate with fruit and veggies.

Moreover being good in your general well being, complete, recent, and frozen produce fuels you with vital vitamins that may assist drive down ranges of irritation.

Along with elevating your threat for illness, continual irritation can block protein synthesis, making it tougher to take care of muscle mass.

(Didn’t know managing irritation issues in relation to preserving muscle? Discover out extra muscle-supporting methods right here: How to build muscle strength, size, and power)

Technique #5: Select high-fiber carbs over low-fiber carbs.

Beans, lentils, complete grains, and starchy tubers like potatoes and candy potatoes do a greater job of serving to you’re feeling full and managing blood sugar than lower-fiber, extra extremely processed choices.

(Learn extra concerning the drawbacks—and occasional advantages—of processed meals right here: Minimally processed vs. highly processed foods)

Technique #6: Select wholesome fat.

Wholesome fat may also help you’re feeling full between meals and defend your general well being.

Gravitate towards fat from complete meals like avocado, seeds, nuts, and olive oil, in addition to fatty fish (which is a protein too!)—utilizing them to interchange much less wholesome fat from highly-processed meals (like chips or donuts).

(Undecided which fat are wholesome? Use our 3-step guide for choosing the best foods for your body)

Technique #7: Contemplate teaching.

It might go with out saying, however the above ideas are simply the beginning.

(There’s additionally: high quality sleep, social help, stress administration, and extra.)

Whereas many individuals select to sort out these methods on their very own, many others discover that the help, steering, and artistic problem-solving {that a} good coach can present makes the entire course of so much simpler—to not point out extra satisfying and extra more likely to stick.

And that’s the actual present of teaching: A coach doesn’t simply assist you determine what to eat and easy methods to transfer; They enable you to take away limitations, construct expertise, and create methods and routines in order that habits turn into so pure and computerized that it’s laborious to think about not doing them.

Then, for those who do wish to cease taking remedy, your ingrained way of life habits (that teaching strengthened, and medicine maybe made simpler to undertake) will make it extra seemingly that you simply preserve your outcomes.

References

Click on right here to view the knowledge sources referenced on this article.

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