Why Ozempic will fail you
Is Ozempic, or some other GLP-1 agonist, good for you? Should you take it if your goal is fat loss? Are there really any downsides?
The short and sweet version is, what are your answers to these two questions:
1. Are you obese?
2. What does your doctor think?
If you’re not obese, you should read this article to learn why GLPs will probably fail you, and what the actual challenges facing your long term fat loss goals are. If I don’t convince you of that, then get counsel from your doctor.
If your doctor has recommended immediate fat/weight loss as a remedy to a pressing health concern, and a GLP-1 agonist as the tool for the job, you should use it. Sometimes the outcome is more important than the process, because without getting the outcome ASAP, your
“process”, life, could be made irrevocably worse, or even end in the worst case scenarios. Don’t risk a heart attack or some other permanent damage for a lesson you can still learn once the crisis is avoided.
If you are obese, and have a BMI of 30+, you may also be a good candidate for GLPs. At this point, the kick start and positive momentum provided by GLPs can be the on-ramp to the healthy life you’re trying to build. However, for reasons I’ll get into, this still comes with tradeoffs. It still requires close supervision by not only your doctor(s), but also a good coach or therapist who is helping you build habits, skills, and a healthy narrative around your health and fitness goals.
Because, even if you are a good fit for GLPs, once you go off them there is roughly a 50% chance you regain 40-60% of the weight you lost. Unless you hop back on the drugs or pursue another “weight loss method”, that being lifestyle changes. The drugs will work, but not after you stop taking them. Not without changing the life that built your previously overweight body.
They won’t solve your problems fully, but they could potentially help you start living the life you want to live, if you are obese.
With that said, what is fat loss, or since they’re nearly synonyms, weight loss?
Weight loss is a skill. Specifically, it’s a set of behaviors that align with your emotional, “internal”, and tangible, “external”, environments. How you feel emotionally on a daily basis, how you relate to food and movement, how you react to those two things, and the reactions your environment promotes are the pieces to the question of why you have the body you have.
For example, let’s look at Stacy. Stacy kinda hates her job, but she makes good money. Day to day she feels kinda bad, and it’s only been getting worse over the last 3 years, along with her slowly increasing body fat. She’s trying to improve her fitness and get lean by running 3-4 times per week, for 2-4 miles per run. She’s an introvert, so after her run, if she runs, she goes home to bake her favorite comfort meal/dessert and have a glass of wine with a movie. Maybe she does this with a friend for company; either way she’s had a fun afternoon and feels better! So she goes to bed happier, but with the nagging dread of going to work the next day to repeat it all. So, we have daily feelings of mild-yet-building negativity, a slightly sedentary lifestyle, the desire (habit) to cozy away those feelings with feel good activities, and a friend group who also enjoy cozy wining and dining.
How would you rate Stacy’s weight loss skillset? What are her emotional regulation activities? What are the fallback activities for her and her support network (friend group)? How robust is her overall plan?
I’d give it about a 4/10. If she were the type of person to use exercise for emotional coping, it’d be more like a 5 or 6/10, but she’s not quite there. She’s less likely to run after a hard day at work, and running still feels more like homework to her than something she’s excited about, an experience I know many people struggle with. Her and her friends are more sedentary than not, and eating and chilling are her go to unwind activities. This isn’t terribly “unhealthy”, but it’s not an environment conducive to getting lean.
This article is going to focus more on the diet side of weight loss for the sake of relevance to GLPs, but keep an eye out for a deep dive into how to grow the skillset holistically in a future piece. As well as what a more full fledged plan would look like that you can use as a template.
So, given her novice skills, should Stacy use GLPs to help her lose weight?
No.
She’s medically fine, she’s only in her mid 30’s, and isn’t at risk of developing type 2 diabetes.
That being said, Stacy wants to get leaner. Why shouldn’t she use GLPs? Let’s build up to that.
If you want to burn fat and get lean, the challenge is a caloric one. Storing calories is a fat cell’s job, and calories come from food. So, you have to ask…
What roles does food currently play in your life, and how did it get those roles?
This begins to get at why so many people struggle to keep weight off without these drugs, and why they regain so much of it. Our relationship with food is similar to our relationships with loved ones and family; among the deepest and most difficult to understand. Its base was built in childhood, and often morphs unconsciously into a tangled web of desires, responses, and judgements as adults. This obscurity is what makes the problem of managing it so difficult, yet fruitful. Think back to Stacy and how she picked a job that worsens her life, where her coping habits came from, and what her social network looks like and encourages.
