Robert F. Kennedy Jr. had some ideas about Olympics. According to the nominee to run the Department of Health and Human Services, the government should not give medicine For millions of Americans Instead, they tackle obesity and diabetes through distribution. Organic food and gym membership– As with all RFK texts, these ideas are present. Causing some resentment.Their basic premise, though, that Americans should control their weight by eating better and exercising could not be more mainstream.
But the general philosophy of weight loss Supported by RFK, the FDA, and almost every doctor you’ve ever asked at any time in recent memory, it’s completely inconsistent with scientific evidence.
Lifestyle intervention has been at the heart of the nation’s decades-old effort to control rates of chronic illness. Eat less, move more: This advice applies to almost everyone. But for those who are obese or overweight That’s about three-quarters of the adult population in the United States. Diet and exercise are considered the most important ways to improve one’s health. Even today When doctors have access to Ozempic and related GLP-1 drugs which helps reduce weight for a long time and Many life-extending benefits without surgery Behavioral change still takes precedence, it’s official. Treatment guidelines for obesity, it more or less confirmed RFK’s approach and argued that “lifestyle therapy remains the cornerstone of treatment” and as required by the government. The medicine itself is suitable for use only.as an add-on” towards a reduced calorie diet and increased exercise.
This insistence on the status quo is starting to look a little strange. It has long been known that prescribing diet and exercise is not as effective as treating obesity, according to Tom Wadden, an obesity researcher at the University of Pennsylvania. Participants in clinical trials of both lifestyle modifications and GLP-1 drugs indicate that people may be thinner enough, at least initially. to prevent or help control type 2 diabetes, obesity, but he told me that losing large amounts of weight won’t help with sleep apnea or prevent heart attack or stroke.
For those who are currently severely obese Even the slight benefits of diet and exercise seem questionable. In the past few years Clinical trials of Ozempic and related drugs have shown that the “foundation” of treatment does little to increase the effects of these drugs on people’s body weight.
The mere possibility that dieting and exercise are no longer as important as they once were causes embarrassment in the field. “I would answer cautiously,” said David Saxon, an obesity expert at the University of Colorado Anschutz Medical Campus. said when I brought the matter up to him last spring. “I don’t want you to quote me on that. ‘He doesn’t think lifestyle is important.’” For older diet pills, he said, the evidence supports prescribing diet and exercise first. (and additional) is very clear: in clinical trials Patients who received lifestyle intervention in addition to medication lost twice as much weight as those who did not.
But the data tells a different story for the new drug, Saxon and other doctors told me. In most clinical trials on GLP-1, patients receive the drug in combination with a modest lifestyle intervention. For example, check in monthly for 15 minutes with a mentor. And get tips on cutting calories and doing it for a few hours. ‘It’s worth exercising, like walking, every week’ in one large trial Wegovy called Step 1This allowed participants to lose approximately 15 percent of their body weight. Another Wegovy experiment called Step 3Try something more: Participants get bi-weekly check-ins with a registered dietitian. And they spent the first two months on very low-calorie meal replacement pills. Evidence shows that without Wegovy, all this additional training would have made a huge difference to people’s health. But for the people on Wegovy, the benefits were negligible: Those enrolled in the Phase 3 trial lost an average of 16 percent of their body weight. Only more hair was lost than people in stage 1. “That suggests that maybe an intensive lifestyle program isn’t necessary for these new drugs,” Saxon said.
He had also seen this play out in the Veterans Affairs system where he worked. Patients taking older, less potent diet drugs are expected to participate in an ongoing lifestyle modification program with monthly check-ins, Saxon told me. Now that he and his colleagues is prescribing GLP-1. “We don’t prescribe that anymore,” he said, “because we see that even if there’s no such drug, People are still maintaining their weight with these newer drugs.” Eduardo Grunvald, medical director of the weight management program at UC San Diego Health, tells me he has the same impression. “The bottom line is that you don’t need severe lifestyle intervention for these drugs,” he said when we spoke in March.
