GLP-1 agonists promise weight loss, but what about the consequences of perpetuating the thin ideal?

June 7, 2024June 8, 2024 ~ Green Apple Dietitian ~ Leave a comment

Over the last few years, the medical landscape has turned completely upside-down. With all the recent hype around GLP-1 agonists, we don’t need any more proof the world’s gone mad.

Semaglutides are effective for significant weight loss and may have other health benefits. Many great resources explain their effectiveness, so I won’t discuss them here. The main thing to know is they slow down the stomach’s digestion and curb appetite, which can result in weight loss. However, some people lose their appetite completely and stop eating. This is where I have a problem.

Losing your appetite is a serious side effect that can lead to severe consequences

Significant weight loss in a short amount of time puts patients on the fast track to malnutrition. Fat cells don’t go away, they shrink. Unintended loss of lean muscle mass diminishes strength, stamina, and resting metabolic rate.
Dehydration and constipation are major side effects of weight loss that need immediate attention.
Gastroparesis which is claimed to be a rare side-effect of GLP-1 should be assessed by a health practitioner.
Significant weight loss and meal restriction are associated with depression, anxiety, and disordered eating.

No one is immune to the pressures of the ideal body weight

I’m not pretending that I understand another person’s struggle with weight or health issues. As a female living in the US, I’d be lying if I said I never experienced negative thoughts like feeling bad about my body size, being unhappy about what I see in the mirror, or feeling guilty after eating certain foods. Conducting medical nutrition therapy sessions over the years has fine-tuned my ability to pick up on the hatred of fat in our society, and how people sell themselves short because of their body size. Let me tell you it’s no picnic to inform patients I don’t specialize in weight loss. The conversation often comes to an incredibly uncomfortable abrupt end. It’s an emotional hot button that’s impossible not to push.

The psychological perspective is always ignored

We all know there are consequences for our actions. The likelihood of maintaining a healthy weight decreases If you are clinically depressed and anxious. There’s no doubt in my mind that mental health issues affect normal eating patterns. So, chances are your weight will go up or it will go down. No matter the direction it won’t be healthy or sustainable if you don’t find a way to deal with reoccurring issues in your life that are holding you back. A healthy mind usually follows a healthy body. Usually. If someone spends most of their time dieting, there’s no way they feel good about themselves. That’s where the focus should be, not on body weight.

What adds to this is when well-intentioned friends, loved ones, and health practitioners validate a person’s bad feelings about themselves and comment on their weight. If you’re somebody who comments on other people’s weight stop it. It’s not helpful and you’re not earning points by doing it. It was once said that if shaming worked everyone would lose weight. Well, it doesn’t. So, knock it off. If people in larger bodies bother you, maybe you should find out why that is.

Are GLP-1 agonists the cure for obesity?

I don’t believe obesity is a disease the way social media preaches it. It’s way too complicated for medication to “make it go away.” As I see it the medical profession continues to ask people in larger bodies to sacrifice way more than thin people to be healthy. As much as it’s proclaimed that side effects are not the norm for most people, it isn’t comforting to those who’ve taken the drug and experienced gastroparesis gotten so bad they couldn’t get through the day without vomiting to the point of severe dehydration. For them, the “rare side-effects” have made a huge impact on their lives. Either way, it’s a lot to expect from folks when there are so many other factors that cause ill health other than obesity.

It’s too early to know what the long-term efficacy will be

If you don’t have an eating disorder, there’s reason to believe you could develop one while taking semaglutides. Medically induced appetite suppression still leaves us with many questions. But what we do know is that severely restricting dietary intake and losing a significant amount of weight messes with the brain and creates an unhealthy obsession with food.

If you’re considering semaglutides for weight loss, you still need to make major lifestyle changes. It’s not a magic pill. You are still responsible for the outcome. An adequate diet and exercise will be necessary to get results. Don’t do it alone. There are plenty of great dietitians out there. Remember no one can predict how your weight will trend within your lifetime. You might need to take the drug for the rest of your life. With the recent shortages, you might not be able to take it the way it’s prescribed. Most importantly, think about how you might feel if your weight doesn’t trend the way you want it to. Semaglutides won’t do much for your mental health.

Increase your awareness by being a devil’s advocate

For every practitioner prescribing this drug, there’s a pharmaceutical company with an inexhaustible marketing budget earning record profits. Semaglutides are already in a nice comfortable space within the diet culture which has welcomed them with open arms. You can be sure there are plenty of weight loss companies vying for the extra dollars by adding them as a weight loss option.

As a consumer, you have the choice to take the wait-and-see approach. Dig your heels in. Don’t let the catchy jingle on the commercials or the celebrity weight loss stories give you false hope. Learn about every side-effect and don’t be afraid to ask the tough questions. In the grand scheme of things, you are the strongest advocate for your health and well-being. No one knows more about what you need than you do.

