Ruder, At ObesityWeek, More Data and Questions About Semaglutide, Tirzepatide, and Retatrutide (2024) 331(1) JAMA 9

[keangkong]

Ruder, At ObesityWeek, More Data and Questions About Semaglutide, Tirzepatide, and Retatrutide (2024) 331(1) JAMA 9, doi.org/10.1001/jama.2023.23141.

One of the more interesting things that this article discusses is how little diet and exercise help to lose weight in comparison to the modern weight loss drugs. Here is an excerpt: "in the Semaglutide Treatment Effect for People with obesity (STEP) clinical trials, people who received semaglutide alongside an intensive lifestyle intervention lost only 1% more of their body weight than those who received the drug without intense diet, exercise, and counseling interventions."

 

[chmuse]

Ruder, At ObesityWeek, More Data and Questions About Semaglutide, Tirzepatide, and Retatrutide (2024) 331(1) JAMA 9, doi.org/10.1001/jama.2023.23141.

One of the more interesting things that this article discusses is how little diet and exercise help to lose weight in comparison to the modern weight loss drugs. Here is an excerpt: "in the Semaglutide Treatment Effect for People with obesity (STEP) clinical trials, people who received semaglutide alongside an intensive lifestyle intervention lost only 1% more of their body weight than those who received the drug without intense diet, exercise, and counseling interventions."

Can I just say that I appreciate how many of your links are easily downloadable so I can send them to my e-reader to read offline later?

Re: the article, I personally gave up calorie counting. I was leaning too far into old ED-like habits. I keep a general idea in my head on days I'm eating unhealthy crap, I order kids meals or just the smaller burger and diet soda without a side. But on days I have yogurt or cottage cheese for breakfast, bean salad for lunch, and chicken thighs for dinner, I don't even think about it. And I'm losing weight just as fast as I did obsessively weighing everything and staying under my calorie goal to the point I weighed my vegetables on a food scale.

 

[penewbie]

Diet and exercise don't work long term on the population level, we have decades of research proving it, and probably over 90% of this forum as anecdotal evidence.

 

[hotdog!]

Can I just say that I appreciate how many of your links are easily downloadable so I can send them to my e-reader to read offline later?

Re: the article, I personally gave up calorie counting. I was leaning too far into old ED-like habits. I keep a general idea in my head on days I'm eating unhealthy crap, I order kids meals or just the smaller burger and diet soda without a side. But on days I have yogurt or cottage cheese for breakfast, bean salad for lunch, and chicken thighs for dinner, I don't even think about it. And I'm losing weight just as fast as I did obsessively weighing everything and staying under my calorie goal to the point I weighed my vegetables on a food scale.

This is exactly where I'm at. I've given up on calorie counting and exercise because it's impossible to stick with long term. I'm not a spring chicken, I've tried a lot. Even when I did everything obsessively, for science, for a year or longer, it never stuck. So I'm done obsessing and feeling like a failure because I can't keep up with what are impossible standards for me. It never turned into an automatic habit, it was always a hassle and I always hated it even when I tried to convince myself otherwise. I accept that it may mean I will always be 15-20 lbs over someone else's imagined ideal weight for me. I don't care, I want that mental freedom and mental space back. As long as I'm not morbidly obese and uncomfortable, I'm ok with overweight.

 

[hexagonal]

Ruder, At ObesityWeek, More Data and Questions About Semaglutide, Tirzepatide, and Retatrutide (2024) 331(1) JAMA 9, doi.org/10.1001/jama.2023.23141.

One of the more interesting things that this article discusses is how little diet and exercise help to lose weight in comparison to the modern weight loss drugs. Here is an excerpt: "in the Semaglutide Treatment Effect for People with obesity (STEP) clinical trials, people who received semaglutide alongside an intensive lifestyle intervention lost only 1% more of their body weight than those who received the drug without intense diet, exercise, and counseling interventions."

Interesting. I'm curious how adherence for the lifestyle intervention people is?

Lifting doesn't seem to impact the number on the scale too much (Hopefully in part because I'm adding some muscle mass...), but the weeks when I'm better about diet, cardio, or both, I definitely see more progress.

Energy must be conserved, so I don't see how significant lifestyle changes wouldn't have impact if people are actually following through.

 

[hotdog!]

That's the thing, people don't follow through long-term. Lifestyle changes definitely have an effect as long as they're applied --this study is just saying they didn't have great effects on weight loss percentages in glp-1 patients. The medication is driving the weight loss. I'm sure if you looked at body comp and other health markers the people who exercise and track diet have other advantages.

But everything about modern American life is set up to make it very, very hard to stick to long-term lifestyle changes. Crap food is cheap, quality food is expensive and it takes more time to cook it. Infrastructure favors driving, not walking, most jobs are sedentary. We all know the drill. If the changes don't eventually become a habit (and many people just aren't wired that way, I'm thinking about neurodivergents here), then it takes a LOT of mental energy, like the kind that disordered eating or obsessive exercising require. Most people just don't have that ability, not for the long-term. Not everyone has what it takes to be a nuclear scientist, right? Or a professional dancer or body builder? Some percentage of people, yes, but it's unrealistic to expect that of most people.

Remember those follow-ups of The Biggest Loser contestants? You can call people lazy or call it an excuse or moral failing but I think that's wrong and more importantly that doesn't solve the problem. Because it's a willful ignorance type of oversimplification.

 

[Superfluous]

Agree with above - diet and exercise work, if you can maintain them. I mean personally I think losing a lot of weight with exercise is easy... I've done it about 5 times now

 

[hexagonal]

That's the thing, people don't follow through long-term. Lifestyle changes definitely have an effect as long as they're applied --this study is just saying they didn't have great effects on weight loss percentages in glp-1 patients. The medication is driving the weight loss. I'm sure if you looked at body comp and other health markers the people who exercise and track diet have other advantages.

But everything about modern American life is set up to make it very, very hard to stick to long-term lifestyle changes. Crap food is cheap, quality food is expensive and it takes more time to cook it. Infrastructure favors driving, not walking, most jobs are sedentary. We all know the drill. If the changes don't eventually become a habit (and many people just aren't wired that way, I'm thinking about neurodivergents here), then it takes a LOT of mental energy, like the kind that disordered eating or obsessive exercising require. Most people just don't have that ability, not for the long-term. Not everyone has what it takes to be a nuclear scientist, right? Or a professional dancer or body builder? Some percentage of people, yes, but it's unrealistic to expect that of most people.

Remember those follow-ups of The Biggest Loser contestants? You can call people lazy or call it an excuse or moral failing but I think that's wrong and more importantly that doesn't solve the problem. Because it's a willful ignorance type of oversimplification.

That's not what I'm talking about, though. It isn't about whether or not long-term adherence to lifestyle intervention is effective in the broader population - we certainly know it isn't - but most studies do track adherence to lifestyle interventions, otherwise you can't be sure if you're measuring the impact of those interventions or the impact of adherence to those interventions.

The fact of the matter is everyone should attempt to make lifestyle changes, GLP-1 or otherwise, and we want to understand the impact of GLP-1s + lifestyle intervention. If you can't adhere to a better diet or regular exercise, a GLP-1 is still going to improve your situation, but you'll still be in worse health than if you also did make those lifestyle changes.

Without knowing adherence, we can't understand if there is something occurring with the lifestyle intervention when on GLP-1s that makes it less effective than we would otherwise expect.

There's also tertiary questions of interest knowing about adherence, too - we know that GLP-1s interact with the reward pathway in the brain, and we see it when it comes to managing addictions, etc. Does this impact our ability to adhere to diet and exercise changes?