For countless people today, maintaining a healthy weight is not just a matter of willpower, but a fight against psychological dependence and the environment. The overabundance of unhealthy and high-calorie products today makes it difficult to maintain proper eating habits. Against this backdrop, the emergence of GLP-1 medications, Ozempic and Zepbound, has completely changed the strategy for fighting obesity. However, to achieve the desired result safely, it is essential to understand the potential risks along with the benefits.
The former head of the FDA (U.S. Food and Drug Administration), Dr. David Kessler, speaks about the potential of GLP-1 drugs. He notes that these medications can transform the field of public health, but at the same time, he calls for caution, as much is still unknown about their long-term use and real effectiveness.
Kessler first tested the effects of GLP-1 drugs on himself in 2023, when he had difficulty finishing his favorite meal due to the drug-induced decrease in appetite. These drugs mimic the hormone glucagon-like peptide-1. They reduce the craving for food by affecting the brain’s reward system and signals from the gastrointestinal tract.
Kessler, who has studied the biological basis of obesity and addiction to ultra-processed foods for years, believes that these medications are a powerful tool that can change medicine’s approach not only to weight management but also to metabolic health in general.
He explains that GLP-1 drugs are used to treat metabolic fatty disease. The accumulation of visceral (internal) fataround vital organs, such as the liver and pancreas, often leads to insulin resistance. This is the condition that later causes diabetes to develop. In addition, this type of fat seriously increases the risk of developing cardiovascular, kidney, and metabolic diseases. By reducing this visceral fat, the drugs can significantly improve the condition of organs and, by managing chronic diseases, prevent organ damage.
The negative impact of obesity is also confirmed by research from Oxford University, according to which a BMI (body mass index) between 30 and 35 reduces life expectancy by an average of three years, while a BMI over 35 reduces it by up to 10 years or more.
Kessler notes that eating an excessive amount of food is not just a lack of willpower. The main reason for this is addictive, ultra-processed food, which is designed to “overload” the brain’s reward system. GLP-1 medications, however, suppress these processes at a biological level and reduce appetite, thereby creating an effective pharmacological tool for treatment alongside other strategies.
It is important to remember that these drugs are only one component of treatment. Most people take GLP-1 agonists for 8-9 months, after which stopping them often leads to weight regain. Therefore, for long-term results, it is essential to combine medications with a healthy diet, behavioral therapy, and physical activity, so that patients can form a healthy relationship with food and metabolic health.
Kessler also talks about the gastrointestinal side effects of the drugs, such as nausea and delayed gastric emptying. In his opinion, these are not only negative events, but mechanisms that get the patient used to consuming less food. Therefore, he calls on the team of specialists to be actively involved in ensuring that dosages are precisely selected for effectiveness and patient tolerance.
Speaking about medical practice and research, Kessler notes that most primary care physicians lack the experience needed to manage obesity and metabolic diseases. He emphasizes that we urgently need research to answer critical questions about the use of the drugs: How long should patients take them? Can the drugs be taken cyclically, at certain intervals? What are the ideal dosing protocols? Without this evidence, many patients will face the risk of weight regain after spending a lot of money.
Despite the existing challenges, Kessler is optimistic about the potential of GLP-1 drugs for public health. He compares the fight against metabolic fatty disease to the historical success of the fight against tobacco. Kessler considers obesity the biggest failure of public health, and these drugs a turning point that can save the lives of millions of people.
Source: Harvard Medicine
