The Olympics are changing the way we eat and work out.
In 1997, the weight-loss drug fen-phen was taken off the market, which broke my mom’s heart. The FDA warned her that the drug could hurt her heart badly or even kill her. She had been trying to lose weight ever since she knew she had a body, and the only thing that had ever worked was having her hands ripped off.
This is a very strong reaction. My mom would rather take a drug that could kill her than go through life without it. This shows how frustrating it can be to be told over and over that you need to lose weight and do everything you can to do it but fail.
For decades, the standard weight-loss advice was to make lifestyle changes, including eating better and moving more. But it was very hard to keep up with these changes over time. People often only got small results from them, even when they did them for years. Not many people were given medicine. Even fewer people chose to have surgery.
GLP-1 drugs, such as Ozempic and Mounjaro, are now being talked about. How doctors talk to and think about patients has also changed a lot because of them. What we can do and how we feel about ourselves. And why we’ve been stuck in a frustrating “treatment” cycle for so long, even though the number of obese people has kept going up.
Why diet and exercise?
In the mid-1990s, public health professionals were trying to find ways to slow down the rise in obesity. This was mainly because being overweight was linked to diseases like Type 2 diabetes and some types of cancer.
It was 1996 when the NIH started a study that would have a big impact on how doctors think about treatment in the future. Researchers looked at how eating better and moving around more could lower the risk of getting Type 2 diabetes. The prevention of Type 2 diabetes was found to be significantly impacted by lifestyle changes that led to even a small amount of weight loss. People who lost just over 5 percent of their body weight met the goal and cut the risk of getting Type 2 diabetes by 58 percent. To give you an idea, someone who weighs 300 pounds would need to lose about 15 pounds. Do not mistake these for weigh-ins from The Biggest Loser. These were supposed to be results that could be reached.
Officials from the government told people what to do. Lifestyle changes were important, according to doctors. Dieting and working out became the recommended ways to control weight.
Dr. Dan Bessesen, an endocrinologist and director of the CU Anschutz Health and Wellness Center at the University of Colorado, said, “I’ve spent 20 years trying to sell the benefits of a 5 percent weight loss.” “The weight change didn’t seem like much, but it had big effects.”
The limits of diet and exercise
The culture quickly changed these results to fit existing ideas about what is beautiful and how to be responsible for oneself. It was no longer, “Lose a little weight to be a lot healthier.” Instead, it turned into, “They could reach their goal if only someone who is overweight could control themselves.”
That’s not how biology works, though.
Bessesen said, “The body has its own ideas about what it wants to weigh.” Biological changes happen when you try to lose weight that make it harder to keep off the weight. We feel more and more hungry, and our bodies store energy as fat. We used to find this useful when we lived in caves. Now that we have wolves as pets and wear soft pants to work, not so much.
In this way, the miracle cure turned into a disease in and of itself.
“One group that thinks, ‘Well, Mrs. Jones, you should be able to handle [losing weight] on your own,'” Bessesen said. “That’s not what we do for people with diabetes or high blood pressure.”
And maybe we’re about to stop when it comes to obesity.
The Ozempic revolution
Medicines have been used to treat obesity for many years. But nothing worked as well or was as appealing to people as the idea of just working out and eating better. ‘Till the Olympic.
One brand name for a group of drugs called GLP-1 agonists that have become very popular in the past few years is Ozempic. These injectables work like hormones that make you feel full and slow down digestion. This makes you eat less and want to eat less. It’s no surprise that you lose a lot of weight—on average, 15 percent. And, like drugs for high cholesterol or arthritis, they don’t depend on willpower to work.
That means the subject has changed. Bessessen told me that patients with GLP-1s ask for specific brands, which doesn’t happen with most other conditions. And doctors don’t have to make someone beat themselves up for months or years before they’ll consider medical help. They can just write a quick prescription.
Now that there is a good medicine for obesity, it seems to have gone from being seen as a personal failure to a disease that can be treated.
It’s interesting that people who take GLP-1 drugs often say they don’t like highly processed foods and instead like fresh fruits and vegetables. People who lose weight can also move around better. Lifestyle changes are not substituted by these drugs. They make it look like they can happen.
An uncertain future
Some people who are overweight don’t need to lose weight. The body positivity movement has also helped a lot of people get over their own fatphobia and escape the prison of impossible beauty standards.
But some people do feel like they need to change in order to avoid Type 2 diabetes or take care of other health problems. It can be hard for them if they decide to take GLP-1 drugs.
Some people have had terrible side effects, like being unable to go to the bathroom or throwing up. Also, the drugs are very very expensive, and most insurance plans do not cover them to treat obesity. Taking these drugs can also hurt you emotionally, which is something else he is worried about.
Since eating with other people is common, changing how you feel about food can also change how you feel about other people. People who have lost a lot of weight may have to have difficult, awkward conversations about their private health choices. It can be very hard for people who have worked hard to accept their weight to be able to change the body they’ve grown to love.
Bessessen said, “When someone has bariatric surgery, we get them ready for it.” The people go to see a psychologist and a nutritionist. They ask other people who have had surgery, “How was that for you?” That much weight loss will come from medicines. But we’re not getting people ready for that.
A new way of thinking about obesity and how to treat it might help fix some problems from the old way of thinking. But now that we’re here, there are a lot of new ones to think about.
Going forward, prices should stay the same as more GLP-1 drugs hit the market. And there’s a strong case for insurance companies to cover the drugs in the long run. Cancer and Type 2 diabetes cost a lot to treat. In the long run, it might save money to stop those diseases. Perhaps it’s not as clear when we’ll be able to deal with the mental effects of changing one’s body. However, as more people follow this path, we will learn more about the side effects of this treatment that were not meant to happen.
