No, taking drugs like Ozempic isn’t ‘cheating’ at weight loss or the ‘easy way out’
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Hundreds of thousands of people worldwide are taking drugs like Ozempic to lose weight. But what do we actually know about them? This month, The Conversation’s experts explore their rise, impact and potential consequences.
Obesity medication that is effective has been a long time coming. Enter semaglutide (sold as Ozempic and Wegovy), which is helping people improve weight-related health, including lowering the risk of a having a heart attack or stroke, while also silencing “food noise”.
As demand for semaglutide increases, so are claims that taking it is “cheating” at weight loss or the “easy way out”.
We don’t tell people who need statin medication to treat high cholesterol or drugs to manage high blood pressure they’re cheating or taking the easy way out.
Nor should we shame people taking semaglutide. It’s a drug used to treat diabetes and obesity which needs to be taken long term and comes with risks and side effects, as well as benefits. When prescribed for obesity, it’s given alongside advice about diet and exercise.
How does it work?
Semaglutide is a glucagon-like peptide-1 receptor agonist (GLP-1RA). This means it makes your body’s own glucagon-like peptide-1 hormone, called GLP-1 for short, work better.
GLP-1 gets secreted by cells in your gut when it detects increased nutrient levels after eating. This stimulates insulin production, which lowers blood sugars.
GLP-1 also slows gastric emptying, which makes you feel full, and reduces hunger and feelings of reward after eating.
GLP-1 receptor agonist (GLP-1RA) medications like Ozempic help the body’s own GLP-1 work better by mimicking and extending its action.
Some studies have found less GLP-1 gets released after meals in adults with obesity or type 2 diabetes mellitus compared to adults with normal glucose tolerance. So having less GLP-1 circulating in your blood means you don’t feel as full after eating and get hungry again sooner compared to people who produce more.
GLP-1 has a very short half-life of about two minutes. So GLP-1RA medications were designed to have a very long half-life of about seven days. That’s why semaglutide is given as a weekly injection.
What can users expect? What does the research say?
Higher doses of semaglutide are prescribed to treat obesity compared to type 2 diabetes management (up to 2.4mg versus 2.0mg weekly).
A large group of randomised controlled trials, called STEP trials, all tested weekly 2.4mg semaglutide injections versus different interventions or placebo drugs.
Trials lasting 1.3–2 years consistently found weekly 2.4 mg semaglutide injections led to 6–12% greater weight loss compared to placebo or alternative interventions. The average weight change depended on how long medication treatment lasted and length of follow-up.
Weight reduction due to semaglutide also leads to a reduction in systolic and diastolic blood pressure of about 4.8 mmHg and 2.5 mmHg respectively, a reduction in triglyceride levels (a type of blood fat) and improved physical function.
Another recent trial in adults with pre-existing heart disease and obesity, but without type 2 diabetes, found adults receiving weekly 2.4mg semaglutide injections had a 20% lower risk of specific cardiovascular events, including having a non-fatal heart attack, a stroke or dying from cardiovascular disease, after three years follow-up.
Who is eligible for semaglutide?
Australia’s regulator, the Therapeutic Goods Administration (TGA), has approved semaglutide, sold as Ozempic, for treating type 2 diabetes.
However, due to shortages, the TGA had advised doctors not to start new Ozempic prescriptions for “off-label use” such as obesity treatment and the Pharmaceutical Benefits Scheme doesn’t currently subsidise off-label use.
The TGA has approved Wegovy to treat obesity but it’s not currently available in Australia.
When it’s available, doctors will be able to prescribe semaglutide to treat obesity in conjunction with lifestyle interventions (including diet, physical activity and psychological support) in adults with obesity (a BMI of 30 or above) or those with a BMI of 27 or above who also have weight-related medical complications.
What else do you need to do during Ozempic treatment?
Checking details of the STEP trial intervention components, it’s clear participants invested a lot of time and effort. In addition to taking medication, people had brief lifestyle counselling sessions with dietitians or other health professionals every four weeks as a minimum in most trials.
Support sessions were designed to help people stick with consuming 2,000 kilojoules (500 calories) less daily compared to their energy needs, and performing 150 minutes of moderate-to-vigorous physical activity, like brisk walking, dancing and gardening each week.
