Embarking on a journey to address obesity through medication is a significant decision that requires careful consideration. In this exploration, we delve into the key aspects of using medication, specifically focusing on Semaglutide, as a potential tool in the battle against obesity.
From safety concerns to effectiveness and beyond, let’s navigate the landscape of medication for obesity to equip you with the essential knowledge needed for an informed decision.
What is the medical definition of obesity?
The most common text message I’ve received lately as a Certified Personal Trainer and nutrition coach is about Semaglutide. A friend used it for 6 months and lost over 30 lbs. People often start with lifestyle changes for weight loss but face challenges like time constraints and plateaus. Some consider bariatric surgery, but it comes with risks. GLP-1 agonists, like Semaglutide, are gaining popularity. Are weekly injections the solution to obesity?
Medically, obesity is defined by BMI, with 30 kg/m2 or higher classifying as obese. Alarming 2023 stats reveal 3 in 4 adults and 1 in 5 youths are overweight, over 40% falling into obesity. Despite diet and exercise messages, obesity rates persist, demanding swift action. The lasting impact on health underscores the need for nuanced understanding and effective interventions.
Treatments for Obesity
The tried and true (and of course supported by many years of evidence) weight loss method is…we have all heard it before…diet, exercise, and lifestyle modification. Creating an energy deficit while at least maintaining lean body mass and getting enough nutrients to promote overall good health is how to achieve victory.
However, in the tournament of maintaining lean mass while squashing fat mass, unfortunately, slow and steady often wins this race. This may make this option less appealing to those seeking fast results, however, it should make up the cornerstone of any diet and weight loss program and the best results will occur with a solid playbook and the right team in place to support you.
Playbook Tip #1: Diet Changes
You can start building your team by consulting with a registered dietitian nutritionist (RDN) who can be helpful at setting up a nutrition plan to aid in weight loss while not compromising overall health. Consultation with a Certified Nutrition Coach can aid you in staying accountable to this plan.
A sensible nutrition plan for weight loss should include:
- A moderate caloric deficit (300- 750 kcal/day deficit depending on body size).
- A diet high in protein (1.4 to 2.0 g/kg of ideal body weight/protein per day)
- Consumption of foods high in nutrient density for calories. For instance, choosing carbohydrate sources from fruits and whole grains rather than sweets.
- A diet high in fiber which is at least 25 g per day for females and 35 g per day for males (Kim, 2020; Cheatham et al., 2023; Moon & Koh, 2020).
Avoid a nutrition plan that:
- Cuts out entire food groups (i.e., restrictive diets or diets extremely low in one macronutrient).
- Recommends very low caloric intake unless prescribed by a physician.
- Is so restrictive that following it long-term is very difficult.
- Interferes with medications or treatments for pre-existing health problems (Kim, 2020; Cheatham et al., 2023; Moon & Koh, 2020)
Playbook Tip #2: Exercise Changes
A great team member to consult first can be a primary care doctor or trusted health care provider who can give you some basic guidelines for creating a sustainable exercise program. However, it may also be helpful to hire a professional coach, or Certified Personal Trainer who is specially trained to design exercise programs. A Certified Personal Trainer will not only create a customized program for your goals but will also hold you accountable and coach you through your programs when consistency becomes difficult.
A solid program to get the proverbial exercise ball down the field should include:
- Aerobic exercise for 150 to 300 minutes a week (moderate intensity) 75 to 150 minutes a week (vigorous exercise), or a combination of both. It is important to note that a daily brisk walk could easily meet this guideline (Cheatham et al., 2023).
- A resistance training regimen consisting of at least 2 sets of 10-15 repetitions of each muscle group on average 2-3 times per week with a frequency of 3 times per week achieving better results, especially in older adults (Yang, 2019).
- Monitoring daily physical activity (i.e., step counts) and ensuring daily totals amount to at least 7,500 to 10,000 steps per day. (Cheatham et al., 2023; Yang, 2019, El Fatouhi et al., 2021)
Playbook Tip#3: Lifestyle Changes
There is more to weight loss than just diet and exercise. In fact, lifestyle habits such as quality sleep, stress management, and self-care can be equally important. In this arena, your healthcare provider and Certified Wellness Coach have your back and can support you to implement some strategies to help you improve this skillset.
