Continuing Lifestyle Intervention, Part 9

This quotation, typical of many others, comes from Healthline:

Research has found that when people stop using semaglutide medications […] weight rebound occurs. Experts say this is because the drug is not a cure…

The author also adds, “and it does not prevent the metabolic adaptation that occurs during weight loss.” Just like in the aftermath of bariatric surgery, the patient will have to cope with the adjustments and compensations the body has made in an effort to get back to what it — rightly or wrongly — perceives as normal.

The term “the chronicity of obesity” has been brought up, and “chronic” is not a word we want to hear associated with any of our physical problems. It also is faintly reminiscent of a concept that Childhood Obesity News discussed at length — the Set Point.

It has been suggested that the Set Point is such a relentless foe, that it does not even stay faithful to its name, but sneakily persists in resetting itself, to an ever-higher figure of course. If the dreaded Set Point exists, then the subject of the present discussion, “continuing lifestyle intervention,” should necessarily be a part of just about everybody’s program, always. Anyone who finds the topic interesting can see more here, here, or here.

If there is such a thing as a set point, long-term maintenance would be impossible except for a small percentage of weight losers who are willing to devote to it a large percentage of their time and efforts.

The big question

One of the most important discussions to be had right now is, what to do about obese children and teens, and most of all, how to prevent them from getting that way in the first place. But, one thing at a time. For kids who are already over the line, they, their parents, and their medical advisors face a choice between surgery and meds. The trend toward favoring and recommending new weight-loss drugs seems so well-established as to be inevitable.

The biggest difference between them is that a whole lot is known about life after bariatric surgery, while not much at all is known about life after beginning one of the drugs. That lack of knowledge is true of patients who stay on the drug they are prescribed, and those who quit after a year or even a few months.

As for staying with a drug for several years or many years, a relatively minuscule amount of information has been collected. The only certainty is that everybody needs some help along the way, and most people succeed much better with continuing lifestyle intervention of some variety.

What has been the point of this series on continuing lifestyle intervention? To emphasize its importance of course, but more than that, to remind the Childhood Obesity News audience that there is an excellent tool for the purpose. We urge readers to check out BrainWeighve as a guide through the scary forest of continuing life.

It is for people who are actively working on breaking their addiction to overeating (and other things as well) and yes, even for people who don’t have an addiction-prone tendency and hope to avoid ever having one. It’s a flexible program, to participate in a little or a lot, as needed; both a tool for maintenance when things are going smoothly, and a staunch ally to do the heavy lifting when the train jumps the track and needs to be put back.

Your responses and feedback are welcome!

Source: “Ozempic Rebound: Why Most People Regain Weight After Stopping Semaglutide,” Healthline.com, 06/09/23
Image by Pam Lariviere/Public Domain

Continuing Lifestyle Intervention, Part 5

UCSF (University of California San Francisco) has words for the patient considering weight-loss surgery. Some of those words are, “Not a cure for obesity, but rather a tool…” In addition,

Long-term success depends on your ability to follow guidelines for diet, exercise and lifestyle changes… Now you must commit to a new way of life.

When the Bariatric Surgery Center talks about followup care and the future, it mentions “a support group, dietitian services and continuing education.” These would come under the heading of continuing lifestyle intervention in anybody’s book. Interestingly, part of the lifestyle is to avoid pregnancy — just like with the semaglutide drugs.

In the weight-loss realm, surgical and pharmaceutical patients both receive numerous tips about how and what to eat. The surgical patients are advised to burn calories and build muscle by working out. The users of the hot new drugs are given the same advice, especially since the drugs seem prone to melt away not just fat, but perfectly viable muscle tissue.

More great advice that applies equally to both types, is to maintain and cultivate social relationships, particularly the kind that fosters the goal. Like, join a weight-loss support group. And spend time doing things that are fun and meaningful, which ties in with the importance of positive displacement.

And furthermore

Other comparisons can be made. People who undergo bariatric surgery, or who have diabetes, are not expected to abandon their support systems partway through life. A person isn’t going to someday get their amputated stomach back, or suddenly receive a revelation about how to stay alive without insulin. The program of lifestyle intervention that comes along with the surgery or the shots is a “forever” kind of thing.

Why should people taking GLP-1 drugs be any different, whether they quit after a year, or continue forever? Either way, they need ongoing support and other elements of lifestyle intervention, on a continuing basis. Surgery is not a “set it and forget it” proposition, nor is embarking on a course of elective medication with no time limit in sight. Positive attention must still be paid to every aspect of life — and if we’re doing it right, attention quite often demands intervention.

