It would seem that, in some circles, there is a huge sigh of relief now that there have been fairly spectacular weight loss results with the new drugs, Ozempic, Wegovy, and Mounjaro.
People using these drugs to help control their type II diabetes have been thrilled to notice the weight loss that comes as a result. Those results have been traced to reduction in appetite, and feelings of fullness.
But, as is widely publicized, once the drug is discontinued, the weight comes back on. At this point it is also important to remember that these drugs are not, at the moment, approved for weight loss. They are to be used to help control blood sugar in diabetics. However, the most effective one for weight loss, Mounjaro, has now been given Fast Track designation with the FDA, with the expectation that it will be approved for weight loss by the end of this year.
Looking for answers
Taking a closer look at what these drugs do can provide some interesting insights (and solutions) into the whole mess of appetite control. As anyone who struggles with their weight can tell you, reining in the desire to eat is huge. If only…
FIRST, just to whet your appetite (sorry) I would like to mention a study out of Yale University that I came across recently. Here’s what they did. They took a group of 28 people identified as “lean” and another group of 30 people identified as “obese.” They put the obese crowd on calorie restriction so that they lost about 10% of their body weight. Before and after, they did functional MRI brain scans on these folks as they infused glucose and fat into them to see how their brains responded.
Long story short, before the obese people lost weight, their brains did not respond in a positive way to fat infusion, whereas the lean participants’ brains responded to both glucose and fat. In other words, the obese people had a blunted brain response to the intake of fat. Researchers concluded that these results are compatible with reduced nutrient sensing in people with obesity. This phenomenon has shown up in plenty of other research.
Now the kicker. Even after the people with obesity lost weight, their brain response to fat was still blunted. In other words, weight loss did not change their brains’ lack of response to nutrient intake.
As usual, there are plenty of caveats here. For one thing, the weight loss program was only 12 weeks. Perhaps it would have taken longer for the brain to switch gears.
However, it is still tempting to apply this finding to what is happening to people’s appetites when they stop taking the aforementioned drugs. Appetite returns, and so does the weight.
It’s worth noting that this is similar to what happens when people go on a diet. Losing weight does not seem to affect appetite much. Statistics show that most of the time, the weight comes back. People seem to go back to eating the way they used to. This seems like a cruel turn of events.
Why does the weight come back on?
Now we get to the “What Can Be Going On” section. (Hang on…we will get to the “Solutions” section at the end.)
Why don’t these drugs create a permanent alteration in people’s appetite? Does the result of the Yale study mentioned above give us a clue?
Actually, they don’t really know. At this point, let me refer to a quote by a high-ranking obesity expert. (Randy Seely, PhD, director of the National Institutes of Health-funded Michigan Nutrition Obesity Research Center) He says, “We’ve run lots of different trials to do obesity prevention, and almost all of them have been abject failures.”
For some sort of an explanation for our cluelessness, let’s take a brief look at what goes in to our appetites. The new drugs causing weight loss act on things called GLP-1 (Ozempic and Wegovy) and GLP-1 plus GIP (Mounjaro). These drugs work in two ways. They decrease blood sugar levels by increasing insulin production and lowering the amount of sugar that the liver makes. So, this is good for diabetics. They also slow the rate that food passes through your body, so you feel full longer. Apparently this is enough to change brain function and its response to food. People on these drugs often rave about the fact that they just don’t think about food all the time any more. This comes as quite a relief to many.
So how come this effect doesn’t last after they stop taking the drug?
To put us on the road to an answer, let’s take a look at how our body deals with food and our appetites. Casting a wide net, there are two basic and complex body systems that are involved. There’s the endocrine system, and the nervous system. The hypothalamus in our brains is in charge of many aspects of appetite, and that means it gets feedback from the liver, pancreas, the entire gut, gallbladder, and kidney. This is the endocrine system. Meanwhile, in the nervous system, all sorts of neurotransmitters tell various areas of our brain what is going as we digest our food, or are hungry.
Bottom line: There is so much going on in our bodies to regulate appetite that just being able to control a few things (even though those few things also have complex functions), does not begin to cover all the bases.
I will leave it there for now.
Let’s get to the good stuff. Potential remedies. These are based on what obesity researchers agree on, and tons of research. I have a feeling that these are going to sound familiar to most of you!
- Avoid processed carbs. Actually, avoid as much processed food as you can.
- Get enough fiber. How? Eat fruit, vegetables, whole grains, legumes, beans, nuts and seeds. In other words, whole, non-processed foods.
- Focus on the Mediterranean style of eating. It has been shown again and again to reduce cravings and lead to weight loss.
- Exercise. Those who exercise get more efficient at using body fat as fuel. People who don’t exercise use more carbs, which leads to blood sugar fluctuations and appetite swings.
Two more bottom lines:
Notice that the remedies above have to do with what we eat and how we move. Both of these approaches will encompass all of our complex bodily systems at once. It is not an approach that isolates one or two molecules that have limited effects.
If you struggle with weight loss, you can stop blaming yourself for being weak-willed! The process is difficult and complicated. You can also extend this understanding and forgiveness to those around you who may also be struggling.
Here’s to good health,
© 2023 Kristen Carter. All rights reserved.
Photo Credit: Olekcii Mach | iStock