A home run of a wellness/self-care program should include:
- Quality sleep and good sleep hygiene – Prioritize sleep for better body composition and weight loss. Aim for 7 hours nightly, enhancing sleep quality with a pre-sleep ritual. Avoid electronics, late-night snacking, work stress, or screens (including TikTok) 30 mins before bed. Consistent sleep and wake times amplify these benefits.
- A stress management plan – This can include self-care activities such as massage therapy, acupuncture, time with friends, time spent outdoors, or playing with pets. It can also be helpful to work with a Certified Wellness Coach on setting limits on obligations and ensuring enough time to rest and recover.
- Seeking treatment for mental health conditions including but not limited to eating disorders. Binge Eating Disorder is very common in individuals with obesity and can often stem from past trauma. It is critical to seek appropriate treatment if this situation applies to you. (Papatriantafyllou et al., 2022; National Institutes of Health, 2011; Palmisano et al., 2016)
If diet, exercise, and lifestyle changes are not quite enough to bring it home with your weight loss game, you can consider an assist.
Medical Procedures
There are several procedures that aim to induce weight loss by reducing the size of the stomach or creating malabsorption of nutrients. It is important to note that there are strict criteria to be considered a candidate for these procedures.
- Gastroplasty (endoscopic sleeve) is a newer surgical option to reduce the volume capacity of the stomach by essentially shrinking the stomach from the inside without removing pieces of the stomach or rerouting the GI tract in any way.
- Gastric banding was a popular surgical option that has fallen out of favor in the last 5 to 10 years due to complication rates but may still be used. The procedure uses a band to reduce the size of the stomach creating early satiety (fullness) with eating.
- Sleeve gastrectomy also aims to reduce the size of the stomach by removing a portion of the stomach.
- Biliopancreatic diversion and Roux-en-Y (gastric bypass) involves both shrinking the stomach, reducing the amount of food that can be eaten, and rerouting the GI tract to induce nutrient malabsorption. (Mayo Clinic, 2019)
Anti-Obesity Medication
You might consider medication if surgery feels overwhelming or if your healthcare provider suggests a more conservative approach. Anti-obesity medications, existing since the 17th century, have seen substantial advancements in the last decade. Which drugs are commonly used, and what are their pros and cons?
- Bupropion-naltrexone (Contravem, Wellbutrin) – Although these agents are commonly used to treat depression and/or aid in smoking cessation, weight loss was a noted side effect. The mechanism of action of these drugs is not well understood, but it is thought that they affect the reward centers in the brain that may be dysfunctional with chronic overeating.
- Phentermine-topiramate (Qsymia) – Until recently this was the most prescribed weight loss drug. It works by increasing the secretion of norepinephrine which in turn reduces appetite and increases energy expenditure.
- Orlistat (Xenical, Alli) – Lipase inhibitors like Xenical and over the counter Alli block gut enzymes, letting some consumed fat pass through the GI tract unabsorbed. While effective, Xenical’s results are not as dramatic as those seen with GLP-1 agonists.
- GLP-1 Agonists: Liraglutide and Semaglutide – These drugs mimic a hormone, stimulating insulin secretion for improved glycemic control and appetite suppression. Liraglutide, the first developed, requires a daily injection, while Semaglutide, a weekly subcutaneous injection, offers greater convenience and more substantial weight loss compared to Liraglutide. (Azuri et al., 2023; Cheatham et al., 2023; Kumar & Aronne, 2017)
Do you need a deeper dive into the evidence? Check out NASM’s evidence-based review on GLP-1 medications.
Are weight loss medications for obesity right for you?
Weight loss medications can be a helpful tool when diet and exercise alone aren’t enough in the battle against obesity. To qualify for these medications, a patient must typically have a BMI over 30 kg/m2 or a minimum BMI of 27 kg/m2 with associated health conditions.