STEP trials varied in other components, with follow-up time periods varying from 68 to 104 weeks. The aim of these trials was to show the effect of adding the medication on top of other lifestyle counselling.
A review of obesity medication trials found people reported they needed less cognitive behaviour training to help them stick with the reduced energy intake. This is one aspect where drug treatment may make adherence a little easier. Not feeling as hungry and having environmental food cues “switched off” may mean less support is required for goal-setting, self-monitoring food intake and avoiding things that trigger eating.
But what are the side effects?
Semaglutide’s side-effects include nausea, diarrhoea, vomiting, constipation, indigestion and abdominal pain.
In one study these led to discontinuation of medication in 6% of people, but interestingly also in 3% of people taking placebos.
More severe side-effects included gallbladder disease, acute pancreatitis, hypoglycaemia, acute kidney disease and injection site reactions.
To reduce risk or severity of side-effects, medication doses are increased very slowly over months. Once the full dose and response are achieved, research indicates you need to take it long term.
Given this long-term commitment, and associated high out-of-pocket cost of medication, when it comes to taking semaglutide to treat obesity, there is no way it can be considered “cheating”.
Read the other articles in The Conversation’s Ozempic series here.
Clare Collins, Laureate Professor in Nutrition and Dietetics, University of Newcastle
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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The Conquest of Happiness – by Bertrand Russell
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When we have all our physical needs taken care of, why are we often still not happy, and what can we do about that?
Mathematician, philosopher, and Nobel prizewinner Bertrand Russell has answers. And, unlike many of “the great philosophers”, his writing style is very clear and accessible.
His ideas are simple and practical, yet practised by few. Rather than taking a “be happy with whatever you have” approach, he does argue that we should strive to find more happiness in some areas and ways—and lays out guidelines for doing so.
Areas to expand, areas to pull back on, areas to walk a “virtuous mean”. Things to be optimistic about; things to not get our hopes up about.
Applying Russell’s model, there’s no more “should I…?” moments of wondering which way to jump.
Bottom line: if you’ve heard enough about “how to be happy” from wishy-washier sources, you might find the work of this famous logician refreshing.
Click here to check out The Conquest of Happiness, and see how much happier you might become!
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Severe Complications for Pregnant Veterans Nearly Doubled in the Last Decade, a GAO Report Finds
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ProPublica is a Pulitzer Prize-winning investigative newsroom. Sign up for The Big Story newsletter to receive stories like this one in your inbox.
Series: Post-Roe America:Abortion Access Divides the Nation
After the Supreme Court overturned Roe v. Wade, ending nearly 50 years of federal protection for abortion, some states began enforcing strict abortion bans while others became new havens for the procedure. ProPublica is investigating how sweeping changes to reproductive health care access in America are affecting people, institutions and governments.
Over the past decade, the rate of veterans suffering severe pregnancy complications has risen dramatically, a new federal report found.
Veterans have raced to the hospital with dangerous infections, kidney failure, aneurysms or blood loss. They’ve required hysterectomies, breathing machines and blood transfusions to save their lives. Between 2011 and 2020, 13 veterans died after such complications.
The report found that among people getting health care benefits through the Department of Veterans Affairs, the rate of severe complications nearly doubled during that time, from about 93 per 10,000 hospitalizations in 2011 to just over 184 per 10,000 hospitalizations in 2020. Black veterans had the highest rates.
The report, which was put together by the Government Accountability Office, also made recommendations for reducing the problem, which focus on conducting more routine screenings throughout pregnancy and in the postpartum period.
“It is imperative that the VA help ensure veterans have the healthiest pregnancy outcomes possible,” the report said, highlighting the increasing number of veterans using the agency’s maternity benefits as well as the troublesome complication rates faced by Black women.
The report’s findings are an unfortunate trend, said Alyssa Hundrup, director of health care at the GAO. The office analyzed data on 40,000 hospitalizations related to deliveries paid for by the VA. It captures a time period before 21 states banned or greatly restricted abortion and the military was thrust into a political battle over whether it would pay for active service members to travel for abortion care if a pregnancy was a risk to their health.
