Can't Win -- Don't Try
When to Reach for the Pharmaceuticals
Photo by Diana Polekhina on Unsplash
Image: How to Fix a Fat Apple [my title]
Recently, something getting some press is Ozempic, which, frankly, I know very little about. We’re all hearing about it as a weight-loss drug, but the weight loss is kind of an indirect side effect. Ozempic, AKA semaglutide, comes from a group of pharmaceutical drugs that are used to control blood sugar, primarily in those with diabetes. It has also been clinically used to help some individuals with weight loss. Now, though, people in non-clinical situations are jumping on the wagon to lose some weight.
Journalist Johann Hari recently published a book about some of these weight loss drugs: Magic Pill: The Extraordinary Benefits and Disturbing Risks of the New Weight-Loss Drugs. His research includes Ozempic, and he even went so far as to take it for a year as he conducted his research.
Admittedly, I haven’t read his book, but I’ve heard him speak about it and his experience on Ozempic. By his own accounts, he subsisted on fast food and restaurant food. He would often start his day with what he describes as a brown roll with lots of chicken and mayo—he’s a Brit, so we might call it something like a chicken sub.
Johann’s standard dietary pattern was on par with that of many people in the west.
He went from his usual fare of ultra-processed and deep-fried foods and made the jump to Ozempic, which affects hunger signaling as well as satiety and satiation. It in itself does not magically remove body tissue, which is always a common misperception about these things—that a pill or supplement will remove body tissue, specifically and conveniently adipose, from where, more specifically and conveniently, we exactly don’t want it. The effects of Ozempic and like drugs manifest in reduced appetite, which equates to reduced energy intakes, which results in body weight loss.
As I’m always blubbering, blabbering, and yammering on about all this, Johann went from one extreme to another, with no middle ground or transition. There are many approaches and strategies that he or any of us could try before reaching for the pharmaceuticals. Now, the problem is that unless he reinvents his baseline eating pattern, he will in all likelihood revert to his original eating pattern of ultra-processed food when he’s off Ozempic, or some approximation of it, which means that he will regain the weight he lost because his appetite will normalize and revert to its own baseline.
The recidivism for weight regain after weight loss is shocking. Kevin Hall and Scott Kahan say it best in a paper: “In a meta-analysis of 29 long-term weight loss studies, more than half of the lost weight was regained within two years, and by five years more than 80% of lost weight was regained” [1].
In just about any other area, most of us wouldn’t take a bet, a risk, or make a gamble with those odds, which are flat out preemptively demotivating, leading many people to adopt the philosophical approach to their weight and health of: “Can’t win. Don’t try.”
Still, it’s not really much of a surprise that many people are turning to prescriptions they don’t really need in order to achieve some degree of weight loss. If you’ve ever tried to exercise and workout your way into weight loss, you know what a grueling experience that can turn into. For those who haven’t tried, the prospect of going from little or no exercise and activity to a lot in one fell swoop is not appealing. Again, it’s understandable. It’s the only way I successfully achieved weight loss for many years—seemingly exercising myself into oblivion for several weeks. Then, sure enough, I’d burn out, dial it back, and finally stop for a period, and then the weight would come back.
The American College of Sports Medicine—the ACSM—published a position stand in 2001 and updated it in 2009, which was/is endorsed by the American Dietetic Association, where they offer their recommendations for exercise activity as a means to pursue weight loss and maintain it: “Appropriate Physical Activity Intervention Strategies for Weight Loss and Prevention of Weight Regain for Adults”. The papers’ authors are researchers and scientists who scoured the research literature to make their recommendations.
The ACSM recommends the following:
…That adults participate in at least 150 min·wk−1 of moderate-intensity PA [physical activity] to prevent significant weight gain and reduce associated chronic disease risk factors. It is recommended that overweight and obese individuals participate in this level of PA to elicit modest reductions in body weight. However, there is likely a dose effect of PA, with greater weight loss and enhanced prevention of weight regained with doses of PA that approximate 250 to 300 min·wk−1 (approximately 2000 kcal·wk−1) of moderate-intensity PA. [2.3]
Yes, siree. For weight maintenance and to reduce the risk of chronic disease, we should be getting about 150 minutes a week—about 30 minutes a day about five days a week—of moderate intensity exercise.
To elicit weight loss through physical activity, with no changes to our diets, we should expect to engage in something upwards of 300 minutes—five solid hours—of moderate exercise activity. That only breaks down to about 60 minutes of exercise five days a week. (That’s a facetious sentence.)
Moderate exercise is physical activity that consistently keeps your heart rate roughly in a zone of 65-75% of your max heart rate intensity. (What’s that equate to? I will get into some of this in subsequent articles, but a very rough heuristic: take your max HR, which is 220 minus your age. Take 65-75% of that number, and you’re in the moderate-intensity zone.) Now, do upwards of 300 minutes of that level of activity each week, and you’re likely to lose a couple of pounds or kilos. By the way, this recommendation is for cardio work, and resistance training recs are separate from this one.
And if you know anything about weight loss, you’ll know about progress plateaus, which is the body responding to the weight loss and trying to slow it down if not outright stop it.
Obviously, I’m all-in, but even for me, it’s no small feat or easy task to accumulate these targets, and trying to max out our time on a piece of cardio equipment to achieve weight loss is simply not time efficient or necessarily fun. Also, it’s not necessary. Moreover, I’d argue that it’s no guarantee that we’ll be successful because, as our energy expenditure increases, guess what else rises in parallel with it—that’s right, our appetites. So, we move more; consequently, we eat more; our body weights and our physiques basically remain the same.