Things like the snacks we enjoy, the story we tell ourselves when we cook, eat, and share meals; they’re building blocks of our identity that we all take for granted. Which means we have to ask, why do we, why do you, perform these fattening behaviors?
Can these behaviors be changed without drugs? Should they be?
Of course they can change. But behavior change may or may not stick, depending on where these behaviors stem from. Your narratives, the stories guiding your emotional state and perception, are even more impactful on your behavior than physical cues like hunger. How often do you eat a dessert past fullness because you feel sad? How terrible does it feel to reject a home cooked meal from family or friends because of a diet? Anorexia is primarily a psychological disorder after all, one of dysfunctional perception and narrative.
This is why changing relationships with food starts with an understanding of your narrative. As a new example, let’s take Jimmy and his love of pastries. Jimmy is 210 lb, has a croissant or two most days with his breakfast, and wants to lose 20 lb of fat. His first thought is, “if I just didn’t eat so many damn croissants, I’d probably lose weight. Hell, if I ate none it would probably even be easy. If only I could stop eating these.” This is an observation, prediction, and judgement. The judgement being, “If only I could stop eating these” which translates subconsciously to “I am an uncontrollably fat, and therefore unimpressive/undesirable/unrespectable/unworthy, or maybe more simply, bad person.”
So, Jimmy’s starting narrative is something like “I will be a happier, better person if I lose weight - by cutting back on the pastries”.
He takes action, starts strength training 3-4 times a week, and cuts out his croissants. Aside from that, he has an easy time eating healthier. No desire for soda, trading greasy meals with cleaner combinations of meat, veg, grains, and potatoes; his diet’s pretty solid. Two weeks in and he’s lost 5 lbs and feels great, but is starting to crave his morning croissants again. Then, he catches up with a friend over coffee and has a croissant with it.
At this point, there are a few different internal reactions that drive many people to crash and burn on their weight loss journey. Let’s go through some.
1. Jimmy feels bad about having his croissant. He set the goal of completely cutting out his favorite pastry until he lost his 20 lbs, and failed after decent progress only two weeks in. An insidious idea sets in, “Why couldn’t I say no? Am I so pathetic that I can’t even go a couple months without croissants to lose 20 lbs? I’m like some lame version of an addict, who can’t give up his pastry habit. I’m pathetic.”
He beats himself up over this failure, and his desire to modulate his croissant consumption slowly fades away. He starts ordering one every other day, feels even more like a failure, says “fuck it” and starts ordering two, one plain and one chocolate, every morning with his coffee, and regains 6-7 lbs over the next few weeks. He doesn’t stop exercising, but gradually stops caring about eating healthy and just falls back into old habits, along with the added sense of being a failure and the shame of being a “food addict” with no self control.
He now adds a new layer to his narrative, “I’m too weak and pathetic to get lean, even with consistent exercise”.
2. He enjoys the croissant for what it is, an occasional treat with good company. For weeks 3-5 he loses another 3 lbs, totaling 8 lb lost, almost halfway to his goal! Except, he really enjoyed having coffee with friends and wants to keep the routine; coffee and croissant once or twice a week. He keeps his training roughly the same, as well as his generally healthy eating. Weeks 6, 7, and 8 he stagnates, gains 2 lbs, then loses a pound. This would be considered a maintenance trend, with his weight fluctuation being 2 lbs of a given weight.
Let’s say for him, he’s stuck hovering between 202-199 lbs, having started at 210 lbs. For three weeks he hasn’t been able to repeat the progress he made early on, and has been stuck above 199 lb. If his goal was only to lose around 10 lbs, then this would be perfect! He’d be hovering right around where he wanted to be, with plenty of flexibility to enjoy his favorite foods and live a social life. Except that’s not his goal, his goal was to lose 20 lbs, getting down to 190 in this example. Now he feels like it’s just not working anymore, but decides to give it one more week.
He even decides no croissants for this week. His weight is back down to 199, maybe even hitting 198 lb once, but he hasn’t had coffee or dinners out with friends this week, and is annoyed he hasn’t reached 197 lbs or lower. He gives up on intentionally eating clean, starts going out and celebrating with meals more generally, and regains the 5-10 lbs that he lost. Jimmy tells himself, “I tried dieting and it didn’t work for me. It’s just not a good fit for my life.”