Hundrup, who led the review, said the analysis included hospital records from days after delivery to a year postpartum. The report was mandated after Congress passed a law in 2021 that aimed to address the maternal health crisis among veterans. The law led to a $15 million investment in maternity care coordination programs for veterans.
The report recommended that the VA analyze and collect more data on severe complications as well as data on the mental health, race and ethnicity of veterans who experience complications to understand the causes behind the increase and the reasons for the disparity. The report also states that oversight is needed to ensure screenings are being completed.
Studies show there’s a connection between mental health conditions and pregnancy-related complications, VA officials said.
The report recommended expanding the screening questions that providers ask patients at appointments to glean more information about their mental health, including anxiety and PTSD symptoms. It urged the VA to review the data more regularly.
“You don’t know what you don’t measure,” Hundrup said in an interview with ProPublica.
The VA health system, which historically served a male population, does not provide maternity care at its facilities. Instead, the agency has outsourced maternity care. But when patients were treated by those providers, the VA failed to track whether they were getting screened for other health issues and mental health problems.
Officials hope the improved data collection will help the VA study underlying issues that may lead to complications. For example, do higher rates of anxiety have a connection to rates of high blood pressure in pregnant people?
VA officials are working with a maternal health review committee to monitor the data as it is gathered. The agency recently conducted its first review of data going back five years about pregnancy-related complications, said Dr. Amanda Johnson, acting head of the VA’s Office of Women’s Health, who is overseeing the implementation of the report’s recommendations.
The VA has created a dashboard to monitor pregnant veterans’ health outcomes. The VA’s data analysis team will also examine the impact of veterans’ ages on complications and whether they differ for people who live in urban and rural areas.
VA officials will begin to review mental health screenings conducted by maternal care coordinators in March. The coordinators advocate for veterans, helping them between health care visits, whether their providers are inside or outside the VA.
Johnson said that reducing racial and ethnic disparities is a priority for the agency. In 2018, ProPublica published “Lost Mothers,” a series that shed light on the country’s maternal health crisis. Studies have shown that in the general population, Black women are three times more likely than white women to die from pregnancy-related complications. While deaths made up only a small portion of the bad outcomes for Black veterans cited in the report, VA care could not spare them from elevated rates of severe complications. Johnson said the maternal health crisis also persists within the VA.
“There is a disparity,” Johnson said. “We are not immune to that.”
Research shows pregnant people who have used the VA’s coverage have higher rates of trauma and mental conditions that can increase their risks of complications and bad outcomes.
This may be because many people who join the military enter it having already faced trauma, said Dr. Laura Miller, a psychiatrist and the medical director of reproductive mental health at the VA.
She said veterans with PTSD have higher rates of complications such as preeclampsia, a potentially fatal condition related to high blood pressure, gestational diabetes and postpartum depression. If untreated during pregnancy, depression also increases the likelihood of preterm birth and lingering problems for babies.
Hundrup said she hopes this proactive work will improve maternal health.
“We want these numbers trending in the other direction,” Hundrup said.
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Breaking Free from Emotional Eating – Geneen Roth
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The isn’t a book about restrictive dieting, or even willpower. Rather, it’s about making the unconscious conscious, and changing your relationship with food from being one of compulsion, to one of choice, wherein you also get the choice of saying “no”.
Roth takes us through the various ways in which life seems to conspire to take consciousness away from eating, from obvious distractions such as TV, to less obvious ones, like “it doesn’t count if you’re not sitting down”. She also tackles other psychological aspects, such as those people get from parents—which can be a big factor for many.
Importantly, she teaches us that when it comes to “have your cake and eat it”, you can also, in fact, have your cake and not eat it. That’s an option too. Its mere presence in our house is not the boss of us. However, overcoming the “this then that” automatic process that goes from having to eating, is something that Roth gives quite some attention to, offering a number of reframes to make it a lot easier.
The style is friendly, conversational, pop-science, and the format dates it a little—this is very much a book formatted the way pop-science books were formatted 20–50 years ago (the book itself is from 2003, for what it’s worth). However, a lack of modern format doesn’t take away from its very valuable insights, and if anything, the older format rather promotes reading a book from cover to cover, which can be beneficial.
