Obesity

GLP-1s and the Risk for Malnutrition

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“We see cases where people take a GLP-1 medication and become so severely malnourished that they need to be hospitalized,” said Rebecca Boswell, PhD, director of Penn Medicine Princeton Center for Eating Disorders, in Philadelphia. “It’s not uncommon.” The Scary Health Risk That Can Sneak Up on GLP-1 Users – Medscape – January 19, 2026. https://www.medscape.com/viewarticle/scary-health-risk-can-sneak-glp-1-users-2026a10001pi

Yikes.

People return to their baseline weight and lose all cardiometabolic benefits in less than 2 years after stopping semaglutide or tirzepatide, a new meta-analysis found. Weight Regain, Health Benefit Loss Rapid When GLP-1s Stopped – Medscape – January 08, 2026. https://www.medscape.com/viewarticle/weight-regain-health-benefit-loss-rapid-when-glp-1s-stopped-2026a10000kr?

YIKES.

You see, cures are passée. Cures kill markets. Getting the population properly hooked on a pharmaceutical treatment for a ‘chronic’ condition is where the serious money is. “Our core insight was simple and grim: it’s far easier—and infinitely more profitable—to convince healthy people that they’re sick than to develop genuine cures for the truly ill.“

Twenty years later, the hustle is bigger, slicker, and more dangerous than ever. Watching that hustle unfold with weight loss drugs feels weirdly ominous, like watching a slow-moving train wreck you can’t peel your eyes off of. You know there’ll be carnage and bodies, vast fortunes won and lost, and humanity left just a little bit poorer. We have often documented the pharmaceutical industry’s proven ability to create enormously lucrative markets overnight, by inventing and selling diseases. Now watch as all that ingenuity and energy gets pointed at one of the biggest problems bewitching humanity: human fatness. The Seven Deadly Sins of Weight Loss Drugs – https://brownstone.org/articles/the-seven-deadly-sins-of-weight-loss-drugs/

YIKES!

This will not end well.

Complications? What Complications? (just another GLP-1 receptor agonist post)

PATHWEIGH Weight Management Model

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The power of PATHWEIGH is that it puts patients and their primary care provider on the same page…It all started with signage placed in clinics that notified patients that if they wanted to make an appointment to specifically talk about weight management, all they had to do was approach the desk and ask for it. That request automatically triggered a mechanism in the patient’s electronic health record that sent them a survey that after completion would flow into the provider’s notes. Instead of spending so much time typing and talking about the patient’s history, the scheduled visit could be centered around solutions. PATHWEIGH: A Model Changing Weight Management For All – https://news.cuanschutz.edu/medicine/pathweigh-pilot-research

Implementation and effectiveness of a care process to prioritize weight management in primary care: a stepped-wedge cluster-randomized trial – https://www.nature.com/articles/s41591-025-04051-5#Sec1

Medscape 2025 Obesity Articles

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  Medscape on Obesity  
  Top Stories 2025  
  Aging & GLP-1s: What Patients Need to Know  
  Anti-Obesity Medications Set to Explode Entering 2026  
  What Comes Back When Stopping GLP-1s?  
  New Obesity Definition Raises the Number Who Have It  
  When GLP-1s Change Patients’ Libido: What to Know  
  Can Creatine Play a Positive Role in Obesity Treatment?  
  New Drug Eases Side Effects of Weight-Loss Meds  
  Does Time-Restricted Eating Cut Extra Belly Fat?  
  High-Fiber Diets and Supplements for Obesity Treatment  
  Most GLP-1 Prescriptions Miss the Mark: Are Yours?  

What Really Works for Long-Term Weight Loss

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From diet to drugs: what really works for long-term weight loss

Ultimately, the key to lasting weight loss and improved health lies in understanding that there is no one-size-fits-all solution. It’s about finding the right combination of support, strategy and science that works for each person. Reiner Jumpertz-von Schwartzenberg – Professorship for Clinical Metabolism and Obesity Research, University Hospital and Medical Faculty, University of Tübingen – https://theconversation.com/from-diet-to-drugs-what-really-works-for-long-term-weight-loss-254551

I read the entire article so you don’t have to. You’re welcome.

Well, knowing there is NO one-size-fits-all changes my future best selling book on weight loss drastically.

What was a “how to” is now memoir. Sigh.

Obesity is Not a Disease

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David L. Katz, MD, MPH, FACPM, FACP, FACLM is a specialist in Internal Medicine, Preventive Medicine/Public Health, and Lifestyle Medicine – globally recognized for expertise in chronic disease prevention, health promotion, and nutrition. The founding director of Yale University’s Prevention Research Center, and past president of the American College of Lifestyle Medicine, Katz is the founder of the non-profit True Health Initiative, founder of Diet ID, and Chief Medical Officer for leading food-as-medicine company, Tangelo. He is a senior science advisor to Blue Zones. He holds multiple US patents, including for advances in dietary assessment. He has roughly 250 peer-reviewed publications, has authored 19 books- including multiple editions of a leading textbooks in nutrition and preventive medicine, and has earned numerous awards for his contributions to public health, including three honorary doctoral degrees.

https://www.vumedi.com/video/obesity-is-not-a-disease-so-what-is-it

Diet until proven otherwise.

