Docs dictating diabetic drugs for disheartened dieters.

A few years back, I ruminated about a radio ad that trumpeted the claim, “You’re not fat… you’re bloated.” Aside from metabolism and genetic causes, it suggested that we’ve been blaming those expansive paunches on things like overeating, poor dietary choices and lack of exercise. Too many of us had apparently been blaming ourselves, but, as it turns out, it’s not our fault and there’s a magic pill or supplement that will deliver a flat stomach in a fraction of the time it took you to construct that oversized belly. In the latest not-my-fault-I’m-fat breakthrough, we now have drugs meant for diabetics that allow us to shed pounds without so much as a sit-up or having to choose between a side of fries or a salad.

The downside, like many quick fixes for a complex condition, was that it was another excuse to justify unhealthy lifestyles and disregard diet and exercise as options for weight loss and improved fitness.

According to the aforementioned theory, which was short-lived as a fad, there is undigested fat just “laying” there in your stomach— described quite crudely as sludge— that was making people appear fat when they were merely bloated. Of course, there was a supplement to counteract this bloating and deflate big bellies into terrific torsos. That was a few years back and part of a growing movement known as body positivity, which was touted as bolstering self-esteem among the overweight majority, reducing body shame and, therefore, helping us  embrace and love our bodies as they are. It was  seen as improving the mental health of millions and bestowing upon them a sense of empowerment that was most notable among the healthy and physically fit.

On the other hand, an effort to convince people that they can blame being overweight, even obese, on bloating verged on ludicrous. Stomach sludge couldn’t be the cause of ballooning thighs, hips and other parts of the body. Part of the psychology in convincing people that obesity can be “cured” without months,  years, even a lifetime of diet and exercise is to assure them that it isn’t their fault. Again, there are some of us who gain weight when other don’t on essentially the same diet and activity level. That is a metabolic issue and  a whole other science.

However, losing weight in a healthy manner does require self-discipline, whether we want to admit it or not. It’s not fair, of course, that some of us gain weight much more readily than  others and, worse yet, that it is so much harder to take off those extra pounds. 

As we approach the end of 2023, looking forward to a new year and a fresh start, we’re seeing the annual advertising assault by manufacturers of fitness equipment, gyms and marketers of magic bullet supplements and diets. What better time of the year to appeal to a desperate and substantial population?

This year, many of the overweight and obese — about two-thirds of U.S. adult Americans, according to Harvard University’s Chan School of Health— are looking at new savior: Type 2 Diabetes drugs. The surge of non-diabetics who have been prescribed Type-2 diabetes drugs has been so recent and  sudden that there are reports of diagnosed diabetics unable prescriptions refilled due to demand. That means that physicians are granting requests from patients not diagnosed with diabetes for some of these prescribed drugs. It can be justified for one specific reason: being overweight, especially obese, is unhealthy and could lead to heart disease, arthritis and, yes, diabetes.

I was prescribed a diabetes drug, Metformin, about two years ago and immediately went on the heart-healthy DASH Diet, the most recommended eating plan for reducing high blood pressure and blood sugar. At the same time, I started an exercise program that included calisthenics, weight training and long walks. At my next checkup six months later, my A1C had dropped from 7.1 to 4.5 . My doctor took me off the drug, and it has remained steady under 5.0 since. Metformin may lead to modest weight loss but isn’t considered among the more highly effective weight-loss drugs. Ozempic, Trulicity and Victoza claim top honors and have highlighted weight loss in their ad campaigns.

As is the case with many strong medications that cause major chemical changes in the body not regarded as natural or organic, there are the dreaded side effects. If you are taking a prescription drug for a disease or illness like diabetes, resolving the effects of the illness might be worth paying any penalty from side effects. Is taking a drug for weight loss,  whether to look better or feel better, worth it? Obviously, some physicians feel that losing 10, 20, 30 or more pounds fairly quickly may be the best strategy as opposed to a healthy lifestyle of nutritious meals and exercise over a much longer span. The latter requires reliance on self-discipline and staying the course until the goal is reached as opposed to taking a pill or an injection that may or may not create other health issues when the weight is gone.

In both cases, there is the probability of the weight coming back whatever path you choose when and if the medicating stops or the lifestyle changes of diet and exercise end. It seems to me that a healthier lifestyle is always a better option than medication, with or without side effects. In truth, weight loss is technically a side effect of a number of diabetes drugs, but it has turned out to be a side effect in much demand in an increasingly corpulent country.

There are various ways Type 2 diabetes drugs lead to weight loss. For starters, some reduce hunger through appetite suppression and a feeling of fullness. Inhibitors may remove excess glucose through the urine, and these calories  are flushed down the toilet instead of being absorbed in the body’s cells. There is also decreased fat absorption in some of these medications, excreting fat from the body  instead of being stored in the cells. Reduced insulin resistance may be a factor in others, more effectively utilizing glucose and stored fat to crank up energy, with the re-energized metabolism burning up calories as its fuel.

As previously noted, weight loss is a side effect of some of these prescribed drugs, but other side effects are not as desirable. Among the most common are nausea, diarrhea and stomach discomfort, which might not seem too steep of a price to pay if you are morbidly obese or your mobility for normal activity compromised. Then there is the possibility of hypoglycemia, or dangerously low blood sugar, most commonly resulting in dizziness, shakiness, anxiety and fatigue as several of numerous symptoms. As it becomes more severe, it can result in loss of consciousness and seizures. There is also the possibility of  deadly low blood pressure, dehydration, urinary tract infection, genital infection and pancreatitis.

Obesity has been described as a pandemic, but two main options to combat it remain: modern medicine and serious lifestyle changes. There is something to be said for both.