\u2026 Inspire you with a sense of awe?<\/strong> That modern medicine has figured out how to treat yet another chronic disease?<\/p>\n \u2026 Bring up questions? <\/strong>Like wondering about the effects of being on medication\u2014potentially long-term? (Or if weight loss is even that relevant\u2014so long as a person is eating healthy and exercising regularly?)<\/p>\n Dr. Fitch is now president of the Obesity Medicine Association and chief medical officer of Known Well<\/a>, a primary care and obesity medicine practice in Needham, Massachusetts. Regardless of how you feel about her story, it illustrates what can initially seem like an inconvenient truth for those of us in the health coaching industry:<\/p>\n For many people with obesity, semaglutide (Ozempic, Wegovy, Rebelsus), tirzepatide (Mounjaro, Zepbound), and other glucagon-like peptide-1 receptor agonists (GLP-1 RAs) serve as valuable tools that make significant and lasting weight loss possible.<\/p>\n But for health coaches, these drugs can seem like an existential threat.<\/strong><\/p>\n You might wonder:<\/p>\n \u2018Who needs a nutrition coach or a personal trainer when people can get faster, easier, and more dramatic results with drugs?\u2019<\/p>\n However\u2026<\/p>\n People need health coaches now more than ever.<\/strong><\/p>\n In this story, we\u2019ll explain why\u2014and show you how to turn \u201cthe golden age of obesity medicine\u201d into a massive career opportunity.<\/p>\n To manage diabetes or treat cancer, most people consider it normal and natural to combine lifestyle behaviors with prescription medicine.<\/p>\n No one would tell someone with cancer, \u201cYou\u2019re on chemo? Way to take the easy way out!\u201d<\/p>\n However, that\u2019s what many people with obesity hear when they mention medication or surgery.<\/p>\n Instead, people have seen it as a willpower problem.<\/p>\n The remedy: \u201cJust try harder.\u201d<\/p>\n However, rather than motivating people to succeed, this \u201cremedy\u201d often encourages them to give up. (More importantly, the willpower theory isn\u2019t based on science.)<\/p>\n In reality, people with obesity likely have as much willpower as anyone else.<\/p>\n However, for them, fat loss is<\/em> harder\u2014because of genetics and physiology, along with social, cultural, behavioral, and\/or environmental factors that work against them.<\/p>\n Imagine life 150 years ago, before the invention of the automobile. To get from point A to point B, you had to walk, pedal a bicycle, or ride a horse.<\/p>\n Food was often in short supply, too. You had to expend calories to get it, and meals would just <\/em>satisfy you (but not leave you feeling \u201cfull\u201d).<\/p>\n Today, however\u2026<\/p>\n \u201cWe live in an obesogenic environment that\u2019s filled with cheap, highly-palatable, energy-dense foods [that make overeating calories easy, often unconsciously], and countless conveniences that reduce our physical activity,\u201d You might wonder: Why do some people gain fat in an obesity-promoting environment while others don\u2019t?<\/strong><\/p>\n The answer comes down to, in large part, genetics and physiology.<\/p>\n (Obesity is complex and multifactorial. As we noted above, there are other influential factors, but your genes and physiology are mostly out of your control, and so medication might be the best tool to modify their impact.)<\/p>\n Some genes can lead to severe obesity at a very early age. However, those are pretty rare.<\/p>\n Much more common is polygenic obesity<\/strong>\u2014when two or more genes work together to predispose you to weight gain, especially when you\u2019re exposed to the obesogenic environment mentioned earlier.<\/p>\n People who inherit one or more of these so-called obesity genes tend to have particularly persistent \u201cI\u2019m hungry\u201d and \u201cI\u2019m not full yet\u201d signals, says Dr. Nadolsky.<\/p>\n Obesity genes also seem to cause some people to experience what\u2019s colloquially known as \u201cfood noise.\u201d <\/strong><\/p>\n They feel obsessed with food, continually thinking, \u201cWhat am I going to eat next? When is my next meal? Can I eat now?<\/em>\u201d<\/p>\n If you gain a lot of fat, the hormones in your gut, fat cells, and brain can change how you experience hunger and fullness.<\/p>\n \u201cIt\u2019s like a thermostat in a house, but now it\u2019s broken,\u201d says Dr. Nadolsky. \u201cSo when people cut calories and weight goes down, these physiologic factors work against them.