Published Dec 7, 2024

One Doctor Says Blockbuster Weight Loss Drugs Provide ‘Dramatically Greater & More Durable Weight Loss Than Lifestyle Interventions’— How Can This Be?

Details
Transcript
Save This Video

Lifestyle Change Vs. Anti-Obesity Drugs

Weight-loss injections like Ozempic (semaglutide), Wegovy, (semaglutide), and Zepbound (tirzepatide) are becoming more popular and have helped many successfully lose weight across the U.S., but some may question whether lifestyle changes are more beneficial than taking medication to shed excess weight.
Dr. Yoni Freedhoff, an associate professor of family medicine at the University of Ottawa, argues that lifestyle changes as “literally not better” than anti-obesity drugs, but it’s important to understand the benefits of eating healthy and exercise.
Semaglutide is a GLP-1 receptor agonist, meaning that it mimics the effects of GLP-1 in the body. Given as weekly subcutaneous injections, it is normally prescribed to manage blood glucose levels in diabetic patients. It also leads to a significant amount of weight loss in these patients.
The Centers for Disease Control and Prevention (CDC) says, “Being overweight or having obesity are linked with a higher risk of getting 13 types of cancer.” Some of these cancers include breast, colon, ovarian, and stomach (gastric).
If you’re considering taking a weight loss drug, talk with your care team about whether that’s a good option for you. And make sure you consider good diet and exercise practices as a part of your treatment plan.
Remember, consistency is the key. Building healthy habits and making them part of your daily routine can potentially improve your overall well-being. Even small steps can have a significant impact, so it’s never too late to start.

As blockbuster weight-loss injections like Ozempic (semaglutide), Wegovy, (semaglutide), and Zepbound (tirzepatide) are gaining popularity across the U.S., many may question whether the effects of these drugs are better than diet and exercise alone—like one doctor who insists “diet and exercise are not better than drugs for obesity.”

Of course, it’s great that people working to shed excess pounds with GLP-1 agonist drugs are seeing results, but the importance of a healthy lifestyle should never be forgotten.

In a commentary piece for Medscape, Dr. Yoni Freedhoff, an associate professor of family medicine at the University of Ottawa, argues that diet and exercise as “literally not better” than anti-obesity drugs.

And no doubt me saying drugs are better than lifestyle for obesity will upset many. But what I'm not saying is that people shouldn't strive to live the healthiest lives they can honestly enjoy (which btw varies with privilege) – we all should be – regardless of our weights.
— Yoni Freedhoff🎗️ (@YoniFreedhoff) December 6, 2024

Dr. Freedhoff writes, “Idealistically, sure, but literally not. And there’s really no debate. Meaning there’s never been a reproducible diet and exercise intervention that has led to anywhere near the average weight lost by those taking obesity medications.

“Furthermore, when it comes to the durability of weight lost, the gulf between outcomes with diet and exercise vs. obesity medications is even more dramatic.

He continues, “Looking to the literature, one of the most trotted out studies on lifestyle’s impact on weight over time is the Look AHEAD trial. Before useful obesity medications came on the scene, I trotted it out myself. Why? Because it was heartening when faced with the societal refrain that diet and exercise never worked to be able to show that yes, in fact they do. But how well?

“Looking to Look AHEAD’s 4-year data, those randomized to the intensive lifestyle initiative arm averaged a 4.7 percent total body weight loss – an amount that remained the same at 8 years. But I chose 4 years because that’s a better comparison with the semaglutide SELECT trial that revealed at 4 years, the average sustained weight lost was more than double that of Look AHEAD’s, at 10.2 percent. Meanwhile the recently released SURMOUNT-4 study on tirzepatide reported that at 88 weeks, the average weight lost by participants was a near bariatric surgery level of 25.3% with no signs suggestive of pending regains.”

It’s important to note that although these types of drugs have been successful, various clinical trials—like the STEP 1 trial extension, STEP 4 trial, and the SURMOUNT-4 Trial—have found discontinuing GLP-1 drugs leads to weight gain. Additionally, a recent report from MedPage Today, in part with the “Ozempic: Weighing the Risks and Benefits” series created through the NIHCM Foundation, experts, referring to clinical trial data, experts say it’s clear patients who lost weight on blockbuster weight loss drugs [GLP-1 agonists] will regain some weight back after stopping them.

With this in mind, it’s clear that making lifestyle changes and incorporating a healthy diet and exercise routine is always a good idea, regardless of whether you’re taking an anti-obesity drug or not.

Meanwhile, Dr. Freedhoff also pointed out that last week “word came out that Medicare is likely to extend coverage to obesity medications for far more Americans,” adding, that “one of the most common refrains was something along the lines of yes, lifestyle modification is the best choice for dealing with obesity but it’s good that there will be medication options for those where that’s insufficient.”

Dr. Freedhoff explains further, “At this point, obesity medications are plainly the first line choice of treatment. They provide not only dramatically greater and more durable weight loss than lifestyle interventions, they have also been shown to very significantly reduce the risk for an ever-growing list of other medical concerns including heart attacks, strokes, type 2 diabetes, hypertension, sleep apnea, fatty liver disease, and more, while carrying minimal risk.

