To begin our series on changes for the New Year, let’s start with the body and talk about what sort of shape we are in, individually and collectively.

At year’s end Americans tend to do two things: Gain weight and make resolutions to lose it. The estimated average end-of-the-year weight gain is somewhere between one and five pounds.

An extra pound or two of weight gain is not a problem unless, year after year, you don’t lose it. Unhappily, we Americans now excel at not losing weight. Nearly 75% of Americans are overweight and almost 10% are classified as morbidly obese. To give the term “morbidly obese” definitive, consider that an average American woman, who would have a height of 5 feet 4 inches, is classified as morbidly obese if she weighs at least 218 pounds, and an average morbidly obese American male, height 5 feet 9 inches, would weigh at least 270 pounds. That’s big. 

So what to do? Well, get hold of ourselves and lose it. But losing weight (and getting into better shape) is, as we know, easier said than done. While it is true, for all of us, that the spirit is willing but the flesh is weak, we can get healthier by understanding a few things about the nature of the problem. Let’s start with two (important) things to understand: First, losing weight and getting fit is not the same thing, and second, doing either comes from steadily pursued habits (which take time) and not the taking of a product or the completion of a process. Staying away from quick fits and being patient is key to changing ourselves. We were not born overweight and out of shape – we got that way over a long time and it will take some time to get out of the shape we are in. 

Unfortunately, we are fed a constant stream of quick-fix processes and products, each claiming that “this time for sure” they are the solution to the problem. Most of them, like fad dieting or workout gadgets, are a waste of time and money. Some of them are not only a waste of money, but dangerous. Topping the list of these expensive and dangerous products are GLP-1s.

Chances are you have seen or will be seeing a blizzard of ads for weight loss drugs like Ozembic and Wegovy, the two most commonly promoted forms of GLP1. President Biden even floated the idea of allowing these drugs to be covered by Medicare and Medicaid, making them available to millions of Americans. But if you need to lose weight and get fit, you should think twice before using GLP-1s.

GLP-1s (“GLP” stands for glucagon-like peptide) are a type of synthetic drug called semaglutides, and are receptor agonists, meaning they bind on cells and cause the cells to do something, a biological response. These synthetic drugs are injected into the fatty tissue under the skin, and act on the body in the following four ways:

 

• They Increase insulin production which reduces blood sugar fluctuations

• They decrease the body’s production of glucagon, a hormone that increases blood sugar levels

• They slow peristalsis, which is the muscular contractions that move food out of the stomach and through the small intestine

• They act on the brain to increase feelings of satiety, the sense that you have eaten enough

In short, GLP-1s reduce blood-sugar spikes, slow down digestive tract emptying, and make the user feel “fuller” longer, all of which encourage them to eat less and lose weight.

Originally, these drugs were designed for diabetics to control blood sugar levels by way of insulin production. When it was discovered that GLP-1s also slowed the digestion of food leading to weight loss, they were quickly pushed as the next magic bullet for weight loss and obesity.

Given that nearly 75% of American adults are overweight or obese, what could be the matter with using these drugs to help people lose weight, even if they were not designed for that purpose? Well, lots.

First, there is the cost. Losing weight, a process that mainly involves less of something (food), should, at its core, cost you less than you are spending currently. However, GLP-1s like Ozempic and Wegovy are very expensive, coming in somewhere between $1,000 to $1,300 a month. Additionally, current data suggests that when people stop injecting GLP-1s, they gain back the weight that they lost, leading to a need to take the GLP-1 for many years if not for life. $12,000 to $15,000 annually, potentially for life, is a lot to spend for something that, at its core, is about consuming less.

The second reason to avoid GLP-1s is that they do not solve the problems that cause weight gain. We are overweight because of our lifestyle and our habits. We consume too many highly digestible calories (sugars and refined carbs) and get too little exercise. Unless you use GLP-1s along with a deliberate lifestyle change (eating less and exercising more), you are merely exchanging one problem for another: Weight management for drug dependency. 

And yes, I have read many testimonials by GLP-1 users who say “I just need something to change my relationship with food,” and then, the logic goes, the user would take it from there. While I am sure that these people are sincere in their beliefs that significantly restricting their caloric intake is what they need to get started, the facts of what happens when we try to lose weight through dramatic calorie restriction don’t support their beliefs. Nearly 95% of those who lose weight through acute caloric restriction regain it within months. Why? Because maintaining a healthy weight is a long-term process that involves the mind, body, and soul, and can not be done by simply focusing on calories. I will write more about the “MBS triangle,” as I call it (Mind-Body-Soul) next week. For now, just know that if someone suggests you can change one, in this case, the body, without help from the other two, mind and soul, know that they do not understand how the whole person works, and you should not listen to them.

