Modern medicine has figured out how to treat yet another chronic disease that affects millions globally — obesity! Medications such as semaglutide (Ozempic, Wegovy, Rybelsus) and tirzepatide (Mounjaro, Zepbound), which are glucagon-like peptide-1 receptor agonists (GLP-1 RAs), are now valuable tools for achieving substantial and sustained weight loss.
Understanding Obesity as a Disease
For decades, society has often mischaracterised obesity as a mere lack of willpower rather than recognising it as a complex, chronic disease. In reality, individuals with obesity likely possess as much willpower as anyone else, but they face greater challenges in losing weight due to a combination of genetic, physiological, social, cultural, behavioral, and environmental factors.
We live in an obesogenic environment filled with cheap, highly palatable, energy-dense foods that make overeating easy and often unconscious, along with countless conveniences that reduce physical activity.
Genetic Predisposition and Environmental Factors
Why do some people gain fat in an obesity-promoting environment while others don’t? Genetically, some people are more predisposed to obesity. While severe obesity linked to single-gene mutations is rare, polygenic obesity, where multiple genes contribute to weight gain, is common. These genetic factors can increase hunger signals and preoccupations with food.
Individuals with certain obesity genes may experience “food noise”— a constant obsession with food, continually thinking, “What am I going to eat next? When is my next meal?” Additionally, physiological resistance to fat loss is common. After significant weight loss, hormonal changes can cause persistent hunger and reduced feelings of fullness, making it challenging to maintain weight loss.
How GLP-1 Medications Work
Current weight loss medications like semaglutide and tirzepatide work primarily by mimicking the function of glucagon-like peptide 1 (GLP-1), a hormone with several key roles:
● Pancreas: Triggers insulin secretion, helping regulate blood sugar.
● Gut: Slows gastric emptying, affecting the sensation of fullness.
● Brain: Reduces cravings and food noise (intrusive thoughts about food).
In people with obesity, the body quickly breaks down endogenous GLP-1, making it less effective. Consequently, it takes longer and bigger meals to feel full, and food noise becomes a near-constant companion. Medications like semaglutide flood the body with synthetic GLP-1 that lasts much longer, increasing feelings of fullness, reducing between-meal hunger and muffling cravings and food noise.
Managing Side Effects
Gastrointestinal Issues: While GLP-1 medications can cause side effects such as nausea, constipation, and other gastrointestinal issues due to slowed gastric emptying, these are typically manageable.
Strategies such as consuming smaller, more frequent meals, avoiding greasy and highly processed foods, and staying hydrated can help mitigate these side effects. It’s important to work with a coach to find more palatable ways to consume nutritious foods. Fortunately, for most people, these GI woes tend to resolve within several weeks.
Muscle Loss: When taking GLP-1 medications, about 30 to 40 per cent of the weight lost can come from lean mass. People with severe obesity generally have more muscle and bone mass than others, allowing for safe loss of some lean mass. For people with severe obesity, the health boost from
body fat loss offsets the health risk of muscle and bone loss. However, for those with less muscle and bone mass, particularly older individuals, a drop in lean mass and bone density can pose health risks. However, muscle and bone loss is not inevitable. Adopting muscle-building behaviors like strength training and adequate protein consumption can help offset these side effects.
The Myth of “Ozempic Face”: The term “Ozempic Face” has gained media attention but is misleading. People lose fat differently depending on where their body stores it. There is nothing unique about semaglutide that specifically targets facial fat.
Addressing the Yo-Yo Problem: GLP-1 medications are expensive, and discontinuing them can result in the return of hunger and
cravings. Without foundational changes in eating habits, individuals may regain the weight lost. In one study, participants who stopped taking semaglutide regained, on average, two-thirds of the weight they had lost.
Using Weight Loss Medications Effectively: Weight loss medications should be used as tools to facilitate lifestyle changes, not as replacements for them. When GLP-1 medications reduce food noise and hunger, it becomes easier to prioritise healthy foods like protein, fruits, vegetables, and minimally processed whole foods. Additionally, weight loss can enhance well-being, making it more likely for individuals to engage in physical activities such as weight lifting.
A 2024 consumer trends survey indicated that 41 per cent of GLP-1 medication users reported increased exercise frequency since starting the medication. The majority also reported improved diet quality, consuming more protein, fruits, and vegetables.
This is great news, because, as mentioned above, lifestyle changes are critical to preserving lean mass and preventing regain, should clients choose to discontinue medication.
Understanding and Managing Food Noise in Obesity
Obese people report experiencing higher levels of food noise than those without obesity, and this phenomenon significantly hinders their ability to make necessary behavioral changes for weight loss. Food noise can be described as compulsive, disruptive thoughts about food that feel intrusive and negatively affect one’s quality of life. It consumes a significant amount of mental time and energy daily, often in a distracting and anxiety-inducing manner.
1) Triggers and Impact of Food Noise:
Thoughts about food can be triggered by internal cues, such as hormones involved in hunger and appetite, and external ones, like the smell of freshly baked cookies or seeing a fast-food advertisement. Food noise can be elicited by sights, smells, tastes, and even discussions about food, with some people being more responsive to these food cues than others.
2) Addressing Food Noise:
For many, food noise cannot be easily silenced, especially if it is rooted in underlying mental health issues such as anxiety, depression, or eating disorders. Therefore, it is crucial for anyone experiencing persistent food noise to seek help from a registered dietitian and therapist. These professionals should be skilled in promoting health for individuals of all sizes and minimising stigma for people with larger bodies.
3) Professional Support and Strategies:
Individuals with obesity report experiencing higher levels of food noise, which can be a significant barrier to making necessary behavioral changes. Food noise is described as compulsive, disruptive thoughts about food that intrude on daily life and can be anxiety-inducing.
4) Strategies to Manage Food Noise:
Work with professionals: Collaborate with a registered dietitian and therapist who understands the importance of health promotion for people of all sizes and can minimise stigma.
Manage stress and sleep: High stress and poor sleep can exacerbate food noise. Positive stress management techniques and sufficient rest are crucial.
Intuitive eating: Avoid getting too hungry or depriving yourself of food as this can spur food noise and lead to overeating.
Environmental adjustments: Modify your surroundings to reduce food cues, such as not keeping tempting foods in visible or easily accessible locations.
Identify patterns: Notice when food noise is most problematic and find ways to break the habits associated with those times.
Weight loss drugs, when responsibly prescribed to informed individuals, offer hope and improved health outcomes for many. However, they should not be used for vanity weight loss. Understanding the complexity of obesity and combining medication with lifestyle changes are key to effective long-term management.
Nutrimend is a diet consultancy clinic founded by Neha Patodia and Nupur Arya in 2015. They coach people on how to eat right so that they feel confident in their bodies and achieve their desired goals.