If you are overweight, it can sometimes feel like you're in a no-win situation.
Trying to lose weight but without visible results? You are labelled "lazy", "unhealthy", or "lacking willpower".
How about a decision to use injections or medication (God forbid!)? You will be straight away accused of "cheating" or "taking the easy way out", even if you've spent years trying to achieve healthy weight through diet, exercise, and lifestyle changes.
GLP-1 receptor agonist drugs like semaglutide (Ozempic, Wegovy, Rybelsus) or tirzepatide (Mounjaro, Zepbound) have sparked more debate than a football match between rival teams.
But the opinion that truly matters? Yours.
I am not here to play judge and jury on whether you should take weight loss medication. That's a decision for you and your GP to tackle together. My goal is to guide my clients and enhance their results, regardless of their choice.
Whether you are on medication or not, I can help you optimise your food and lifestyle choices, find exercises that suit your changing body, and help you navigate the emotional rollercoaster on this challenging journey.
Why is losing fat so difficult?
Let's be honest here: fat loss is tough. Full stop.
But it's even harder for some people due to a combination of environmental, genetic, physiological, social, cultural, and behavioural factors.
We live in an "all-you-can-eat buffet" world
Think back 150 years. Before cars and public transport, we walked and cycled a lot. Food was often scarce, and you had to burn calories to get it. Meals would satisfy you, rather than leaving you stuffed.
Fast forward to today, we found ourselves in an "obesogenic" environment filled with cheap, highly palatable, energy-dense foods that make overeating easy. Plus we don't need to move much to get all that food.
As pessimistic as this might sound, some people still manage to maintain lean, healthy bodies.
Why?
Some people are genetically predisposed to obesity.
While rare genes can cause severe obesity at a very young age, polygenic obesity is more common. Here multiple genes work together to make you more susceptible to weight gain (and they work even more actively in our processed food environment).
These genes can also lead to "food noise" - a constant preoccupation with food. It's like having a non-stop internal monologue of
"What's for dinner?
When can I eat next?
Is it snack time yet?"
Your body can be as stubborn as a mule when you decide to lose fat
If you gain a lot of fat, the hormones in your gut, fat cells, and brain can change how you experience hunger and fullness. It's a bit like a thermostat - it will keep pushing the temperature (hunger) up. After weight loss, your gut might keep sending "I'm hungry" signals, even after eating, and even if you have enough body fat.
Living in a larger body often means facing stigma and discrimination
Until you've experienced it, it's hard to understand how the world might treat you when you're in a larger body.
My clients have shared with me horrible stories of gym and swimming pool bullying, public shaming at shops, and relentless comments about their body shape, health, and even self-worth. Their GPs dismissed their symptoms, attributing all health concerns to weight (that must be lost, of course).
All this causes a huge amount of stress, which can increase appetite for high-calorie foods, reduce physical activity, and decrease sleep quality.
It is a vicious circle.
Taking medication isn't "cheating" - it's more like using sat-nav on a tricky journey
In 2013, the American Medical Association categorised obesity as a disease. Yet, it is still viewed as a willpower problem, the result of "too many biscuits and too little jogging".
(The remedy: "Just try harder, mate!")
If you have obesity, you have as much willpower as anyone else. However, losing fat for you is more challenging (as discussed above).
Just as chemotherapy or insulin isn't 'cheating' for cancer or type 1 diabetes, weight loss medication isn't 'taking the easy way out' for obesity.
Medication is a tool that can be used together with healthy lifestyle choices. This combination can help counterbalance some of the genetic and physiological factors which are often beyond the control of people with obesity.
How Ozempic and other obesity medicines work
Current weight loss medications primarily mimic the function of glucagon-like peptide 1 (GLP-1).
In the pancreas, it triggers insulin release, aiding blood sugar regulation and promoting fullness.
In the gut, it slows digestion, affecting satiety.
In the brain, it reduces cravings and food-related intrusive thoughts.
How effective are GLP-1 drugs for weight loss?
About 86 per cent of people taking GLP-1 drugs like Ozempic, Rybelsus, and Wegovy lose at least five per cent of their body weight, with about a third of participants losing more than 20 per cent.
How do weight loss medications compare to lifestyle changes?
Historically, people would lose weight under a caloric restriction, with increased physical activities and sometimes counselling. Instead of pitting lifestyle changes against weight loss medicines or surgery, it's more beneficial to view them as complementary approaches.
Lifestyle modifications and support can lead to an average weight loss of 5 to 13 per cent of body weight.
