Has your doctor recommended a medical weight loss program or oral medications that cause weight loss? “Hollywood’s new weight loss drug” has been a hot topic since the drug Wegovy was approved for use in overweight teens and adults.
As a former clinical research dietitian who participated in the clinical trials that led to its approval, I want to weigh in on the benefits, side effects and natural alternatives to weight loss medication.
But first, a bit of background…
When I was approached to work on the drug trial, I almost didn’t return the phone calls. To say I was initially reluctant to participate is an understatement - as a private practice functional dietitian, most people I worked with were trying to get off of medication, not go on it.
But I agreed to listen to the job offer and understood that my role would be to support trial participants in behavioral, diet, and exercise interventions that would help them to lose weight. I could get on board with this because, regardless of their medications, it would be important for patients to make these healthy changes!
I had no idea that by agreeing to be part of one trial I would end up doing three more 68-week trials! During these years as a research dietitian, trial participants were required to meet with me every 2 to 4 weeks. My job was to teach them good nutrition and to coach them into new, healthy habits.
In my experience, there’s no doubt that the drug works to decrease appetite but what are the trade-offs? Here, I set out to explain what the weight loss drug is, how it works, what the side effects are, and natural alternatives to this weight loss medication.
What is Semaglutide?
In 2021, the U.S. Food and Drug Administration (FDA) approved Wegovy (semaglutide) for chronic weight management in adults with obesity or overweight with at least one weight-related condition (such as high blood pressure, type 2 diabetes, or high cholesterol), for use in addition to a reduced calorie diet and increased physical activity.
The drug is intended for chronic weight management in patients with a body mass index (BMI) of 27 kg/m2 or greater who have at least one weight-related ailment, or in patients with a BMI of 30 kg/m2 or greater.
While Wegovy was only recently approved, its predecessor Ozempic was approved for use in diabetics in 2017. Both Ozempic and Wegovy are injections that contain the drug semaglutide, however Wegovy is a higher-dose version that’s specifically approved for weight loss.
Semaglutide drugs like Ozempic and Wegovy work by mimicking a hormone called glucagon-like peptide-1 (GLP-1). This is a naturally occurring satiety hormone in the body that helps the brain regulate food intake. When we eat, GLP-1 is released from our intestines and sends signals to our brain centers that control appetite.
Do Weight Loss Medications Work?
This appetite suppression leads to weight loss however per its FDA approval, it is considered an adjunct to diet and exercise. It has also been shown to improve glycemic control and reduce the risk of major cardiovascular events in adults with type 2 diabetes.
In the clinical trials for Wegovy, non-diabetic patients with a BMI of 38 kg/m2 lost an average of 12.4% of their initial body weight compared to those who received placebo, while diabetics lost an average of 6.2%. For the average non-diabetic female in the trial who started at a BMI of 36 kg/m2 and 231 pounds, this was a 28 lb weight loss over the course of 18 months. Diabetics lost an average of 13 lb during the trial.
In contrast, a recent randomized clinical trial compared low fat to low carb diets for non-diabetics in which the average BMI was 33. At 12 months, the low-fat group had lost 11.7 lbs and the low-carb group 13.2 lbs. Both groups were based on a whole foods diet and both were able to improve certain health markers including BMI, body fat percentage, waist circumference, blood pressure, and fasting insulin and glucose levels.
While neither the low-fat or low-carb diet proved to be superior, this study does show that healthy diets rich in whole foods is an effective way to lose weight and improve markers of health - and may be as effective as weight loss medication. According to the lead author of the study, Dr. Christopher Gardner, the people most successful in keeping their weight off “changed their relationship to food”.
Side Effects of Weight Loss Medication
The weight loss drug is not without side effects. According to the FDA, “The most common side effects of Wegovy include nausea, diarrhea, vomiting, constipation, abdominal (stomach) pain, headache, fatigue, dyspepsia (indigestion), dizziness, abdominal distension, eructation (belching), hypoglycemia (low blood sugar) in patients with type 2 diabetes, flatulence (gas buildup), gastroenteritis (an intestinal infection) and gastroesophageal reflux disease (a type of digestive disorder).” Additionally, the drug comes with a warning of potential risk of thyroid C-cell tumors.