Bottom line: if emotional or compulsive eating is something that you’ve found tricky to overcome, then this book can help make it a lot easier.
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Beating Sleep Apnea
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Healthier, Natural Sleep Without Obstruction!
Obstructive Sleep Apnea, the sleep disorder in which one periodically stops breathing (and thus wakes up) repeatedly through the night, affects about 25% of men and 10% of women:
Prevalence of Obstructive Sleep Apnea Syndrome: A Single-Center Retrospective Study
Why the gender split?
There are clues that suggest it is at least partially hormonal: once women have passed menopause, the gender split becomes equal.
Are there other risk factors?
There are few risk other factors; some we can’t control, and some we can:
- Being older is riskier than being younger
- Being overweight is riskier than not being overweight
- Smoking is (what a shock) riskier than not smoking
- Chronic respiratory diseases increase risk, for example:
- Asthma
- COPD
- Long COVID*—probably. The science is young for this one so far, so we can’t say for sure until more research has been done.
- Some hormonal conditions increase risk, for example:
- Hypothyroidism
- PCOS
*However, patients already undergoing Continuous Positive Airway Pressure (CPAP) treatment for obstructive sleep apnea may have an advantage when fighting a COVID infection:
What can we do about it?
Avoiding the above risk factors, where possible, is great!
If you are already suffering from obstructive sleep apnea, then you probably already know about the possibility of a CPAP device; it’s a mask that one wears to sleep, and it does what its name says (i.e. it applies continuous positive airway pressure), which keeps the airway open.
We haven’t tested these, but other people have, so here are some that the Sleep Foundation found to be worthy of note:
Sleep Foundation | Best CPAP Machines of 2024
What can we do about it that’s not CPAP?
Wearing a mask to sleep is not everyone’s preferred way to do things. There are also a plethora of surgeries available, but we’ll not review those, as those are best discussed with your doctor if necessary.
However, some lifestyle changes can help, including:
- Lose weight, if overweight. In particular, having a collar size under 16” for women or under 17” for men, is sufficient to significantly reduce the risk of obstructive sleep apnea.
- Stop smoking, if you smoke. This one, we hope, is self-explanatory.
- Stop drinking alcohol, or at least reduce intake, if you drink. People who consume alcohol tend to have more frequent, and longer, incidents of obstructive sleep apnea. See also: How To Reduce Or Quit Drinking
- Avoid sedatives and muscle relaxants, if it is safe for you to do so. Obviously, if you need them to treat some other condition you have, talk this through with your doctor. But basically, they can contribute to the “airway collapses on itself” by reducing the muscular tension that keeps your airway the shape it’s supposed to be.
- Sleep on your side, not your back. This is just plain physics, and a matter of wear the obstruction falls.
- Breathe through your nose, not through your mouth. Initially tricky to do while sleeping, but the more you practice it while awake, the more it becomes possible while asleep.
- Consider a nasal decongestant before sleep, if congestion is a problem for you, as that can help too.
For more of the science of these, see:
Cultivating Lifestyle Transformations in Obstructive Sleep Apnea
There are more medical options available not discussed here, too:
American Sleep Apnea Association | Sleep Apnea Treatment Options
Take care!
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7 Kinds Of Rest When Sleep Is Not Enough
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Taking Rest Seriously (More Than Just Sleep)
This is Dr. Matthew Edlund. He has 44 years experience as a psychiatrist, and is also a sleep specialist. He has a holistic view of health, which is reflected in his practice; he advocates for “a more complete health: physical, mental, social, and spiritual well-being”.
What does he want us to know?
Sleep, yes
Sleep cannot do all things for us in terms of rest, but it can do a lot, and it is critical. It is, in short, a necessary-but-not-sufficient condition for being well-rested.
See also: Why You Probably Need More Sleep
Rest actively
Rest is generally thought of as a passive activity, if you’ll pardon the oxymoron. Popular thinking is that it’s not something defined by what we do, so much what we stop doing.
In contrast, Dr. Edlund argues that to take rest seriously, we need do restful things.
Rest is as important as eating, and we wouldn’t want for that to “just happen”, would we?
