To get rid of obesity, we need to deal with what causes obesity. “Weight management” medication works in the short term, but usually makes things worse in the long term.
Obesity is, simply put, excess body fat. It’s clearly visible, doesn’t look good, and that’s typically the main reason people want to lose weight.
But the more important reason to shed pounds is health. Obesity is linked to many chronic diseases, including cardiovascular diseases, diabetes, cancer and osteoarthritis. Carrying excess baggage also hampers the person’s overall performance and self-esteem.
Numerically, obesity is defined as the body mass index (weight/height squared) over 30, while being “just” overweight means the body mass index is within the 25 – 30 range.
However, these are just numbers; it’s better to perceive excess weight on a spectrum, from mildly overweight to monstrously obese, with the health risks increasing accordingly.
What You Should Start With
This article is about how not to tackle obesity, but still, I should first present a simple and effective strategy to lose weight, whether you’re obese or “just” overweight:
Stop consuming highly processed food (including soda) and food containing wheat. That’s it.
These two categories of food cause food cravings that make you eat in excess. Yes, even the seemingly innocuous wheat, because modern wheat is just sugar in disguise, spiking your blood glucose more than table sugar.
Once you gradually eliminate highly processed food and wheat from your diet, you won’t have any cravings, meaning you’ll need little to no willpower to stay on the right track. You’ll not only lose weight, but (more importantly!) your health will improve as well.
Please note that this approach differs from dieting (which does not work). In dieting, you’re using your willpower to eat less than you would normally eat. Sooner or later, you’ll run out of that willpower, typically once you reach certain desired weight.
By adopting the nutritional lifestyle of not consuming food that gives you cravings, you’re eating less because your satiety levels return to normal, as opposed to being artificially increased on a regular basis. You’re no longer haunted by those cravings.
There are of course other factors contributing to obesity, such as chronic stress, childhood trauma or heavy metal toxicity, but food is always a root cause. Start with eliminating this biggest culprit first and deal with the other potential factors later, if needed.
And yes, physical exercise is also important, but more for your health in general rather than directly for losing weight.
Comparing the effectiveness of proper food vs. exercise for weight reduction, food is responsible for 80% of your success, while exercise accounts only for 20%. You can’t outrun your bad diet!
Wegovy: A Revolutionary Anti-obesity Drug?
What prompted me to write this article was the craze around Wegovy. Mainstream media are portraying it as a game-changer in the battle against obesity. Celebrities post their “before and after” photos to show what “miraculous” results Wegovy provides.
Even Elon Musk fell for this craze. Which is a clear example that being a genius in one area doesn’t make you a genius in another. And that having billions of dollars doesn’t guarantee you’ll get sound medical advice if you only ask doctors with the same educational background.
Can Wegovy indeed solve the obesity epidemic? Sure not.
The great thing about the RCM framework is that it quickly directs you to questions that matter rather than to the shiny surface of marketing claims.
Knowing that we need to focus on root causes, we should ask: Is obesity caused by the absence of Wegovy? Or any other “anti-obesity” medication?
Preferring long-term over short-term, we need to ask: Is Wegovy a long-term solution? Will I have to take it for the rest of my life if I want to keep my weight? What happens once I stop using it? And what are the side effects?
Keeping in mind that food is always a root cause, how come the doctors prescribing Wegovy don’t tell their patients that the main drivers of their cravings are highly processed foods and wheat?
And given the Root Conflict of Interest in medicine, who stands to profit if you don’t change your eating habits and revert to long-term use of “anti-obesity” medication instead? Is it really you?
To help you answer those questions, let’s dive a bit deeper into how Wegovy works.
Introduction to Wegovy
This article focuses on Wegovy because it’s currently the most known of the “anti-obesity” drugs, but the principles apply to all weight loss medications based on a similar mechanism of action.
The names or labels aren’t important – always strive to understand the underlying principles. So let’s have a look at how Wegovy works.
When you eat, your intestines start producing a little-known but important substance called GLP-1. It’s a hormone that helps your body digest food and deal with the absorbed nutrients, such as glucose and fat.
To this end, GLP-1 slows gastric emptying, giving the stomach more time to break down food and mix it with gastric juices, resulting in a more thorough digestion process. For similar reasons, GLP-1 slows down the movement of the gut as well.
When blood glucose levels are elevated due to food digestion, GLP-1 also stimulates insulin secretion from the pancreas. The main role of insulin is to increase the cellular intake of glucose from the blood, so it normalizes your blood sugar levels.
Last but not least, GLP-1 also directly stimulates the satiety center in the brain, which suppresses your appetite. This is on top of the effect of (physically) having a full stomach. “Satiety promotion” or “appetite suppression” is the name of the game here.
Now, Wegovy is a brand name for an injectable hormone similar to GLP-1. It’s a synthetic (unnatural) hormone called semaglutide. Because of this similarity, semaglutide acts on the same receptors in the body as GLP-1, so it belongs to a class of hormones called GLP-1 receptor agonists (agonist = activator, the opposite of antagonist).
