According to the National Health and Nutrition Examination Survey, the prevalence of obesity in adults from 2021 to 2023 was estimated at roughly 40.3 percent. The use of obesity drugs has been on the rise, sparking debates about whether or not these drugs are actually beneficial to obesity and weight loss management.
Many argue about the potential downsides for these medications, which include side effects such as nausea, vomiting, diarrhea and complications related to the stomach and bowel movement. Furthermore, there are several ethical concerns, primarily their cost and accessibility. For example, brand-name obesity drugs like Ozempic and Wegovy can reach prices of up to $1,300 per month.
As a result, many are concerned about the equity of access, health becoming a luxury of the wealthiest, and how these medications “might overshadow crucial public health efforts focused on prevention and lifestyle changes.” In fact, many researchers argue that the effects of these medications are not sustainable, suggesting that lifestyle changes, with a particular focus on diet, are most effective in treating obesity.
However, implementing healthy lifestyle changes is easier said than done for some, as obesity is often linked to mental health.
Due to social pressures, individuals diagnosed with obesity are at greater risk for developing psychological stress. To cope with psychological stress, individuals often resort to harmful methods, such as overeating, which typically worsen the health consequences related to obesity.
In addition, about 1–5 percent of individuals with obesity suffer from monogenic obesity, which is obesity caused by some genetic defect. Mental health and genetics are common barriers that hinder progress in lifestyle changes for obesity management.
Having obesity can also make physical activity challenging, complicating efforts to achieve and maintain a healthy weight. In instances where making healthy lifestyle changes is seemingly ineffective, obesity drugs are a possible alternative. While it is acknowledged that obesity drugs aren’t a magical cure, they can support obesity management, producing the most optimal effects when paired with healthy lifestyle changes.
So how do obesity drugs, specifically Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), actually work?
The GLP-1 RA drug agent functions by mimicking the effects of a peptide called GLP-1 that is produced in the gut in response to food intake. GLP-1 RAs are activators for GLP-1 receptors and influence functions of the brain, gut hormone regulation and glucose metabolism; all of which are responsible for the regulation of food intake, appetite and satiety.
In the brain, GLP-1 RAs activate neurons that express GLP-1 receptors, particularly in regions where the brain is exposed to circulating blood. This activation of neural circuits in brain centers such as the hypothalamus and the brain stem leads to the regulation of appetite.
GLP-1 RAs also influence gut hormone regulation by affecting the levels of three particular gut hormones: ghrelin, peptide YY and cholecystokinin. Ghrelin, known as the “hunger hormone,” stimulates appetite, increases food intake and promotes fat storage. GLP-1 RAs decrease ghrelin levels, thereby suppressing appetite and food intake. Both peptide YY and cholecystokinin are released during food intake and stimulate our sensation of being full. GLP-1 RAs increase the activity of both peptide YY and cholecystokinin, ultimately reducing appetite and food intake by increasing satiety signals.
GLP-1 RAs impact glucose metabolism by stimulating insulin release within the pancreas. This further leads to a reduction in blood glucose levels and an overall improvement in glycemic control. They also work to suppress the secretion of glucagon, which helps control blood sugar levels. This is relevant because stable glucose levels lead to an overall reduction in appetite by diminishing hunger levels transmitted by the brain.
Obesity results from a chronic imbalance between energy intake and energy expenditure. This imbalance is due to an overall excess in calories relative to the amount of calories being used for energy and metabolic processes. The excess calories eventually become stored as fat.
This is only a simple description. The actual pathophysiology of obesity is much more complex, influenced by hormonal factors, genetics and differences in individuals’ biological processes.
Still, obesity drugs aid in managing obesity by suppressing appetite and reducing total energy intake. Individuals are less inclined to overconsume when appetite is suppressed. A continuous reduction in energy intake can help restore the balance between energy intake and energy expenditure and can also help with weight loss. Reports show that on average a person can lose about 12 percent of their body mass, though they must remain on this medication in perpetuity to keep the weight off.
While certainly not a definite remedy to the growing number of people identified as obese in the United States, when combined with a healthy lifestyle and dietary changes, obesity drugs can be a potential option for individuals struggling with obesity management.
Still, diet remains a key concern even while on these medications, especially since changes in diet can reduce an individual’s usual food intake by as much as 50 percent. It is recommended that GLP-1 users prioritize protein, fiber and hydration. Fiber in particular has also been identified as a nutrient that can naturally increase the body’s production of GLP-1.
While these drugs should be used with careful consideration, they can be an effective option for individuals struggling with obesity and should be considered alongside dietary changes, such as increased intake of fruits, vegetables, whole grains and lean protein.
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