3. Lastly, let’s view this morning coffee or breakfast as a work event. He travels for work or has lots of meetings out over meals for his business, and is just very frequently exposed to delicious options. He’s generally quite happy with how everything is going, but the options are just too tasty to keep passing up when he’s out 1-3 times a week for business meals.
The croissants are good, the breakfast burritos delicious, lunches extravagant, and it just feels bad to only order salads or a plain black coffee with no snack every time he’s out. There’s so much joy to be had in delicious meals, and they’re meals indicative of business going well. It’s a double whammy! He wants to celebrate with the tasty food he loves on the menus, and it’s not like he isn’t working out. So, he slowly laxes on the diet and just starts enjoying life as it comes. He regains 5lbs and hovers around 205, 5 lb down from where he started, but still a long way from his initial goal. He’s kinda fine with it, but feels kinda stuck and still wants to be lighter, down at that 190 mark. Jimmy thinks, “Meh, I’ll just do it later” or “I’ll wait until things calm down.”
Three different responses, for three slightly different circumstances, with similar outcomes. All being stuck in some way, all having missed the goal. These different problems require different approaches to overcome, and is where much of the fitness and nutrition industry fails its customers. Bad trainers will blame Jimmy for having no self control, for not caring enough about losing the weight, for not being able to just say no and drink the black coffee by itself. A cookie cutter nutrition program will not factor in the desire for croissants and ends up feeling too restrictive. If Jimmy is just researching YouTube videos and motivating himself, he ends up setting expectations that are too aggressive, too fast, making him feel like a failure when he hits a plateau. That’s if he isn’t drowning in decision fatigue from the ocean of available information.
So, is the answer Ozempic at this point, for any Jimmys?
As a coach, I have to say no. Here’s my diagnosis:
Jimmy #1 has false expectations, and a black or white paradigm that sets him up for failure. To be clear, it’s a paradigm that COULD work for other people. Some folks don’t have as deep a relationship with food, or a big appetite for that matter. Eating is more a necessary biological process for them, that sometimes is very fun with friends, but it isn’t a core driver for them. It’s not a key experience they prioritize in life, so it’s much easier to just cut out the morning pastry cold turkey, and literally eat cold turkey for lunch every day until they lose 20 lbs. But for Jimmy, who loves food, and especially croissants, applying this hard cut will feel tormenting at first. He doesn’t need croissants everyday, but if he’s told to cut croissants, he’s likely to develop the idea that in order to have the body he wants, he can never have his favorite foods. The narrative being, “to be a better person, I can’t have, or even like, what I like”. His nature is set against his desire for improvement in fitness, and so he’s destined to feel like an eternal failure if this idea sticks around. He needs a program that allows for croissants in an amount that still allows for progress while scratching the itch. At first, this can be a croissant everyday, despite the extra difficulty. However, as he makes progress, this amount can be reduced in tandem with his increase in belief in the process and desire to progress faster. Eventually, the desire for progress outweighs the desire for croissants, and a pastry everyday turns into a pastry once or twice a week. Now he feels both fulfilled, successful, and free to enjoy his life in a way that’s aligned with him personally.
Jimmy #2 needs a clearer understanding of progression. He can have his social events, but needs to up his weekly activity or clean up his diet in other areas to compensate. For example, let’s say he was already getting around 8000 steps a day for weeks 1-5, but then stagnated. He would need to increase his average step count to 11-12,000 per day to burn enough calories to keep him on pace (if you’re interested, convert steps to miles walked here). He could, and probably should, also do a little cleaning up in his diet elsewhere. Maybe 3-4 nights a week he usually has bread with his dinners, centered around fish. Well, to make room for the pastry with friends, he replaces most of the bread with lightly oiled vegetables, or steamed and salted vegetables (I like frozen mixed veggies for example, because I am a child). Average step count is up, his core meals compensate to make room for croissants, and maybe he even starts doing a light run, swim, or bike ride once a week just to really put gas on the fire, on top of his 3-4 usual workouts. With this, he’d crush through the wall at 199 lb and start hitting new lows in his weight loss, and feel pleasantly social while doing it.
This is like progressive overload, the process of gradually adding more weight/reps to a strength exercise over time, but for his dieting. Now he’s building a nuanced view of the weight loss process, and a greater sense of confidence in being able to bust through even harder walls in the future if he decides to go after more ambitious fitness and physique goals.