Most likely, you’re already getting the idea of Wegovy’s mechanism of action, but let’s have a quick look at the differences between Wegovy and GLP-1 first.
GLP-1 regulation is highly fine-tuned, with the half-life of GLP-1 being just 1 or 2 minutes, so once your intestines stop secreting it, its effects quickly subside. And any time it’s needed, GLP-1 is secreted again.
This subtlety and precision is very important because hormones in the body never work in isolation. Hormonal system is an orchestra that needs to be in complete harmony, with each instrument playing only when needed and in tune with other instruments.
Whereas GLP-1 is a refined tool able to react within minutes to the contents of your gut, Wegovy, in comparison, is a sledgehammer. Its half-life is full 7 days(!), so once you inject it under your skin, it affects your body for the whole week no matter what.
And after a week, you inject another dose! For how long? For months on end, or even for more than a year, until you reach the desired weight (or a weight plateau).
Side effects, anyone? We’ll get to that soon. But yes, that’s another reason why people drop out from the Wegovy “treatment”.
Obviously, the most desired effect of Wegovy is the satiety promotion at the brain level, because if works even if your stomach is empty. When you feel full, your appetite is suppressed, you eat less, and your weight goes down. Who wouldn’t want that?
The problem is that to achieve this “brain-level” effect – basically tricking the body into feeling full despite not eating much – a relatively high dose of semaglutide (2.4 mg) has to be applied. Which intensifies the side effects. Speaking of which, let’s have a look at them.
Wegovy Side Effects
Knowing the refined and timely effects of GLP-1, you can guess what to expect when you extend them almost forever with the Wegovy sledgehammer.
By slowing gastric emptying and gut motility for an extended period, you’re causing constipation. This irritates your vague nerve, so you can also feel sick (nauseated), sometimes leading to vomiting.
Bloating is another result of sluggish bowel movements – due to the extended decomposition of fecal matter by gut bacteria. Bloating usually leads to abdominal pain, burping and flatulence.
Your body knows that this state of “gut affairs” is detrimental, so it temporarily overrides the sluggishness with other hormones, causing diarrhea. Given the length of Wegovy application, the cycles of constipation and diarrhea can become regular.
In short, messing up with GLP-1 receptors can cause all sorts of digestive issues you can think of. And given the existence of the gut-brain axis, any problem in the gut also affects the brain, which can end up in anxiety, nightmares and depression.
As mentioned above, activating GLP-1 receptors in the pancreas stimulates insulin secretion. Although this effect largely depends on increased glucose levels, prolonged activation of GLP-1 receptors can nevertheless increase insulin levels.
This could result in hypoglycemia (low blood glucose), particularly if you’re taking insulin as well. Hypoglycemia presents itself as unusual tiredness or weakness, confusion, dizziness, cold sweats or headaches.
If you think I’m exaggerating, check out the Wegovy side effects yourself. I’ve mentioned just the more common ones. There are additional side effects, although fortunately less common, including the risk of gallstones, pancreatitis and potentially also thyroid cancer.
No one will suffer from all the side effects, but given how many side effects are known, it seems almost impossible to avoid some of the more common ones. If you use a sledgehammer where a fine scalpel is needed, there are bound to be consequences.
What Is The End Result?
With your appetite suppressed for many months while feeling sick and tired as a potential “bonus,” you’re bound to lose weight. But is it worth it?
Let’s say you took Wegovy for a year, withstood all the side effects and reached your desired weight. What do you think will happen once you stop suppressing your appetite with Wegovy?
Yes, you’re right. Your appetite will be back. And since you haven’t changed your nutritional lifestyle while taking Wegovy (you were just eating less), you will carry on consuming the same junk food that caused your obesity in the first place.
The food cravings this food causes will no longer be muted, so you’ll eat more. Sooner or later, you’ll be back where you started with your weight, with all the negative effects of weight yo-yo-ing and hormonal disbalance caused by long-term use of Wegovy.
Regaining the original weight is common sense, the result of applying basic principles of human physiology. So not surprisingly, this is also what the studies show. Look at this graph from a 2021 article on semaglutide clinical study:
You can clearly see that once semaglutide was no longer administered and switched to placebo at week 20, the mean weight of the study participants was gradually returning to the original level, except that the study was discontinued at week 68.
Participants who carried on taking semaglutide beyond week 20 achieved further weight loss (losing 18 % of body weight on average) before the weight started plateauing at week 68 when the trial was discontinued.
Given the clear reversal at week 20, after semaglutide was not applied, you know what most likely happened to the participants’ weight after week 68. But the study wasn’t designed to show yet another weight loss reversal – it was to prove that Wegovy is more effective than placebo.
Given the data shown above, you’d think that the authors of the study would conclude that withdrawing semaglutide treatment results in weight loss reversal; in other words, that its effects are only temporary. To put it bluntly, that the drug is basically useless, which obviously cannot justify its many side effects.
