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Obesity caused by the American lifestyle of exercising less and eating more is a major contributing factor Type 2 diabetes. In the United States, 38.4 million people have diabetes, and 95% are type 2, caused by insulin resistance.
Worse still, and waiting in the wings, are 97.6 million people over the age of 18 who have prediabetes. This means that they are on the path to full-blown type 2 diabetes, and for most of them it is only a matter of time.
These are frightening statistics, and on top of that, health care costs for type 2 diabetics are two and a half times higher than the cost of treating someone without diabetes. And don’t forget that type 2 diabetes is just one piece of the puzzle, with cardiovascular disease also expected to contribute significantly to healthcare costs in the future, especially as we keep people alive longer.
Can our healthcare system handle these ever-growing costs?
Do New GLP-1 Weight Loss Drugs Really Work?
Common sense says no, unless something major changes. Could that big change be the new highly touted GLP-1 weight loss drugs? Hard to say. Yes, they are promising, as people who take the drugs for a year or more tend to lose 15%-20% of their body weight. That is certainly useful. But what about the longer-term consequences? We don’t know the answer because these drugs haven’t been around long enough.
Experts point to the medical benefits associated with the drugs, in addition to weight loss. However, other experts remain cautious. Weight loss with these medications appears to result from eating very little, because the medications significantly reduce appetite. I’ve heard firsthand stories of people going to a fancy restaurant and ordering their favorite meal, then taking just a few bites and then stopping. Sounds good, right? But that is a very heavy impact, and such effects are often accompanied by serious side effects.
As with any new drug, there will be pros and cons. I will take a step back and let the medical people fight about the efficacy and safety of these drugs. Two facts stand out to me. One is that appetite can be reduced so drastically that the effect is a lot like going on a crash diet, from 2,000 calories to 500 per day. Yes, weight loss is fast, but what are you losing? Fat cannot be lost quickly because the body values body fat as a reservoir of stored energy that helps ensure survival. Although fat cannot be lost quickly, the opposite is true for muscle, which can be lost five times faster than fat. This means that a significant portion of the weight loss comes from muscle, along with some fat loss.
Another concern similar to crash dieting is that once you stop taking the medications, the weight will return. But if you reverse the situation and go from 500 calories a day to 2,000, your body considers this gross overeating and a significant portion of the excess “new” calories are stored as fat.
The response from drug manufacturers? When you sign up to take these medications, you sign up for life. That means you can’t look at these medications as a starting point, something to get you started and then you can move on to another “healthier” approach.
Is the obesity epidemic the same as the former smoking epidemic?
We need to do something to reduce obesity, but in my opinion we are going about it all wrong. When I see experts on TV talking about these drugs, they tell us that these drugs are for people “who cannot lose weight.” Undoubtedly, some people cannot lose weight for some legitimate medical reason. But this is certainly not the case for every obese person, who makes up 42% of the US population. I also hear that diets and exercise don’t work. Put these two expert thoughts together and it’s no wonder people refuse to lose weight the right way and are desperate to pop a pill.
How about this as an analogy? It used to be believed that the vast majority of people who smoke cigarettes cannot quit. And on top of that, it was believed that the available treatments, ranging from hypnosis or counseling to the nicotine patch, don’t work, so it’s hopeless. Sounds like our obesity problem, right?
Seventy years ago, about half of American adults smoked cigarettes and this continued for decades with no end in sight. But things changed dramatically when C. Everett Koop became Surgeon General of the United States and waged a war on smoking. He released report after report on the negative health consequences of smoking. He also condemned second-hand smoke as dangerous, bringing non-smoking victims into the fray. During his tenure in the 1980s, he reduced smoking rates to 27%. Today the incidence is 11.5%.
Maybe we should start a Koop-like campaign, starting by listening to what smart people have been trying to tell us for centuries, starting in 400 BC when Hippocrates urged people to walk more to prevent disease. Sound advice, especially for the 80% of American adults and more than 80% of adolescents who fail to follow even minimal daily exercise guidelines.
How can I lose weight?
As Pogo, the cartoon character, famously said, “We have met the enemy, and he is us.”
It’s time we heed the warning signs and stop pretending that our healthcare system can stay on this path and survive. Fortunately, simple steps like a daily walk and some good dietary changes can help us turn the tide and hopefully maintain the best healthcare system in the world.
Reach Bryant Stamford, professor of kinesiology and integrative physiology at Hanover College, at stamford@hanover.edu.
This article originally appeared in the Louisville Courier Journal: Can weight loss drugs combat the US obesity epidemic? What you need to know