GLP-1 Medications are not Cures
Semaglutide (Ozempic/Wegovy) isn’t a cure for obesity.
Yes, most people who take them experience some weight loss, but the average effectiveness is 15% weight loss – over the course of more than a year. Don’t get me wrong – 15% is clinically significant (and I would jump up and down if all of my patients achieved that degree of loss), but it’s far from what most people expect – and when expectations and reality don’t align, it’s usually a recipe for disaster.
For example, someone beginning a weight loss journey at 250 pounds can reasonably expect to get their weight down to 213 pounds – after at least a year of intense behavioral and pharmacologic therapy. And then, after that slog, they have to continue the same intensity to maintain it – which is psychologically much harder.
The human body isn’t designed to drop weight continuously until it wastes away to nothing. When it is living in a state of hormonal chaos (cardiometabolic dysfunction), where most of us exist today, the body responds to calorie deprivation with predictable physiologic responses designed to maintain equilibrium.
Call these plateaus or set points or whatever you like – the body (understandably) has to freak out from time to time. Fixing the underlying cardiometabolic dysfunction is essential to push past these (and keep the weight off long-term) – and no drug does that.
That’s the lifestyle intervention that is so often missing in today’s discussion about weight. We need to look at the whole picture. Obesity isn’t a GLP-1 deficiency. Yes, these can be great tools for helping to implement an intensive lifestyle intervention and address cardiometabolic dysfunction, but they aren’t magic bullets…
