The Obesity Problem
For many, being great requires being happy with what they see in the mirror and how they feel. Thus, the quest for the perfect body—or, at least, one that feels and looks good—is a regular pursuit for millions of individuals each day. And yet, the success rate in achieving the desired body is relatively low, despite the billions of dollars spent annually on products and programs promising to deliver amazing weight and fat loss results.
While some individuals seeking weight loss programs and products are already in good shape and looking for ways to push past a plateau to become extraordinary, most are overweight or obese. They aspire to get their weight under control—for either aesthetic or health purposes, or possibly both.
Being overweight (BMI of 25-29.9 kg/m2) or obese (BMI ≥30 kg/m2) is a significant health concern, with obesity ranked as the fifth foremost reason for death globally. Obesity contributes to numerous chronic diseases, including cancers, diabetes, metabolic syndrome and cardiovascular diseases. The World Health Organization (WHO) predicts that 30% of deaths worldwide will be initiated by lifestyle diseases, such as obesity, in 2030.
Using methods to lose weight and combat obesity is essential, as an obese state not only impairs the quality of life but also results in a significant economic burden. A 2021 study noted higher annual medical care costs for those who are obese versus a healthy weight—to the tune of $2,505 per year, with costs increasing significantly with the class of obesity, from 68.4% for class 1 to 233.6% for class 3. Simply put, the higher the person’s BMI, the greater the medical costs.
While spending an extra $2,500 per year may not seem like a concern to some, consider the aggregate medical cost for all obese individuals. In 2016, this number among adults in the United States alone was $260.6 billion. With a rapid increase in obesity cases, these costs continue to climb. This is unfortunate, as in nearly all cases of obesity, the problem can be avoided.
With an estimated 42% or more of the United States population now categorized as obese and close to 70% of the country considered overweight or obese, solutions are desperately needed. Of course, the simplest (though not necessarily the quickest) approach is to adopt and maintain a wellness lifestyle program. This includes regular physical activity and structured exercise performed most days of the week, adequate and quality nightly sleep, and appropriate nutritional intake (including calories from macro- and micro-nutrients).
Introducing Weight Loss Drugs
While altering lifestyle is encouraged for long-term success, many people want a faster approach, including using medications designed to aid in weight/fat loss.
People have been using drugs to address weight/fat loss for decades. For example, bodybuilders are notoriously rumored to use drugs to improve their physique. While most outsiders believe bodybuilders achieve their builds through steroid use, the truth goes far beyond this. Most importantly, bodybuilders achieve their physique through superior and unusual genetics, coupled with insane commitment and brutally hard training—something most people are unwilling to do.
When discussing weight loss drugs, we need to look beyond steroids to a combination of many drugs, including those that aid weight and fat loss. These work by decreasing appetite and increasing thermogenesis (i.e., burning calories).
For many, the drug of choice is semaglutide (Wegovy®), a glucagon-like peptide-1 (GLP-1) receptor agonist that was recently approved by the US Food and Drug Administration (FDA) for chronic weight management. This medication appears to blunt appetite and slow food movement from the stomach into the small intestine. As a result, users may feel full faster and for more extended periods, so they eat less.
The clinical trial data are convincing, with subjects losing considerable weight— adverse events (specifically, gastrointestinal) notwithstanding. There has been so much talk about this drug recently, and others like it, that the manufacturers are struggling to meet the demand. In fact, popularity has grown so much that many employers are now covering weight loss drugs as a part of health benefits—an estimated doubling in the number of employers who will cover these drugs in 2024 compared to 2023.
Wegovy® is a variant of the popular diabetic drug Ozempic, produced by the Danish drugmaker Novo Nordisk. These drugs are not the only medications gaining popularity for their weight loss effects, as demand is increasing for Mounjaro. This diabetes medication promotes weight loss using a different key ingredient, tirzepatide. With the overwhelming interest in these drugs, it is unsurprising that others are currently under development.
Do Weight Loss Drugs Work and Are They Safe?
The latest weight loss drugs on the market are so enticing because they produce significant weight loss and ancillary benefits such as lower blood pressure. For example, a recent large-scale study published in the New England Journal of Medicine noted a nearly 15% reduction in body weight following 68 weeks of treatment with once-weekly semaglutide (2.4 mg), plus lifestyle intervention. A more recent publication by the same group noted a significant reduction in BMI for obese adolescents.
