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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11 Minutes to Pain-Free Hips – by Melinda Wright
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If hips don’t lie, what are yours saying to you? If what they’re saying to you sounds like a cry for help sometimes, this is the book to get you onto a better track.
The hip is the largest joint in your body, and it bears a lot of weight. So it’s little wonder if sometimes they’d like a word with the boss. The question is: what will you do about it? Melinda Wright has suggestions to keep your hips—and you—happy.
She spends the first couple of chapters introducing key concepts, and some anatomy and physiology that’ll be good to know.
Then we’re into resistance stretching, basic hip exercises, all the way through to more advanced stuff. There are very clear photos for each. One thing that stands out about this book is each exercise is not just explained simply and clearly, but also offers “easing oneself in” exercises. After all, we’re not all at the same starting point.
The book finishes off with some more holistic advice about chronic pain management, based on her personal experience with scoliosis, and some dietary tips to reduce joint pain and inflammation too.
All in all, a very helpful book!
Pick up 11 “Minutes to Pain-Free Hips” at Amazon today!
^You will also see options for pain-free back, and pain-free neck, by the same author
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The Case Against Sugar – by Gary Taubes
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We generally already know that sugar is bad for the health. Most people don’t know how bad.
Taubes makes, as the title goes, “the case against sugar”. Implicated in everything from metabolic syndrome to cancer to Alzheimer’s, sugar is ruinous to the health.
It’s hard to review this book without making a comparison to William Duffy’s 1975 bestseller, “Sugar Blues“. Stylistically it’s very similar, and the general gist is certainly the same.
However! Where this book beats Sugar Blues is in content; Duffy’s book often makes bold claims without scientific backing. Some of those claims didn’t stand the test of time and are now disproven. Instead, Taubes’ book leans on actual up-to-date science, and talks more about what we actually know, than what we imagine.
If this book has a weak point, it’s when it veers away from its main topic and starts talking about, for example, saturated fat. In this side-topic, the book makes some good points, but is less well-considered, cherry-picks data, and lacks nuance.
On its main topic, though, the investigation of sugar, it is rather more thorough.
Bottom line: if you want a next-level motivation to reduce or eliminate dietary sugar, this book may certainly provide that.
Click here to check out The Case Against Sugar and reduce a lot of your health risks!
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State of Slim – by Dr. James Hill & Dr. Holly Wyatt
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The premise of this book is “people in Colorado are on average the slimmest in the US”, and sets about establishing why, and then doing what Coloradans are doing. As per the subtitle (drop 20 pounds in 8 weeks), this is a weight loss book and does assume that you want to lose weight—specifically, to lose fat. So if that’s not your goal, you can skip this one already.
The authors explain, as many diet and not-diet-but-diet-adjacent book authors do, that this is not a diet—and then do refer to it as the Colorado Diet throughout. So… Is it a diet?
The answer is a clear “yes, but”—and the caveat is “yes, but also some associated lifestyle practices”.
The diet component is basically a very low-carb diet to start with (with the day’s ration of carbs being a small amount of oats and whatever you can get from some non-starchy vegetables such as greens, tomatoes, etc), and then reintroducing more carbohydrate centric foods one by one, stopping after whole grains. If you are vegan or vegetarian, you can also skip this one already, because this advises eating six animal protein centric meals per day.
The non-diet components are very general healthy-living advices mixed in with popular “diet culture” advices, such as practice mindful eating, don’t eat after 8pm, exercise more, use small plates, enjoy yourself, pre-portion your snacks, don’t drink your calories, get 8 hours sleep, weigh all your food, etc.
Bottom line: this is a very mixed bag, even to the point of being a little chaotic. It gives sometimes contradictory advice, and/but this results in a very “something for everyone” cafeteria approach to dieting. The best recommendation we can give for this book is “it has very many ideas for you to try and see if they work for you”.
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How & Why Non-Sleep Deep Rest Works (And What Activities Trigger The Same State)
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Stress is a natural response that evolved over thousands of years to help humans meet challenges by priming the body and mind for action. However, chronic stress is harmful, as it diverts energy away from essential processes like cell maintenance and repair, leading to deterioration of health (physical and mental).
Counteracting this requires intentional periods of deep rest… But how?
Parasympathetic Response
Practices as diverse as mindfulness meditation, yoga, prayer, tai chi, qigong, knitting, painting, gardening, and sound baths can help induce states of deep rest—these days often called “Non-Sleep Deep Rest” (NSDR), to differentiate it from deep sleep.
How it works: these activities send signals to the brain that the body is safe, initiating biological changes that…
- protect chromosomes from DNA damage
- promote cellular repair, and
- enhance mitochondrial function.
If we then (reasonably!) conclude from this: “so, we must embrace moments of stillness and mindfulness, and allow ourselves to experience the ease and safety of the present”, that may sound a little wishy-washy, but the neurology of it is clear, the consequences of that neurological response on every living cell in the body are also clear, so by doing NSDR (whether by yoga nidra or knitting or something else) we can significantly improve our overall well-being.