That’s not to negate the benefits of exercise, which are, as I’ve said, probably too numerous to even quantify, but from a weight loss or even a weight management perspective, it’s a lot of time, effort, and work, and it may not even have the result we want.
Some good news is that weight loss and healthy body weight maintenance is really no secret. There are, however, a few key principles that need to be learned and understood in order to achieve it and maintain it. Once you have a grasp on energy manipulation, it’s actually quite a simple and straightforward process, which is why some bodybuilders have huge swings in their bodyweights between competition seasons. My favorite example is Lee Priest from the ‘90s.
Lee Priest was an Olympia contender for several years, and he was frequently all over the muscle magazines. In some issues, he’d be lean and ripped. In others, he’d be, frankly, overweight. Some of the supplement ads in the magazines played this up. I remember reading a Q&A he did in one magazine, and someone asked him if he had an obese brother. Lee just knows how to manipulate his energy, and it gave him the confidence to really indulge in his foods and kind of let himself go [4].
It’s also important to emphasize that he’d gain this weight when he was intentionally bulking, that is, trying to put on muscle, but the lesson remains. It’s also important to remember that he, like all IFBB pro bodybuilders, used/use anabolic steroids, which changes the context of the weight-manipulation conversation. Also, I’d also argue that such drastic swings in weight is reflective of disordered eating, irrespective of the fact that it was a purported vehicle for bodybuilding. Moreover, gaining weight by definition calls for more calorie dense foods, foods that are often high in saturated fat, sugar, and salt. Simply put: not healthy. Excess body weight on its own taxes and stresses our bodies, which is, again, unhealthy.
The easiest and most efficient and therefore most effective form of weight manipulation in my book is food manipulation. As I keep being a broken-record: attempting to manipulate your weight before addressing your baseline eating is, as they say, getting ahead of the skis. Fix your foods first; then, you just start reducing it little by little until your scale weight starts moving. You want to keep your protein intake consistent, though, so your portion reductions will come from your carbs and fats.
But just looking at this all from body-scale-numbers is really overlooking the more important issue, which is our health.
In June, Dr. John McDougall, one of the progenitors of plant-based diet advocacy, passed away. If you’re not familiar with his story, he was a physician who got into medicine after suffering a stroke at the very old age of 18. While doing his medical residency, he started making connections between diet and chronic disease. For his own health as well as his patients, he then started advocating a low-fat vegetarian diet. (To be clear, I’m not specifically advocating this or any diet. We all make up our own minds about what to eat and not, when to eat and how much. However, he was on to something.)
He attributed his own cardiovascular event at age 18 due to his heavy diet of a lifetime of ultra-processed foods. He became a vegetarian and then vegan and promoted such diets, writing several books and articles, as well as keeping a visible presence with speaking engagements and interviews. He bobbed and weaved with plenty of pushback, and he admitted that maybe he was a little pushy at times. Still, he maintained a healthy body weight, and passed away in his sleep on June 22, 2024, at the age of 77. In my mind, there is no doubt that he would have succumbed to another, more severe cardiovascular event decades earlier had he not taken control of his health through his nutrition.
You can look at any nutritional recommendations from any reputable organization, from the US Dietary Guidelines, the World Health Organization, the American Heart Association, the American Diabetes Association, the Academy of Nutrition and Dietetics, and they all promote the same or similar dietary patterns: one that keeps us in energy balance, is plant rich, fiber rich, and minimizes saturated fats, red meat (the largest contributor of saturated fats), avoids processed and cured meats (like deli meats), as well as minimizes ultra-processed foods, added sugar, alcohol, and keeps an eye on sodium intake.
Creating a dietary pattern that focuses on these guidelines will help us all stave off chronic disease: cardiovascular, metabolic, cancer, neurodegenerative. And it’ll make it easy to maintain a healthy body weight, and we’ll never even have to consider the pharmaceuticals.
When I have conversations about nutrition with people, I tell them that if we were all to start life eating a simple and healthy dietary pattern as recommended by these guidelines, we’d all be superheroes in our twenties. It might be too late for me to be a superman, but I think I can still make it to Batman-level.
And so can you, no matter where you are. Start by fixing your baseline foods, and use those guidelines as a starting point and framework. Come up with maybe 6 or 8 meals that are your staples, that you rely on regularly. Build them with whole foods you want to eat. (It’s perfectly fine to have some processed foods—not so much ultra-processed, though—even as part of your staples.)
It’s all a work in progress to tweak them towards your perfect entrée. You can certainly cycle foods in and out as you prefer. You can deviate on occasion with treats or treat meals, but even if you do, you’ll likely find that they lose whatever appeal they seemed to have before. It’s ironic, and it’s an illusion.
While you reinvent your daily and weekly menu, try to work in some regular physical activity—again, something you enjoy and want to do. I love lifting weights more than I love running, so that’s what I start with. I work in cardio as much as I reasonably can; sometimes, it’s decent; sometimes, not so much. I endeavor to be better more often than not.
None of this has to be perfect. It just has to be a start.
And that’s how we win.
A full list of the ACSM’s position stands: ACSM Position Stands
Do a quick search: “Lee Priest bulk vs. cut”, and you’ll see what I mean. I don’t want to link any sites that I don’t know and am not familiar with.