“Let it also be said that improvements to diet and exercise are worth striving for at any weight, though one should not lose sight of the fact that perpetual, dramatic, intentional, behavior change in the name of health requires vast amounts of wide-ranging privilege to enact — amounts far beyond the average person’s abilities or physiologies (as demonstrated with obesity by decades of disappointing long-term lifestyle outcome data). ”

How Does Semaglutide Work?

Semaglutide, the key ingredient in popular weight loss drugs, works by impacting the glucagon-like peptide-1 (GLP) GLP-1 hormone.

Integral to blood sugar control, GLP-1 is a hormone released by the gut in response to food. It causes the pancreas to release insulin. A rising blood insulin level causes all the body tissues to start absorbing glucose (blood sugar) from the bloodstream, thereby lowering blood glucose levels. GLP-1 also prevents the release of glucagon, which is a hormone that raises blood sugar levels by stimulating liver cells to release glucose and helps people feel full for longer. These effects can also cause people to lose weight.

The Role of Diet and Exercise in Cancer Risk

Modern studies on GLP-1 have shown that it has a role beyond glucose control. It modulates the immune system cells, including NK cells, in a way necessary for weight loss.

Semaglutide is a GLP-1 receptor agonist, meaning that it mimics the effects of GLP-1 in the body. Given as weekly subcutaneous injections, it is normally prescribed to manage blood glucose levels in diabetic patients. It also leads to a significant amount of weight loss in these patients.

Although semaglutide has been approved for blood sugar control in people with type II diabetes, under the brand name Ozempic, and for weight loss under the brand name Wegovy, it has not been approved for use as an immune booster and cancer preventative. Thus, it should not be prescribed for that purpose. Those taking it to control their diabetes or weight, however, can expect the additional benefit of improving their immunity. as per a recent study, and lowering their cancer risk, as a link between weight and cancer does exist.

It’s important to note there are a variety of drugs available right now for weight loss, like Nova Nordisk’s semaglutide—which can be purchased under brand names Ozempic, Weygovy, and Rybelsu—and Tirzepatide, sold under the brand names Mounjaro and Zepbound. Others include Phentermine (Adipex-P, Lomaira), a prescription medication which lessens one’s appetite, Contrave (naltrexone/bupropion), and bupropion (the generic form of Wellbutrin).

Living a Healthy Lifestyle

One major part of weight loss is eating healthy and good exercise habits, something SurvivorNet experts recommend.

The general recommendations for a healthy lifestyle are the same whether you have cancer or not. Dr. Ken Miller, the Director of Outpatient Oncology at the University of Maryland Greenebaum Cancer Center, has some guidelines for cancer survivors who are concerned about a recurrence:

1. Exercise at least two hours a week, and walking counts.

2. Eat a low-fat diet. The Women’s Intervention Nutrition Study, which looked at early-stage breast cancer patients, found that a low-fat diet was associated with reduced risk for cancer recurrence, particularly in those with estrogen receptor-negative cancers. Other studies have found that foods with a high glycemic index that are digested quickly and cause a spike in blood sugar may lead to tumor growth in lung cancer patients.

3. Eat a colorful diet with lots of fruits and vegetables. The American Cancer Society recommends aiming for two to three cups of vibrant vegetables and fruits each day.

4. Maintain a healthy weight. Studies have shown that being obese can increase your risk for several types of cancer.

Dr. Ken Miller says a healthy diet and regular workout routine are important

Cancer Risk and Obesity

Bodyweight can be a sensitive subject for many people on any given day. However, among cancer patients whose treatment and diagnosis may influence their weight, the numbers on the scale fuel an already emotional journey.

The Centers for Disease Control and Prevention (CDC) says, “Being overweight or having obesity are linked with a higher risk of getting 13 types of cancer.”

Research published in the journal “Cancers” says that “Obesity also increases the risk of dying from cancer and may influence the treatment choices. About 4–8% of all cancers are attributed to obesity.”

Some of the cancers associated with being overweight or obese include:

Colon
Breast
Ovarian
Esophagus
Pancreatic
Multiple myeloma
Endometrial
Liver

WATCH: Living a healthy lifestyle.

According to the National Cancer Institute (NCI), fat tissue “produces excess amounts of estrogen,” which is associated with an increased risk of certain cancers, including breast, ovarian, and endometrial cancer. The NCI says a person who is severely obese is “7 times” more likely to be diagnosed with endometrial cancer.

Obesity is associated with high levels of insulin, which can lead to colon, kidney, prostate, and endometrial cancer.

Obesity can affect cancer survivors in various ways, including the chance of cancer recurrence and overall quality of life.

To learn more about your ideal healthy weight, determine your body mass index (BMI).

Body weight that exceeds what the body mass index deems appropriate for your weight and height can help determine body fat content. Although your BMI can help you learn if you are at a healthy weight, underweight, overweight, or obese, other factors may contribute to your overall health.

The NCI analyzed several studies to observe physical activity’s impact on overall cancer risk. The NCI says that “higher levels of physical activity are linked to lower risk of several types of cancer.”

Regular exercise, a balanced diet, and managing stress are some ways people can practice leading a healthy life. For cancer survivors, a healthier lifestyle alongside getting regular checks for recurrence may improve your quality of life.