Thoughts on GLP-1s (like Ozempic)

Ok, onto the drugs!

I recently took a course on GLP-1s (like Ozempic). I figure they’ll be increasingly common in the years to come and wanted to get a handle on how to work with folks taking them. Here are some of my thoughts:

The drugs work surprisingly well

Originally formulated to treat type 2 diabetes, GLP-1s have shown themselves to be highly effective for reducing weight, blood pressure, and cholesterol levels. They’re currently being studied for treating kidney disease, addictive cravings (booze and darts), and as a prophylactic for dementia. Are there risks. Yes — mostly digestion-adjacent and some quite serious. That being said, the results are, on net, very positive.

All that being said, I've seen some personal trainers — and others — being critical about the use of these drugs. So, I want to address all of that too.

“Big pharma something something”

For-profit pharma will always be a double-edged sword. The profit motive has absolutely driven innovation. However, it’s is not exactly problem-free. I don’t know enough to say whether lifetime use (a typical expectation) is truly necessary. But I’ll bet I know what the shareholders want. Indeed, there’s a high risk of GLP-1s being over-prescribed right now.

Decreasing “food noise”

One of the main psychological effects of GLP-1s is a reduction in “food noise.” For folks who constantly experience internal chatter about food, taking these drugs is like putting on noise-cancelling headphones. Suddenly, it’s quiet in there. That can be liberating. Indeed, the feedback I’ve heard so far has been overwhelmingly positive BUT… is there ever fallout from this rapid shift in headspace? I’ll bet there is.

I’m reminded of a challenge that special forces applicants sometimes experience during training or qualification. When their cardio is lagging, survival takes up almost all their headspace during long runs. However, when they bring their cardio up, some struggle even more. That’s because now they have long stretches of time to ruminate. The most successful ones already have mental strategies queued up — or figure them out PFQ. I think this tracks for GLP-1s too and I’d be cautious about some folks jumping in without some therapeutic support. Fortunately, this is often concurrently prescribed.

“They’ll never have to learn the skills for sustainable eating”

Dosages of GLP-1s start low and are ramped up over time — largely because of the nausea that comes with them. Once someone is at cruising speed, though, it may be tough to eat much — whether that’s nutrient-paste or pizza. Some folks celebrate how little they can eat on the drugs. This might be pretty novel for them but they are also literally risking muscle and bone-density loss, if not real malnutrition. Every calorie matters more on GLP-1s.

The effects (reduced appetite and food enjoyment) and demands (the need to chase nutrients like a pro) often result in a more mechanistic relationship with food. Food as fuel. This is another radical shift in perspective and requires organized and intentional eating skills. These skills might offer some of the longest-term benefits — and support some people in eventually off-ramping these drugs.

“You should have to earn it”

There is nothing more tedious to me than someone moralizing about health. We live in an environment that is — at the same time — obesogenic and fat-phobic. So, while a thin person can simply eat a donut in public without fanfare, a fat person (with exactly the same exercise and nutrition habits) is often scrutinized for the same behaviour. They are also more likely to be hard on themselves later. It’s a tension that so many people have to live with — and it sucks.

If we want to be serious about supporting non-pharmaceutical interventions, then we have to look at the upstream factors in our health environment. I’ve hammered on bike lanes plenty this summer. And. I. will. Not. Stop. But there are opportunities to support health in everything from urban planning to cracking down on price-fixing between major grocery stores. Yelling downstream is reactionary and mostly pointless. You can give a man a fish and teach him to fish and get the company up the river to stop dumping fish poison into the water. All of these things can happen at the same time.