Show 1362: Lowdown on New Medicines for Treating Obesity –Part 2

This week’s radio show is the second of a two-part series on new medicines for treating obesity. This episode features Dr. Robert Lustig, neuroendocrinologist and anti-obesity crusader. He discusses the uses and disadvantages of drugs such as semaglutide (Wegovy, Ozempic) and tirzepatide (Mounjaro). In addition, he offers a completely different way to combat obesity. 

The new medicines for treating obesity are so popular that they are in short supply. But how well do they address the underlying metabolic dysfunction leading to weight gain? 

The Consequences of Obesity:

Excess weight can have health consequences for both children and adults. But not all extra weight is equally dangerous. Subcutaneous fat, such as that stored on the buttocks or thighs, is not really likely to become a problem until a person is carrying more than 22 pounds or so. However, visceral fat around the organs (“big belly fat”) is caused by excess stress and is far riskier. Only 5 pounds of visceral fat can lead to metabolic disruption. The third fat depot is the liver. Just a tiny amount of fat in the liver (about ½ pound) can lead to type 2 diabetes and other metabolic problems.

Metabolic Problems Associated with Obesity:

Eventually, the metabolic dysfunction signaled by obesity can lead to the development of type 2 diabetes, cardiovascular complications, fatty liver, cancer and even dementia. The most common complication is insulin resistance, which can lead to a vicious cycle of hunger and overeating.

Keep in mind that you can’t see fat in the liver by looking at people or even by weighing them, although it is by far the riskiest form of fat accumulation. Fatty liver is extremely common in the US, but that wasn’t always the case. Can we trace the origins of this problem to metabolic dysfunction caused by too much sugar in the American diet? How should this affect our approach to treating obesity?

Are GLP-1 Agonists Best for Treating Obesity?

Drugs like semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro) can help people who have struggled with their weight shed pounds. What are the pros and cons? Although they do help most people lose quite a significant amount of weight, not everyone can tolerate the side effects. Gastroparesis, or stomach paralysis, is especially dangerous. In addition, the medications essentially induce a state of starvation in which people lose muscle as well as fat. Finally, when people need to stop taking the medicines, they frequently regain the pounds they lost. What is the solution?

Eat Real Food:

Our guest is clear that we must pay more attention to real food as the foundation for treating obesity. Highly processed foods contribute to metabolic dysfunction. Sugar, in particular, is a mitochondrial toxin, impairing three essential enzymes we need to produce energy and keep our metabolism healthy. In addition, a lot of processed food and its packaging contains PFAS, which also harm the mitochondria. As if that weren’t enough, the lack of fiber in our processed food deprives our gut microbes of what they need to keep inflammation under control.

What Is Real Food?

Real food does not come from factories. It comes out of the ground or off trees or plants. Possibly it comes from animals that eat plants–pigs, cows, chickens or fish. Eating real food instead of highly processed food is a good way to start healing from metabolic dysfunction.

What About Food Deserts?

Some people live in places where the only food they can buy is highly processed, with a long shelf life and devastating metabolic consequences. Dr. Lustig is active with an organization called Eat Real, which provides real food for children in school. In addition to minimizing the processed foods kids eat in their lunchrooms, it introduces them to a delicious variety of real foods that are available in their communities without sugar or other mitochondrial toxins.

One prime consideration for American consumers is price. Real food often costs more than highly processed treats. On the other hand, the new medications for treating obesity are extremely expensive, and not all insurance companies cover them adequately. Moreover, the downstream costs of treating the consequences of metabolic dysfunction are exorbitant.

This Week's Guest:

Robert Lustig, MD, MSL, is Professor Emeritus of Pediatrics in the Division of Endocrinology at the University of California, San Francisco. He specializes in the field of neuroendocrinology, with an emphasis on the regulation of energy balance by the central nervous system. His research and clinical practice has focused on childhood obesity and diabetes.

Dr. Lustig is the author of several books, including his most recent, Metabolical: The Lure and the Lies of Processed Food, Nutrition, and Modern Medicine. You may also be interested in his previous books, Fat Chance and The Fat Chance Cookbook as well as The Hacking of the American Mind. His website is https://robertlustig.com/

A Different Perspective:

In last week’s episode, we spoke with Dr. Jamy Ard. He is a professor of epidemiology and prevention at Wake Forest University School of Medicine. He is also a clinical researcher focused on studying strategies to treat obesity and Type 2 diabetes in adults. Dr. Ard also co-directs the Atrium Health Wake Forest Baptist Weight Management Center, where he oversees the medical weight management programs. He is the vice dean for Clinical Research at the Wake Forest School of Medicine. Dr. Ard is President-Elect of the Obesity Society and will be president in 2024.