With so much interest in weight loss and so much buzz around weight loss drugs, we put together some of the top questions we get in this latest Q&A blog. Here Dr. Sears answers your questions on weight loss, weight loss drugs and what he thinks is the most scientifically backed way to lose weight. See what he has to say.Question: What medical conditions could impede weight loss, and how can they be identified?
Answer: Any condition associated with insulin resistance will make it difficult to lose weight. This would include diabetes, heart disease, neurological disease, etc. Also, any drug that induces insulin resistance will also make it difficult to lose weight. These include corticosteroids and many neurological drugs.
Question: How do hormones affect weight loss, and which imbalances are most detrimental?
Answer: High levels of insulin (caused by insulin resistance), high levels of cortisol (caused by stress), and low levels of satiety hormones such as GLP-1 will make weight loss difficult.
Question: Is there a connection between sleep quality and weight loss?
Answer: Poor quality sleep increases cortisol levels that lead to insulin resistance. The higher your level of insulin resistance, the more difficult it is for any organ to remove glucose from the blood for transport into the cell, where it can be converted to energy. This i
Question: Do any weight loss supplements work?
Answer: Not really. You have to restrict calories to activate AMPK which causes your body to effectively burn excess stored body fat.
Question: What medications are FDA approved for weight loss?
Answer: There are number of approved older drugs, but the most widely used is still an old drug (Phentermine) that was only recently approved for long-term use. However, the new injectable GLP-1 receptor agonists are more powerful and more popular. The scientific name for the most well-known injectable weight-loss drug is semaglutide, which is marketed under the tradenames Ozempic and Wegovy. In simple terms, these injectable drugs activate the release of the hormone GLP-1 from the gut that goes directly to the brain to tell you to stop eating. These drugs were initially developed to treat type 2 diabetes, but the clinical studies in overweight and obese individuals demonstrated significant weight loss at higher levels.
Question: What are the unintended side effects of weight loss medications (i.e. GLP-1s, dual GIP/GLP-1). Answer: One major problem is that the lack of hunger caused by the drug makes you less likely to consume sufficient protein to maintain lean body mass. Lean body mass is defined as functional tissue such as organs (including the brain) and bone. Nearly 40 percent of the weight loss in obese patients comes from loss of lean body mass. Without adequate protein (especially on a diet that is calorie-restricted because of lack of hunger), the replacement of damaged cells is compromised. The skin and hair are the first site to suffer. This lack of protein also makes it difficult to maintain mitochondrial function that provides energy for each of your 30 trillion cells. As a result, fatigue (both mental and physical) is often experienced.
Question: Would you recommend an injectable weight loss drug?
Answer: The answer is no. There is a big difference between weight loss and fat loss. Weight loss is the combined loss of stored body fat and lean body mass (i.e., muscle). You want to lose fat but not muscle. Although the weight loss using weekly semaglutide injections is impressive according to the literature, a deeper look shows that about 40 percent of that weight loss is due to loss of lean body mass. That is not a good sign. It suggests that the injections reduce hunger to the extent that the person has little desire to eat enough protein to maintain muscle mass. In essence, the drug increases the patients' sarcopenia (muscle loss). One of the consequences of sarcopenia is increased frailty. Also once you stop using these weight loss drugs, the weight quickly returns.
Question: Does a high protein diet help with weight loss?
Answer: Most high protein diets are ketogenic diets that disrupt metabolism in addition to being high fat. The appropriate diet is protein-adequate (about 30 grams of protein at each meal), carbohydrate-moderate (primarily non-starchy vegetables, low-fat (to reduce calories) and rich in fermentable fiber. The common name for such a diet is the Zone diet. The ideal amount of protein at each meal for weight loss is about 30 grams. Less than 30 grams of protein at meal will not generate the hormonal signals from the gut to stop hunger. Too much protein at meal, greater than 30 grams, will inhibit AMPK activity which helps cells burn excess stored fat.
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