Yves here. While this Richard Murphy post makes a valid point about the failure to sustain weight loss after going off GLP-1 agonists, I have to take issue with his contention that fatties just need to man (or woman) up and give up their bad habits to get and keep weight off.
I went on my first diet when I was 11. This was my idea, not my parents’. My BMI was in the overweight as opposed to obese category, but I was very large for a kid those days (in height as well, another story). I got 25 lbs off, more than the average weight loss with Ozempic. It came back on over 2 years. I went on another diet, then taking off 30 lbs. It again largely came back over the next two years.
Mind you, this is as a young person when it is theoretically easier to lose weight.
The dirty secret, even with young people, is when you engage in calorie restriction (aka dieting), unless you do in in a very particular way (periodically but far from regularly eating a “normal” calorie level; exercise routines designed to generate lactic acid, which increases growth hormone and therefore raises your metabolism, can also help), your body thinks you are starving and downregulates your metabolism. So when you stop dieting, you are if anything more inclined to gain weight due to the diet-induced slowdown in your metabolism.
As an adult, I found the only way to keep weight off after my see-saw diets in my teens (there were a couple more) was to permanently restrict my intake to 1000 or so calories a day. The NIH should be paying me for being on my own long-term severe calorie restriction experiment (animal studies suggests it increases longevity). lAnd starting at age 25, I was also exercising an hour or so a day (pretty hard cardio + some calisthenics, later cardio + weight training).1
Admittedly, this is n=1. But my own experience illustrates that once you become fat, it is hard to reverse that and sustain the reduction. So I’m not keen about finger-wagging at the overweight, at least on the basis that they should be able to pull themselves up by their bootstraps. Most of the advice about getting and keeping weight off is terrible even before getting to fads. So no wonder the overweight take magic pills.
The key, as RFK, Jr.s MAHA indicates, is to improve diet and lifestyles so fewer people fall into the overweight trap, particularly young people. But neoliberalism and other practices work against that. Children no longer walk to and from school. My impression is that middle and upper class parents drive them to their play dates, rather than the kids getting their under their own power, usually bikes. Recesses are shorter than when I was young.
Neoliberalism also has resulted in less involvement by parents in community activities, like fathers playing softball, which would also serve as a model for their offspring.
Perhaps IM Doc will disagree, or some readers will say it was easy for them to shed pounds and keep them off. But I was diligent as an adult, to the extent that I did things like reading bodybuiding magazines for weight loss and supplement tips (bodybuilders are bleeding edge on weight loss methods, since they have to get “cut” for contests) and experimenting with quite a few diet and supplement fads. And I was still unable to relent on my draconian eating self-discipline, which I doubt many could maintain long-term.
By Richard Murphy, Professor of Accounting Practice at Sheffield University Management School and a director of the Corporate Accountability Network. Originally published at Funding the Future
The Guardian has reported this morning that:
People on weight loss drugs regain all the weight they have lost within a year of stopping the medication, analysis has shown.
Analysis of 11 studies of older and newer GLP-1 weight loss drugs by the University of Oxford found that patients typically lost 8kg on weight loss jabs but returned to their original weight within 10 months of stopping them.
The study, presented at the European Congress on Obesity, found that even for those taking newer, higher-dose weight loss drugs such as Wegovy and Mounjaro, people put weight back on once they stopped treatment.
Why note this? That is because what this evidence makes very clear is what I have been suggesting on this blog for a while, and that is that the purpose of these drugs is not to solve the problem of obesity. It is instead intended to create a new form of dependency, or even addiction. In this case, this dependency is on the weight loss drugs that the person becomes totally reliant upon to maintain their body image, and so their mental health, whatever the physical health side effects might be (and they can be serious, with significant potential long-term costs to the NHS).
The serious medical side effects of these drugs are ignored by most of their users. They want the dopamine hit of being slimmer without having to adjust their lifestyles, or to address the other addictions that they must shake off if they are to achieve sustainable weight loss. Those addictions are most especially to sugar and carbohydrates.
The GLP-1 drug industry is not, I suggest, interested in the side effects of its drugs. These are, as far as it is concerned, an economic externality that they can ignore as someone else (the state) will bear that cost.
And they are definitely not interested in suggesting that the other addictions that those who become dependent on their drugs might have be addressed, because if they were, then the steady flow of new sugar and carbohydrate addicts on which their business model now depends will be impacted.
Most bizarrely, the NHS, whose job it should be to see through all this and rise above it, very clearly does not do so. It has been captured by commercial interests whose only interest is in promoting addiction or dependency, at the very least.
All the GLP-1 drugs have done is add another drug on which people can become dependent, quite possibly for life, to the vast array that the NHS already spends a fortune on to keep the medical-pharmaceutical industry in the extraordinary level of profits to which it has become accustomed, without ever actually solving almost any of our real health problems, to all of which it turns a blind eye, as to address them would reduce their future earnings.
There is a sickness at the heart of the NHS in the form of drug companies, who are fleecing us all.
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1 I am now weirdly able to eat more but still less than a normal person since moving to Thailand; I attribute it to being in >80 degree temperatures nearly all the time.