Still, obesity experts Including the Saxons, they still did not abandon dieting and exercise. But the field has begun to reassess the nature of such recommendations. “We need to figure out what this is going to look like,” Sue Janofsky, co-director of the Office of Obesity Research for the National Institute of Diabetes and Digestive and Kidney Diseases, told me. Since last year, the series of comment– editorialand view documentMost of which are published in obesity journals. This question has been explored. For example, one report argued that instead of focusing on the “quantity” of weight loss, Its “quality” should be emphasized by obesity experts, co-authors of that paper wrote. Wake Forest University obesity doctor and epidemiologist Kristina Lewis tells me that the GLP-1 drug makes dieting and exercise completely irrelevant. In fact They help patients It “focuses on lifestyle intervention in a more subtle way” by eliminating cravings and scheduling the need to count calories. She said people on Ozempic and their doctors can also start thinking about switching to a healthy diet. more enthusiastic and get more sleep All of these measures will be beneficial no matter your weight.
This all sounds very reasonable. But in a broader context It also feels like surrender. For decades, some of the most ardent critics of the weight loss industry and associated doctors have been saying something similar: Healthy behaviors can and should be separated from the like-minded goal of creating a healthy diet. person smaller– Surprisingly, the doctrine of this movement, which later became known asHealth at every size” that is being adapted to treat obesity.
But what if lifestyle intervention aims to provide people diagnosed with obesity with the same benefits as everyone else? How unique will their role in healing be? Lewis and other doctors Tell me people at Ozempic might still need tailored diet and exercise advice. This is because rapid weight loss can create specific health needs. For example, clinical trials found that people taking GLP-1 pills lost a lot of muscle and bone as their bodies shrank. In fact These and other lean tissues account for 25 to 40 percent of total weight loss. To reduce the increased risk of possible weakness or fractures. Some experts suggest that people taking these drugs should eat more protein and undergo resistance training rather than traditional lifestyle interventions.
Advice on a muscle-building diet and exercise could be part of standard care for people on Ozempic, “on the basis of logic,” he said. I would say we should do this,” Wadden, a member of the research team for the Phase 1 and Phase 3 trials, told me. However, he acknowledged that the evidence for this approach is still incomplete. Wadden has gone. Study lifestyle intervention for obese people for decades Some of that work meet Adding resistance training and aerobic exercise to a very strict diet does not prevent the loss of lean body mass. People who exercise these He’s “really swimming against the tide” of the effects of rapid weight loss, he told me. Other obesity researchers Disputes the idea that muscle loss was a problem in the first place. A latest paper from Journal of the American Medical Association argue that the link between physical frailty and GLP-1 drugs is not supported by data. And it was noted that if more than half of the weight of the people taking Ozempic was fat, they would almost certainly end up with more muscle. Fat ratio than ever before
Doctors still don’t fully understand why people using GLP-1 lose so much weight in the first place. Ozempic may work on its own to promote a different way of eating, Wadden told me. a lot without a lot of effort,” he said. “How has it changed? We don’t know.” People who take drugs may end up eating less food in general, while still eating whatever they ate before, like one Pop-Tart for dinner, let’s say, instead of five (in (In this case, meeting with a nutritionist would be helpful.) But medications can also change people’s tastes. “Suddenly you like fruits and vegetables more,” says Wadden, “and you like lean protein.” Question Similar may apply to exercise: The mere fact of losing a large amount of weight may cause some people to exercise more. Regardless of going to the gym or spending time with a trainer. Studies that might rule this out have not yet been conducted.
Wadden, like many other doctors, Still firmly believe that diet and exercise should remain the standard treatments for people who are overweight or moderately obese. But for people who have lost more weight, such as the tens of millions of Americans with a BMI above 35, let’s say they now believe the rules are changing. For this group, he said, “I don’t think lifestyle modification is any longer the cornerstone of obesity treatment.”
