The healthcare industry is abuzz with the potential of GLP-1s, a growing class of weight-loss medications that includes Saxenda and Wegovy with others, like Mounjaro, on the horizon. GLP-1s indicated for diabetes (such as Ozempic) are seeing increases in off-label use for weight loss. In many quarters, these medications, known officially as glucagon-like peptide-1 receptor agonists, are seen as a magical cure for obesity and perhaps for the entire obesity epidemic. With increasing access, new approvals for on-label use for weight loss, and forthcoming oral tablets, these drugs may seem like the harbinger of a new era in weight management.
But while GLP-1s do indeed help and may be indicated for certain people, as a society we run the risk of focusing single-mindedly on treatment at the expense of investing in prevention. A better method of addressing the obesity epidemic is working harder to avoid the clinical necessity of weight-loss medication in the first place. Focusing on education, prevention, and support for weight management without drugs offers greater potential for better overall health and more cost savings in the long term.
However, any prevention-focused lifestyle intervention program that expects to make a difference must actually serve the patients it targets. This means not only designing interventions to be comprehensive, individualized, and supportive. It also means taking seriously the mental weight of weight management.
Unaddressed issues
Weight-management programs are typically—and rightly—centered on transforming lifestyle and diet in a way that can prevent further weight gain, promote weight loss, and lead to better health. But these interventions too often don’t work over the long run. Permanently changing one’s lifestyle and diet proves very hard for many. Even those who successfully lose weight typically revert to old lifestyle and eating patterns eventually, allowing the weight to creep back on.
While the inability of many individuals to keep the weight off is in part due to the U.S.’s obesogenic environment, there are underlying emotional and psychological issues driving the reversion to weight gain. These issues too often go unaddressed by weight-management programs.
To help people succeed in transforming their relationship to food, eating, and exercise, intervention programs need to delve into complex mental and societal territory. Importantly, the must recognize that obesity carries a high level of social stigma in U.S. society.
“Numerous studies have documented harmful weight-based stereotypes that overweight and obese individuals are lazy, weak-willed, unsuccessful, unintelligent, lack self-discipline, have poor willpower, and are noncompliant with weight-loss treatment,” write researchers from Yale University.
Such perceptions result in bias and discrimination and cause many patients who struggle to maintain their weight to suffer emotional distress and poor self-image. There are also a number of other social factors that affect weight management. These such as social determinants of health, access to healthy food, and cultural biases around body image.
If unaddressed, these emotional, cultural, and logistical issues surrounding lifestyle and diet make it all the more difficult for many patients to maintain weight loss.
“Miracle” drugs?
In this context, it’s little wonder that millions of patients are eager to try out GLP-1s. After all, these “miracle” drugs seem poised to easily solve one’s weight-management woes without the need for lifestyle interventions or confronting personal demons and societal biases.
But even those on these drugs won’t be able to avoid these difficult elements of health maintenance. Taking a proactive approach to eating and activity is necessary for the maximum effectiveness of GLP-1 medications. Both the drugs and the healthy lifestyle must be maintained for life in order to keep the weight off. While GLP-1s can allow people to lose weight more effortlessly, the weight will return once the patient stops taking the drug unless they have significantly altered their lifestyle or behavior in the meantime.
A holistic approach to weight management
A sustainable population weight management approach that doesn’t rely on widespread, life-long use of medications must be prevention-focused, comprehensive, and address the emotional and psychological side of weight management. Programs that expect to successfully assist in reducing obesity must be individualized to patients’ unique context and needs.
Our experience at Cecelia Health shows that we can help people achieve long-term outcomes by focusing on trusting relationships. This is the case with adherence to treatment regimens, and it surely will apply to weight management interventions as well. Patients need programs that lean toward accountability and personalization, not just broad “eat less, exercise more” advice.
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Our solution is designed to help patients develop a mindset for sustainable change. Our clinicians work to meet each person where they are via a holistic approach to weight loss. They have disease-state expertise to address comorbid conditions and manage medications. They also understand the social and emotional context for weight management. We help patients address psychological issues that may be holding them back from changing their lifestyle for the better. There’s a better way to manage weight.
About the Author
Teresa McArthur is a Registered Dietitian and Certified Diabetes Care and Education Specialist with a Masters Degree in Clinical Nutrition. She has experience working with diabetes, health and wellness, nutrition support, weight, and chronic disease management. She has worked in higher education, long-term acute care, critical care, community nutrition, and inpatient and outpatient accredited programs.
Teresa has a wealth of experience working various populations living with diabetes. Including adults and children with type 1 and type 2 diabetes and women with gestational diabetes. She served as a diabetes educator in the inpatient, outpatient, and community settings. Teaching patients how to understand their diabetes and manage their diabetes has been her passion for many years.
She believes nothing is more rewarding then to inspire and empower patients. This includes giving them knowledge and skills to reach their goals and witnessing their health and quality of life improve. Teresa understands that chronic illness impacts every aspect of a person’s life. Therefore, working with patients to identify specific barriers and setting realistic and sustainable goals is the key to lifelong success.