“Let Food Be Thy Medicine and Medicine Be Thy Food.” – a familiar phrase from Hippocrates dating back to around 400BC. While a few things may have changed in the world since then, this statement has never been more relevant. There is a rising ‘tsunami’ of chronic condition diagnoses, both physical and mental, and along with these, an increasing reliance on prescription medications to treat and manage them, a distinct shift away from ‘lifestyle medicine’ of old.

While medication can be life-changing and lifesaving, it is not without its downsides – both in terms of side-effects and cost. Yet, the lure of a ‘quick fix’ very often outweighs these. And speaking of weight, this is where the need for that quick fix is most prevalent. In 2022, the global weight loss and weight management market size was valued at around US$ 224,27, with a predicted growth to around US$ 405.4 billion by 2030 (1). It’s no surprise then that weight loss, or ‘anti-obesity’ medications, like Ozempic, have taken their place at the top of prescription pads around the world.

How does it work?

Ozempic is a prescription medication traditionally used to manage blood glucose control in type 2 diabetics. The medication mimics a natural hormone in the body, known as glucagon-like peptide 1 (GLP-1), that is secreted by in the intestine in response to food intake. This sets in motion a hormone driven process that stimulates the increased production of insulin, a reduction in the amount of glucose produced by the liver and an overall slowing of digestion. Finally, GLP-1 travels to the brain and activates the area that regulates fullness and hunger; essentially telling you to stop eating before you’ve even done so. By doing this, the medication doesn’t just lower your appetite, it affects the signalling between your gut and your brain, ultimately changing how your body responds to food.

The upside

The positive impact on insulin response and glucose control makes Ozempic a critical part of diabetes management. Poorly regulated blood glucose has several complications, including heart disease, kidney disease and stroke. Weight loss in itself supports overall metabolic health and improves numerous health markers including inflammation and blood pressure.

The downside

With the increased off-label use of Ozempic due to its newfound fame, supply issues have arisen making availability increasingly difficult for those who really need it. In addition, it’s a costly exercise, with monthly dosages ranging in price anywhere between R1600-R3000 (2), and no associated reductions in general healthcare costs (3).

Cost and availability aside, side effects and sustainability are growing concerns. Early side effects may include nausea and vomiting together with heartburn and bloating. More serious side-effects may include pancreatitis, gallstones, kidney issues and thyroid tumours or cancer (4). Studies investigating the sustainability of these medications have shown that the majority of users (68%) discontinue treatment within the first year (3), and with discontinuation comes weight regain, similar to the original weight lost (5, 6).

The alternative

Since the medication works by mimicking natural hormones, it makes sense that there is a ‘natural’ option: real food. Food not only provides your body with energy, but it also provides it with ‘instruction’. Your body has multiple hormonal pathways that respond differently to different types of food. Making the right food choices goes beyond satiating you – it literally changes how your body responds. So, choosing the right foods means giving your body the ‘right’ instructions. 

There have been major changes in the global consumer food environments over the past 40 years. The typical diet now widely adopted is low in fruits and vegetables and high in refined grains, isolated sugars and ultra-processed foods (7). Together, these dietary factors can alter the gut’s composition and function, essentially overriding the body’s natural hormone response to food and having almost the opposite effect to Ozempic: a blunted insulin response, and a poorly regulated mechanism of telling you when to stop eating.

A study done by Virta Health in the US found that people with type 2 diabetes who stop using drugs like Ozempic can avoid regaining the lost weight if they adopt a ketogenic diet (8). These results, together with the successful weight loss and management experienced with a low carbohydrate, high fat diet suggests that reverting back to a diet more similar to our ancestors may be the ‘quick fix’ option we’ve been searching for all along. 

Ultimately, there is no doubt that the short-term weight loss associated with Ozempic is powerful and significant, but it’s not a lifelong solution for your weight or your health. For this, you need to adopt a sustainable approach that trains your body to appreciate the fuel you’re providing it. This is what will set you up for a lifetime of healthy weight.

REFS:

1. https://www.globenewswire.com/en/news-release/2023/02/09/2604662/0/en/Latest-Global-Weight-Loss-and-Weight-Management-Market-Size-Share-Worth-USD-405-4-Billion-by-2030-at-a-6-84-CAGR-Growing-obesity-rate-to-propel-market-growth-Facts-Factors-Industry.html
2. REF: https://medicineprices.org.za/#search:ozempic
3. Leach J, Chodroff M, Qiu Y, et al. Real-world analysis of glucagon-like peptide-1 agonist (GLP-1a) obesity treatment one year cost-effectiveness and therapy adherence. Prime Therapeutics. July 11, 2023. Available at: https://www.primetherapeutics.com/wp-content/uploads/2023/07/GLP-1a-obesity-treatment-1st-year-cost-effectiveness-study-abstract-FINAL-7-11.pdf . Accessed 1 August, 2024.
4. https://www.novomedlink.com/diabetes/products/treatments/ozempic/efficacy-safety/safety-profile.html
5. Wilding JPH, Batterham RL, Davies M, Van Gaal LF, Kandler K, Konakli K, Lingvay I, McGowan BM, Oral TK, Rosenstock J, Wadden TA, Wharton S, Yokote K, Kushner RF; STEP 1 Study Group. Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. Diabetes Obes Metab. 2022 Aug;24(8):1553-1564. doi: 10.1111/dom.14725. Epub 2022 May 19. PMID: 35441470; PMCID: PMC9542252.
6. Rubino D, Abrahamsson N, Davies M, Hesse D, Greenway FL, Jensen C, et al. Effect of Continued Weekly Subcutaneous Semaglutide vs Placebo on Weight Loss Maintenance in Adults With Overweight or Obesity. JAMA. 2021 Apr 13;325(14):1414.
7. Martínez Steele E, Baraldi LG, Louzada ML, Moubarac JC, Mozaffarian D, Monteiro CA. Ultra-processed foods and added sugars in the US diet: evidence from a nationally representative cross-sectional study. BMJ Open. 2016 Mar 9;6(3):e009892. doi: 10.1136/bmjopen-2015-009892. PMID: 26962035; PMCID: PMC4785287.
8. McKenzie AL, Athinarayanan SJ. Impact of Glucagon-Like Peptide 1 Agonist Deprescription in Type 2 Diabetes in a Real-World Setting: A Propensity Score Matched Cohort Study. Diabetes Ther. 2024 Apr;15(4):843-853. doi: 10.1007/s13300-024-01547-0. Epub 2024 Feb 29. PMID: 38421559; PMCID: PMC10951146.

About the Author: 

A passionate health advocate and researcher with The Noakes Foundation, Karen Heath has a PhD degree in exercise physiology from the University of Cape Town. She has experience in health communications via multiple media platforms and believes it’s never too late (or early) to start making healthy choices.