Your Health Checkup: New Information on Obesity, Diet, and Drugs

Some new studies offer possible new solutions related to diet and weight loss.

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“Your Health Checkup” is our online column by Dr. Douglas Zipes, an internationally acclaimed cardiologist, professor, author, inventor, and authority on pacing and electrophysiology. Dr. Zipes is also a contributor to The Saturday Evening Post print magazine. Subscribe to receive thoughtful articles, new fiction, health and wellness advice, and gems from our archive. 

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I’ve written about the significance of diet and maintaining an appropriate weight many times because of its importance in achieving and sustaining good health. I think my own family members may be reading my columns because I seem to be surrounded more and more by slim, red meat abstainers, from my wife to my children and grandchildren.

A recent scientific statement from the American Heart Association presents a guide to healthy eating. They recommend adjusting food intake to balance body needs as part of a diet that should include lots of fruits and vegetables, plant oils (like olive oil), whole grains, low-fat dairy products, and protein, mostly from plants, fish, and lean cut poultry. The diet minimizes processed foods, as well as beverages and foods with added sugars, and contains little salt and limited (if any) alcohol.

Most of these recommendations should be no surprise since they have been advocated for years, especially for followers of the Mediterranean Diet.

Two things about eating and dieting are new. The first is the order in which food is eaten. Eating salads before proteins and finishing the meal with a starchy carbohydrate such as potatoes, bread, rice, or pasta appears to flatten the post eating blood sugar spike, which is healthy since glucose spikes detrimentally impact many hormones and proteins, including those that trigger inflammation.

The second new finding is a novel class of weight loss drugs initially developed for diabetics. Called incretins, they stimulate a decrease in blood glucose levels and may significantly impact the obesity epidemic seen in the U.S. and around the world. Many experts consider obesity a chronic disease that should be treated as intensively as heart disease, diabetes, and high blood pressure. However, the general perception is that being overweight is self-imposed and can and should be self-corrected by diet and exercise. Until recently, weight loss medications have been minimally effective and/or toxic, some resulting in severe heart valve problems.

Two new drugs, semaglutide (Ozempic) and liraglutide (Saxenda), have been approved for chronic weight management in obese and overweight adults who also have a risk marker such as hypertension, type 2 diabetes, or lipid problems, as an adjunct to a reduced calorie diet and increased physical activity.

Another new drug called tirzepatide (Mounjaro), FDA approved for diabetes (not yet for obesity), given in once-weekly injections, also holds great promise. A 72-week randomized trial of 2,500 obese adults resulted in an average of 35 pounds lost for those receiving 5 milligrams, a 49-pound loss for the 10-milligram dose, and a 52-pound loss for the 15-milligram dose. The outcome was quite remarkable since almost 40 percent of individuals lost a quarter of their body weight. Systolic blood pressure fell by 6.2 mmHg, and triglycerides by 20 percent. Insulin levels also improved in the treated group as did the quality of life. Many of these improvements in the past could only be achieved with bariatric surgery.

However, important questions about tirzepatide remain to be answered, including which patients qualify. Only diabetics? Only those markedly obese? How obese? Must they have additional risk factors? What are long term side effects? Will patients tolerate weekly injections? For how long? Who pays, since the drug is expensive?

While these and other queries remain to be answered, nevertheless, this new class of drugs represents a remarkable advance in treating obesity in both diabetics and nondiabetics.

Featured image: Shutterstock

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