Instead, the first sentence of the article abstract says:
“The effect of continuing vs. withdrawing treatment with semaglutide … on weight loss maintenance in people with overweight or obesity is unknown.” (emphasis added by me)
Really? The effect on weight loss maintenance is unknown, despite the clear reversal in the body weight graph?
Well, at least you know how current science works. It’s effectively science-for-hire. If the results don’t support the narrative, let’s at least tweak the abstract – most people don’t bother reading the article anyway.
If you want an explanation of why the authors didn’t want to acknowledge the solely temporary effects of semaglutide, take a look at the interest disclosed at the end of the article. Here it is:
Novo Nordisk, the name repeatedly mentioned in the conflict of interest disclosures, is the pharmaceutical corporation that sells Wegovy (semaglutide). And we’re talking about billions of dollars in sales every year.
Is it also you who stands to profit? You decide. Your local GP can have a different opinion than your Functional Medicine practitioner. I prefer going for long-term health rather than short-term results.
Alternatives to Wegovy (Equally Problematic)
There are other GLP-1 receptor agonists like Wegovy in the pipeline for anti-obesity “treatment,” but the principal mechanism of action is the same as Wegovy (semaglutide).
So expect weight loss when your appetite is artificially suppressed, then gradual weight rebound after the appetite suppression stops. In short, a yo-yo with side effects.
But common-sense logic doesn’t prevent pharmaceutical companies from attempting to make even more money. They don’t care that the effects of appetite suppression are only temporary – that allows them to sell the drug again … and again … and again.
The side effects are also no problem because they can be “treated” with other pharmaceuticals, which increases the pharmaceutical profits even further. It’s a self-perpetuating money-making machine designed to make money by ignoring the root causes of illness and health.
The most serious contender to Wegovy is Mounjaro (tirzepatide), manufactured by Eli Lilly. It is currently available as anti-diabetic medication (2.5 mg), but in higher doses (10 mg), it works for weight loss as well. Eli Lilly expects Mounjaro to be approved as anti-obesity medication this year already.
Mounjaro is a few percentage points more effective for weight loss than Wegovy because it stimulates not only GLP-1 receptors but also receptors for another hormone called GIP. This hormone functions similarly to GLP-1, including the “holy grail” of appetite suppression at the brain level.
But again, while GIP regulation is (like GLP-1) fine-tuned, with GIP half-life being just 5 to 7 minutes, tirzepatide is (like semaglutide) a sledgehammer, with its half-life being full 5 days. So expect similar side effects to Wegovy.
Talking of side effects, it’s good to learn from history. In the past, more than two dozen anti-obesity medications (with various mechanisms of action) were withdrawn from the market due to severe side-effects, such as the increased occurrence of cancer, heart attacks, strokes, anxiety and depression.
Given this track record, what is the likelihood of similar side effects eventually showing up again with the “new” anti-obesity medications like Wegovy or Mounjaro? Not insignificant, to put it mildly.
However, learning from history also includes learning from recent history. The regulatory capture of healthcare agencies progressed so much in previous years that now almost no human and social cost can keep a lucrative pharmaceutical drug off the market.
So don’t expect any more withdrawals regarding the newly released anti-obesity medications. Like COVID, also obesity will be considered such a huge epidemic that the “benefits” of treatment will outweigh any side effects and risks.
And who cares that the “benefits” are only temporary, leading to weight yo-yo-ing and hormonal disbalances, not talking about many side effects. Let’s not get carried away by little details. The show must go on:
With this attitude, it’s only logical that healthcare costs are skyrocketing every year, yet the population is getting sicker and sicker. This business model is simply too profitable to be stopped until the majority of the population realizes what’s going on. And we’re far from that.
The good news is that at an individual level, you can start dealing with the root causes right away.
If you’re obese, it’s very important that you get rid of the excess weight. Your health is at stake. If you’re overweight, the same applies, although it’s somewhat less imperative.
For sustainable weight loss, you need to change what led to your current weight. There can be several causes, but consuming highly processed and wheat-containing food is almost certainly the primary cause. This food gives you food cravings, and they force you to eat more than necessary.
Therefore, you need to stop consuming what incites those cravings. It’s not a viable strategy to resist food cravings in the long run. Willpower is limited; you need to employ habits.
That habit to be implemented here is eating whole foods because they don’t cause food cravings. Do you know why there was almost no obesity 100 years ago? Because it’s virtually impossible to get obese on whole food. It naturally suppresses your appetite, freeing you from food cravings.
Unfortunately, that’s now how pharmaceutical companies make money. They’re not interested in dealing with the root causes of health issues; they like blocking or suppressing natural processes with their drugs.
Trillions of dollars are made this way, and a lot of this money goes back into promotion, sponsorships and funding. Media, politicians, regulatory agencies, universities, hospitals, medical associations, doctors, researchers, public health institutions and non-profit organizations – they are all on the receiving end.
Not many are left to defend what doesn’t serve pharmaceutical interests.
Being aware of this uneven environment helps. Better awareness leads to better decisions – and better results. You can either be a passive recipient of countless drugs, or an active facilitator of your own health. It’s up to you.