“Lifestyle” is much more than a glossy magazine cover. There is nothing trivial about it. Life is a serious concept, comprising today and tomorrow and each succeeding day of our existence until it ends. And “style” being the individual choices and cumulative effect of the way we do every little thing, every single day, from now until infinity.

Your responses and feedback are welcome!

Source: “Life After Bariatric Surgery,” UCSFHealth.org, undated
Image by Alachua County/Public Domain

Goodbye to Addiction? Continued

Semaglutide-based pharmaceuticals like Ozempic and Wegovy are thought to achieve results by counteracting genetic mutations. Many people already regard semaglutide as The Answer to obesity, and there is a new wrinkle in the narrative.

Sarah Zhang, staff writer for The Atlantic, reports on evidence that the new drugs might alleviate not only a bad relationship with eating but some other toxic bonds as well. A significant number of people taking Ozempic (for weight loss, not diabetes) say they have lost interest in such compulsive behaviors as drinking, smoking, shopping, and more.

As we have seen, semaglutide and other GLP-1 agonists can quiet “food noise,” which annoys the brain like tinnitus or the thump of a car’s sound system half a mile away. Patients seeking weight loss, who previously would have replaced food with some other dependency, also apparently have those noises extinguished. One way to describe it is that something flipped a switch in their head.

Other strange effects may show up, not all of them positive. Zhang says,

Patients who undergo bariatric surgery sometimes experience “addiction transfer,” where their impulsive behaviors move from food to alcohol or drugs. Bariatric surgery works, in part, by increasing natural levels of GLP-1, but whether the same transfer can happen with GLP-1 drugs still needs to be studied…

But semaglutide could one day be more widely useful, as this class of drug may alter the brain’s fundamental reward circuitry… This drug that so powerfully suppresses the desire to eat could end up suppressing the desire for a whole lot more.

This is not a new concept in the addiction realm. The notion of a universal compulsion turn-off switch has been something of a holy grail. It’s just that nobody has yet found the magic recipe to pharmaceutically extirpate the detrimental behaviors that people feel compelled to engage in.

The long and short of it is, although nothing ever works for everybody, it presently looks as if food cravings are still the most likely kind to be eliminated by these drugs. At the same time, “The long-term impacts of semaglutide, especially on the brain, remain unknown.” Probably the effect on other body parts will be a surprise, too.

Nobody knows how this will turn out, 10 or 20 years down the line. Another whole area of confusion lies in the fact that…

Unlike addiction, compulsion concerns behaviors that aren’t meant to be pleasurable… Still, addictions and compulsions are likely governed by overlapping reward pathways in the brain, and semaglutide might have an effect on both.

The author mentions a woman whose urge to pick at her skin simply melted away, without even an awareness of slowing down. One day, she just realized she wasn’t doing that anymore. Another female patient stopped skin-picking and nail-biting, and experienced quietness of mind, while others affirmed that their minds “no longer raced in obsessive loops.”

Does semaglutide take the joy out of life? According to those who use it to lose weight, no. They still like what they like, just not in the same quantities as before. So it does not extinguish the pleasure-having ability, only makes it more choosy.

Your responses and feedback are welcome!

Source: “Did Scientists Accidentally Invent an Anti-addiction Drug?,” TheAtlantic.com, 05/19/23
Image by Shannon Holman/CC BY 2.0 DEED

The New Drugs and Unforeseen Consequences, Continued

Death and drinking are two more areas that interact with GLP-1 drugs and their cousins. This article by Tyler Durden is very thorough about what happened and when, in the history of tracking a particular problem. The U.S. Food and Drug Administration, which catalogs adverse event reports, recently analyzed a lot of data and found…

[…] 6,253 serious adverse reports, including 163 deaths, tied to Ozempic since 2018. Wegovy has been linked to over 460 serious cases, with 6 fatalities since 2021, while Saxenda is associated with nearly 2,000 serious reports and 49 deaths since 2015. An analysis of around 150 cases linked self-injury and suicidal ideation to these drugs soon after patients started taking them.

Over half the reports make references to suicidal thoughts. According to the analysis, “About 40 percent found relief after quitting the meds or taking a smaller dose.” In other words, of people who were affected in this alarming way, fewer than half were able to feel better after discontinuing the medications.

