Suzanne Soares-Wynter and Laura-Gaye Findlay | Weight loss shortcuts: GLP-1 or diet?

In a world where high-fat, salty and sugary foods are increasingly available and accessible, obesity and non-communicable diseases (NCDs) are among the most visible public health crises affecting many countries. It is estimated that one of every two Jamaican adults is overweight or obese which contributes to the huge burden of the NCDs (e.g., type II diabetes, cardiovascular disease, and some cancers). Finding a workable weight management solution is a priority if we are to achieve improvements in our public health system.

A multibillion-dollar weight loss/diet industry continues to bloom because of this global obesity burden. It offers a range of solutions including lifestyle, diet, pharmacological and surgical approaches. Treatments span innovative and evidence-driven therapies to hyper-sensationalised, unhealthy fads, with all carrying the promise of weight loss and life transformation. Cotton-ball diet? Hallelujah/Bible diet? Cabbage soup diet? As nutrition professionals, we have heard of them all.

Over-the-counter weight-loss remedies include a variety of herbal “detox” teas, supplements, and diet pills. Sadly, any weight loss from these is more often due to their laxative or diuretic properties. Like the typical snake oil, terms such as ‘easy,’ ‘rapid,’ ‘used by millions’ and ‘weight loss guaranteed’ will frequently accompany their narrative. Marketing targets a consumer’s desire for a magical and no-effort fix, while avoiding any reference to harmful side effects, product safety, or the inevitable weight regain.

POPULAR ATTENTION

A class of prescription drugs, including semaglutide and liraglutide (with familiar brand names of Ozempic, Wegovy and Victoza), is receiving popular attention as a revolutionary pharmaceutical approach to weight loss. Although primarily indicated for managing type 2 diabetes, these medications are being marketed as alternative therapies for obesity. These drugs are designed to mimic a hormone, glucagon-like peptide-1 or GLP-1, which is released naturally by the stomach to regulate blood sugar and appetite. It works by triggering the release of insulin for removing sugar from the blood, slowing digestion, and suppressing appetite. However, like many other promising drugs, questions remain about long-term effectiveness, safety and health consequences. For anyone considering these options, patients are advised to undergo a thorough medical review and seek physician guidance to determine whether they qualify for its use. Personal risks may differ.

To be clear, all weight management approaches require adjustment and adherence to diet, lifestyle and behaviours. Without these, the long-term effectiveness of alternate therapies, including weight loss drugs is usually reduced. Decisions to use surgical and pharmacological/drug therapies also depend on patients meeting specific criteria. Current guidelines for drug treatment include the patient being obese with a body mass index (BMI) of 30kg/m2 or more. Lower BMIs (≥27 kg/m2) can be considered for overweight persons if they also have at least one weight-related health condition (e.g. diabetes or sleep apnoea).

As previously highlighted, GLP-1 agonist drugs aid weight loss by suppressing appetite, slowing digestion and increasing insulin release. While loss of appetite may seem beneficial, there is an increased chance of patients experiencing nutrient deficiencies, fatigue, weakness, muscle loss and reduced metabolism. Similarly, slowed digestion, especially when artificially induced by GLP-1, can lead to chronic and uncomfortable bloating, nausea and constipation. Treatment with weight loss drugs requires close monitoring by a medical team.

There are ethical concerns regarding GLP-1 drug use. The high cost is prohibitive, making it inaccessible to low-income individuals, and the efficacy and safety for use with children have not been fully established. Its popularity among celebrities and social media is particularly concerning, as these may drive misuse for cosmetic weight loss in the absence of serious health conditions such as diabetes or obesity. Any misuse of weight-loss drugs can lead to neurotoxicity, over-reliance on medications and long-term health complications. Notwithstanding these many side effects, GLP-1 drugs are showing promise for diabetic patients who are obese. In addition to weight loss, reports include reductions in risk of kidney disease and heart problems, while supporting better energy regulation.

HEALTHY LIFESTYLE

Despite any changes in body weight profile with GLP-1 drug treatment, healthy diet and lifestyle behaviours remain the cornerstone of successful weight management and disease prevention. Many patients struggle with weight regain after stopping weight-loss medications, particularly if they have not developed appropriate eating and physical activity habits. This underscores the importance of including dietary counselling as an adjunct approach to medical treatments. Efforts would include reversing unhealthy dietary behaviours that contributed to the patient’s initial weight gain.

Unfortunately, even the most well-intended Jamaican consumer is challenged to make informed and healthy food choices in the absence of a supportive environment. Assuming personal responsibility for health is all but impossible given the expanse of poor-quality products on offer by our local food industry. Our food landscape is transforming quickly into food deserts with streets overrun with unhealthy fast food and high-sugar beverages (both of which contribute to obesity and NCDs among Jamaicans). Many fresh food markets have also closed with no signs of reopening. Additionally, most pre-packaged products available in Jamaica are ultra-processed and contain harmful amounts of salt, sugars, and unhealthy fats. This shows a lack of industry accountability and regulations. It also shows that implementation of healthy food policies, including school nutrition and front-of-package warning labels, should neither be delayed nor dismissed. For Jamaica to show true progress in reducing the national burden of obesity and NCDs, we can no longer afford to deny citizens the fundamental right to health.

Achieving sustainable and healthy weight loss, whether at an individual or population level, requires commitment, effort and a supportive environment. Innovative approaches to treatment, such as the GLP-1 drugs, show promise for obesity treatment and diabetes control. Prioritising the implementation of healthy food policies will help the population achieve long-term change. But in the end, maintaining a balanced diet, adopting healthy behaviours, and leading an active lifestyle remain the foundation for long-term, successful weight management, health, and wellbeing.

Suzanne Soares-Wynter, PhD is clinical nutritionist and Laura-Gaye Findlay is a project assistant at Caribbean Institute for Health Research, The University of the West Indies. Send feedback to columns@gleanerjm.com