If Traditional Weight Loss Tactics Aren’t Working, a GLP-1 May Help

When it comes to weight loss, I see it all the time. Frustration — especially when one of my patients works hard and sacrifices only to end up staring at the same number on the scale. They count calories, change their diet and increase their exercise but don’t lose weight.  

It’s frustrating for them, and it’s frustrating for me. I know how hard it is and also how important reaching a healthy weight can be for their health.  

Trying to lose weight and failing isn’t uncommon. Some estimates put the failure rate at 95 percent, but that’s probably apocryphal. What is true is that it’s hard to lose weight and hard to keep it off.

Here’s why so many Americans struggle with their weight (two in five adults are considered obese) and a few options when traditional weight loss methods don’t work.  

What Is Obesity?

Obesity is a complex medical condition that involves having too much body fat, significantly increasing the risk of numerous diseases and health problems. It's not simply about appearance — obesity is a serious health issue that affects virtually every system in the body. Obesity can impact your quality of life and raise your risk of heart disease, high blood pressure, unhealthy cholesterol levels, type 2 diabetes, fatty liver disease, sleep apnea, osteoarthritis, depression and cancer. It’s a long list.

Obesity also isn’t about how much you weigh. Weight is merely a number on a scale and really doesn’t provide an accurate picture of your body size or shape. Obesity is about your body composition – the percentages of fat, bone, water and muscle in your body.

This is why MDVIP-affiliated practices like mine measure body composition using a sophisticated electronic impedance scale. Not only does this device tell us the percentages of fat and muscle, but it helps us understand your metabolism and the number of calories you burn when you’re at rest. When we know this last part, we can determine how many calories you need to maintain your weight and how many you should cut to lose weight. But even armed with this information, it can be hard for people to drop unwanted pounds.  

What Causes Obesity?

Obesity’s main cause is consuming too many calories (including alcohol calories) while being sedentary — too many calories in and not enough exercise. But if you’ve ever struggled with your weight, you know that lifestyle isn’t the only problem. Other variables that can lead to weight gain include genetics, medical conditions like hypothyroidism and type 2 diabetes; medications such as steroids and some antidepressants; age-related changes and lifestyle factors like excessive stress and poor sleep habits; even an unhealthy microbiome can cause you to pack on pounds.

Traditional Weight Loss Approaches

Successful weight loss stems from a caloric deficit — using more calories than you consume. I recommend talking to your doctor before beginning a weight loss program. They may suggest that you:

Cut calories. Weight loss happens when you burn more calories than you take in, so your first step is to reduce calories (if possible).

Eat healthy foods. Healthy foods like fresh fruits and vegetables, whole grains, lean protein and healthy fats tend to have more nutrients and fewer calories.

Exercise regularly. Exercise burns calories and builds muscle. It also helps raise your metabolism, the rate at which your body burns calories.

Get enough sleep. Sleep deprivation interferes with the regulation of hormones that control appetite. When you’re tired, it’s common to feel hungrier and crave junk food.  

Manage stress. Stress raises cortisol levels, a hormone notorious for triggering hunger and causing belly fat.

Intermittent fasting. This technique, where you cycle between periods of eating and fasting, works for some patients, but it’s not for everyone. Discuss intermittent fasting with your doctor before trying it.  

Traditional Methods are Often not Effective

Unfortunately, these traditional weight loss methods don’t work for everyone, especially once you hit middle age. In fact, research has found that more than 50 percent of lost weight is regained within two years, and 80 percent is regained within five years, according to a study published in the journal Medical Clinics of North America. This is why I find myself discussing GLP-1 drugs with more and more patients.  

The Role of GLP-1 Medications

For people who struggle with losing weight, newer medications like Wegovy, Ozempic, Mounjaro and Trulicity may be an answer. These drugs help regulate your appetite and blood glucose levels to help control cravings while maintaining energy levels.

These medications are usually prescribed for people who are obese (BMI ≥ 30) or overweight (BMI ≥ 27) with related health conditions, or to manage a chronic condition like type 2 diabetes. (Ozempic is designed for type 2 diabetes, for example.) Studies have shown that some people experienced modest but meaningful weight loss during the first year of use; others lose a substantial amount of weight on the injectable drugs.

They’ve also been shown to help people lower their blood pressure, improve cholesterol levels, improve fatty liver disease and reduce heart disease and kidney disease risk. They’re also helping people control addictions to drugs and alcohol.

However, these drugs aren’t always an easy solution to weight loss. These drugs:

• Cost hundreds of dollars a month and often aren’t covered by insurance
• Involve an injection
• Have potential side effects, like loss of appetite, nausea, vomiting and diarrhea, among others
• Require a healthy diet and regular exercise, particularly strength training, to maximize benefits
• Only work when taken; it’s likely you’ll regain the lost weight once you stop taking the medication.

When they work, however, they can work really well. I’ve had several patients use GLP-1s to lose weight they weren’t able to shed using traditional weight loss methods. That doesn’t mean they’re for everyone. Besides the issues above, some patients don’t tolerate the drugs well and others do not lose weight. If you’re on an antidepressant or a beta blocker, drugs that can sometimes cause weight gain, a GLP-1 may not help you lose.

Work Closely with Your Primary Care Doctor

Before taking a GLP-1, you should work closely with your primary care physician. They can help assess your individual risk factors, rule out underlying medical causes and develop a personalized plan that's safe and effective for your situation.  

Your doctor also will be your biggest cheerleader, reminding you that losing weight is difficult and even modest amounts of weight loss can improve blood pressure, cholesterol levels and risk for chronic conditions. And of course, your doctor can help develop a comprehensive, sustainable approach to achieving and maintaining a healthier weight once you decide to stop taking a GLP-1 drug.  

Weight loss is hard. For most people, becoming overweight or obese doesn’t happen overnight. Neither does losing weight. It’s frustrating but worth the effort. Losing weight can reduce the risk of so many diseases and make life more enjoyable. If you’ve struggled to lose weight, talk to your doctor about GLP-1s.