I saw many of these gastrointestinal side effects with my trial patients, to the point it negatively affected quality of life. Often, my patients were challenged to eat more than 1000 calories a day - far below the basic needs of most adults - and "overeating" would most definitely trigger unwanted side effects.
While a drastic calorie deficit is initially effective for weight loss, it eventually stops working. Your body becomes more efficient with less fuel and the metabolism slows down. It's not a sustainable approach and is challenging to maintain post-medication.
Weight regain is common following usage of the medication. In follow-up with trial participants one year after withdrawal of the semaglutide, participants had regained two-thirds of their prior weight loss, with similar changes in cardiometabolic variables.
Natural Alternatives to Weight Loss Medications
No matter what “diet” or medication is used, weight regain is likely if new, long-term habits are not adopted as “the new normal.” Sustainability of any approach has to be considered - can you do this for the rest of your life?
For many people it is cost-prohibitive to take a medication like this for the rest of their lives, not to mention people get tired of the short- and long-term side effects.
So how can you promote the natural production of GLP-1 to help promote weight loss without spending the big bucks on medication? Here are a few proven ways to increase GLP-1 hormone:
Chew your food - eating slowly with longer mastication time can have a positive impact on the GLP-1 secretion and insulin levels.
Exercise - physical activity (aerobic/resistance training), intensity of exercise, duration, time and frequency of exercise have shown to improve GLP-1 levels.
Antioxidants - specifically those in herbals such as berberine, quercetin, tea, curcumin, cinnamon, resveratrol, and gardenia, can have an influence on GLP-1 release. These can be taken in supplemental form or in their natural food forms.
Protein - Studies in enteroendocrine cell models have shown that amino acids can directly stimulate GLP-1 secretion.
Whole foods - the thermic effect (i.e. calorie burn) is higher post a whole food meal than after a meal of processed foods. Foods such as high-fiber grain products, nuts, avocados and eggs also seem to influence GLP-1 secretion.
When it comes to weight loss, there is no magic pill or easy button. Effective weight loss requires commitment, consistency, and hard work. There's no one size fits all approach - the approach that works for you is an eating style that fits your food preferences, health goals, lifestyle. Most importantly, it's an eating style you can sustain. Need help determining what that looks like? Set up a strategy call with me to figure out what will work for you!
RESOURCES:
Bodnaruc, A.M., Prud’homme, D., Blanchet, R. et al. Nutritional modulation of endogenous glucagon-like peptide-1 secretion: a review. Nutr Metab (Lond) 13, 92 (2016). https://doi.org/10.1186/s12986-016-0153-3.
FDA Approves New Drug Treatment for Chronic Weight Management, First Since 2014
Hira T, Trakooncharoenvit A, Taguchi H, Hara H. Improvement of Glucose Tolerance by Food Factors Having Glucagon-Like Peptide-1 Releasing Activity. Int J Mol Sci. 2021 Jun 21;22(12):6623. doi: 10.3390/ijms22126623. PMID: 34205659; PMCID: PMC8235588.
John P. H. Wilding D.M, Rachel L. Batterham MBBS, Melanie Davies M.D, Luc F. Van Gaal M.D, et al. Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. 19 April 2022 https://doi.org/10.1111/dom.14725 https://dom-pubs.onlinelibrary.wiley.com/doi/10.1111/dom.14725#
Yaribeygi H, Jamialahmadi T, Moallem SA, Sahebkar A. Boosting GLP-1 by Natural Products. Adv Exp Med Biol. 2021;1328:513-522. doi: 10.1007/978-3-030-73234-9_36. PMID: 34981502.
Yuki Fujiwara, Shunsuke Eguchi, Hiroki Murayama, Yuri Takahashi, Mitsutoshi Toda, Kota Imai, Kinsuke Tsuda. Relationship between diet/exercise and pharmacotherapy to enhance the GLP-1 levels in type 2 diabetes. 16 May 2019 https://doi.org/10.1002/edm2.68
Comments