When combined with a weight-loss drug, this amount can increase by ten per cent or more.
Shedding pounds often brings a range of health benefits
If you lose between 5 and 10 per cent of your total weight, you will start to see your blood sugar, cholesterol, and pressure drop. However, losing 15 to 20 per cent of your weight (which is common when combining lifestyle changes with new-age GLP-1s) can alleviate symptoms of diabetes, fatty liver disease and sleep apnea.
The additional benefit? You take fewer pills altogether.
What on earth is a "healthy body weight"?
Many people say, "I just want to be at a healthy weight."
But what does that even mean? Here are 5 basic principles.
You have more lean mass (from muscle and bones), and less body fat.
You can maintain it relatively easily by adopting basic, sustainable behaviours (like being active and eating well), rather than fad diets or other extreme measures.
You do the activities you like, with as few limitations as possible.
Your health markers (like blood pressure, cholesterol, and blood sugar) are within a healthy range.
You feel good in your skin (most of the time!).
The frustrating thing is that it's not about a specific size, shape, look, body fat percentage, or BMI category.
A "healthy" weight is different for each of us.
How would you know you've reached yours without a specific number to aim for? Your quality of life will give you a hint. You will feel good. And most probably, it won't be your "ideal" weight. But it does not matter anymore, right?
7 tips to improve your results with weight loss medication
When food noise and hunger are tuned down, It becomes easier to prioritise lean protein, fruits and veggies, whole grains, and other minimally processed foods. When you start losing excessive weight, you will feel better, so it will be easier to do resistance training and other forms of exercise.
According to a 2024 consumer trends survey, 41 per cent of GLP-1 medicine users reported that their exercise frequency increased since starting the medication, as well as diet quality.
Once again, medication isn't simply "the easy way out."
(Exceptions do exist, of course. People can continue to eat rubbish food - just less of it. This can lead to losing crucial muscle and bone, and, sometimes, minimal body fat.)
Tip 1: Find ways to eat nutritious foods despite side effects
GLP-1 drugs can make your belly feel like it's on a go-slow, leading to constipation.
The good news?
These issues tend to disappear within a few weeks. Meanwhile, get creative with your nutrition, for instance, fruits and veg blended into a smoothie or whizzed into a soup.
Try to avoid:
Large portions
Greasy meals
Highly processed foods
Sugar alcohols (like xylitol, erythritol, maltitol, and sorbitol, often lurking in diet fizzy drinks, chewing gum, and low-sugar protein bars), can send you to the loo at lightning speed.
Tip 2: Make strength training your new best mate
When you are on a weight loss drug, about 30 to 40 per cent of the weight can be lost from lean mass.
However, there are two important caveats to this statistic:
People carrying a lot of extra weight generally have more muscle and bone mass than others.
Muscle and bone loss aren't set in stone.
To keep your muscles and bones strong, aim for at least two full-body resistance training sessions a week.
On top of that, keep active as much as you can. Walking and other forms of physical activity are crucial for keeping your metabolism at its pick performance.
Tip 3: Lean into protein
Along with strength training, getting enough protein is vital for helping to protect your muscle mass. Most people will need 1 to 2 palm-sized protein portions per meal, or about 0.5 to 1 gram of protein per pound of body weight per day.
Tip 4: Fill your plate with nature's goodness
Whole, fresh, and frozen foods fuel you with crucial nutrients that can help decrease inflammation, which can increase your risk for disease, and put brakes on protein synthesis, making it harder to keep your muscles healthy.
Tip 5: Choose high-fibre carbohydrates over their low-fibre cousins
Beans, lentils, whole grains, and sweet potatoes keep you fuller for longer and are better at managing blood sugar compared to their more processed variations.
Tip 6: Opt for healthy fats
Healthy fats can help you feel full between meals and keep your overall health in check. (think avocado, seeds, nuts, olive oil and fatty fish (which is a protein too!).
Tip 7: Reach out for support
There is plenty we have not covered yet: good quality sleep, social support, stress management and more.
While many people choose to tackle these strategies solo, many others find that the support, guidance, and creative problem-solving that a good therapist/coach can provide makes the whole process much easier, more enjoyable and more likely to stick.
A coach doesn't just help you figure out what to eat and how to move, but, most importantly, remove barriers, build skills, and create sustainable habits. Then, if you do want to stop taking medication, your ingrained lifestyle habits will make it more likely that you maintain your results.
Curious to learn more? Get in touch!
References:
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