Perfect Transformation

My latest, published ahead of print in the Canadian Journal of Cardiology looks briefly at the historic failure of public health to move the needle on chronic non-communicable diseases like obesity, and its historic opportunity now to find some success. And it's not just public health's failure. As I've noted in the past, there has never been any diet or intervention, demonstrating reproducible, clinically meaningful, sustained and durable weight loss in even a study group, let alone one scalable to a population. That said, suddenly we find ourselves with an intervention that does in fact lead to very meaningful sustained average weight losses - obesity medications - and they just keep getting better and better (google retatrutide). Bringing me to my two key points: 1. Traditional public health interventions targeting food and fitness behaviours, even when supported by regulations targeting those same behaviours, are unlikely to lead to any demonstrable impact upon obesity rates. 2. If interventions designed to support the use of current obesity medications were deployed, we might reasonably expect to see both obesity rates decline and increased impact of existing food and fitness behaviour interventions. Full text available online (at least for now)

https://onlinecjc.ca/article/S0828-282X(25)00191-6/fulltext?fbclid=IwY2xjawKFoplleHRuA2FlbQIxMQABHigVTo-6ExaN_0akrQk8nlJeIdccga2um74b8CkOwFwkM9R3NQVhSYjT2DN7_aem_zAcg8GOv81YLdJtd_eYSzQ

Obesity and Public Health—Dare We Have Hope? Despite its best efforts, public health has yet to unlock the combination of policies and programs capable of turning the tide of obesity and other diet-responsive chronic noncommunicable diseases (cNCDs). Add to this the fact that a durable, exclusively behavioural, clinically meaningful, reproduci...

GLP-1 (Glucagon-Like Peptide-1) is a naturally occurring peptide hormone with multiple physiological roles in the human body, primarily related to insulin secretion, blood sugar regulation, and weight control. The effects of GLP-1 are closely tied to glycemic control and gastrointestinal function, making it highly relevant for the treatment of diabetes and obesity.

Key Effects of GLP-1:

Stimulates Insulin Secretion: GLP-1 enhances insulin release after meals, particularly when blood glucose levels are elevated, helping to lower postprandial blood sugar.

Delays Gastric Emptying: GLP-1 slows the emptying of stomach contents, promoting satiety and reducing food intake.

Suppresses Appetite: GLP-1 acts on the brain's satiety center to decrease hunger, which is a key mechanism for weight loss.

Regulates Blood Sugar: It effectively controls postprandial glucose by increasing insulin and reducing glucagon secretion.

Improves Fat Metabolism: GLP-1 has been shown to promote fat oxidation and may contribute to weight loss.

GLP-1-Based Medications:
Due to its benefits, GLP-1 receptor agonists are widely used to treat type 2 diabetes and obesity. These drugs mimic GLP-1 to enhance insulin secretion, reduce appetite, and accelerate fat metabolism.

Common GLP-1 medications include:

Liraglutide: Saxenda (for weight loss) and Victoza (for diabetes).

Dulaglutide: e.g., Trulicity.

Semaglutide: e.g., Ozempic and Wegovy, a highly effective GLP-1 agonist recently popularized for weight loss and diabetes management.

GLP-1 and Weight Loss:
GLP-1-based therapies have demonstrated significant weight loss effects, particularly in obese and type 2 diabetic patients. By naturally reducing calorie intake through appetite suppression and delayed gastric emptying, they facilitate sustainable weight reduction.

Side Effects of GLP-1:
While beneficial, GLP-1 medications may cause adverse effects, especially during early treatment. Common side effects include:

Nausea and vomiting (particularly at initiation)

Diarrhea or constipation

Abdominal discomfort

Hypoglycemia (especially when combined with other glucose-lowering agents)

Conclusion:
GLP-1 analogs have proven highly effective for type 2 diabetes and weight management. However, their use should be monitored by healthcare providers to ensure safety and efficacy.