The obesity epidemic spread from the United States into a worldwide phenomenon. And the latest treatment to combat this is medications rather than dietary and lifestyle changes themselves.
As a physician dealing with this problem – both personally and professionally – I have made the following conclusions:
1. Avoiding obesity requires willpower.
2. Losing weight and keeping it off once obese requires herculean willpower.
3. Ozempic and similar medications cause weight loss, but you have to take them forever.
Let’s look at these points individually:
Avoiding obesity requires willpower. All one has to do is look at old pictures of underfed prison populations to realize that calorie restriction prevents obesity. One does not see ten skinny prisoners for every fat one. They are all skinny. Thus, the idea that some people are genetically programmed to be obese even if they eat normally is by and large a myth. People are obese because they eat more food than necessary to function, and this food is stored as fat.
The main cause of obesity is the plummeting of food prices along with the availability of cheap junk food in places such as McDonalds, Kentucky Fried Chicken and Taco Bell. Furthermore, there are favorable, pleasure-inducing foods that are dirt cheap such as Oreos, Doritos, Almond Joy and a variety of sumptuous ice creams. Avoiding obesity in this milieu requires willpower as these temptations are relatively new to the masses.
Losing weight and keeping it off once obese requires herculean willpower. To understand this, one must go back 150,000 years to our distant ancestors roaming around the plains of Africa trying to avoid starvation. There were no Oreos. There were no Doritos. If the hunters went into a slump, people died. Evolution gave us a mechanism to counter this called starvation metabolism.
It wasn’t until 5,000 years ago that humans even developed an agrarian economy and only in the past 100 years that a significant number of humans ate three meals a day. Thus, starvation metabolism is encoded in our DNA.
Why is this relevant. Because when an individual becomes obese and tries to lose weight, the DNA from our distant past sends a message to the brain that tells this individual that she is starving. The message – ravenous hunger.
And it gets worse. Our body uses food more efficiently when trying to lose weight. Perhaps an example will make this clearer:
Let’s say a woman requires 2,000 calories a day to maintain her weight. She goes on a diet and loses 10% of her weight. It would follow that she should be able to maintain her new weight by eating 1,800 calories a day (10% less than 2,000 calories); but this is not the case. She has to eat in the range of 1,650 calories or else she will regain the weight she lost. This is why only 5% of people who lose weight keep it off.
The proponents of fad diets and Weight Watchers (of which I am a lifetime member) have now admitted that their message is tainted at best. Oprah Winfrey, who was a spokesperson for Weight Watchers (along with a major stockholder), has basically thrown in the towel in controlling her weight.
Ozempic and similar medications cause weight loss, but you have to take them forever. Ozempic is used to lower blood sugar in diabetics. It is a member of a class of drugs called semaglutides that mimic a hormone produced by the gastrointestinal track that reduces one’s appetite. And it works. It has become the rage of the Hollywood set. Those who take it have diminished appetites and are happy with one piece of pizza instead of three (or in my case six).
But many patients have abdominal pain, bloating, constipation and in rare cases, pancreatitis – a potentially fatal condition. If a patient stops taking this medication, they will quickly put on the weight they lost and probably more.
Furthermore, these medications have been around for about two years. The long-term side effects are unknown. Also, many medications result in tachyphylaxis, a fancy medical word that means the medication stops working after prolonged usage.
Perhaps, improvements in semaglutides will result in fewer side effects and excellent long-term results. But in my experience as a physician, short cuts that avoid patient discipline are rarely effective.
Besides, is it really a crime to be overweight? Many people may be happier waddling around while enjoying the pleasure of good food. What’s the sense in being constantly hungry? A significant number of patients may say to themselves, “Let the health nuts eat the tofu. I would rather sit on my recliner, watch the football games, and enjoy my pizza, beer and kielbasa. If it knocks of a few years of my life – that’s my choice.”