> "The environment that people live in needs to be one that promotes health, not weight gain. […] Obesity is not a GLP-1 deficiency," he says.
This is my biggest issue with weight healthcare, the idea that if only the patient would eat correctly they wouldn’t be overweight. It’s not some moral failing a person often over eats, it very well could be some physiological issue that should be treated. It would be like telling someone with asthma that they just need to get into better shape to breathe better.
I don't have a horse in this race, but from my personal experience eating satiating whole foods with lower glycemic index, higher fiber and protein content makes it very difficult to gain excessive weight.
On the asthma front, from experiences with someone close to me -- getting in great physical shape (with caveats regarding training) DID indeed help greatly with broncho-constriction and higher scores on FEV. Basically symptoms and inhaler use went down tremendously over a few years and a physical transformation.
Before GLP-1s, there was rarely any such thing as "satiation" for me. Getting full was something that happened without the feeling of having had enough. The main effect of wegovy, for me, was having a feeling of not needing to eat rather than just feeling too full to eat. It was quite an experience, and one I am not sure I had had in more than 30 years.
I find for me that doesn't work. I have to actively count calories to lose or maintain a healthy BMI range. If I don't, no matter what I eat, I end up stabilizing in the overweight category. I'm lucky enough that my wife has a very flexible work schedule where she is able to cook most meals for us, but she hates weighing everything out so I can track... we've tried to stop the tracking multiple times but it never works. I'll think I'm eating to the same satiety level as before, but I end up slowly creeping back up in weight. My wife is fine either with or without tracking for maintaining her weight, though she does also seem to have an easier time losing when she's counting her calories. I think this is why it's so hard to have discussions about it, people's experiences literally don't match even when they try the same things. I suspect I'd be one of those people that if they tried Ozempic would be able to lose tons of weight, and who would shoot back up as soon as they stopped, unless I track the whole time... at which point I wouldn't need the Ozempic in the first place
As someone with asthma, let me tell you that they _do_ need to get into better shape to breathe better. Part of that is a medically proven practice called pulmonary rehabilitation, but also, regular cardiovascular exercise at different intensities and direct training of the abdominal muscles has a marked improvement both on pulmonary function (to a limit, but even more important as you age) and oxygen utilization from the reduced pulmonary function. Finally, both acid and laryngeal reflux are silent contributors to asthma by introducing acid and pepin into the airways, and weight loss can improve the symptoms of those.
Thank you for sharing this and elaborating on what I've seen firsthand. Another thing we've noticed is that an increase in VO 2 Max, which does take quite a bit of time to change, makes a major difference.
Altitude is another factor, due to dry and colder air and lower oxygen -- a double whammy for asthma.
People also are often unaware that the symptoms of asthma which cause the most concern (dyspnea, tightness, etc.) are less hypoxia and more hypercapnia. Hypoxia in normal people does not feel like breathlessness: it's lightheadedness, low energy, turning blue, etc. Asthma is almost definitionally airway hyper-responsiveness (and relevant structural changes): any fitness intervention that can help improve CO2 expulsion will probably greatly help an asthmatic seek relief. This is also why in acute attacks, pursed lip exhalations can really help.
Some people have literally been able able to overcome asthma — or at least significantly reduce symptoms — by learning to breathe better. Getting in better physical shape can be part of this. That doesn't necessarily work for all patients but at least some have been successful.
Until we are able to fix the environment and culture, we're stuck with medications like this. The good news is that glp1 medicine can be used to break addictive behaviors, so it is the very tool that can help change our environment by reducing demand for junk food.
This is my biggest issue with weight healthcare, the idea that if only the patient would eat correctly they wouldn’t be overweight. It’s not some moral failing a person often over eats, it very well could be some physiological issue that should be treated. It would be like telling someone with asthma that they just need to get into better shape to breathe better.