While the evidence is clear that lifestyle changes in physical activity and nutritional intake could be equally as helpful, many people are enticed by the quicker path to success and opt to take a weight loss drug rather than modify their lifestyle. However, patients should be instructed by the prescribing physician to engage in lifestyle modification simultaneously with drug use, as noted on the company website. It is unclear whether all patients adhere to this sound guidance.
Potential Harm and Concerns of Weight Loss Drugs
The weight loss drugs I have mentioned are powerful. So, even without much lifestyle change, it is likely that the semaglutide will deliver weight loss. But what are the consequences?
As with all drugs, there are known and potential side effects. This should never be a surprise. Individuals must understand that they now accept the responsibility for the ensuing adverse effects when choosing to use a drug.
For Wegovy® semaglutide, the side effects, including pancreatitis, gallbladder problems, kidney failure, depression and suicidal thoughts, are openly presented on the company website and should be considered before using this medicine.
These have been noted noted in the clinical trials and highlighted in the paper describing the above study (Rubino et al., 2021), where authors stated that “Gastrointestinal events were reported in 49.1% of participants who continued subcutaneous semaglutide vs. 26.1% with placebo.”
You might ask why the placebo treatment would lead to GI events (e.g., nausea, vomiting, diarrhea). Remember that in this study, all subjects received the semaglutide for the initial 20 weeks and were randomized to either continued drug use or placebo. The 26.1% of subjects reporting adverse events could be due to residual problems stemming from the initial 20 weeks of treatment or unrelated to treatment.
Another concern is that users will immediately regain their lost weight after they stop using the medication. This is valid. As with other weight loss methods, the weight will likely return once individuals stop using them. This reality has undoubtedly been shared by many former semaglutide users in anecdotal accounts and confirmed by a large-scale clinical trial.
In this study, 803 subjects who received the drug for an initial 20 weeks (and experienced an average weight loss of 10.6%) were assigned to either continue with the drug for an additional 48 weeks or be switched to using a placebo for the remaining 48 weeks (lifestyle intervention to be followed by subjects in both groups).
On average, those assigned to the continued drug treatment lost an additional 7.9% of body weight. However, on average, those assigned to the placebo gained 6.9% body weight. Now, considering that these subjects initially lost an average of 10.6% body weight, they may have still been at a net loss of 3-4% from baseline. Based on the average starting weight of subjects, this likely equates to 7-8 pounds.
To sum up, semaglutide does work to facilitate weight loss, substantially in some cases. There is a rapid and continuous decline in weight through the initial year of drug use (amounting to approximately 15% of body weight, equating to close to 30 pounds for those with a starting weight of 200 pounds), followed by stabilization, assuming continued treatment. However, once treatment stops, some of the weight will likely return.
Mental health side effects
Finally, mental health side effects are possible. These include anxiety, depression, and suicidal ideation and attempt. Those considering semaglutide should at least consider the possible adverse effects of use and discuss these with their physician.
Natural Weight Loss Options
There is no silver bullet for weight loss. Many who are committed to weight loss are unwilling to accept the potential adverse side effects of weight loss drugs, commit to long-term use for continued effectiveness, or incur the significant financial cost of these drugs—(assuming their insurance plan does not cover these). But there is still hope! Much can be done about the problem of excess body weight.
First, recognize that carrying excess body weight contributes to both acute and chronic health problems—it is not merely an issue of aesthetics. In short, obesity is a disease that needs to be addressed on the individual level.
Second, make a conscious decision to shed the pounds. You need to be excited about this, set realistic goals (perhaps a weight loss of 1 pound per week), develop a plan of action, get to work, and be consistent! Accept that it will not be easy—especially at the start. There will be sacrifice, discomfort and challenges. But the return on the invested effort will be well worth it.
As part of your action plan, identify people who can assist with direction and goal setting. Two important people in this situation include a registered dietitian/nutritionist who can assist with the dietary manipulation and planning and an exercise physiologist or personal trainer who can assist with the exercise prescription and encourage a change in attitude towards exercise.
