With 71% of Americans overweight or obese, plenty of people are looking for better solutions. Here is a graph from the Centers for Disease Control (CDC) charting the alarming trend for obesity (BMI 30 or greater):
Overweight and obesity are not just cosmetic issues, of course, but come with real and substantial health problems: increased risk for type 2 diabetes, fatty liver, arthritis in weight-dependent joints (knees and hips), heart disease, kidney disease, cancer, and Alzheimer’s dementia. Depending on severity, lifespan can be shortened by 2-10 years, similar to the life-abbreviating effects of smoking cigarettes. There’s also a financial burden, both personal and societal. Direct healthcare costs for overweight and obesity, for instance, are between $450 and $500 billion dollars per year to deal with all the complications of excess weight.
The weight loss industry is big business, estimated to generate $78 billion in 2019 alone from products such as meal replacement shakes, ready-to-eat meals, calorie-counting apps, and all the other (needless, unnecessary) products and programs.
Naturally, many people turn to their doctors for answers. What are the weight loss “solutions” that doctors have to offer? In past, prescription drugs for weight loss have been plagued by problems such as increased cardiovascular events with sibutramine, depression and suicide with rimonobant, heart valve disease with fenfluramine, increased cancer risk with lorcaserin, prompting their withdrawal from the market by the FDA.
Are current strategies or drugs any better? Among the choices:
Reducing calorie intake–We all know that reducing calorie intake is an unpleasant process that leads to unrelenting hunger and food obsession. But restricting calories has also been associated with two very real health complications: 1) reduction in metabolic rate that causes long-term weight regain even if a low-calorie lifestyle and exercise are maintained, and 2) development of gallstones in a substantial proportion of people. If you lose, say, 50 pounds by cutting calories—a combination of fat and muscle loss since about a third of weight loss is muscle—that reduces your metabolic rate by 25%, then regain 50 pounds, the weight you put back on is all fat, making future weight loss efforts difficult or impossible: less muscle, lower metabolic rate. And it’s horrifying just how many people develop gallstones by cutting calories. I’m shocked that no one has launched a class action lawsuit against the calorie-cutting weight loss programs that you see advertised on TV.
Glucagon-like peptide-1 (GLP-1) agonists and sodium glucose cotransporter–2 (SGLT-2) inhibitors—Prescription glucagon-like peptide-1 (GLP-1) agonists liraglutide, semaglutide, and others and sodium glucose cotransporter 2 (SGLT-2) drugs such as canagliflozin and dapagliflozin are prescribed to people with type 2 diabetes to manage blood sugars, but they also provoke weight loss, typically 5-10 pounds over one year. But they also have substantial difficulties that include:
- All but one GLP-1 agonists are administered via injection and are not available as oral preparations
- GLP-1 agonists increase risk for pancreatitis
- GLP-1 agonists can cause life-threatening hypoglycemia (low blood sugar) if used in combination with other diabetes drugs
- Because SGLT-2 agents cause urinary loss of blood sugar, they cause urinary tract infections, yeast infections, and serious effects that include increased kidney failure and need for limb amputation.
- Cost—Monthly costs for GLP-1 agonist drugs range from $700-$1400, SGLT-2 drugs about $200 per month less.
Phentermine is an amphetamine-like (an isomer of methamphetamine) prescription agent that reduces appetite and increases feelings of satiety. It was formerly one of the components of “Fen-Phen,” a combination weight loss drug that was removed from the market due to the fenfluramine component that was associated with causing heart valve problems and pulmonary hypertension, effects not associated with phentermine. Used alone, weight loss of up to 27 pounds over 36 weeks has been reported. Because of its amphetamine-like properties, phentermine cannot be taken by people with coronary disease, hypertension, heart rhythm disorders, history of stroke, or anxiety. There have been reports of heart attacks, stroke, and cerebral bleeding with its use. Phentermine is scheduled as a Class IV drug, meaning it has potential for addiction and abuse. It is therefore intended only for short-term use (12 weeks). Despite these considerable drawbacks, phentermine prescriptions constitute 75% of all prescription weight loss agents. Phentermine is also combined with anti-seizure drug, topiramate, as Qysmia, also targeted for weight loss. In clinical trials, 24-25 pounds were lost over 56 weeks. Adverse effects include increased heart rate, liver toxicity, and birth defects if taken by a pregnant mother. Cost per month is typically $190-210. The European Medicines Agency turned down approval for the combination drug for weight loss, citing concerns over cardiovascular and mental health.
Orlistat is a fat absorption-blocking drug (lipase inhibitor) marketed as a prescription agent (Xenical) or over-the-counter (Alli). It is the only weight loss drug approved for long-term use by the FDA. In one study, participants lost nearly 13 pounds over 4 years compared to 6 pounds on placebo. Likely due to the unpleasant potential to be incontinent and leak oily stool, this agent has had limited success and limited consumer acceptance. There have been rare reports of severe liver injury with orlistat. Price runs from $600 to $820 per month as Xenical, $45-60 per month as Alli (with 50% lower dose).
Step back for a moment and think about this peculiar situation we find ourselves in: National dietary guidelines advocate a style of eating that is unnatural, contrary to the diet that accompanied human evolution, and associated with weight gain. We have multinational food companies who advertise and sell foods that cause weight gain, foods such as chips, soft drinks, and breakfast cereals. We then have the healthcare and pharmaceutical industries come to our rescue at substantial cost, all to manage a problem that was rare a century ago, even 50 years ago, certainly non-existent in people living the way humans evolved such as Tanzanian Hadza or Brazilian Yanomami.
In the Wheat Belly lifestyle, you will find no talk of lap-band procedures, no mention of drugs that cost $1000 per month with risk for pancreatitis or liver damage, no need for cutting calories or “pushing the plate away.” The Wheat Belly lifestyle achieves weight loss without risk for kidney dysfunction, yeast or urinary tract infections.
Losing weight by banishing gliadin-derived opioid peptides, addressing the nutrients that modern people lack that help reverse insulin resistance, and addressing the dysbiosis/SIBO/SIFO and the endotoxemia that accompany these situations all add up to substantial control over weight. And we don’t have side-effects; we have side-benefits such as reversal of fatty liver, reduction in HbA1c, type 2 diabetics become non-diabetic, improvement in many autoimmune conditions, receding seborrhea and other skin rashes, all the (real, not overly-simplistic cholesterol) markers for cardiovascular risk improved dramatically, etc.