Weight Loss Medications: The Latest Diet Trend

Weight loss medications - including Wegovy, Semalgutide and Ozempic - are currently being touted as the miracle for weight loss. According to a recent survey by KFF, nearly half of those who had heard of the drugs were interested in taking them. But there's a larger question at play here: Do the Benefits Outweigh the Risks?

Let’s Dig Deeper.

These medications belong to a class called Glucagon-like peptide-1 (GLP-1) agonists that were originally developed for individuals with type 2 diabetes and/or obesity. These medications have gotten a lot of attention for their ability to reduce weight, as well as lower blood pressure, cholesterol, and HgA1c levels (a 3 month average blood sugar marker). GLP-1 is released from the gastrointestinal tract when you eat to help regulate satiety, your blood sugar levels and insulin secretion. These medications act by mimicking the effects of the GLP-1 hormone which include: 

• Stimulating insulin release: GLP-1 stimulates the pancreas to release insulin, a hormone that transports glucose from the blood into your cells. 
• Inhibiting the release of glucagon: GLP-1 reduces the release of glucagon, a hormone that raises blood sugar by taking stored forms of glucose and releasing them from the liver. 
• Slowing gastric emptying: GLP-1 slows the emptying of the stomach, which slows down how much glucose is absorbed. 
• Promoting satiety: GLP-1 can make you feel more full and satiated after a meal. 

This results in better blood sugar control, decreased calorie intake and subsequent weight loss. As a result, people who are seeking to lose weight quickly and lower blood sugar levels are being advised to try - or themselves asking to try - one of these medications.

What Is The Health Impact?

The primary concerns with these medications are the impact on metabolism (specifically muscle), weight regain and blood sugar dysregulation once the medication is stopped as well as potential side effects while taking the drug.

Metabolism

Medications that promise quick weight loss do not account for where that weight comes from. Quick weight loss can lead to the loss of muscle, in addition to fat, and a decline in muscle mass can have a negative impact on your metabolism. 

Your resting metabolic rate (RMR) is the amount of energy required to keep your body functioning at baseline. The RMR supports the needs of multiple organ functions, like the brain, heart, liver, and digestion. One of the biggest contributors to your RMR is muscle. In fact, muscle can influence your RMR by an estimated 20%, making it one of the largest controllable factors we have to increasing caloric output. Even a small amount of gained muscle, such as 2-4 lbs, can provide up to an 8% boost in your RMR! This means you burn  more calories at rest, making it easier to maintain an optimal body composition. When you lose weight too quickly, you run the risk of muscle loss, which in turn leads to declines in your resting metabolic rate.  Past studies estimate that weight loss through calorie restriction can cause up to a 33% decline in lean muscle mass. This 2021 study found that taking semaglutide specifically was associated with a loss of lean body mass.

Blood Sugar & Weight Regain

Our muscle tissue doesn’t just support our resting metabolic rate, but also plays a significant role in promoting metabolic health and managing blood sugar. For those who don’t want to be on weight loss medications long-term, this can be problematic because once the medication is stopped, it is very likely that weight regain in the form of fat will occur in addition to issues controlling blood sugar.  We are already seeing studies of individuals regaining weight after stopping one of these medications. 

A 2022 study - which followed close to 2,000 people over the course of a year - identified that ongoing treatment was needed to maintain improvements in weight and metabolic health after stopping the medication. The participants in this study received either weekly Semaglutide injections, or a placebo, for 68 weeks. The semaglutide group saw a 17% reduction in weight loss while on the medication, but a year after stopping the medication, this group had re-gained two-thirds of the lost weight. Cardiometabolic improvements that occurred while on the medication were also diminished with levels returning to baseline by the end of the study.

A separate study compared the results of individuals who continued to take Wegovy after 20 weeks of medication versus those who did not. The study showed a steady weight increase in the individuals who stopped this medication, thus confirming the need to continue weight loss medications long term for continued results. 

