Reviewed by Shilpa P. Saxena, MD of Forum Health Tampa
GLP-1 weight loss medications take center stage with the queen of daytime television returning to the big screen to address obesity as a disease and the medications taking the industry by storm.
At a Glance:
- Forum Health Chief Medical Officer Dr. Shilpa P. Saxena responds to Oprah Winfrey television special – watch video.
- Obesity is a disease, and GLP-1 medications reduce associated health risks.
- Functional medicine uses epigenetics to ensure long-term, medication-assisted weight loss results.
In case you missed it, Oprah Winfrey returned to television to launch a special episode addressing all things weight loss. In An Oprah Special: Shame, Blame and the Weight Loss Revolution, Oprah had doctors, patients and experts on for a conversation into the drugs revolutionizing the weight-loss industry.
The prescription medicine taking center stage? Semaglutide. A GLP-1 medication, or glucagon-like peptide-1 receptor agonist, made popular under the brand name Ozempic.
Glucagon-like peptide-1 receptor agonist medications work by mimicking the action of a hormone called GLP-1, which is normally released by the intestines in response to food intake. It helps regulate blood sugar levels, improves insulin sensitivity, and reduces appetite, which can lead to weight loss in some people. These medications are typically used in combination with diet and exercise to help control blood sugar levels in people with type 2 diabetes. Read more about GLP-1 medications.
Forum Health’s Chief Medical Officer Dr. Shipla P. Saxena responded to Oprah’s special on Forum Health’s social media to highlight what she got right and to expand on the genetic component affecting obesity through a functional medicine lens.
Obesity is a Disease: Getting the Facts
It’s no surprise that this topic has gained such popularity with the World Health Organization (WHO) reporting alarming global obesity facts:
- 1 in 8 people living with obesity
- 890 million adults living with obesity
- 160 million children living with obesity
And the Centers for Disease Control and Prevention (CDC) categorizing obesity as a disease in 2013 to emphasize its complex nature and its health risks, such as type 2 diabetes, heart disease, stroke, and certain types of cancer.
Oprah says, “the number one thing I hope people come away with is that it’s a disease. It’s in the brain.”
Emphasizing further what doctors and health organizations have been recognizing for years. There is more to obesity than choosing to lose weight. Factors from environment, socioeconomic status, and genetics all play a role in your likelihood of developing obesity.
GLP-1 Medications Reduce the Health Risks Associated with Obesity
With so many people having success with these medications, it’s clear that weight loss is only the beginning. Once you understand obesity as a disease, it is clear how GLP-1 medications can help mitigate obesity risk factors by doing the following:
- Appetite Reduction: This effect is thought to be mediated through the central nervous system, where GLP-1 receptors are present in areas that regulate appetite and food intake.
- Slowed Stomach Emptying: Regulating the absorption of nutrients and glucose, leading to improved blood sugar control and potentially aiding in weight loss.
- Improved Insulin Release & Sensitivity: Stimulating the pancreas to release more insulin, making it easier for fat and liver cells to aid in regulating blood glucose and insulin resistance.
- Weight Loss: Reducing the risk of obesity-related complications such as heart disease, stroke, and type 2 diabetes.
- Cardiovascular Benefits: Reducing the risk of heart attack, stroke, and cardiovascular-related death.
In her video, Dr. Saxena highlights that simply being overweight alone is not the whole issue. It is the storage of excess adipose fat that triggers an inflammatory response in the body, drives other diseases, and increases health risks. Read more about the risk factors of obesity.
Further, Oprah validates a key point that Dr. Saxena echoed - “It’s not your fault.”
A vital component of this dialogue was the emphasis on the shame that is put on those struggling with weight loss resistance and obesity.
Weight loss resistance is an inability to achieve significant or sustained weight loss, even with traditional weight loss methods like diet and exercise. It is often attributed to underlying metabolic issues, hormonal imbalances, genetic predispositions, or other health conditions. Watch this Masterclass to learn more about weight loss resistance.
Dr. Saxena acknowledges that obesity is a complex issue influenced by a variety of factors, including lifestyle, genetics, and even addiction tendencies. She emphasizes that there is a genetic propensity to store fat, which can make weight management more challenging for some individuals.
So, it is not simply a lack of willpower or not wanting to lose weight bad enough.
The Functional Medicine Approach: Epigenetics, Lifestyle and Obesity Medications
In her special, Oprah attributes obesity and what makes losing weight so hard to the “fat gene” – Dr. Saxena explains this further as the study of epigenetics in functional medicine.
Epigenetics is the study of changes in gene expression that do not involve alterations to the underlying DNA sequence. These changes are influenced by environmental exposures, lifestyle choices, age, and more. Epigenetic modifications can affect how genes are turned on or off, which can have a profound impact on health and disease risk. Understanding epigenetics is important because it provides insights into how environmental and lifestyle factors can interact with your genes to influence health.
Genes may predispose you to obesity, however, it is often the environment that determines when and how it is expressed.
“In functional medicine, we look at the science of epigenetics,” says Dr. Saxena. “We understand that genes are not our destiny, but rather a blueprint that can be influenced by our environment and lifestyle choices. This means that even if you have a higher chance of becoming obese due to your genetic makeup, functional medicine can help you navigate your best options for managing your weight.”
What did the Oprah special miss? Putting a greater emphasis on these lifestyle factors that contribute to the development of weight-loss resistance and obesity.
Functional medicine addresses the root causes of disease, rather than just treating symptoms. And our providers approach obesity from a holistic perspective understanding that this disease is rarely the result of only one thing. Rather, a collection or buildup of many factors manifesting as illness.
Where there’s weight-loss resistance and obesity, there is often also:
- Insulin Resistance: impairs the body’s ability to regulate blood sugar levels, leading to increased fat storage
- Hormonal imbalances: disrupt the metabolism and can lead to increased fat storage, particularly in the abdomen
- Inflammation: can interfere with hormone signaling and metabolism regulation
- Gut Health Imbalance: can lead to inflammation and insulin resistance
- Toxic Burden: can disrupt metabolism and hormone function
- Nutrient Deficiencies: can slow metabolism and reduce energy levels
- Stress and Mental Health: can lead to overeating or poor food choices, and decreased motivation
“There are many factors many factors that you can control that can contribute to weight gain and obesity,” says Dr. Saxena. “By understanding these factors and addressing them through a holistic approach, we can work towards improving your health and well-being.”
Based on a comprehensive evaluation of your health history, genetic predispositions, and lifestyle factors our Forum Health providers can customize a medical weight loss program that doesn’t solely rely on medication but uses it as part of your integrative treatment plan to overcome obesity.
Dr. Saxena’s response to the Oprah special underscores the importance of taking a compassionate and science-based approach to understanding and treating obesity. By recognizing the complex interplay of genetic, environmental, and lifestyle factors, functional medicine offers a path towards sustainable weight management and improved overall health.