DISCLAIMER: The Green Apple Dietitian blog provides nutrition information for education only and is not intended to offer medical advice or cure any health conditions. The content should NEVER be used as a substitute for medical advice, diagnosis, or treatment of any health condition or problem. Any questions regarding your diet and health should be addressed to your specific healthcare providers. Never disregard professional medical advice or delay seeking it because of something you have read on this blog.

Green Apple Dietitian makes no warranties expressed or implied regarding the accuracy, completeness, timeliness, comparative or controversial nature, or usefulness of any information posted or shared on this blog. Green Apple Dietitian does not assume any risk whatsoever for your use of any information contained herein that was posted or shared on this blog in the past, present, or future. By accessing this blog, you agree that neither Green Apple Dietitian nor any other party is to be held liable or otherwise responsible for any decision made, or any action taken or not taken, due to your use of any information presented on this blog website.

Why exercise and fitness goals are not sustainable for a lifetime

January 23, 2024 ~ Green Apple Dietitian ~ Leave a comment

Since the new year, dieting and exercise commercials dominated our viewing screens. The pressure to “fix yourself” is in full swing. But the perfect exercise routine isn’t a destination to the ultimate fitness utopia. At the very least, if you’ve been active in some way for most of your life your body might reward you for it. But life always has a way of sending us back to the sidelines.

After bruising my ribs during a fall, my usual exercise routine came to a stop. Lifting my left arm over my head or twisting my waist was excruciating. For me, the start of the year meant avoiding as much pain as possible. While watching TV, the “new-year-new-you” commercials interrupted my shows constantly. Every year it’s the same.

Fitness ads tell us that the product they’re selling will give us everything we want out of life. The now-famous stationary bike company is the latest example. The machines are expensive and membership for video classes is extra. The ridiculous hype is so obvious as they try to make customers feel they’re getting more for their high-priced soon-to-be dusty clothes rack. The sweaty actor’s gregarious yell of satisfaction while feverously peddling could be mistaken for an adult movie.

The “if I can do it, you can do it” mantra forgets about life’s uncertainties and ignores individual levels of physical ability and motivation. Maintaining a fit body doesn’t happen in a vacuum. This generalization fails to meet folks where they are and instead encourages conformity to unrealistic fitness stereotypes. Any advice in commercials is just a sales pitch.

The fitness industry wants you to believe that you have total control over aging, body shape, and uncertainty. If you are sick and tired of being told how to look, here are three grounding perspectives against the hype and pressure to conform to be someone you’re not.

Aging is a fact of life, not a failure

The fountain of youth has been for sale since the beginning of time. Regular exercise can help you move and feel better and there is science proving its benefits. But the promise of adding years to your life is ridiculous since tomorrow is promised to no one. Hoping for a better future only squanders the present. You’ll be a different person every decade you’re alive and you have every opportunity to reinvent yourself. Getting older can be as good or as bad as you make it. Physical fitness doesn’t have to be grueling and regimented unless you like that sort of thing. But I’m betting most of you don’t and your body will appreciate exercise at a more leisurely pace.

Accept and love your mind, body and soul, faults, and all

It’s okay if you’re not an athlete or live in the body of one. Running on a treadmill for an hour at full speed isn’t for most folks. Sometimes going outside to walk while enjoying the sunshine and fresh air will be all you need. If you don’t have a competitive spirit, does it make sense to push yourself? What you don’t enjoy you won’t do, period.

Starting an exercise regimen to change how you look won’t last. In the beginning, you might believe you have all the willpower to keep it going. But after a while, you’ll realize keeping up with the workouts is difficult. Results can take months. Building and maintaining muscle requires dedication that doesn’t fit the average lifestyle. In my experience, most folks don’t have time to spend all day in a gym or can afford a personal trainer most days of the week. I know don’t. As you get older maintaining that gym membership becomes more difficult.

Since more of us are living longer, the fitness industry pressures women to maintain a thin ideal even after 50. Menopause and weight gain are a natural part of aging, but they want you to believe it’s within your control if you buy their product. But it’s not all in your control, and no one ages in the same way. It used to be when women got older, they became more confident and accepting of themselves. But now the trend is the older you get the goal is to prove how young you can be.

You might end up back at the starting line… and that’s okay

Meet yourself where you are today. It might mean running a quarter mile when you used to run 10 miles or lifting 5 pounds instead of 20 pounds. Pushing your body to do more than it can handle is useless and leads to injury and self-deprecation. Ditch the all-or-nothing approach. Start with an exercise your body can do without feeling any pain. After a while choose a different movement and then do the same. When you build confidence, challenge your body to do more. Remember there will be days when you don’t have the motivation and other days when you want to go for it.

Being on the sidelines can give you a new perspective. You now have the extra time to plan and do things you were putting off. It might be the excuse you needed to slow down a bit to realize where you are and where you want to go.