Additional Side Effects

The drugs do not come without their side effects and it’s important to be informed on them prior to taking the medication. In addition to the concerns of weight regain, there are also numerous side effects reported. The Wegovy website discloses that the medication is not known to be safe with other prescriptions, over the counter medications, and herbal supplements. They also highlight the risk for thyroid tumors, cancer, pancreatitis, gallbladder problems, hypoglycemia, kidney problems/ failure, increased heart rate, depression or thoughts of suicide.  

Is Medication the Answer?

Personalized nutrition and food as medicine recommendations rarely have side effects. They can also play a role in weight loss while building up muscle rather than breaking it down. Whether you are taking weight loss medications now, have taken them in the past, or are thinking about it, there are certain approaches to nutrition that can be used as an alternative or complementary approach: .

You Must Change Your Nutrition Habits.

If you don’t want to take medications long term and you don’t want to regain the weight, prioritizing your diet is essential. We recommend following the Optimal Plate Method as a guide to support a healthy weight, blood sugar balance and metabolism. The Optimal Plate includes half your plate coming from nutrient dense non-starchy vegetables at each meal. Increasing vegetables is a great way to add volume to your meals and boost your fiber intake, which supports satiety, and helps slow down the absorption of sugars which promotes better blood sugar control.  

Eat Enough Protein.

Aim for at least a quarter of your plate from protein at each meal. Protein supports lean muscle synthesis and repair, as well as satiety.  It also helps balance your blood sugar which supports weight loss. A general recommendation for daily protein intake should be about 1.2-2.0g per kilogram of body weight. 

Start Strength Training.

Building muscle boosts your metabolism.  In order to rebuild muscle lost, or just build new muscle, consistent weight lifting - about 2-3 times weekly - is recommended. You can start with your own body weight and eventually progress to dumbbells and weight lifting machines. If you are unsure where to begin, or have a history of injuries, I would recommend working with a certified Personal Trainer to get you started.  

Control Your Blood Sugar.

This is the key! These drugs are super effective for weight loss and satiety because of the benefits that they have on blood sugar and insulin sensitivity. Consistent spikes in blood sugar can contribute to weight gain. A continuous glucose monitor – like Levels –  is a great way to self-educate on what foods, or habits, spike your blood sugar so you can make choices that support healthy blood sugar and likely in turn, a healthy weight. Let us help you use food as medicine consistently every day with blood sugar balancing meal plans! Our team of functional medicine dietitians would love to support you in The Being Collective, our meal planning and coaching program that includes hundreds of blood sugar balancing recipes, a weekly plan that you create for you and/or your family that generates an automated grocery list and a meal prep plan for the week. This is the best way to improve your efficiency in the kitchen, get DELICIOUS blood sugar balancing meals on your plate, and help you make progress with your health goals.

Do Not Rely On The Scale!

Focusing on weight alone will usually lead to disappointment and frustration. Weight is not the sole marker of health. In fact two people with the same height and weight can have very different body compositions. The differences are due to the distribution of fat and muscle in their body. Consider assessing your body composition through a DEXA scan or on an InBody scale, rather than tracking weight alone. Think fat loss not weight loss.

Find Your Tribe!

From working in a group setting with countless clients at Being Functional Nutrition, we know that having the right social support plays a significant role in helping individuals achieve their goals. Surround yourself with people who are living an active and healthy lifestyle to motivate you on your health journey. You are more likely to reach your full health potential when you have the right support in place and feel confident in your healing journey.

Craving more information on this topic? We shared more on the truth of weight loss medications including other nutrition & lifestyle strategies that can naturally increase GLP-1 in this recent post on our social!

In Conclusion

Improving your body composition and figuring out what works best for you should be very personalized. While there are some strategies that have been shown to naturally increase your body's production of GLP-1, it's always best to have a personalized nutrition, supplement and lifestyle plan that works best for YOUR body. Reach out if you are interested in working with one of our functional medicine dietitians in our VIP Next Level Nutrition program!