24 yo male, BMI of 34, waist circumference > 104 cm. Goal: healthy waist circumference and blood pressure moderation.
Training Hx: Resistance training for 6 years consistently. Have added conditioning 3-5 days/week with the goal of running a 10k in the next 6-8 months.
Systolic blood pressure measurements have been consistently over 130 during some week-long periods of at-home monitoring over the past 2 years. During other periods it has stayed in the mid 120s. My blood lipid panel, including Lp(a) is normal, no endocrinopathies.
Reading The Hungry Brain and following the simple food diet the author proposes really helped. I have started losing weight confidently after many years of trying and failing. Since this diet has started to work without making me ravenous and obsessive about food, I may be able to reach my goals with time.
I am also a candidate for weight loss medication. I have put off starting on liraglutide [the only one of the new agents available where I live], even though the physician I am consulting says that I am an ideal candidate for it. I am worried that I will not “build up my dieting muscle” if I get on these treatments, and therefore not be able to maintain if/when I am off the medication.
Guess I want to prove to myself I can lose/maintain the weight loss without the drug, just to be sure I am not dependent on a lifelong and expensive treatment. I know the right thing to do is pursue this treatment, but my brain isn’t fully on board.
From your experience, do people that get on these medications maintain their target weight? Should I start even if I may end up regaining the weight? Is there a way to reframe the situation that will be helpful?
Nice job with your progress so far. To address your questions:
I am worried that I will not “build up my dieting muscle” if I get on these treatments, and therefore not be able to maintain if/when I am off the medication.
I’m not sure that this is a “muscle” that can be “built up” in the way you are thinking. A large portion of people who successfully lose weight will deal with their bodies fighting against them in various ways, regardless of how hard you try. These include things like increasing appetite and food reward, decreasing satiety, decreasing energy expenditure, and many others that often lead to a degree of weight regain. Individual experiences vary, of course, and some individuals may have an easier time maintaining weight loss than others. High levels of physical activity seem to be especially helpful in sustaining weight loss, for example.
But ultimately, this is why obesity is now viewed as a chronic condition, like high blood pressure, and long-term treatment is typically required to sustain benefits.
From your experience, do people that get on these medications maintain their target weight? Should I start even if I may end up regaining the weight? Is there a way to reframe the situation that will be helpful?
People who get on these medicines generally lose a substantial amount of weight, and maintain this weight loss while they are on treatment, which should ideally be long-term. Discontinuing the medicine restores the normal underlying physiology, whereby appetite increases, satiety decreases, and over time leads to varying degrees of weight regain between individuals.
Thank you for pushing back on that, had not realized this was an unconscious assumption of mine. I understand intellectually that willpower is not “the thing” for weight loss, and am not talking about that as a muscle I can train. Instead, I would clarify that I am referring to other behavioral components (habits, valuing and preparing simple food, dedicating time to cook, eat and train). I see the underlying point though. Working on behavior does not preclude getting a prescription. If I don’t need the medication in the future will be self evident on its own.
Those are all habits that will need to be sustained regardless; research indicates that the use of medications like Liraglutide appear to increase self-efficacy and behavioral control over eating, essentially facilitating your ability to do these things rather than have to continuously exert conscious effort against increasingly powerful subconscious urges to not do those things.
That is amazing - I had indeed read that they reduce compulsive behavior, but had only connected it to cravings. I hadn’t realized it could be that broad of an effect.
things are going well, having lost about 12 kg so far while being on only 0.5 mg semaglutide weekly, with a weekly rate of weight loss of above 0.5 kg. It has been incredible. Thank you for bringing this intervention to my attention with your content! Plus, my blood pressure has started to normalize!
Are there benefits to increasing the GLP-1a dose if somebody is losing weight at a satisfying rate?