No magic bullet for the long haul

Hey there, time traveller!
This article was published 28/12/2024 (299 days ago), so information in it may no longer be current.

In the world of weight loss, everyone wants a magic pill — a quick fix that sheds pounds with the least amount of time and effort.

Enter Ozempic, the latest prescription drug making waves for its ability to help users lose lots of weight in just a few months. But what’s the real cost? And is there a better way to achieve lasting results? Or maybe it’s the missing piece some need to stay on track?

Let’s dive deeper into the science.

Ozempic (semaglutide) was originally developed as a treatment for Type 2 diabetes. It works by mimicking a hormone called GLP-1, which slows digestion and suppresses appetite.

Appetite can be a major obstacle for many dieters looking to shed pounds. For some, their appetite becomes ravenous with the slightest calorie drop and no amount of willpower helps. No doubt there’s a genetic component at play here. Plus, being overweight and overfed for a long time can break some of the internal hard-wiring that regulates how much we eat.

As effective as these medications are, they have their drawbacks. They are pricey, rarely covered by insurance for weight-loss purposes in Canada (Ozempic is only approved for Type 2 diabetes), and they can have side effects.

Ozempic may eventually be replaced by next-generation drugs of the same class, hopefully with fewer side effects. But there are still the following key downsides to consider.

Muscle loss

Studies show that up to 40 per cent of the weight lost on Ozempic comes from lean tissue — muscle, bone and other non-fat components. This looks worse on paper than it likely is in the real world, since body scans lump all of that together into the lean-mass category. But losing muscle isn’t just a cosmetic issue; it has serious health implications.

I also suspect this loss of muscle could be partially mitigated by focusing on sustainable weight loss (no more than one per cent per week of total body weight), strength training and increased protein consumption, but most users find it difficult to eat enough protein because of how full they feel.

There are many reasons to prioritize muscle.

● A 2014 study published in The American Journal of Medicine found that greater muscle mass was associated with lower all-cause mortality in older adults. Researchers concluded muscle mass is a better predictor of longevity than BMI.

● Grip strength, a proxy for overall muscle strength, has been strongly linked to mortality. A 2018 study in The Lancet found lower grip strength predicted a higher risk of cardiovascular disease, cancer and all-cause mortality.

● Muscle acts as a metabolic powerhouse, improving insulin sensitivity and glucose regulation. A 2019 study in Diabetes Care found greater muscle mass decreases the risk of developing Type 2 diabetes, a condition that significantly impacts lifespan and quality of life.

● The loss of muscle mass (sarcopenia) is a key factor in frailty among older adults, leading to reduced mobility and higher risk of falls and fractures. A 2016 review in Ageing Research Reviews noted that maintaining muscle mass through resistance training and adequate protein intake is critical for extending health-span.

● Muscle mass plays a role in modulating inflammation, which is linked to aging and chronic diseases. A 2020 study in Nature Medicine found that muscle-derived proteins (myokines) help reduce systemic inflammation and support immune function.

Side effects

Users frequently report nausea, fatigue and digestive issues. Beyond that, emerging research suggests potential risks for gallstones, pancreatitis and even thyroid tumours in isolated cases. Studies have shown GLP-1s increase resting heart rate and decrease heart-rate variability. While a small increase in a resting heart rate might not be clinically significant for healthy individuals, it could pose risks for those with existing cardiovascular conditions.

As for rate variability, it tends to decrease with GLP-1 use, which can signal added stress on the cardiovascular system.

Both higher heart rate and lower rate variability are linked to increased cardiovascular risks over time. The benefits may out-weigh the risks in obese individuals, but these heart-related side effects warrant monitoring, especially for individuals with pre-existing heart conditions.

Cost

Although out-of-pocket costs are lower in Canada than in the United States, they are still out of reach for many. Without insurance, prices are typically around $250–$400 per month for these medications. Coverage through provincial health-care plans is limited and often requires a diabetes diagnosis. For those with private insurance, coverage might include some or all of the cost, but many plans impose restrictions, such as requiring pre-approval or setting a coverage limit. And, based on the body of research, you may need to stay on the drug indefinitely to sustain results, so budget accordingly.

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I believe in transformations that last. That’s why my approach is designed to help people shed fat, build muscle and sustain results without gimmicks or extreme measures. These are the five fundamental principles we follow:

Calorie and protein-alignment control: Calories drive weight loss, but protein supports optimal body composition. Without enough protein, you risk losing muscle during weight loss. A controlled calorie deficit, while hitting an optimal protein target (0.8–1 g per pound of goal body weight), is a true “diet hack” for its effects on satiety. Protein shakes, lean meats and plant-based sources make it easy to meet these goals without feeling deprived.

Three litres of water: Staying hydrated throughout the day is essential for fat metabolism, muscle recovery and curbing hunger.

Sleep: Seven to eight hours of restorative sleep is critical. Poor sleep increases hunger hormones, like ghrelin, and reduces your body’s ability to burn fat.

Strength training: It is the antidote to muscle loss. It increases lean body mass and keeps your metabolism revving. A mix of progressive strength training three to four times a week ensures muscle gain while in a calorie deficit. Unlike cardio-heavy weight-loss plans, I like to focus on preserving muscle while dieting off body fat.

Steps: Walking is an underrated fat-loss tool that reduces stress, burns calories and supports recovery. Aiming for 8,000-10,000 steps per day is a simple, sustainable way to stay active, even on rest days.

The bottom line is healthy living is greater than any hack.

While Ozempic may be a support piece to help overcome food “noise,” such as cravings, you cannot rely solely on it or any weight-loss drug — they just put you in a position to do the work with less self-sabotage, potentially.

In a perfect world, should you explore the use of one of these drugs, you would focus on instilling the five habits listed above to build to last while using the medication to support adherence.

Drugs like Ozempic and Zepbound — assuming you can tolerate the side effects and cost — may help you get started and keep going once you build some momentum and see results.

Please consult your health-care provider before making any health-related decisions and for guidance regarding any specific medical condition.

Mitch Calvert is a Winnipeg-based fitness coach who has worked with more than 1,500 clients over the past decade. Visit mitchcalvert.com for more information.