Lisdexamfetamine Dimesylate (not just for ADHD anymore)

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Llisdexamfetamine dimesylate is currently the only drug to be approved in the USA for the treatment of moderate to severe binge eating disorder (BED) in adult patients. – https://pubmed.ncbi.nlm.nih.gov/29134566/

Just a few side effects BTW.

The prescribing information also includes warnings and precautions regarding serious cardiovascular reactions, blood pressure and heart rate increases, psychiatric adverse reactions, suppression of growth, peripheral vasculopathy (reduced circulation of blood flow to body parts), and serotonin syndrome (a potentially life-threatening overage of serotonin). Please see Vyvanse’s full prescribing information for additional details.

The most common side effects in children, adolescents and/or adults with ADHD taking lisdexamfetamine dimesylate capsules and chewable tablets were anorexia, anxiety, decreased appetite, decreased weight, diarrhea, dizziness, dry mouth, irritability, insomnia, nausea, upper abdominal pain, and vomiting. The most common side effects in adults with BED were dry mouth, insomnia, decreased appetite, increased heart rate, constipation, feeling jittery, and anxiety. https://www.fda.gov/drugs/news-events-human-drugs/fda-approves-multiple-generics-adhd-and-bed-treatment

Take Home Lesson for Life Underwriters

Know your drugs and read the prescription DB reports. You’re welcome.

Compounding Compounds the Problem

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Compound pharmacies that bulk produce weight-loss drugs without FDA approval are doing so without that oversight.  And because compounding pharmacies aren’t required to report instances of patient harm involving their medications, problems may go undetected.“It’s kind of like ‘Whack-A-Mole,’” said Al Carter, a pharmacist and executive director at the National Association of Boards of Pharmacy. He said state boards will only investigate when they receive a complaint.“There are bad actors out there, purporting to be compounding pharmacies that are licensed in specific states or have the credentials to be able to compound when in actuality they don’t,” said Carter. “My understanding is most licensed, legitimate pharmacies aren’t compounding” weight-loss medications. ‘Compounded’ weight-loss drugs are a growing problem for state regulators – https://stateline.org/2024/07/08/compounded-weight-loss-drugs-are-a-growing-problem-for-state-regulators/

A website sold patients obesity drugs at affordable rates. Now they’re paying the price.– https://www.npr.org/2025/02/08/nx-s1-5246124/a-website-sold-patients-obesity-drugs-at-affordable-rates-now-theyre-paying-the-price

“The two main goals of the medication are weight loss and diabetes management, so patients should stay on the lowest dosage possible until they feel like they’ve plateaued,” said Charu Sawhney, DO, MPH, an internal medicine physician with Harbor Health in Round Rock, Texas. When patients move up on the dosage too fast, they’re going to have more trouble, said Sawhney. “This is when we see the most severe side effects like the malnutrition and dehydration that can sometimes land patients in the hospital,” she said. Considerations for Prescribing GLP-1s Get More Complicated – Medscape – February 07, 2025 – https://www.medscape.com/viewarticle/considerations-prescribing-glp-1s-get-more-complicated

I admit as a Former Fat Man that the world of obesity and now a miracle drug to fight the disease fascinates the hell out of me. Caveat emptor!

Nutrition, Drugs, or Bariatric Surgery?

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The key to healthy and sustained weight loss is to “become attuned to the body’s signals, learn how to honor hunger, stop eating when satisfied, and eat more healthful foods, such as fruits and vegetables, whole grains, lean proteins — especially plant-based proteins — and the body gives signals that this is what it wants.” Supatra Tovar, PsyD, RD — Nutrition, Drugs, or Bariatric Surgery: What’s the Best Approach for Sustained Weight Loss? – Medscape – January 10, 2025 https://www.medscape.com/viewarticle/nutrition-drugs-or-bariatric-surgery-whats-best-approach-2025a10000kj?src

Lifestyle changes worked for me.

My Fat Cells Have a Memory

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Even after drastic weight loss, the body’s fat cells carry the ‘memory’ of obesity, research1 shows — a finding that might help to explain why it can be hard to stay trim after a weight-loss programme.

This memory arises because the experience of obesity leads to changes in the epigenome — a set of chemical tags that can be added to or removed from cells’ DNA and proteins that help to dial gene activity up or down. For fat cells, the shift in gene activity seems to render them incapable of their normal function. This impairment, as well as the changes in gene activity, can linger long after weight has dropped to healthy levels, a study published today in Nature reports.

Fat cells have a ‘memory’ of obesity — hinting at why it’s hard to keep weight off – www.nature.com/articles/d41586-024-03614-9

For the geeks, here’s a link to the original study – https://doi.org/10.1038/s41586-024-08165-7

Even without this study I already knew my fat cells have a memory because they are constantly trying to make me gain weight.