“I think that this should not be about weight. It’s not about how big or small you are. The most important thing about the GLP-1 drugs is that they change the landscape of how we look at obesity.”
That’s according to Dr David Kessler, the former commissioner of the US drug regulatory authority. Kessler is the author of Diet, Drugs, and Dopamine: The New Science of Achieving a Healthy Weight. He was recently interviewed by Harvard Medical News, and discusses his own experience taking GLP-1 drugs.
Ozempic is the most well-known brand name for this class of drugs, which also includes Wegovy, Trulicity and Victoza. These drugs mimic effects of a gut hormone called glucagon-like peptide-1 (GLP-1).
GLP-1 has many roles in digestion and metabolism. But the most significant, as far as treating obesity is concerned, is hunger and the speed at which the stomach empties after eating. A major medical advance, these drugs have since become notorious for off-label use by regular folks trying to lose weight.
But Kessler’s experience might change your perception of these drugs.
“There’s a sense of fullness and then there’s Thanksgiving fullness, being pushed to the edge of nausea,” Kessler told Harvard Medical News. “These drugs pushed me to the edge of nausea.”
In other words, for people taking these drugs, their stomach empties so slowly that you simply lose appetite. The feeling of food sitting in the stomach becomes almost sickening.
Because of their novelty, medical practitioners were not trained in how to prescribe GLP-1 drugs. Kessler suggests using very small doses, so as to steer well clear of nausea and gradually condition patients to learn to eat less on their own.
Kessler gives a conventional account of the obesity epidemic. He describes overprocessed foods as “hijacking the brain’s reward system” and likens obesity and overeating to an addiction.
Ozempic and other semaglutide-based drugs, on this view, are a form of addiction treatment. Excess adipose or “fat” tissue accumulates in the heart, liver and pancreas of obese people, causing a range of severe health conditions further down the line. So instead of a fat-loss fad mostly driven by off-label use, these drugs can be seen as revolutionary preventative medicine for this range of metabolic-related conditions.
That’s the medical side of things. Kessler’s account also shows that GLP-1 drugs are not the easy road they’re often made out to be.
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