The New Weight Loss Drugs Might be Amazing, But So is This

weight loss drugs versus eating real whole food

In 2005, I started writing a medical mystery called Not Quite Dead, where a diabetes researcher discovers a drug that helps people to lose a remarkable amount of weight. Only there might be significant side effects. My idea was that if people knew about these side effects, the drug might flop.

…After three months on the experimental drug, the mice were losing about fifteen percent of their body weight. Of equal importance, no significant side effects could be noted. So none were.

—Not Quite Dead (page 7)

If you think this sounds a little like semaglutide, a medication initially developed to control blood sugar (also called Ozempic or Wegovy), but which turned out to be a jaw-droppingly effective medication for weight loss, you’d be wrong. Because despite a link to thyroid cancer, the drug is an absolute blockbuster. These side effects might turn out to be much ado about nothing. Or, they might not.

What happens when there is a new medication that gets widely used by millions of people, possibly for decades, is that we learn more about the drug—both good and bad. Using a newly approved medication is a little bit of an experiment, but if the benefits outweigh the potential costs for a given individual, it is not unreasonable to try it. I have prescribed semaglutide (and others in this medication class) for patients who are able to get a hold of it (read: afford it, because in the US, it is almost $1,000 a month without insurance) and who medically qualify for it. It’s hard not to get excited about this medication, especially for people who struggle with their weight and diabetes.

For years, the medications to control diabetes led to further weight gain, precipitating a vicious cycle in which people with diabetes would need more and more medication to control their blood sugar as their weight increased. Drugs that help people with diabetes to lose weight and break this cycle were long sought after. These drugs got additional approval for people with a medical problem that wasn’t diabetes, like high blood pressure or sleep apnea, and obesity. It makes sense that people with stubborn medical problems would want to take a newly approved drug that might help them lose weight and better control their medical issues. But now, it seems that everyone wants semaglutide. Articles are being written about healthy people who want to lose 10 or 20 pounds and find a provider to prescribe the medication. Instead of being afraid of side effects, which I thought would doom the fictional medication in my book, people are more concerned with weight loss, even in the absence of medical problems.

Vanity often gets the blame for the incredible off-label demand for these new medications. But, I don’t agree with this. Besides marketing and societal pressures to be thin, we are actually hungry—hungrier than we think we should be—and we are looking for something, anything to help control our cravings.

Besides marketing and societal pressures to be thin, we are actually hungry—hungrier than we think we should be—and we are looking for something, anything to help control our cravings.

A piece of the puzzle that I write about in Eat Everything: How to Ditch Additives and Emulsifiers, Heal Your Body, and Reclaim the Joy of Food, is the idea that when our digestive systems are presented with certain food additives, they encourage us to eat more.

In Eat Everything, I tell the story of a patient named Thomas (not his real name), who reports that he feels like he can’t control himself around store-bought ultra-processed cookies and cakes. But, Thomas has a lot more control over his intake of sweets when he is eating homemade desserts made with whole ingredients—even if they are cookies and cakes. Those treats have lots of sugar and flour in them too, but they don’t generally have a substance, ubiquitous in ultra-processed food, called maltodextrin.

Maltodextrin imparts a sweetness to foods and can allow producers to use less “sugar.” So, it can make an ultra-processed food appear lower in sugar than it otherwise would be. It helps the product to last longer on the shelf too. As a result, you can now find it on ingredient lists on everything from breakfast cereals to pricey chocolates. But, it has been noted to raise blood sugar faster than real sugar does, causes mice to consume more calories when they are given the substance in their water, and is even taken by bodybuilders who are trying to bulk up on purpose. There have also been studies linking it to changes in our gut microbiomes that may contribute to colitis. The International Organization for Inflammatory Bowel Diseases asks patients suffering from colitis to avoid maltodextrin in their 2020 guidelines. While maltodextrin might be the biggest offender, there are plenty of other reasons to avoid ultra-processed foods.

Most of my patients can’t afford expensive weight loss drugs, even if they have diabetes or other conditions for which they’ve been approved. Sometimes we turn to less expensive medications to help with weight loss (after discussions about benefits and possible side effects), but sometimes we are only left with dietary modification and that can work, too.

In one of the best-done studies on ultra-processed versus whole foods, participants lost two pounds in just two weeks of being on a whole foods diet, while they gained two pounds when on the ultra-processed one. Large population-based studies have also shown a strong association between the consumption of ultra-processed foods and weight gain. Importantly, ultra-processed foods aren’t just what we think of as “junk” foods like fast food and candy. Many whole-grain breads and yogurts marketed as health foods are classified as ultra-processed.

Whether or not you are in the market for one of the new weight loss drugs, if you want to cut cravings and increase your ability to be sated by your food, skip the ultra-processed stuff (especially foods with maltodextrin) and try to eat as whole food-based a diet as possible. Sure, eggs are expensive these days, but not as expensive as semaglutide.

To learn more about how avoiding key additives can help you manage your weight more easily: