What Really Works for Long-Term Weight Loss

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

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)

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

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 regulatorshttps://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, 2025https://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?

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

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.

Dietary Approaches to Obesity Treatment

There is no single diet that can universally fit everyone for weight loss benefit.

Parmar RM, Can AS. Dietary Approaches to Obesity Treatment. [Updated 2023 Mar 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK574576/https://www.ncbi.nlm.nih.gov/books/NBK574576/

Words of Wisdom from a former 370 pound human.

What worked for me may not work for you.

Keep searching for what works for you.

Find the differences that make a difference.

Good luck.

Sensational yet Obvious! Time Restricted Eating Works!

Photo by Tim Mossholder on Pexels.com

In a randomized-controlled trial, people who followed a time-restricted diet lost about the same amount of weight as people who ate the same diet without the time restriction, according to a study published Friday in Annals of Internal Medicine…nutrition experts Krista Varady and Vanessa Oddo of the University of Illinois wrote in an editorial accompanying the study. “Using a controlled feeding design, Maruthur and colleagues show that TRE is effective for weight loss, simply because it helps people eat less.” It’s cutting calories—not intermittent fasting—that drops weight — https://arstechnica.com/science/2024/04/its-cutting-calories-not-intermittent-fasting-that-drops-weight-study-suggests/

You learn something old every day.

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

Adverse events are common in those using GLP-1 agonists, but the vast majority of these are minor. GI adverse effects are most common (20-70% of patients). Greater rate of GI effects with higher doses.

  • Most common problems: nausea (overall most common), vomiting, and diarrhea. Others included abdominal pain, dyspepsia, and constipation.
  • Symptoms are typically more severe within the first four weeks of therapy or with sudden escalation of therapy and tend to decrease over time.
  • Thought to be due to reduced gastric emptying and activation of centers involved in appetite regulation and nausea.
  • Severe diarrhea and vomiting may lead to volume loss, dehydration, and hypotension (not common).
  • There is an association with pancreatitis. GLP-1 agonists may stimulate pancreatic islet beta cells and exocrine duct cells leading to overgrowth and smaller duct size, which increase the pancreatic weight and risk of ductal occlusion.
    • Retrospective study published in 2022 of 81,752 adverse events associated with GLP-1 agonist therapy found an increased risk of pancreatitis, particularly with liraglutide (ROR 32.67; 95% CI 29.44-36.25). 2023 observational study found increased risk of pancreatitis (adjusted HR of 9.09, 95% CI 1.25-66).
  • Other GI issues include gallbladder and biliary tract disease (usually after 26 weeks of therapy and included cholelithiasis, cholecystitis, cholangitis), elevated LFTs, hepatitis, liver injury.
emDOCs Podcast – Episode 94: GLP-1 Agonist Complications — https://www.emdocs.net/?s=glp-1

But I Lost 25 pounds!

New Wonder Drug! Treat Diabetes, Obesity AND Addiction – (yup another GLP-1 receptor agonist post)

Why People Stop Using Drugs Like Ozempic – Wired (yet another GLP-1 receptor agonist post)

What the Scientists Who Pioneered Weight-Loss Drugs Want You to Know – Wired Magazine