\u201d<\/p>\n After losing weight, your gut may continually send out the \u201cI\u2019m hungry\u201d signal, even if you\u2019ve recently eaten, and even if you have more than enough body fat to serve as a calorie reserve. It also might take more food for you to feel full than, say, someone else who\u2019s never been at a higher weight.<\/p>\n In 2017, semaglutide\u2014a synthetic analog of the metabolic hormone glucagon-like peptide 1\u2014was approved in the US as an antidiabetic and anti-obesity medication.<\/p>\n With the emergence of this class of drugs, science offered people with obesity a relatively safe and accessible way to lose weight long-term, so long as they continued the medication.<\/p>\n Current weight loss medications work primarily by mimicking the function of glucagon-like peptide 1 (GLP-1), which is a hormone that performs several functions:<\/p>\n In people with obesity, the body quickly breaks down endogenous (natural) GLP-1, making it less effective. As a result, it takes longer to feel full, meals offer less staying power, and food noise becomes a near-constant companion, says Dr. Nadolsky.<\/p>\n Semaglutide (Ozempic, Wegovy, Rybelsus) and medicines like it flood the body with synthetically made GLP-1 that lasts much longer than the GLP-1 the body produces. This long-lasting effect helps increase feelings of fullness, reduce between-meal hunger, and muffle cravings and food noise.<\/p>\n Interestingly, by calming down the brain\u2019s reward center, these medicines may also help people reduce addictive behaviors like problem drinking and compulsive gambling, says Dr. Nadolsky.<\/p>\n To understand the power of semaglutide (Ozempic, Wegovy, Rybelsus) and other GLP-1 medicines, it\u2019s helpful to know a little about the drugs that predated it.<\/p>\n Decades before the age of Ozempic, physicians realized that several drugs originally developed to treat other conditions also seemed to help people lose weight.<\/p>\n These included:<\/p>\n However, weight loss from these older medicines was modest, helping people to lose (and keep off) around 5 to 10 percent of their body weight.1 2 3<\/sup><\/p>\n Around 2010, liraglutide (Victoza, Saxenda) was approved by the FDA to treat diabetes. Like Ozempic and other newer weight loss medicines, liraglutide mimics glucagon-like peptide-1 (GLP-1), but it\u2019s less effective than the newer medicines.<\/p>\n Ozempic has become the Kleenex of weight loss medicines\u2014a name brand people toss around as if it\u2019s generic.<\/p>\n This fame is at least partly earned: Dr. Fitch says that semaglutide (Ozempic, Rybelsus, Wegovy) also works more effectively than liraglutide, its GLP-1 predecessor.<\/p>\n \u201cSemaglutide is 94 percent similar to our own GLP-1,\u201d she says, \u201cThey\u2019ve been able to make it closer and closer to the GLP-1 our bodies make.\u201d<\/p>\n It also lasts longer than liraglutide, and more of it reaches the brain.<\/p>\n However, newer meds outperform Ozempic. <\/strong>(See the table in the section below.)<\/p>\n And there are other medicines\u2014available orally rather than via injection\u2014coming. These pills will be easier to mass produce, which will drive down costs and make GLP-1 medicines even more accessible to more people.<\/p>\n So, although Ozempic is the current reigning brand of the weight loss drug world, it may be ousted in time.<\/p>\n<\/p>\n<\/div>\n Researchers measure a weight-loss medicine\u2019s success based on the percentage of people who reach key weight loss milestones.<\/p>\n For example, most people start to see health benefits after losing five percent of their weight\u2014and remission from disease after losing around 20 percent.<\/p>\n As the chart below shows, weight loss medicines have become increasingly effective at helping people to reach both milestones.<\/p>\nBehavior change on its own isn\u2019t always enough.<\/h3>\n
With fat loss, there\u2019s no such thing as an \u201ceasy way out.\u201d<\/h2>\n
For decades, much of society hasn\u2019t viewed obesity as the disease that it is.<\/h3>\n
Why is it so difficult to lose fat?<\/h2>\n
\nsays Karl Nadolsky, MD, an endocrinologist and weight loss specialist at Holland Hospital and co-host of the Docs Who Lift<\/a> podcast.<\/p>\nGenetically, some people are more predisposed to obesity.<\/h3>\n
Physiologically, bodies tend to resist fat loss.<\/h3>\n
Enter: GLP-1 drugs<\/h2>\n
How Ozempic and other obesity medicines work<\/h3>\n
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The lesser-known history of weight loss medicine<\/h2>\n
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Why does Ozempic get all the credit?<\/h3>\n
The growing effectiveness of weight loss drugs (especially in combination with lifestyle modifications)<\/h2>\n
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