Note: the list of activities above is far from exhaustive, but do be aware that this doesn‘t mean any activity you enjoy and do to unwind will trigger NSDR. On the contrary, many activities you enjoy and do to unwind may trigger the opposite, a sympathetic nervous system response—watching television is a common example of this “wrong choice for NSDR”. Sure, it can be absorbing and a distraction from your daily stressors, but it also can be exciting (both cognitively and neurologically and thus also physiologically), which is the opposite of what we want.
For more on all of this, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
Non-Sleep Deep Rest: A Neurobiologist’s Take
Take care!
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10 Ways To Self-Soothe That Don’t Involve Food Or Drink
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If one is accustomed to comfort-eating or drowning one’s sorrows, what are the alternatives that can actually work? Holistic nutritionist Selin Bilgin has a list:
Self-Care That’s Not Self-Sabotage
You might want to make a note of these 10 things, so they can be a sort of “menu” for you when you need them:
- Give your introversion or extroversion what it needs (e.g. alone time to decompress, or social activities)
- Treat your senses: often we don’t actually need food/drink so much as culinary entertainment. So, we can sate this sensory mood in other ways, for example pleasant candles, flowers, and so forth.
- Bathe/shower nicely: it’s cliché but some personal pampering can go a long way
- Beautify yourself: it’s also cliché, but a makeover evening has its place
- Move! Go for a walk, do some yoga, whatever suits you, but move your body.
- Make movie nights luxurious: instead of making it about food/drink, focus on creating an enjoyable atmosphere
- Physically release tension: at 10almonds we recommend progressive relaxation for this!
- Create something: whether it’s art, craft, baking, or something else, creativity feels good
- Tackle things you’ve been procrastinating: this one doesn’t seem like self-soothing from the front end, but from the back end (i.e., having done it), it makes a big difference!
- Journal: expressing your thoughts and feelings can help a lot—really.
For more on each of these, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
- The Mental Health First-Aid That You’ll Hopefully Never Need
- Rebalancing Dopamine (Without “Dopamine Fasting”)
- Self-Care That’s Not Just Self-Indulgence
Take care!
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Kava vs Anxiety
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Kava, sometimes also called “kava kava” but we’re just going to call it kava once for the sake of brevity, is a heart-shaped herb that
bestows the powers of the Black Pantheris popularly enjoyed for its anxiolytic (anxiety-reducing) effects. Despite the similarity of the name in many languages, it is unrelated to coffee (except insofar as they are both plants), and its botanical name is Piper methysticum.Does it work?
Yes! At least in the short-term; more on that later.
Firstly, you may be wondering how it works; it works by its potentiation of GABA receptors in the brain. GABA (or gamma-aminobutyric acid, to give it its full name), as you may recall, is a neurotransmitter that is associated with feelings of calm; we wrote about it here:
So, what does “potentiation of GABA receptors” mean? It means… Scientists don’t for 100% sure know how it works yet, but it does make GABA receptors fire more. It’s possible that to some degree GABA fits the “molecular lock” of the receptors and causes them to say “GABA is here”; it’s also possible that they just make them more sensitive to the real GABA that is there, or there could be another explanation as yet undiscovered. Either way, it means that taking kava has a similar effect to having increased GABA levels in the brain:
As for how much to use, 20–300mg appears to be an effective dose, and most sources recommend 80–250mg:
Kava as a Clinical Nutrient: Promises and Challenges
This review of clinical trials found that it was more effective than placebo in only 3 of 7 trials; specifically, it was beneficial in the short-term and not in the long-term. For these reasons, the researchers concluded:
❝Kava Kava appears to be a short-term treatment for anxiety, but not a replacement for prolonged anti-anxiety use. Although not witnessed in this review, liver toxicity is especially possible if taken longer than 8 weeks.❞
Another review of clinical trials found better results over the course of 11 clinical trials, though again, short-term treatment only was considered to be where the “safe and effective” claim can be placed:
❝Compared with placebo, kava extract appears to be an effective symptomatic treatment option for anxiety. The data available from the reviewed studies suggest that kava is relatively safe for short-term treatment (1 to 24 weeks), although more information is required. Further rigorous investigations, particularly into the long-term safety profile of kava are warrant❞
Source: Kava extract for treating anxiety
Is it safe?
Nope! It has been associated with liver damage:
The likely main mechanism of toxicity is that it simply monopolizes the liver’s metabolic abilities, meaning that while it’s metabolizing the kava, it’s not metabolizing other things (such as alcohol or other medications), which will then build up, and potentially overwhelm the liver:
Constituents in kava extracts potentially involved in hepatotoxicity: a review
However, traditionally-prepared kava has not had the same effect as modern extracts; at first it seemed the difference was the traditional aqueous extracts vs modern acetonic/ethanolic extracts, but eventually that was found not to be the case, as toxicity occurred with industrial aqueous extracts too. The conclusion so far is that it is about the quality of the source ingredients, and the problems inherent to mass-production:
Meanwhile, short-term use doesn’t seem to have this problem, if you’re not drinking alcohol or taking medications that affect the liver:
Mechanisms/risk factors – kava-associated hepatotoxicity ← you’ll need to scroll down to 4.2.4 to read about this
Want to try it?
If the potential for hepatotoxicity doesn’t put you off, here’s an example product on Amazon ← we do not recommend it, but we are not the boss of you, and maybe you’re confident about your liver and want to use it only very short-term?
Take care!
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