However, any medication carries risks, and a healthcare provider must carefully assess each patient before prescribing. For GLP-1 medications, caution is advised if there’s a history of pancreatitis, gall bladder issues, or a personal/family history of multiple endocrine neoplasia syndrome type 2 (MEN2) and thyroid tumors. (Cheatham et al., 2023)
Side effects of anti-obesity medication
Short-term side effects of GLP-1 medications include, but are not limited to:
- Stomach issues (nausea, vomiting, abdominal pain, or distention)
- Gastrointestinal issues (diarrhea, constipation, or flatulence)
- Fatigue
- Dizziness
- Runny nose,
- Sore throat
- Headache
- Vision changes
- Allergic reactions
- Increased heart rate
- Depression
- Suicidal thoughts
Though every individual responds to drug therapies differently, in a review of the evidence, the NASM evidence-based review on GLP-1 medications points out that the most common side effects are nausea, constipation, vomiting and diarrhea though a significant proportion of users did not report adverse effects (Cheatham et al., 2023)
Do medications for obesity affect body composition?
Yes, GLP-1 medications may lead to muscle and bone mass loss, especially in older adults (over 65) and those using them for cosmetic reasons. This concern is heightened when the drugs are used solely for weight loss without proper guidance on diet, exercise, and lifestyle changes, potentially mimicking the effects of a very low-calorie diet (Cheatham et al., 2023; Zhang et al., 2021).
How long do you have to take obesity medications?
The effects of obesity medications like GLP-1 agonists only last if you take the drug. This means that without implementing changes in diet, exercise, and lifestyle habits, weight will likely be regained after discontinuing the drug. The NASM evidence-based review points out that in previous studies, participants who stopped taking GLP-1 medication regained approximately two-thirds of lost weight within a year.
Imagine yourself as a runner getting ready to do an ultra-marathon. Your training program, nutrition, and recovery are what you are relying on most heavily to get you to that finish line. It is always nice to have a high-end piece of equipment like fancy running shoes, compression clothing, or high-tech sports drinks, however, these things are only tools that give you a small edge to improve your performance.
Your diet, exercise, and wellness program will ultimately dictate your long-term success. Anti-obesity medications are simply a nice accessory to give you a temporary (or more permanent) performance edge in your race against obesity.
REFERENCES
Azuri, J., Hammerman, A., Enis Aboalhasan, Sluckis, B., & Ronen Arbel. (2023). Liraglutide versus semaglutide for weight reduction—a cost needed to treat analysis. Obesity, 31(6), 1510–1513. https://doi.org/10.1002/oby.23752
Cheatham, S., Davilla, E., Dieter, B., Bustillo, E., Fantigrassi, M., & Sutton, B. (2023). GLPT-1 Medication: An Evidence Based Review. National Academy of Sports Medicine. https://www.nasm.org/docs/nasmlibraries/pdf/glp1_medication_evidence-based_review_final-medical-10-19-23.pdf
El Fatouhi, D., Delrieu, L., Goetzinger, C., Malisoux, L., Affret, A., Campo, D., & Fagherazzi, G. (2021). Associations of Physical Activity Level and Variability With 6-Month Weight Change Among 26,935 Users of Connected Devices: Observational Real-Life Study. JMIR MHealth and UHealth, 9(4), e25385. https://doi.org/10.2196/25385
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Kumar, R. B., & Aronne, L. J. (2017, August 7). Pharmacologic Treatment of Obesity. Nih.gov; MDText.com, Inc. https://www.ncbi.nlm.nih.gov/books/NBK279038/
Mayo Clinic. (2019). Bariatric surgery . Mayoclinic.org. https://www.mayoclinic.org/tests-procedures/bariatric-surgery/about/pac-20394258
Moon, J., & Koh, G. (2020). Clinical Evidence and Mechanisms of High-Protein Diet-Induced Weight Loss. Journal of Obesity & Metabolic Syndrome, 29(3), 166–173. https://doi.org/10.7570/jomes20028
National Heart, and Blood Institute, National Institutes of Health, & U.S. Department of Health and Human Services. (2011). AMER ISBN 1-933236-04-3. https://www.nhlbi.nih.gov/files/docs/public/sleep/healthy_sleep.pdf
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Papatriantafyllou, E., Efthymiou, D., Zoumbaneas, E., Popescu, C. A., & Vassilopoulou, E. (2022). Sleep Deprivation: Effects on Weight Loss and Weight Loss Maintenance. Nutrients, 14(8), 1549. https://doi.org/10.3390/nu14081549
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