What’s the best way to lose weight, following a diet or taking drugs like Ozempic?

The first thing I have to explain to you is that there is a paradigm shift regarding people who are obese or overweight. We have to end the social stigma associated with this disease, we have to stop blaming these people because no one chooses to be fat. So all tools that enter the therapeutic field are welcome. And in that welcome I include the new drugs that we have developed very recently, GLP-1 agonists, commercially known as Ozempic and Wegovy.

Until now, to treat obesity and the overweight, we could only recommend lifestyle changes. Just because this is no longer the case does not mean that lifestyle changes are not important. Even though we now have drugs, eating healthily, exercising and having good sleep patterns — in addition to taking care of your psychological and emotional health — continue to be the cornerstone for anyone living with obesity.

The thing to keep in mind about obesity is that it is excess fat. That’s why it’s not just about losing weight. What must be reduced is the buildup of fat that triggers metabolic alterations. And these alterations can cause other pathologies, which is why obesity is a risk factor for other diseases. Advances in our understanding of how obesity and excess weight impact people’s overall health have forced us to change what was, until recently, our vision of what is a fat or not fat person. And this in turn means that we cannot simplify treatment either.

Fortunately, one of the most important scientific findings of 2023 has been drugs to reduce obesity and its risks. But you have to use them appropriately. It must be clear that these drugs do not work for what we know as “operation bikini”: they are not for losing two or three kilos. What they are used for is a comprehensive approach in the treatment of patients who are obese or overweight. But we must not forget that the cornerstone remains following a healthy lifestyle.

What has happened so far is that often lifestyle changes were not enough. People get tired of dieting; you can’t always be on a diet, although you can always eat healthily. In this aspect, it is key to have a successful therapeutic tool that supports patients and prevents them from being blamed for their condition, such as these new drugs. It should be borne in mind that obesity is the only disease in which patients were not only blamed, but also had to carry the entire burden of treatment. But not anymore, now we have other tools at our disposal.

The keys to staying motivated

Obesity is a very complex disease that involves very diverse components because it is multifactorial. It is influenced by the obesogenic environment, which are the factors that surround us and that can lead to the condition; as well as genetics, the environmental framework, the socioeconomic situation and other circumstances. Taking action in all these areas was very complicated. But these new drugs, which are effective, help us to make patients more motivated, they see that effects are achieved, and it is easier for them to maintain a healthy lifestyle.

But these drugs must be properly prescribed and must serve medical therapeutic purposes. They have a long-term focus. We cannot forget that obesity and being overweight are chronic diseases, just like diabetes or hypertension. After starting pharmacological treatment against these diseases, there must be ongoing follow-ups. This is essential to accurately assess the effectiveness and safety of the treatment.

In summary, in response to your question, the important thing to keep in mind is that in the treatment of obesity we cannot say that one option is better than the other. What is needed is an integrative approach of all the measures we have available, indeed psychological support with behavioral therapy is often necessary to help patients. It’s also important that we send society the message that we must stop blaming patients with obesity.

María José Castro Alija is a doctor specializing in clinical nutrition, researcher and Professor at the Faculty of Nursing of the University of Valladolid, member of the VIMAS+ research group.

Question sent via email by Paula García.

Coordination and writing: Victoria Toro.