In today's media-savvy world, terms like 'ozempic' and 'saxenda' have taken the limelight, primarily due to their association with weight loss. The prevalence of obesity and morbid obesity is reaching epidemic proportions, especially in Australia, where the number of individuals exceeding the standard 'healthy weight' BMI range is surpassing those falling within it. As a medical professional, I frequently navigate two distinct dimensions during weight loss consultations. Firstly, the health aspect of weight comes into play. While it's well-established that extreme BMI levels carry health risks, what about those whose weight falls between these extremes? For instance, individuals with a BMI of 20 or 30? Research indicates that regular physical activity plays a pivotal role in determining overall health, even among larger individuals—a phenomenon known as 'fit but fat.' Studies have demonstrated that well-conditioned individuals with larger body sizes often enjoy better health outcomes than 'normal' sized individuals who aren't physically fit. I occasionally encounter larger individuals with entirely normal health parameters: normal blood pressure, biochemical markers, sleep patterns, and more. These individuals are functionally 'healthy.' Moreover, research suggests that we all have a natural weight 'set point,' implying that despite our efforts, we tend to gravitate back to this point eventually. Short-term interventions like diets, exercise, programs, and weight loss drugs validate this phenomenon. The only sustainable long-term weight loss method is invasive bariatric surgery, typically reserved for cases of severe health risks linked to morbid obesity. The second dimension I confront in consultations pertains to societal weight pressures. Even individuals fitting the 'fit but fat' description often express concerns about their weight due to relentless exposure to airbrushed or AI-generated ideal body images. Societal pressures often push us toward desiring smaller bodies, often for reasons beyond health considerations. So, how does all this tie into weight loss medication? As a general practitioner in family medicine, I often find myself on the front lines of patients seeking medication to aid in weight loss. However, matters are rarely as straightforward as they appear. Weight loss medications have been available for decades and, akin to other medication trends, they are sometimes embraced without adequate contemplation of the broader implications. Think of the opioid epidemic where pharmaceutical companies promoted opioids as an easy, side-effect-free solution, only for regions across America to be devastated by addiction. Past weight loss medications have encountered similar turbulence. Medications like phentermine, akin to speed, can elevate metabolic rates but also raise heart rates and blood pressure, potentially leading to long-term metabolic effects and increased cardiac risks. Returning to contemporary weight loss medications, it's essential to revisit the evidence. All weight loss medications, including those mentioned earlier, demonstrate short-term weight reduction. What's often overlooked is that studies show that over 95% of cases witness weight regain after discontinuing these medications, often exceeding the initial baseline. In essence, stopping the medication leads not only to regained weight but also additional kilo’s. While some may deem this risk acceptable under societal weight pressures or for special occasions like weddings, the yo-yo effect of weight fluctuations is emerging as a significant contributor to chronic inflammation, triggering various chronic conditions such as heart disease, stroke, dementia, autoimmune disorders, and diabetes. Notably, certain medications even bear black box warnings due to their potential cancer risks. At present, accessing these medications is remarkably easy. There's a proliferation of prescribers and companies profiteering from weight loss medications,, and pharmaceutical firms producing these drugs are reaping substantial profits. However, I believe the fundamental principle of medicine must be considered- "First, do no harm," echoing the words of Hippocrates.
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