Dr. Edlund advocates for restful activities such as going to the garden (or a nearby park) to relax. He also suggests we not underestimate the power of sex as an actively restful activity—this one is generally safer in the privacy of one’s home, though!
Rest physically
This is about actively relaxing our body—yoga is a great option here, practised in a way that is not physically taxing, but is physically rejuvenating; gentle stretches are key. Without such things, our body will keep tension, and that is not restful.
For the absolute most restful yogic practice? Check out:
Non-Sleep Deep Rest: A Neurobiologist’s Take
this is about yoga nidra!
Rest mentally
The flipside of the above is that we do need to rest our mind also. When we try to rest from a mental activity by taking on a different mental activity that uses the same faculties of the brain, it is not restful.
Writer’s example: as a writer, I could not rest from my writing by writing recreationally, or even by reading. An accountant, however, could absolutely rest from accounting by picking up a good book, should they feel so inclined.
Rest socially
While we all have our preferences when it comes to how much or how little social interaction we like in our lives, humans are fundamentally social creatures, and it is hardwired into us by evolution to function at our best in a community.
This doesn’t mean you have to go out partying every night, but it does mean you should take care to spend at least a little time with friends, even if just once or twice per week, and yes, even if it’s just a videocall (in person is best, but not everyone lives close by!)
If your social life is feeling a little thin on the ground these days, that’s a very common thing—not only as we get older, but also as many social institutions took a dive in functionality on account of the pandemic, and many are still floundering. Nevertheless, there are more options than you probably realize; yes, even for the naturally reclusive:
How To Beat Loneliness & Isolation
Rest spiritually
Be we religious or not, there are scientifically well-evidenced benefits to religious practices—some are because of the social aspect, and follow on from what we talked about just above. Other benefits come from activities such as prayer or meditation (which means that having some kind of faith, while beneficial, is not actually a requirement for spiritual rest—comparable practices without faith are fine too).
We discussed the overlapping practices of prayer and meditation, here:
The Science Of Mantra Meditation
Rest at home
Obviously, most people sleep at home. But…
Busy family homes can sometimes need a bit of conscious effort to create a restful environment, even if just for a while. A family dinner together is one great way to achieve this, and also ties in with the social element we mentioned before!
A different challenge faced by a lot of older people without live-in families, on the other hand, is the feeling of too much opportunity for rest—and then a feeling of shame for taking it. The view is commonly held that, for example, taking an afternoon nap is a sign of weakness.
On the contrary: taking an afternoon nap can be a good source of strength! Check out:
How To Nap Like A Pro (No More “Sleep Hangovers”!)
Rest at work
Our readership has a lot of retirees, but we know that’s not the case for everyone. How then, to rest while at work? Ideally we have breaks, of course, but most workplaces do not exactly have an amusement arcade in the break room. Nevertheless, there are some quick resets that can be done easily, anywhere, and (almost) any time:
Meditation Games: Meditation That You’ll Actually Enjoy
Want to know more?
You might also like:
How To Rest More Efficiently (Yes, Really)
Take care!
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Why Curcumin (Turmeric) Is Worth Its Weight In Gold
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Curcumin (Turmeric) is worth its weight in gold
Not financially! But, this inexpensive golden spice has an impressive list of well-studied health benefits, for something so freely available in any supermarket, and there’s a reason it gets a place in “Dr. Greger’s Daily Dozen”, right up there with things like “leafy greens” and “berries” when it comes to superfoods.
Let’s do a quick run-down:
- It fights inflammation, and thus helps fight many diseases where inflammation is a factor (ranging from atherosclerosis to arthritis to Alzheimer’s and more)
- It has powerful antioxidant effects too
- It boosts brain-derived neurotropic factor (BDNF) and thus improves memory and attention
- It helps protect against heart disease…
- …and can give a 65% decreased risk of experiencing a heart attack
- It can help prevent cancer, and reduce cancerous lesions by 40%
- It’s also good against depression
- It even slows aging
In short, it’s—like we said—worth its weight in gold.
Quick advice though before we move on…
If you take curcumin with black pepper, it allows your body to use the curcumin around 2,000% better. This goes whether you’re cooking with both, or take them as a supplement (they’re commonly sold as a combo-capsule for this reason).
Want to get some?
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