Podcast Review: Weight Loss Drugs: Are they a cure all? With Dr. Lustig

Dr. Robert Lustig speaks on the San Fransisco Experience podcast about the new weight loss drugs being used throughout the United States. The three main drugs being used are: Ozempic, Mounjaro, and Wegovy.

It should first be noted that rates of obesity continue to surge throughout the United States and is one of the leading risk factors in chronic diseases such as type 2 diabetes and cardiovascular disease. Dr. Lustig states that obesity is caused by gluttony and sloth, aka overeating and not exercising.

However, this is not the only problem, it has been found that insulin is a major culprit in weight gain as well. They have found that decreasing insulin levels within the body causes a decrease in intake (related to lower cravings, better satiety, etc.) as well as a spontaneous increase in exercise (likely related to feeling less tired, more energized, and being in a state of burning calories rather than storing).

But, again that is not the only problem. Ultra processed foods are the major culprit behind increased insulin levels and obesity. An estimated 73% of items in grocery stores are ultra processed and 67% of our added sugar intake comes from these ultra processed foods.

Ultra processed foods are those that can not be made at home using standard cooking practices.

These ultra processed foods are high in added sugars and low in fiber. Fiber is what feeds the gut microbiome, aka the good bacteria in our intestines that help break down food so we can absorb it. When we don't eat enough fiber the bacteria starves and turns to eating the gut itself, this causes inflammation within the gut and subsequent gut diseases (such as inflammatory bowel disease, celiac disease, leaky gut syndrome, etc). The second problem of ultra processed foods is too many added sugars. Added sugars are metabolized the same way as alcohol, which kills our mitochondria. This is causing rising rates of alcohol related diseases such as liver disease in children (as well as adults).

So what does this have to do with weight loss drugs?

Weight loss drugs are proving to be effective, in both adults and children. There is an average weight loss of about 16% over 1 year using these drugs.

Dr. Lustig states,

"In the right hands, for the right patient, in the right venue these can be good". -However, we don't know all these factors yet.

There are 3 major problems with these weight loss drugs.

Physiological Effects: the drugs work by slowing down gastric (stomach) emptying, which means that the user can no longer eat as much. With this decreased intake they are burning their energy stores more rapidly.

The problem: Both muscle and fat are lost at the same time, in equal amounts. Muscle mass predicts longevity and it is not good to lose muscle mass, this puts added stress on the body.

2. Side Effects: slowing down gastric emptying causes foods and liquids consumed to be held in the stomach for longer periods of time, this can lead to nausea and vomiting. The FDA has also recently put out a warning that the drugs are causing gastroparesis in many users. Gastroparesis means the stomach is not moving. Digestion of food relies on the movements of the stomach to break down foods and move it along in the intestines for further breakdown and absorption.

The bigger problem: the gastroparesis does not always stop when the user stops taking the weight loss medication. It is unknown how long the condition will last. This means that people may have to turn to artificial nutrition such as feeding tubes or parenteral nutrition (nutrients given through IV) to provide essential nutrients.

3. Economic Effects: it has been estimated that if every person that needed the drugs in the U.S. received them it would cost $2.1 trillion. The drugs are wildly expensive and not often covered by insurance. This is causing the people that could truly benefit from them not to be able to gain access while people in Hollywood, who do not actually need them, are using them up and jacking up the prices.

The problem: if everyone in the U. S. simply lowered their sugar intake to the recommended guidelines there could be an estimated $3.1 trillion savings. So this drug would cost $2.1 trillion and distract researchers, professionals, and decision makers from the actual underlying problem which is ultra processed foods that are causing these diseases and more.

Overall, Dr. Lustig seems to believe that these drugs have a potential use within healthcare, however the current use is not responsible. The bigger driver in health would be to reduce sugar and improve our quality of food which would result in better health outcomes and less healthcare costs.

To listen to the full podcast and more on Dr. Lustig's book Metabolical go here.

Written by: Meghan Hawley, RD