Amr Bo Shanab/Getty Images/fStop
Amr Bo Shanab/Getty Images/fStop
The headlines are compelling, with sentences like: “The obesity revolution,” And “A new ‘miracle drug’ for weight loss really works.” The before-and-after photos are inspiring. People who have struggled for decades to shed pounds are finally finding an effective strategy.
Recent years have seen breakthroughs in the treatment of obesity, with new weight-loss drugs dominating recent news reports. The medications, semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound), work by slowing stomach emptying and reducing appetite. They are usually given as a weekly injection.
Clinical trials had success comparable to surgery. Celebrities like Oprah Winfrey shared encouraging personal stories.
The scientific literature behind the headlines is also impressive. Those who use the drugs lose an average of 10% to 20% of their body weight. Originally developed for type 2 diabetes, the medications are known to improve blood sugar control. In December we also learned that semaglutide appears to do that in people with cardiovascular disease who are overweight or obese reduce serious adverse cardiac events by 20%.
For general practitioners like me, who have advised thousands of patients – often without success – about their weight, this news is welcome. For many obese people, these medications can feel like a game changer.
Being overweight is linked to a range of medical problems, including diabetes, heart disease, osteoarthritis, sleep apnea and many types of cancer. It is linked to shorter life expectancy and higher disability rates. With about 40% of American adults classified as obese – and another 30% overweight – many doctors and patients are embracing the new drugs as a solution.
Medicines are not addressing the root causes of America’s health crisis
But even as many adopt the latest medications, we must recognize and address their limitations, including a lack of long-term safety data and potential side effects such as nausea, vomiting and, in rare cases, pancreatitis and gallbladder disease. Poison control centers are reporting an increase in calls due to drug overdoses, which can lead to low blood sugar and associated symptoms, such as dizziness, irritability and – in severe cases – confusion and coma.
The high price of the weight-loss drugs — typically more than $1,000 per month for each patient — is especially troubling in a country that already outspends the rest of the world on health care costs and faces wide disparities in care. Concerns about costs are reinforced by studies showing that the drugs usually need to be taken long-term to prevent weight gain.
“While these medications are powerful and wonderful tools, they are not a silver bullet,” says Jonathan Bonnet, a board-certified obesity, lifestyle, family and sports medicine physician who serves as the medical weight loss program director at the Weight Management of Palo Alto VA. Center Clinical Resource Hub.
He sees positive results in his patients, but sees cost as a major barrier. “Treating everyone with obesity in the US with drugs will bankrupt the country and still not cultivate the kind of health and vitality we actually want,” he said.
More than half of employer insurance plans in the United States, as well as Medicare, do not cover weight loss medications.
Medicines also fail to address the root causes of the problem. Obesity rates have risen significantly in recent decades and have continued to rise since the COVID-19 pandemic. a Gallup poll The study published in December found that obesity rates increased by 6 percentage points from 2019 to the current level of 38.4%. The prevalence of type 2 diabetes – a known consequence of obesity in many people – has increased from an estimated 10.3% of US adults from 2001-2004 to 13.2% from 2017-2020.
Our society’s easy access to ultra-processed, high-calorie foods and our high levels of inactivity contribute to excessive weight gain and its associated health consequences. A health care system designed for “sick” care – supported by a multibillion-dollar pharmaceutical industry that benefits when we get sick – does not prioritize disease prevention.
And while we must embrace a culture of acceptance of all body types, we also cannot ignore the fact that rising rates of obesity are part of a growing health crisis.
Real health is not just a number on a scale
Enter lifestyle medicine. This rapidly growing field focuses on the prevention and treatment of chronic diseases through the adoption of healthy habits, including a minimally processed diet rich in vegetables, fruits and whole grains; regular physical activity; restorative sleep; stress management; positive social connection; and avoiding harmful substances.
Lifestyle medicine practitioners work with patients to understand their core values and help them achieve goals — whether it’s losing 20 pounds, managing high blood pressure, or improving mood and energy.
