Wednesday, November 29, 2023

Ozempic, Weight Loss Drugs, and the Gut Microbiome: Why Old-School Strategies Still Work Best

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As weight loss drugs like Ozempic are more popular than ever, they bring up questions about their safety. How do they impact the gut microbiome? And are there other, safer strategies that work?

Conversations about weight loss are difficult. We now know that a healthy range of BMIs (body mass index) means there’s no one-size-fits-all. But, that said, keeping off excess weight reduces the risks of a number of life-limiting diseases such as diabetes, heart disease, and certain types of cancer. Plus, extra weight can make conditions such as arthritis and high cholesterol more difficult to manage, among other issues.

But sustainable weight loss isn’t easy to achieve, and as the Hollywood elite flock to obesity drugs like Ozempic for quick results, there’s a lot to unpack. What do weight loss drugs like Ozempic do to your gut microbiome? Does the weight come back after you stop using the medications? And what are the long-term health implications?

Here’s what you need to know about sustainable weight management and why rapid weight loss may not be the key to keeping it off.

Slow and steady old-fashioned weight management: diet and exercise

A 2022 report by media content agency SWNS found that just 32 percent of Americans who successfully lost weight noted that they ended up gaining it back. In addition, 28 percent of individuals lost weight and managed to keep it off. Studies have shown that maintaining a healthy diet can help support sustainable weight loss. Specifically, research has found that vegan and plant-based foods have an antioxidant and lipid-lowering effect that can keep BMI more stable over time. The secret may be high fiber content.

kale salad
Kale salad. Photo courtesy Nutriciously | Unsplash


Plant-based diets are focused on equipping your body with sufficient amounts of vitamins and minerals. A 2021 study published in the journal Advances in Nutrition found that a plant-based eating pattern is also associated with reducing the risks of developing type-2 diabetes. But equally important, certain foods, including raw fruits, vegetables, roots, and nuts, offer healthy antioxidants including carotenoids, vitamin C, and vitamin E. 


Antioxidants play an important role in managing weight. A 2021 report on obesity posted by MDPI shared that the compounds found specifically in apples, garlic, ginger, and onions can not only decrease blood pressure but can also reduce waist circumference and BMI.  

Exercise also plays a critical role in healthy weight. One study found adults who exercised more than 200 minutes per week lost more weight compared to those who exercised between 150-199 min per week. Exercise doesn’t need to be elaborate or expensive, either. Just 30 minutes of brisk walking a day burns about 150 calories. A 2016 study, found that walking 10,000 steps or about 5 miles per day, is ideal for optimal weight loss. Tools like this walking calculator can help you set your walking target.

Utilize medical-based solutions

Sometimes, though, diet and exercise aren’t enough. If you’re finding it hard to manage your weight even though you’ve tried diet changes and increased physical activity, you can turn to medical-based solutions to complement your weight management efforts. In particular, FDA-approved weight loss medications are an underutilized treatment option for obesity. And that includes those weight loss drugs like Ozempic.

One 2022 study posted in the Endocrine Society found that some of these drugs can lead to long-term weight loss. This is because medical weight loss medication can help level the playing field for individuals whose biology makes weight management a struggle. 

The drug Orlistat is clinically proven to aid in preventing fat absorption in the intestines. But according to health experts, because obesity is a complex disease, these medications need to be paired with nutrient-rich foods and regular exercise in order to be most effective. 

runner on the manhattan bridge
Runner Courtesy Christian Negroni

Popular weight loss drugs like Ozempic and Wegovy can work similarly, especially for people suffering from obesity. For those people, the drug is part of weight management and will be taken long-term. For those using it just temporarily, experts say the weight comes right back once the medication is stopped.

“I think this is what we see when people go on diets or different exercise regimens, similar to when they go on a pharmacological treatment,” Karin Conde-Knape, Novo Nordisk’s senior vice president of global drug discovery, told CNBC. “As long as you’re keeping your intake the same, your output the same, you’re able to control your weight. But if you go out of this, you will immediately start to come back.” 

According to the pharmaceutical giant, these drugs mimic a hormone produced in the gut called GLP-1, which signals to the brain when a person is full. The drugs can also help to control what type of food people crave.

These drugs have noted side effects including constipation, diarrhea, nausea, and vomiting, which can disrupt the gut microbiome, leading to an overgrowth of bad bacteria. Research has connected a healthy gut microbiome to healthy weight management. 

Fortunately, a plant-based diet rich in fruits, vegetables, whole grains, beans, and nuts and seeds, can help to promote a healthy gut microbiome. Prebiotic and probiotic foods such as fermented foods like dairy-free yogurt, sauerkraut, and even kombucha, can further aid in gut health.

Leverage meditation apps to practice mindfulness


While incorporating plant-based foods into your diet is critical to healthy weight, there are other tools that bring benefits. Practicing mindfulness can help you focus on — and adhere to — your diet plan.

According to the Mindfulness Meditation Institute, overeating is associated more with the brain than the body. This is what platforms like Noom target: behavior triggers, rather than caloric restriction. Eating based on emotion — specifically due to feelings of boredom, loneliness, or stress — can develop deeply entrenched habits and lead you to gain extra pounds.

woman meditating
Courtesy Jared Rice | Unsplash

Something as simple as the number of meditation apps available can be a convenient way to alleviate stress and reduce overeating.

Popular apps such as Calm or Headspace provide guided meditations and soothing nature sounds that promote relaxation. These apps also offer quick meditations that you can include in your daily routine. Check your local neighborhood for meditation studios, too. These are other fun ways to bring the practice into your life.  

Meditation brings a number of other benefits into your life as well and may improve your personal and professional relationships, and help you deal with depression, anxiety, and other mental health challenges, too.

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