Beyond this, set goals for nightly sleep, understanding that obtaining adequate and quality sleep is vital in the quest to lose weight and maintain weight.
Exercise for weight loss
When it comes to shedding body weight and fat, physical activity and structured exercise are effective methods to some degree, as both contribute to overall energy expenditure. Burning calories through exercise will create an energy deficit when coupled with reduced calorie intake.
Make a point to increase your daily physical activity, such as walking, housework and yardwork. Although these activities are less intense than structured exercise, they expend energy and can prove helpful. Structured exercise such as running, swimming and weightlifting not only expends calories but also improves cardiorespiratory fitness, muscle strength and endurance, and metabolic health—which assists with weight loss and maintenance over time.
For cardiovascular exercise, those serious about weight loss should aim for a minimum of three hours per week, divided over three or more days. This exercise includes jogging, cycling, stepping, swimming and similar activities—yielding approximately 100 calories burned per 10 minutes of moderate to high-intensity activity.
For resistance exercise (weight lifting), the goal should be approximately 1.5 hours per week, divided into 2-3 sessions—splitting the body parts into different days to allow for adequate recovery between sessions. Resistance exercise will also expend energy but to a lesser degree than cardiovascular exercise (assuming matched intensity). However, resistance exercise will help develop muscle mass, which can slightly raise the overall metabolic rate (how many calories one expends at rest).
Nutritional intake for weight loss
As important as physical activity and exercise are to weight loss and maintenance, dietary intake is arguably more important.
It takes significant effort to expend 1,000 calories through exercise (about two hours of hard work for most individuals), but those same 1,000 calories (or more) can be easily consumed in one fast-food meal. Therefore, paying close attention to nutritional intake is of vital importance.
While it seems simple, and an overwhelming number of different approaches exist to lose weight, the basic goal is to consume fewer calories each day than you expend. For weight loss, this tends to be around 10–20% fewer calories than your body uses for maintenance.
Beyond the number, the type of calories consumed is important. Prioritize eating a nutrient-dense diet of high-quality protein (e.g., white meat of chicken and turkey, lean pork and red meat, cottage cheese), low glycemic index carbohydrate (e.g., beans, whole grains, most vegetables, some fruits), little to no sugar (including sweetened beverages), low to moderate amounts of fat (but adequate essential fatty acids), and a high volume of water (~1 gallon per day).
While caloric restriction is generally viewed as the standard method for weight loss, other plans have proven successful in recent years—including intermittent fasting (IF) and the ketogenic diet. With IF, individuals may not modify the type of foods or how much is consumed, but rather, when foods are consumed (usually during a 6–8-hour feeding window during the day). With the ketogenic diet, carbohydrate intake is reduced significantly (usually < 30 grams per day). This prompts the body to produce ketones in the liver from stored body fat, resulting in significant weight loss over time.
Although the results from this approach are attractive, maintaining such a low carbohydrate intake is challenging. To assist, some individuals choose to use exogenous ketones in the form of a ketone ester beverage like Tecton. Consuming 1-2 Tecton drinks each day can help to maintain a state of ketosis, reduce appetite and assist in the quest for reduced body weight—with safety data supporting Tecton intake at relatively high levels.
Obesity is an ongoing problem in the United States and most developed nations worldwide. People desire a quick-fix approach to weight loss. Most recently, attention from both doctors and patients has shifted from lifestyle changes to weight loss drugs—GLP-1 agonists, to be specific. While these drugs can be highly effective in weight loss, they can promote undesired side effects, which must be carefully evaluated and considered before use.
It could be argued that a better long-term strategy is to adopt a healthy lifestyle approach, including regular exercise and a structured nutrition program. The latter may consider intermittent fasting or a low-carbohydrate ketogenic diet. Both approaches have proven highly effective, with weight loss results from adherence to a low-calorie ketogenic diet paralleling or exceeding those of the semaglutide drugs—roughly 30 pounds in two to six months.
Using the Tecton ketone beverage as a nutritional tool may further assist weight loss success, as appetite can be suppressed—helping to extend a fasting window—while adherence to the lower carbohydrate/lower calorie plan can be more easily maintained.