Lifestyle medicine is cheap and has little risk. Its proven benefits extend far beyond weight loss and can be lifelong. Those who make positive lifestyle decisions, including exercising, eating right and not smoking, can reduce their lifestyle habits incidence of coronary artery disease by more than 80% and type 2 diabetes by more than 90%. They use fewer medications. They live longer and experience better mental health and less cancer, chronic disease and disability.
And a diet that emphasizes whole, plant-based foods is also better for our planet, reducing deforestation, air and water pollution, and greenhouse gas emissions from meat and dairy production.
Lifestyle medicine and the new slimming medications are not mutually exclusive. In fact, the package inserts explicitly state that these medications should be prescribed in combination with increased physical activity and a low-calorie diet.
Yet the lifestyle piece is usually glossed over. It’s not a quick fix; it requires dedication and a reexamination of personal values. It encourages us to cut back on the ultra-processed foods we like, high in added sugar and salt, which still increase the risk of heart disease, stroke and some cancers, even in those who are not overweight.
According to the American Heart Association, less than 1% of American adults and adolescents engage in all the practices recommended to achieve the ideal cardiovascular healthcovering most principles of lifestyle medicine.
New anti-obesity drugs are an important tool. But real health isn’t just about a number on the scale. Widespread adoption of the principles of lifestyle medicine would reduce health care costs, reverse the recent decline in U.S. life expectancy, and transform lives.
Opportunities for change
Because more than 82% of Americans consult a health professional each year, incorporating lifestyle medicine into these visits is an obvious way to reach those who need support. But healthcare providers are often unprepared to provide the kind of intensive coaching needed.
A 2017 questionnaire indicated that, for example, 90% of cardiologists reported receiving little or no nutritional education during fellowship training.
Medical schools and residency programs must teach the next generation of physicians to promote healthy behaviors – and implement these practices in their own lives.
Time is another limitation. In my years working in community clinics, I was routinely expected to see patients in 20-minute increments, leaving almost no opportunity to address lifestyle changes in a meaningful way. I might encourage patients with heart disease to eat more fruits and vegetables, but I didn’t have time to understand the rationale for their dietary choices, often influenced by a complex combination of culture, finances and personal preferences.
I also couldn’t refer patients to supportive colleagues such as dieticians, behavioral therapists and health coaches; my clinic didn’t have them.
Doctors need time for difficult conversations to understand the drivers behind patients’ choices and what might motivate them to change. They need to be able to collaborate with other professionals who can provide support and expertise.
But even more important – and more difficult – is the need to change cultural norms and public policies to make it easier for individuals to adopt healthy behaviors.
For example, the SNAP (Supplemental Nutrition Assistance Program), formerly known as food stamps, should be reformed to reduce taxpayer-subsidized consumption of sugar-sweetened beverages and ultra-processed foods. Even small actions, like moving healthy food to the front of the grocery store, can have an impact.
“Our environments are optimized for unhealthy living.” Bonnet said. “Willpower will only get us so far.” What we need, he told me, is to design communities that make healthy choices the default, cheaper option.
Such communities would have more green space and walkable streets, easier access to fresh produce, plant-based entrees at restaurants, and more opportunities for in-person socializing. By removing the dependence on willpower and financial resources to live well, we can reduce health disparities and improve the quality of life for everyone.
This story is coming true Public Health Guarda nonprofit, nonpartisan investigative news organization focused on threats to American well-being.
Lisa Doggett is a columnist for Public Health Watch, a family and lifestyle medicine physician at UT Health Austin’s Multiple Sclerosis and Neuroimmunology Center, and senior medical director of Sagility. She is the author of a new memoir, The escalator down: medicine, motherhood and multiple sclerosis. The views expressed in her columns do not necessarily reflect the official policies or positions of Public Health Watch, UT Health or Sagility. Doggett can be reached through her website.