Finally, let’s help Jimmy #3, the happiest of the bunch. He’s made a little progress, and is even holding onto it, but just can’t go any further. Ozempic HAS to be the answer, he’s just too busy and grateful to do otherwise, right?
Not really. Jimmy #3 lacks a skillset around managing his cravings, hunger, and fitness goals. He requires the most flexible approach because of the unpredictable nature of his day to day life. One answer could be developing a fasting practice. Fasting isn’t easy at first, and admittedly I’m not a seasoned expert here, though I have dabbled. From practiced fasters, it seems like days 1-2 of a multi day fast are the hardest, then there is a swell of energy and focus, along with a lack of appetite. So, Jimmy could fast 1-3 days before traveling or having a business meal, then make mostly clean eating decisions while leaving room for some fun options. He could also just stick to intermittent fasting on travel/meeting days, not eating outside of the big business dinner or breakfast, then maybe having a small low calorie snack before bed to curb any remaining hunger.
This is an extreme approach, but is similar in spirit to what I recommend for my traveling clients who want to lose weight. Eat exceptionally clean on days at home with fewer meals out planned, basically protein, fruits, and veggies, then have a little fun at the bigger meals. However, eating out shouldn’t always be in the spirit of decadence-maxing. Associations are powerful in our minds, and if we can’t associate flexibility with restaurants, Jimmy ends up eating his weeks worth of calories all in a few meals and makes no progress. Some of these meals should still be clean; lean meats, salads, vegetable dishes, soups, etc, to make more room for the meals he cuts loose on.
All while focusing on a combination of consistent strength training and weekly steps/cardio of choice. If Jimmy’s job involves a lot of sitting, and he works a lot, I’d recommend finding a cardio based activity that he enjoys over walking, unless he already loves to walk. Things like group bike rides, runs, swims, or even pick up sports like soccer, basketball, volleyball, or racquetball/tennis.
As a result, all three Jimmys have begun the process of changing that initial narrative, including its insidious addendum “-by cutting back on pastries”. Jimmy isn’t a bad person for liking pastries, for eating pastries, or for being fat. He did feel bad about his body, he did eat too many pastries to successfully lose weight at first, he was fat, but none of this makes him bad. He had competing desires, as we all do. With knowledge, setting accurate expectations, and taking action he gradually changed the balance of his desires. Repressing the desire isn’t a long term solution. With informed changes that are bought into, come small successes. And success begets more success. Wins make you feel more like a winner, in time. Winning builds a desire for the process itself. Eventually, the desire for daily croissants morphs into the desire to live a fitness oriented life, which can still include some croissants.
Why not just use Ozempic though?
Ozempic is a tool, and the job is fat loss… Why make it so difficult?
Like all tools, it is best used for the appropriate job, at the appropriate time. For high risk people in need of immediate intervention. For people with genetically dysfunctional hunger/satiety signaling. For people with physical dysfunction who can’t even move their bodies enough to transform themselves in a meaningful way. Maybe even for people old enough that they don’t have the time or desire left in life to learn the meaningful lessons of physical transformation, and just want to pay for access to a longer life and healthspan to spend more time doing what they love before they die. For people with mental conditions withholding the awareness and knowledge needed to regulate their eating habits. Maybe, if in some future the cost and physical side effects of GLP-1 agonists are as low as something like aspirin, then it might just be preferable for many to rely on these drugs instead of managing it themselves…
But there’s the rub, the externalizing of your locus of control. The idea that “I can’t do this thing by my own will, I NEED a tool”, thereby making it a crutch, and creating all the downsides of relying on emotional and spiritual crutches to live the life you “want to live”. This feeling out of control is a side effect, and an insidious one. This isn’t me blaming Jimmy for not having enough self control or willpower. This is about understanding yourself. The goal is transformation, terraforming if you will, because we are all creatures of our environment. Where we are put will influence what and who we are. However, with awareness, presence, and knowledge, we can begin to terraform our environment into something that grows what we want. The internal and external environment. This feeling of control is where a lot of self contentment and peace comes from. The feeling of having options, of being successful, and of confidence in the self.
Why do people want to lose weight in the first place? To feel happier and more satisfied with life. For the time being, life happens as a body, and anyone with a desire to lose weight probably has a desire to live as a more fit and capable body.
So, the initial question becomes; do you want your happiness to come from a tool outside of you, or from the tools, skills, and awareness that you develop and carry with you for a lifetime?