The third reason not to use GLP-1s is the issues of reliability and some serious side effects. GLP-1s were designed to help diabetics regulate their blood sugar, not for weight loss. The prescribing of drugs for things other than what they were designed for is called “off-labeling,” and is not uncommon in the pharmaceutical world. When it was discovered that diabetics using GLP-1s were also losing weight, companies both in and out of the United States began manufacturing and aggressively pushing GLP-1s to physicians and directly to consumers. But consumer beware, the GLP-1s that you can buy online and self-inject may not be what they are advertised, and simply put, you just don’t know what’s in the stuff that comes through the mail.

Even the “good stuff” (if any GLP-1 can be called that) that comes from the pharmacy has a slew of dangerous and down-right icky side effects. Increased risks of various cancers, undigested food rotting in the stomach and even gastric paralysis (the stomach and small intestine stops moving food along the digestive tract) top the list. Since the putting of synthetic GLP-1s into our bodies is so new, no one knows what the long-term side effects might be. 

If you think that the government or the pharmaceutical industry would not allow a drug to be prescribed widely for years and years if there was evidence of serious side effects, well, think again. Remember the opioid epidemic? Pharmaceutical companies only stopped pushing highly addictive and dangerous opioids after attorneys (representing both states and individuals) forced them to pay some $27 billion in compensation and damages. 

Opioids are not the only instances of a widely prescribed drug that has caused harm to its users. Have a look, for example, at the now multiple support groups for men who, starting in their teens and early twenties, were given isotretinoin (a synthetic derivative of vitamin A) which is commonly marketed as Accutane for acne. Exactly how isotretinoin works in the body is not known, but it causes the death of some cells and is a powerful disruptor of hormone production, especially testosterone. Many of these men now live with permanent erectile dysfunction and/or disrupted libidos. They were not, as they will tell you, informed about what isotretinoin could do to them, and now feel shamed, ignored, and forgotten by the very industry that gave them the drugs in the first place.

Finally and perhaps the most serious reason not to use a GLP-1 for weight loss is the type of weight that their users lose. A number of studies have shown that somewhere between 30% to 50% of the weight lost while using a GLP-1 is lost muscle mass. This is not surprising, since diets that involve sudden and dramatic restriction of caloric intake cause the body to burn muscle tissue for fuel. The problem with the loss of muscle mass, a process called sarcopenia, is that it reduces the body’s ability to lose weight in the future and results in a significant decline in overall bodily health. 

Understand that fat is metabolized (burned) through muscular activity; lifting things and moving around. The more muscle you have, the faster you will burn fat. The less muscle you have, the harder it is for your body to burn fat. Building muscles is a long, slow, and depending on your age, difficult process for your body. Anything, be it age, inactivity, or sudden calorie restriction that reduces your muscle mass also reduces your body’s ability to function well and burn fat. Here, too, the research is clear that a drop in muscle mass, be it age-related or otherwise, is perhaps the number one risk factor in older adults for everything from serious falls to dementia. Put simply, the less muscle mass you have as you age the greater your chances of developing an illness, having a debilitating fall, or experiencing sharp mental decline.  

Giving GLP-1s to masses of people in their 30s and 40s is, by all indications, creating an illness timebomb for people in their 50s and 60s. Reduced muscle mass will lead to more illness, falls, and mental decline. Who knows, too, how widespread and serious issues like gastric paralysis will also prove to be.  

So why would we do that? Why would we take or promote GLP-1s? Short-sightedness, mostly. Collectively, we have a habit of applying sudden fixes to long-term problems and (somehow) expecting positive results. This is, of course, strange, and even, well, silly, and it speaks of the broken relationship that we have between our spiritual, mental, and physical selves. It also speaks volumes about the profit-over-people structure that is our health system. Without hyperbole, it is fair to say that we do not have a healthcare system, but a “sickcare” industry, one that does not primarily focus on the prevention of illness but profits from its treatment. If you are in the sick-care business, which pharmaceutical companies are, getting people dependent on drugs now that will necessitate more drugs and medical devices later is not as foolish as it might seem.

What, then, should we do to get back to a balanced relationship with ourselves and the food around us? Next week, I will tell you about a few things that you can do, drug-free and sick-care-be-damned, to move back towards balance, to be healthier and holier in 2025.