Body shrinking is the number one goal for a lot of folks starting January 1st. Imagine if New Year’s resolutions were more about where we want to be in life instead of something as superficial as looks. How different would your life be?

The perfect fitness goal is doomed to fail for a variety of reasons. Especially if you’re working out to lose weight or sculpt muscle. When the unexpected happens those goals are just not sustainable which is why folks end up in the same place at the start of the new year. They do the same thing year after year expecting different results. It’s madness.

What will you do the next time that stupid stationary bike ad comes on? Me? I’m going to hit the off button.

How diabetes nutrition education “inadvertently” encourages disordered eating

July 4, 2023 ~ Green Apple Dietitian ~ 1 Comment

Over 10 years ago, my mom was diagnosed with diabetes. She was referred to a diabetes educator who taught her about foods that affect blood glucose levels and those that don’t. The educator recommended a carbohydrate intake of 45 grams of carbs for meals and 15 grams of carbs for snacks. She didn’t keep up with carb counting but always ate a wide variety of foods, and is one of the healthiest eaters I’ve ever known.

Last year after my mom’s second knee surgery, she lost a noticeable amount of weight. It made sense the weight loss was the result of healing and her dedication to physical therapy. However, during a follow-up procedure, the anesthesiologist reviewed her chart and noticed her blood glucose was consistently above 200. After a 6-month checkup, her A1C was 9.5. When she was first diagnosed, excessive weight loss was a symptom of hyperglycemia and her recent weight change signaled high blood glucose once again.

Weight loss is not a reliable measure of good health. Rapid and significant weight loss can indicate an underlying issue. If eating habits and medication haven’t changed, it’s crucial to consult a healthcare practitioner for an evaluation.

My mom’s doctor, again, referred her to a diabetes educator. She received the same carb-counting education as before, including the proverbial cut-a-banana-in-half speech. Bananas sold in stores are usually larger than what’s recommended on diabetes exchange lists. Patients are encouraged to eat one half and save the other for later. From a behavioral health perspective, how the patient interprets this advice is important. Do they see it as increasing food variety, or an opportunity to consume fewer calories?

If the diabetes educator is unaware a patient is struggling with an eating disorder, the advice may encourage food restriction. If this patient is encouraged to eat half a banana, this validates disordered thinking, “Eat less food so you don’t gain weight.” The eating disorder doesn’t care about diabetes or the patient’s health, only the fear of weight gain. Without screening for and addressing disordered eating, diabetes care is like a band-aid that comes off in the water.

Diabetes educators teach patients about foods that raise blood glucose. The goal of this education is to improve their diet, so it trends within a healthy range. But unfortunately, traditional carb-counting diets put food into distinct categories like eating disorder thought patterns. In simplistic terms, the carb-counting diet has 2 major lists of foods. 1. Foods that don’t affect blood glucose. 2. Foods that affect blood glucose. 3. The eating disorder will see them as good and bad foods while sifting through them to find safe foods that won’t cause weight gain. The result is usually less food intake while raising the risk of malnutrition.

Eating disorders aside, carb-counting diets are not easy to follow, especially when preferred foods are not available. Science proves behavior change is difficult. Not everyone will adapt well to a new diet as people tend to move toward what’s expedient. When feeling stressed, some patients might stop seeking treatment altogether or seek unproven alternative care treatments that can make diabetes worse.

After her appointment, what my mom said later that day is something I hear all too often in my practice, “I don’t know what to eat.” While revisiting the education booklet at home she said, “I’ve forgotten about the carbs. I should get back to that.” Yet she was confused about the difference between a carbohydrate and a protein. Her desire to change perceived incorrect eating behavior insinuated by the diet was evident. She also wasn’t happy with the idea she couldn’t have her oatmeal for breakfast when it was suggested she try to eat something different in the morning.

In my mom’s case, carb-counting education disrupted her healthy relationship with food by causing her to second-guess her choice to eat a banana and oatmeal. Later, she began giving away foods she loved because she believed she could no longer eat them.

As a dietitian specializing in disordered eating, I’ve observed how a carb-counting diet can overwhelm some folks more than it can help. It encourages perfectionistic dieting behaviors that are difficult to follow in real-world situations. The diet requires the patient to learn a lot of information in a short amount of time. There are numerous ways a patient can misconstrue what they’ve learned at first. For example, a newbie to carb counting may decide to “avoid” instead of “balance,” and take an all-or-nothing approach. Then the language becomes, “I can’t eat that, it has too many carbs,” which sounds just like a punishment for bad behavior.

Screening for disordered eating behaviors can help practitioners become aware of treatments that may do more harm than good. Diabetes educators should create an environment that’s all food inclusive while encouraging patients to consume healthy fruits and vegetables as nature intended. The longer I’m a dietitian the more it seems like this diet inadvertently blames the patient for their diabetes instead of giving them the help they need to better manage it.