What’s going on with weight loss?
What Ozempic and the like mean for our health
“We cannot solve our problems with the same thinking we used when we created them.” — Albert Einstein
Obesity is a chronic condition that increases the risk of hypertension, type 2 diabetes, and certain cancers. In the quest to improve our overall health, avoiding obesity is one of the main ways we can live better for longer. Unfortunately, for the past two decades in particular, rates of obesity and severe obesity have risen substantially in the United States and other developed countries in spite of public health efforts. But in the past two years, the trend has changed and most are pointing the finger at one thing in particular: GLP-1 agonists.
What are GLP-1 agonists?
GLP-1 agonists (brand names include Ozempic, Wegovy, Zepbound) mimic a natural hormone called glucagon-like peptide-1, which plays a role in regulating blood sugar and appetite. Originally developed to treat Type 2 diabetes, these medications have gained attention for their significant effects on weight loss. The rise of GLP-1 agonists has led to a surge in over $1 trillion in market cap for pharmaceutical companies, and for perhaps the first time, we have a medical treatment that effectively and safely treats obesity.
How do they work?
When we eat, GLP-1 is released from the gut, signaling the brain to reduce appetite and slow gastric emptying. GLP-1 agonists amplify this signal, helping users feel fuller with less food and supporting blood sugar stability. In essence, GLP-1 agonists support metabolic health by curbing appetite and reducing calorie intake, helping achieve better energy balance (see Nuance of Nutrition).
What does this mean for our health?
GLP-1 agonists are different from other topics generally covered in this newsletter. You’re not going to come away with an actionable plan for how you can plead with your doctor for a prescription. However, GLP-1s serve as a great example for discussing one of the 5 broad domains of tactics at our disposal for improving health: exogenous molecules (e.g., medications, supplements). The other four domains include sleep, exercise, nutrition, and emotional health.
When it comes to improving health, we often focus on habits: better sleep, balanced nutrition, consistent exercise, and emotional well-being. Quite frankly, these are the topics this newsletter has focused on and will continue to focus on. However, GLP-1 agonists show how purely behavioral interventions are not always the answer when it comes to improving our health.
Of the five tactical domains, the medical community has the greatest control over medications, while the other four are more heavily influenced by public health efforts, with campaigns urging us to “eat less, move more,” prioritize sleep, and manage stress. While well-intentioned, these efforts have been lackluster in preventing or reducing obesity at scale.
Why hasn’t public health succeeded? The reasons are complex, but one key issue is that these initiatives often overlook the systemic, biological, and behavioral barriers that make achieving healthier habits so difficult. To name a few:
Nutrition guidance is based on sufficient, not optimal levels and often undermined by the abundance of ultra-processed, calorie-dense foods.
We live in urban environments designed around cars where accessibility has become associated with minimal movement.
Emotional health remains stigmatized and underfunded, even as stress and mental health challenges increase.
GLP-1 agonists are not the first, nor will they be the last, medications to reshape how we think about health. Pharmacological interventions have long been part of our toolkit. What’s different now is the growing recognition that some health challenges - obesity among them - may require solutions that extend beyond the usual public health advice to “eat less and move more.”
This doesn’t mean abandoning the other domains. Rather, it’s about understanding that rarely can a single domain fully address the complexity of human health. While better sleep, nutrition, and exercise are essential, they may not fully resolve the issue for everyone.
What does this mean for our healthcare system?
The key factors of healthcare systems are quality, access, and cost, of which the United States ranks in that order: great quality, generally good access, and very high cost. GLP-1 agonists fit this description.
Part of what enables us to fund a healthcare system that values high quality and abundant access over low costs is the continued growth of the US economy. As more and more working citizens enter retirement, this reality becomes more bleak as productivity moves out of the workforce and greater demands are placed on our healthcare system. Unless, however, citizens who were once compromised or unable to work can better function in society. This is a future that GLP-1 agonists could help create. While the costs for these drugs remain high, it’s one that could be justified, if not paid back in spades, by productivity gains enabled by a broad-scale reduction in obesity. Only time will tell.
Stepwise Strategies
So where do busy professionals fit into this? There are so many tactics at our disposal that it’s hard to know where to start. However, we know that some are better than others, and that generally a combination of tactics works better than using one tactic alone. This isn’t a sign to start taking new medications; instead, this a a call to action to start leveraging the various domains of tactics to improve health.
Take one of your health-related goals (e.g., reduce body fat by 5% in the next 12 months) and pick two to three different domains of tactics to focus on for accomplishing this goal. For example, good sleep improves insulin sensitivity and can improve weight management, exercise grows muscle mass and improves our metabolic function, and improved emotional health can strengthen motivation and adherence to healthy habits. We can think of this a “tactic stacking.” But remember, it’s important to leverage the combination of these approaches while not spreading ourselves too thin. Our goal is to improve health, not all at once, but in a stepwise fashion.
Resources
The Drive: Rethinking Nutrition Science
The Drive: Choices, Costs, and Challenges in US Healthcare
Next Newsletter
We’ll discuss supplements, the other side of exogenous molecules