For decades, massive industry has revolved around weight loss, (weight watchers, Herbalife, lighter life, Atkinson etc.) The search for the magic pill has included snake oil supplements, fad diets, bio-hacks, bro-science fat burners. Nothing has delivered real results until now. The magic pill is upon us and the fitness industry may change forever. This magic pill comes in the form of GLP-1 receptor agonists. The most popular form of that is currently semaglutide. AKA. Ozempic and Wegovy. It’s also available in oral form because the others are injectables right now. it’s called Rybelsus.

If you are considering using Ozempic for losing weight you need to know about these weight loss drugs based on the scientific consensus.

How these drugs work.

GLP-1 receptor agonists, as the name implies, mimic GLP-1. GLP-1 is a hormone that’s produced by our intestines. The drug has the same effect as the hormone in our intestines, just like injecting testosterone has the same effect as the testosterone that’s produced by our own bodies.  There are actually multiple similarities between anabolic steroids and these weight loss drugs. The effects of GLP-1 are to release insulin to inhibit the release of glucagon, to suppress gastric emptying, meaning it slows down the rate at which food leaves your stomach, and as a result of those effects it has potent appetite suppressing effects. It reduces your appetite, makes you feel more full, makes you eat less.

Originally these drugs were developed as anti-diabetes medicines, but it turned out that they were very effective for weight loss due to the appetite-suppressive effects. And now the drugs are equally marketed as weight loss drugs as anti diabetes medicine. These drugs really work. Most people lose around 10% of their body weight over the span of approximately six months when they start taking these drugs. That makes these drugs the most effective weight loss treatment currently available on the planet other than bariatric surgery and, you know, actually going to the gym and dieting. These drugs are also very safe. The rate of serious adverse side effects is very low and the medical consensus is that these drugs are certainly a net positive. Most people experience significant health improvements in most of their health biomarkers and their quality of life because the positive effects of the weight loss completely overshadow any negative effects of the drugs. This is particularly true for people with blood sugar issues because the drugs are very effective to control your blood sugar.

Unsurprisingly, the stock prices of the companies selling these drugs have absolutely skyrocketed over the last years. Many investors are even reluctant to invest in fitness and other medical industries because the thought is that these drugs can basically cure the obesity pandemic just by taking a pill or taking an injection once per week. If that’s the case, if you can just take a pill once per day, you can do a small injection in your abdomen once per week, why would anyone still go to the gym?

GLP-1 agonists are not without problems.

There are some very serious issue with their use.

Appetite suppression

The first issue of using GLP-1 agonists to lose weight is that by relying purely on appetite suppression rather than sustainable lifestyle change and healthier food choices for your weight loss is that you exacerbate any nutritional deficiencies that you may have. Most people actually have at least one or multiple nutritional deficiencies Their deficiency rates of iron, vitamin D and magnesium, for example, are very high. So if you take a random individual off the street, it’s very likely that they have at least one micronutrient deficiency. If this individual’s on their current diet, just start eating less of the same food, they will exacerbate whatever deficiencies they currently have.

Lean  body mass loss is very significant.

In many of these trials, people lose a third or up to 40% of their weight from lean body mass. That’s much more than the normal 25% or so that we see in most literature. And it’s much more than the 0% that you would like to see in people when they actually exercise and they have a high protein diet. But because people eat significantly less due to the appetite suppression many people essentially involuntarily crash diets and often do so on relatively low protein intakes. If you combine excessive weight loss without high protein diets and without exercise, that is a recipe for lean body mass loss. So it’s not that GLP-1 agonists inherently cause muscle loss is just a combination of the weight loss that they produce with generally a poor diet that results in lean body mass loss. And that is a significant problem even if you don’t care about muscle loss because it will also reduce your energy expenditure, your metabolic rate and any muscle that you’ll lose is fat that you’re not losing because you’re only losing the energy from the body in one form.

very expensive.

At about a thousand per month it’s fair to say that these drugs are exy. If you’re covered by insurance that’s fine, but for people that are not that’s a serious consideration.

Side-effects.

In fact, the vast majority of individuals on these drugs do report side-effects, usually ranging from things like nausea, heartburn, diarrhea and constipation to sometimes more serious issues. But usually they’re at relatively low grade. Just because they’re not serious medical events, though, doesn’t make them pleasant. And it’s also very hard not to have these side-effects because it’s part of the inherent mechanism of action. As discussed, GLP-1, the hormone produced in your intestines is responsible for slowing down the passage of food and drinks from your stomach to the intestines. That’s inherently part of the mechanism of action, and it’s part of the reason why have the appetite suppression. So some of these digestive side-effects will probably be very difficult for medical technology to resolve. This problem is bigger than it may seem because we’re not talking about some side effects for a small period of time.

If you stop using these drugs you stop reaping the benefits.

Most people, when they go off these drugs, they regain all of the weight that they lost slowly over time. This is exactly the same problem people experience with any type of fat diet: when they go off the diet and they haven’t sustainably changed their lifestyle, they’re going back to the diet that got them fat in the first place, they’re going to get fat again. That’s how the body works. The body is merciless with the physics. If you’re not changing your lifestyle, you’re not making smarter food choices and you’re just relying on the drug to eat less of the same foods that you’re currently eating, what happens when you stop taking the drug? Your appetite goes back to normal, your food intake increases and you will reach an equilibrium at the same weight that you were at before you started taking the drug. So sustainable lifestyle change and making different food choices, exercising. These things are still important for long term weight loss success unless you plan on using the drug for life.

In this sense, these weight loss drugs are very similar to anabolic steroids. Using anabolic steroids without exercising will put some muscle on you, but if you stop using the drugs you’ll lose the muscle mass. Similarly, if you don’t change your lifestyle and you use these weight loss drugs, you’re going to regain the weight after you stop using them. So ironically, while these drugs were originally designed for overweight individuals, some people with diabetes, there’s actually an argument to be made that these drugs are more suitable for bodybuilders preparing for a contest because that’s inherently an unsustainable practice. So then you might as well do it with less hunger. Of course, a strong argument can be made that just like using anabolic steroids for muscle growth is cheating, so can it be called cheating to use these weight loss drugs to lose fat, at least for something like a bodybuilding show.

This unsustainability of using the drug itself purely for the weight loss makes them a complete Band-Aid solution. Of course, it’s still better to lose weight, at least periodically, than to be overweight all the time. But that’s not what most people have in mind when they start taking these drugs.

It’s also worth noting that these drugs are currently only available on prescription. That may change in the future, but they’re currently not available over the counter. Now, most of these problems can be overcome, theoretically, at least by medical technology. If these drugs get cheaper because the market moves away from the current oligopoly, where we have only a few major suppliers of all the drugs, and if the drugs become better in terms of managing side-effects, maybe it will be suitable for people to actually stay on them for life.

I would strongly advise people to consider it a long term effects and think of the long term future. Do you plan on using these drugs for life? Are you okay with the level of side-effects and the possible economical costs? And importantly, are you going to change your lifestyle? Without sustainable lifestyle change, you’re not going to reach optimal health, and you’re going to have to stay on these drugs essentially for life to stay lean. And if you are going to change your lifestyle, then why do you need the drugs in the first place?