As Zepbound dominates headlines as a new obesity-fighting drug, a nutritionist warns that weight loss shouldn’t be the only goal
- Written by Mandy Conrad, Assistant Clinical Professor in Nutrition and Dietetics, Mississippi State University
If the buzz surrounding a medication could elevate it to celebrity status, then Zepbound[1] is reaching Taylor Swift rank.
Zepbound is the newest addition to the weight loss drug arena. In November 2023, it joined the list of obesity-fighting drugs – administered as an injection – to be approved by the U.S. Food and Drug Administration[2].
The key to Zepbound’s weight loss potential is its active ingredient, tirzepatide[3]. This is the same active ingredient found in the drug Mounjaro[4], which is approved to treat Type 2 diabetes.
The relationship between Zepbound and Mounjaro is similar to two other popular drugs making headlines, Wegovy[5] and Ozempic[6]. Both Wegovy and Ozempic contain the active ingredient semaglutide[7], with Wegovy approved for the treatment of Type 2 diabetes and Ozempic approved for the treatment of obesity.
Tirzepatide and semaglutide both mimic the digestive hormone GLP-1[8], which is released by the intestines when we eat to stimulate insulin production and help regulate blood sugar. GLP-1 also suppresses appetite while promoting a sensation of fullness.
Weight loss medications are intended to be used in conjunction with lifestyle changes, such as exercise and a healthy diet[9]. But too often, people view them as a silver bullet for weight loss. And the high price tag[10] and variable insurance coverage[11] for these popular weight loss drugs create a barrier for many people.
I am a registered dietitian and dietetics educator[12]. Whether I am counseling patients, teaching students or working in my community to address food access challenges and healthy eating, I focus on overall well-being. I am passionate about helping people make informed and realistic health decisions based on their circumstances and helping them see opportunities to overcome the barriers they may encounter.
A doctor outlines the differences between Zepbound and other weight loss drugs.Health risks of obesity
The potential impact of these drugs is staggering, since more than 2 in 5 American adults are obese[13], according to the National Institutes of Health.
Obesity is not just an American issue, nor is it going away. The World Obesity Federation[14] estimates that by 2030, 1 in 5 women and 1 in 7 men will be living with obesity worldwide.
Many serious health conditions are associated with obesity, including heart disease[15], diabetes[16], high blood pressure[17], stroke[18], certain cancers[19] and osteoarthritis[20]. By treating obesity, a person can reduce or reverse obesity-related disease and improve both their health and quality of life.
However, long-term weight management depends on a number of complex factors. Meal timing and types of foods eaten[21] can affect energy levels, satisfaction and hunger levels[22]. A person’s typical schedule, culture and preferences, activity level and health history must be taken into consideration as well. No single “best strategy” for weight management has been identified, and research indicates that strategies for weight loss and maintenance need to be individualized[23].
In addition, it is critical to note that research on the long-term effects[24] of these newer weight loss drugs is limited. The available research has focused specifically on weight loss, heart health and metabolism and has found that ongoing use of these new medications[25] is necessary to maintain improvements in weight and related health benefits.
Common side effects and the emotional toll experienced by those who regain weight once they stop taking the drugs are trade-offs that need to be considered[26]. More research is needed to better understand the long-term impact of both direct and indirect health consequences of taking drugs for weight loss.
It’s not just what you see on the scale
Throughout my years working as a registered dietitian, I have counseled numerous people about their weight loss goals. I often see a hyperfocus on weight loss, with much less attention being placed on the right nutrients to eat.
Societal standards and weight stigma in the health care setting[27] can negatively affect patients’ health and can lead them to obsess about the number on a scale rather than on the health outcome.
Weight loss may be necessary to reduce risks and promote health. But weight loss alone should not be the end goal: Rather, the focus should be on overall health. Tactics to reduce intake and suppress appetite require intention to ensure that the body receives the nutrients it needs to support health.
Additionally, I remind people that long-term results require attention to diet and lifestyle[28]. When a person stops taking a medication, the condition it’s meant to treat can often return. If you stop taking your high blood pressure pills without altering your diet and lifestyle, your blood pressure goes back up. The same effects can happen with medications used to treat cholesterol and obesity.
Nourish your body with nutrients
Despite the prevalence of obesity and the emergence of newer drugs to treat it, 95% of the world’s population doesn’t get enough of at least one nutrient[30]. According to one study, nearly one-third of Americans have been found to be at risk of at least one nutrient deficiency[31]. Additional research indicates that those actively trying to lose weight are more prone to nutrient deficiencies and inadequate intake[32].