Damned if you do, damned if you don’t

Of course, failing to treat obesity can also lead to suicide. In 2020, a paper was published about whether childhood obesity leads to an increased mortality risk in young adulthood. A team of researchers based a study on data concerning 41,359 children and teens from the Swedish Childhood Obesity Treatment Register, which is known for the high quality of its information. It has been compiling facts since 1997 and even includes fatalities that take place outside the country’s borders. The findings were:

Both the risk of death due to diseases and the risk of death due to suicide were higher among those who had obesity in childhood… Individuals who had undergone obesity treatment in childhood had an increased risk of death from suicide and self-harm and death from endogenous causes, compared to the comparison group.

Now, what about alcohol?

Tirzepatide can bring along some uncomfortable side effects and, as we have seen, combining it with alcohol can increase the risk of hypoglycemia, and at the same time, mask the warning signs. Some consequences are all too foreseeable. When withdrawal from addictive substances is undertaken, Dr. Pretlow always stresses the importance of avoiding “trigger situations,” or environments that will cause stress, like hanging out in a bar when trying to eject alcohol from one’s life.

Dr. Pretlow once received a letter from a pediatrician — a medical professional! — in her forties who had been an over-eater all her life. When office staff left a plate of brownies in the break room, she resisted until she suddenly consumed the entire dozen. “At that point, she said, she realized that she was just like an alcoholic, an addict in the gutter. It was a stark realization to her, what was going on.”

Point being, it is extremely doubtful whether all the people who take tirzepatide will be able to avoid trigger situations involving alcohol for the rest of their lives. And if they drink, consequences lie in wait for them — some known and some as yet unknown.

Your responses and feedback are welcome!

Source: “Over 200 Cases Of Suicidal Thoughts After Taking Weight Loss Drugs: New Analysis,” ZeroHedge.com, 19/03/23
Source: “Association of childhood obesity with risk of early all-cause and cause-specific mortality,” PLOS.org, 03/18/20
Image by Ed Bierman/CC BY 2.0 DEED

The New Drugs and Unforeseen Consequences

It might be useful to review the things that are known, suspected, or feared, about the new weight-loss drugs. Of course, they are not all the same, or else why even bother to create a different formula? The point is, it really pays to check out the potential side effects of the various possibilities, before making an appointment with a physician. A person might come across some surprising information and decide, without further ado, to give the medication idea a pass.

The stuff works by slowing gastric emptying, to preserve the sensation of fullness. By now, probably everyone has heard about a widely discussed problem:

[S]ide effects of Ozempic, Wegovy and other members of the class have been linked to serious stomach risks, including gastroparesis or stomach paralysis, which can result in severe and long-term gastrointestinal damage.

An AboutLawsuits.com article by Irvin Jackson lists 13 unpleasant consequences of being on semaglutide. Worse, some folks are having miserable side effects even after discontinuing the meds. A discouraging number of lawsuits are currently underway, with potentially thousands more waiting in the wings.

Whether Ozempic was prescribed because of diabetes or for weight loss, if elective surgery is on a person’s schedule, the drug should probably be discontinued at least a week beforehand. In fact, the Mayo Clinic and other prominent medical establishments have come out in favor of quitting semaglutide three whole weeks before surgery. Its job is to empty the stomach slowly, but nobody should be on an operating table with anything in their stomach. Jackson writes,

In late June, the American Society of Anesthesiologists […] warned against using the drugs before elective surgery, due to the risk of vomiting and aspiration during anesthesia.

Skipping it for even that one day could save a life. While the chance of fatality is not huge, neither is it non-existent, and if the temporary cessation of the drug does not seem like enough of a precaution, the surgical team can opt to have the patient intubated for even a minor procedure, which adds not only safety but also discomfort and complication.

As if that weren’t enough, at a semaglutide factory in North Carolina, apparently slipshod quality control has led to government inspectors finding “objectionable organisms” in batches of the drug, and to elevated concerns about microbial contamination on the premises in general.

Your responses and feedback are welcome!

Source: Ozempic Stomach Risks Result in Debate Among Anesthesiologists Over Surgery Guidelines,” AboutLawsuits.com, 09/13/23
Source: Microbial Contaminant Control Problems at Ozempic Manufacturing Facility Has Resulted in FDA Investigator Warning,” AboutLawsuits.com, 09/20/23
Image by Craig Howell/CC BY 2.0 DEED