Thoughts on Obesity Medication (GLP-1 Agonists) (Update)

Pros and cons of using prescription medication in treating obesity for various populations along with recent developments regarding partnerships and shortages.

Semaglutide

Recently there has been a good amount of buzz regarding medication for obesity, both positive and negative. These compounds were developed to help control blood sugar in Type-2 diabetics, but were soon noted to have the added benefit of curbing hunger, naturally leading to fewer overall consumed calories. The most promising of these compounds appears to be the drug semaglutide (brand names Ozempic, Wegovy, Rybelsis) which is taken by injection weekly. Long term studies aren't available but short and mid term trials show relatively few risks or side effects.

In place of knee-jerk outraged dismissal or blind praise to the pharmaceutical industry let's allow room for nuance.

First let's split this into two patient populations to consider. Adults, and children.

Who Is This For?

For adults I believe this can serve as a valuable option that can be used before, and optimally in place of, more invasive procedures like bariatric surgery. I would not however turn to the permanent use of a pharmaceutical before further qualifying just who this would make sense for.

Obesity exists on a spectrum of severity. Adults who were once upon a time perfectly fit teens/young adults and over the course of years gradually packed on some pounds while never paying much mind to their physical health...they don't need medication for obesity. They need some motivation, some education, and some coaching, with a side of discipline. Where this medication truly shines is for those who have had a life long battle with morbid obesity, and those starting to face health consequences because of said battle. Especially if they report very high or endless hunger. This can give them the room to at last encounter more regulated hunger signals, jumpstarting the process to reclaiming their health by making dietary changes easier to adjust to.

For children this becomes a complex situation as they are not in control of their food environments, nor do they have independence. Though the subject is sensitive, in most instances, obese children come from obese families. Be it nature or nurture, they are a function of their home life and can't be expected to succeed without addressing the family in it's entirety. If that is being done in earnest, it can be appropriately used to serve as early intervention.

As science has unanimously shown for decades. The only permanent solution to obesity is lifestyle intervention. We now have an additional tool to aid in reaching that end goal. But this does not do the work for you.

GLP-1 agonists can be used to save lives. They can also be used (and will be used) as an unnecessary crutch, an excuse, or a pointless risk for 10 vanity pounds. All depending on how well the doctor writing the prescription is qualifying patients.

Originally posted to the Illusion's Demise Fitness Instagram on 3/3/23

Addendum: Shortages & Acquisitions

In the few weeks that have passed since I originally made this post on my Instagram page there have been a couple meaningful developments, this story seems to be shifting rapidly!

First off Sequence, a telehealth company that is a common avenue for people to get GLP-1 prescriptions for weight loss, was acquired by Weight Watchers. On the surface this is a positive development as it builds a comprehensive care plan beyond just writing a prescription, but I have some concerns. The populations who sincerely need a medication to assist in weight loss need support beyond the WW point system which does its best to obfuscate the mechanisms by which successful long term weight loss is achieved, and all but guarantees failure for those struggling with binge eating. This acquisition makes me think these drugs will not be selectively handed out to well qualified patients but will be casually shoveled out to whoever can afford them and wants to lose any amount of weight, overlapping entirely with the customer base of Weight Watchers.

More importantly however has been the shortage of these drugs. With the majority of adults in the US now being overweight or obese it is no surprise a drug promising to help resolve those challenges would become a red hot commodity. Tragically this also means that the people who need these medications for their on-label use treating the more acute health condition of Type-2 diabetes are finding their prescriptions hard to fill. There have also been numerous cases of those taking semaglutide for weight loss now facing almost immediate weight rebound with this shortage, furthering concerns that semaglutide is not being provided alongside proper lifestyle intervention support.

Ultimately, I stand by the conclusion I reached in the original post. Semaglutide is a miracle for specific populations to get them on a path to reclaiming their health. It should be reserved for more severe instances of obesity alongside a dietician and a certified fitness professional, but in practice that doesn't seem to be occurring.

-Coach Kevin