A Nutritionist's Concerns About Weight Loss Drugs
If you have watched the news, looked at social media, or picked up a newspaper anytime in the last couple of months, you have likely heard of the new weight loss drugs like Ozempic and Wegovy. Ozempic, a semaglutide injectable, was approved for use in those with type 2 diabetes in December of 2017. It had the seemingly unexpected result of causing weight loss in users. Since then, Wegovy, a higher dose of essentially the same medication, was approved for “weight management” in June of 2021 but really seems to have taken off in Hollywood and the media right at the end of 2022.
Since the topic has come up with several clients and other professionals, I wanted to offer my thoughts for those that are curious. Disclaimer, I am not a doctor. The following statements represent my current thoughts as a nutritionist. Please feel free to reach out to me directly at anytime to discuss further.
Like with most things in life, I suspect these drugs will work for some people and not for others. I suspect they will be seemingly good for some people and cause harm to others. People are complicated.
Increase in Anti-Fat Bias
Let’s start with a potential positive. These drugs seem to be shifting the conversation (ever so slightly) about weight. One of the talking points seems to be that weight is not something completely within an individual’s power to control, no matter how hard they try. Weight is multifactorial, being influenced by genetics, environment, food, movement, sleep, hormones, and more. It is not as simple as calories-in and calories-out (and never has been).
My concern with that shift is that it is only starting because there is an expensive new drug that seems to “solve” the problem. To be clear, I don’t think being at a higher weight is necessarily a problem that needs solving (a tangent that I will save for another time). Considered by some to be an “easy fix,” these drugs have to potential to exacerbate anti-fat bias. The affordability, spotty insurance coverage, and the fact it won’t work for everyone (either because it simple doesn’t work or the side effects are untenable), or someone simply doesn’t care to take a medication, means these biases will unduly impact those with marginalized identities including those in larger bodies, POC, trans folks, and those with lower socioeconomic status.
Low Nutrient Intake
From a nutrition perspective, I am concerned about meeting minimum dietary requirements. From anecdotal reports the drugs seem to suppress appetite, sometimes to an extreme. This means it is even more important that the limited amount of food that someone consumes is as nutrient dense as possible. It can be hard to prioritize nutrient density when appetite is low or one feels nauseous (one of the more common side effects). Often bland foods or simple carbohydrates like toast or crackers are more appealing in those situations.
If someone doesn’t get enough protein from dietary intake, the body will take protein from muscles to use it for more essential processes like the production of enzymes, hormones and to repair tissue. If protein intake continues to be inadequate for several months or longer, it is likely that people could experience hair loss, slow wound healing, impaired immune function, and loss of strength and muscle tone. I have similar concerns about mineral intake. The body will take minerals stored in bone if needed, which has the potential to weaken bones overtime. These are a few examples of things we see when people have low food intake like in starvation or in eating disorders like anorexia.
Body Disconnection
As an Intuitive Eating counselor, I wonder how someone can re-learn how to trust their body and listen to internal signals when those signals are skewed by a drug. These drugs reinforce that our bodies are not to be trusted. I am uncertain how it will impact those that identify as emotional eaters or have untreated eating disorders or disordered eating that include binging. In addition, food is more than nutrition; it is also connection and pleasure. What happens when eating is no longer fun and enjoyable? How are holidays and special occasions celebrated?
Uncertain Future
It also remains to be seen what happens over the long term. With traditional weight loss diets and even bariatric surgery, people generally start to regain weight within 2-5 years. Early accounts indicate that most people regain weight once they stop taking these drugs. We don’t have enough data to know what the effects could be if one stays on the drug for years or decades (these are approved for teenagers as young as 12, after all).
Ultimately, whether to use a weight loss drug is a personal choice. The same way that going on a diet, getting bariatric surgery, or opting out of diet culture is a choice. As with any choice, I encourage you to ask questions and seek out trusted and compassionate resources to educate yourself. One of my favorite resources is Ragen Chastain’s Weight and Healthcare Substack. She did a review of the history of weight loss drugs last summer that is definitely worth a read. Whatever you choose to do for yourself, please treat the choices that others make with kindness and respect. If it is not your body, it is not your business!
The information provided is for educational and informational purposes only. It is not intended to be medical advice or to diagnosis, treat, cure or prevent any disease. This information does not replace a one-on-one relationship with a physician or healthcare professional. Dietary changes and/or the taking of nutritional supplements may have differing effects on individuals.
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