For instance, a decline in iron intake can lead to iron deficiency anemia[33], which can cause fatigue as well as an increased risk of many conditions. Adequate intake of calcium and Vitamin D reduce the risk of bone fractures[34], yet many people get less than the recommended amounts of these nutrients.
It is true that a healthy body weight is associated with reduced health risks and conditions. But if a person loses weight in a manner that does not provide their body with adequate nourishment, then they may develop new health concerns. For example, when a person follows a diet that severely restricts carbohydrates, such as the ketogenic diet[35], intake of many vitamins, minerals, phytochemicals[36] – or biologically active compounds found in plants – and fiber are reduced. This can increase risk of nutrient deficiencies and impair the health of bacteria in our gut[37] that are important for nutrient absorption and immune function.
Nutrition recommendations[38] set by the Food and Nutrition Board of the National Academies of Sciences, Engineering, and Medicine and the Dietary Guidelines for Americans[39] provide guidance and resources[40] to help meet nutrient needs to promote health and prevent disease, regardless of the strategy used to lose weight.
His transformation began with a wake-up call from the doctor.Optimizing health
There is no doubt that striving for a healthy body weight can reduce certain health risks and prevent chronic disease. Whether a person strives to maintain a healthy body weight through diet alone or with medications to treat obesity, the following tips can help optimize health while attempting to lose weight.
Adopt an individualized approach to healthy behaviors that promote weight loss while considering personal preferences, environmental challenges, health conditions and nutrient needs.
Focus on nutrient-dense foods to ensure the body is getting required nutrients for disease prevention and optimal function. If medications reduce your appetite, it is crucial to maximize the amount of nutrients in the foods you do consume.
Include exercise in your program[41]. Weight loss as a result of reduced calorie intake can decrease both fat and lean body mass, or muscle. An exercise routine that includes strength training[42] will help improve muscle strength[43] and preserve muscle during weight loss.
Seek professional help. If you are uncertain about how to adopt an individualized approach while ensuring adequate intake of essential nutrients, talk to a registered dietitian. They can learn about your individual needs based on preferences, health conditions and goals to make dietary recommendations that support health.
References
- ^ Zepbound (www.zepbound.lilly.com)
- ^ approved by the U.S. Food and Drug Administration (www.fda.gov)
- ^ tirzepatide (doi.org)
- ^ Mounjaro (www.mounjaro.com)
- ^ Wegovy (www.wegovy.com)
- ^ Ozempic (www.ozempic.com)
- ^ semaglutide (www.mayoclinic.org)
- ^ digestive hormone GLP-1 (doi.org)
- ^ a healthy diet (theconversation.com)
- ^ the high price tag (www.kff.org)
- ^ variable insurance coverage (www.nbcnews.com)
- ^ dietetics educator (www.fsnhp.msstate.edu)
- ^ more than 2 in 5 American adults are obese (www.niddk.nih.gov)
- ^ World Obesity Federation (www.worldobesity.org)
- ^ heart disease (doi.org)
- ^ diabetes (www.ncbi.nlm.nih.gov)
- ^ high blood pressure (doi.org)
- ^ stroke (doi.org)
- ^ certain cancers (www.cancer.gov)
- ^ osteoarthritis (doi.org)
- ^ types of foods eaten (www.ncbi.nlm.nih.gov)
- ^ hunger levels (doi.org)
- ^ need to be individualized (doi.org)
- ^ research on the long-term effects (doi.org)
- ^ ongoing use of these new medications (www.tctmd.com)
- ^ trade-offs that need to be considered (chicago.suntimes.com)
- ^ weight stigma in the health care setting (doi.org)
- ^ long-term results require attention to diet and lifestyle (www.washingtonpost.com)
- ^ Peter Dazeley/The Image Bank via Getty Images (www.gettyimages.com)
- ^ at least one nutrient (doi.org)
- ^ at least one nutrient deficiency (doi.org)
- ^ nutrient deficiencies and inadequate intake (doi.org)
- ^ iron deficiency anemia (doi.org)
- ^ reduce the risk of bone fractures (doi.org)
- ^ ketogenic diet (www.ncbi.nlm.nih.gov)
- ^ phytochemicals (www.uclahealth.org)
- ^ impair the health of bacteria in our gut (doi.org)
- ^ Nutrition recommendations (ods.od.nih.gov)
- ^ Dietary Guidelines for Americans (health.gov)
- ^ resources (www.nutrition.gov)
- ^ exercise in your program (theconversation.com)
- ^ includes strength training (www.mayoclinic.org)
- ^ help improve muscle strength (www.forbes.com)
Authors: Mandy Conrad, Assistant Clinical Professor in Nutrition and Dietetics, Mississippi State University
