Rethinking Obesity: Beyond "Eat Less and Move More"
Ever since puberty, I've been grappling with being overweight or obese. Throughout my adult life, I've cycled through gaining and losing the same 60 pounds multiple times. Unlike fad diets, I've always relied on well-researched, scientifically grounded approaches. Losing weight, on the surface, is a simple equation of creating a 3,500-calorie deficit. But it's far from easy.
Recently, I embarked on a journey with a GLP-1 receptor agonist, a weekly subcutaneous injection known for its impact on weight loss. The medication gained social media prominence due to its success stories among celebrities and influencers. It enhances insulin sensitivity and delays gastric emptying, making individuals feel full sooner and for longer. However, it has revealed an overlooked aspect of the obesity puzzle, leading me to believe that we've misunderstood this complex issue.
This revelation centers around what I term "brain chatter." Other users of GLP-1 medications describe it as "food noise." As someone who's grappled with weight for most of my life, even with a high level of education, I didn't recognize this phenomenon until it diminished on the medication. This "brain chatter" is the ceaseless mental chatter about food, the inner dialogue questioning the point of resisting a snack, the ongoing struggle against indulgence that persists until it's yielded to. This unrelenting desire for food, fueled by brain chatter, significantly contributes to obesity. Recognizing the absence of this desire and chatter on GLP-1, I've realized how naturally thin individuals navigate their lives. They eat to live, unlike me, who's lived to eat. They eat when hunger calls and stop when fullness arrives. They don't battle constant urges to overindulge. Having lived without brain chatter, I'm resolved to sustain this way of life. (Brain chatter also clarifies why weight loss surgery patients can regain weight; it's not just about stomach size.)
Data reveals that up to 95 percent of Americans who lose weight regain it within a few years. The same statistic likely holds for those who cease blood pressure medication; maintenance of blood pressure control might falter. But we haven't conducted such studies because we acknowledge hypertension as a lifelong chronic ailment, warranting consistent treatment. Similarly, the medical field must acknowledge obesity as a chronic disease. This isn't an issue of laziness. Nor is it solely overeating (although overeating is at the core, the reasons are multifaceted).
Individuals resort to anti-obesity medications when they've exhausted other options. Medications like GLP-1 receptor agonists target the underlying biology and pathophysiology of overeating, encouraging early satiety, delaying gastric emptying, boosting insulin sensitivity, and crucially, dampening brain chatter. Once I attain a healthy weight, I won't cease my GLP-1 medication. It's granted me a life devoid of brain chatter, an understanding I've lacked my whole adult life. Let's approach obesity as the chronic disease it is, ceasing to blame those with obesity for their medical condition. Let's dispel the simplistic advice of "eat less and move more." Recognize that attaining and sustaining a healthy weight is far more intricate.
