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  • Writer's pictureSheri Colberg, PhD

The Weight Loss Debate: Meds v. Lifestyle

Weight loss is a topic on many people’s minds, especially after the holidays when most of us gained a few pounds from all the delicious treats. But there is a debate raging right now about the best way to go about losing those (and other) excess pounds, and it’s worth your consideration.

While the tried-and-true methods of weight loss that involve changing your diet, eating fewer calories, and being more active do work (that is, lifestyle changes), the most popular method of weight loss currently is taking one of the new medications like Wegovy and Zepbound. You may have heard of the diabetes-approved versions, Ozempic and Mounjaro, respectively. (Ozempic was even a punchline in one of the “Saturday Night Live” skits late in 2023.)

Why do people prefer taking meds instead of making lifestyle changes? Any medications can have negative side effects, but most of the ones from having a better diet or exercising more are positive. My guess it’s that taking a medication is easier to stick with than changing what you’re eating and doing over the long haul.

Many studies in the past few decades have shown that people can and do lose weight on almost any diet, but the harder part is avoiding regaining the pounds they were able to shed. Part of that is for metabolic reasons—you need fewer calories to maintain your weight after you get lighter, and your metabolism can slow down—and part is related to the type of weight you lost. If you dropped weight quickly, you likely lost more muscle mass than someone who exercised regularly and lost pounds more slowly.

It can be discouraging when you lose weight slowly by being more active instead of just starving yourself or cutting out carbs, etc. But exercising when you’re cutting back on calories is essential to keeping more of your muscle, which you really want to do to help avoid weight regain later. Simply increasing how many calories you burn through physical activity without changing your diet can also lead to weight loss, but that can take even longer.

Why are we having this discussion? It really helps when you think more long-term when you’re deciding how to go about losing weight. Do you want to keep the pounds off after you lose them? (Most people do!) Unfortunately, most people also have a hard time keeping their weight down with lifestyle changes alone, hence the popularity of these new weight loss medications.

Since I have been hearing for decades about the class of medications that many people are now using for weight loss (GLP-1 receptor agonists)—they were developed to treat type 2 diabetes first and foremost—I know most of the good, the bad, and the ugly about them!

·         The good: These medications can help you lose weight, even if you don’t make any lifestyle changes. They generally suppress your appetite, so you eat less and lose weight. If you add in the lifestyle changes at the same time, you can have even better long-term results.

·         The bad: You may experience nausea and other GI issues when using this class of medications. It may be worse when you start and get better with time, or you may need to take a lower (less effective) dose to avoid these symptoms. In any case, they’re common and unpleasant. (Many people stop taking them for these reasons.)

·         The ugly: It appears most people start regaining weight soon after they stop using these medications. Their long-term side effects have not been well-studied to date. However, once you start taking them, you may need to keep using them forever to keep the excess pounds from returning. And they’re not inexpensive!

My word of advice is this: Only consider using these meds if you feel like you need a kick-start with your weight loss and really are having trouble losing it any other way, BUT consider making at least small tweaks to your food choices and your exercise patterns to improve those at the same time. Then even if you do go off the meds at some point, you’ll have a better lifestyle habit in place and will be less likely to regain any pounds that you lost. Remember, almost all of the people included in the National Weight Loss Registry who have managed to keep the weight off continue to exercise regularly, watch how much they’re eating (i.e., practice portion control), and weigh in frequently to catch backsliding early. These are things you can do as well.

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