In later life, weight loss can be a double‑edged sword. A few pounds off the joints can be both helpful and risky. Shedding a few pounds may ease joint pain, but losing weight without meaning to can be a warning sign. Fast weight loss can also lead to muscle loss, which is key to staying independent.

Experts also point out practical issues: injections need good vision, steady hands, and a regular routine. Stomach and bowel side effects can be tougher for seniors, especially if they’re already losing weight without trying. complicate life for older adults — and how to approach them with a “safety first” mindset.

1) Aging changes the risk–benefit math (even when a drug “works”)

Older adults, especially those who are frail or have several health issues, are often left out of clinical trials. This is important because average trial results may not match the real-life experience of a 75-year-old who takes several medications and needs to manage appetite and hydration.

A 2024 debate paper on GLP-1 drugs in older patients, including those with kidney disease, points out that limited trial data and multiple medications make it harder to judge safety and effectiveness for frailer seniors. Clinicians need to make decisions based on each person, not just on averages. In simple terms, the real question is not whether GLP-1s are good or bad, but whether they help this specific older person with their unique health needs.

There’s another subtle issue: in later life, the goal is often less about chasing an ideal weight and more about protecting function—walking safely, rising from a chair, maintaining balance, staying hydrated, and maintaining enough strength to live independently. So for older adults, the most important question isn’t “How much weight will I lose?” It’s “What will this do to my strength, my nutrition, and my ability to stay steady on my feet?”

2) Common side effects can become serious for older adults.

GLP-1s often cause nausea, vomiting, diarrhea, constipation, and less appetite. Younger people may find these symptoms unpleasant but manageable. For older adults, though, these issues can quickly lead to dehydration, dizziness, and falls, especially if they also take blood pressure medicines or diuretics.

Current FDA labeling for semaglutide products highlights this pathway: stomach and bowel side effects can lead to volume depletion, and acute kidney injury has occurred, including in postmarketing reports. The label advises monitoring kidney function when starting or increasing doses in people who develop severe gastrointestinal reactions, and it notes that dehydration has been part of reported kidney injury cases.

This is how many real-life problems start: a few days of not being able to eat or drink much, then feeling lightheaded, falling, or needing emergency care for dehydration. Older adults may not feel as thirsty and may have less ability to recover. So, it’s important to watch hydration, electrolytes, blood pressure, and kidney function, especially in the first months of treatment and after increasing the dose.

3) Muscle and frailty: losing weight does not always mean better health.

The headline benefits of GLP‑1s often focus on pounds lost. But the body doesn’t lose only fat. Lean mass (including muscle) can drop, too. This matters in older adults because age‑related muscle loss (sarcopenia) is already common — and it’s tightly linked to frailty, falls, and loss of independence.

A 2025 mini-review on older adults warns that starting and stopping GLP-1s repeatedly can change body composition, sometimes leading to ‘sarcopenic obesity’ — having too much fat and too little muscle. The authors are not saying to avoid GLP-1s, but to remember that weight loss does not always mean better health for older people.

More pointedly, a 24‑month retrospective cohort study in older adults with type 2 diabetes reported that semaglutide use was associated with muscle loss and functional decline, particularly at higher doses and in patients who already had sarcopenia. The authors emphasize individualized risk–benefit assessment and the need for monitoring and intervention.

If you’re reading this as an older adult, it may help to translate the research into plain questions to bring to your next appointment: “If I lose weight, how will we protect my muscles?” “How will we check whether I’m getting weaker?” “What would make us stop or change course?” An older adult who becomes “smaller but weaker” has not gained health — only risk.

4) Other complications: gallbladder, pancreas, vision, and low blood sugar

Gallbladder and bile duct problems can be an unexpected issue. Losing weight already increases the risk of gallstones, and GLP-1s seem to increase it even further. A large review found that using GLP-1 drugs increases the chance of gallbladder or bile duct disease, especially at higher doses, for longer periods, or when used for weight loss.

For older adults, this might present as sudden pain in the upper right side of the belly, nausea, fever, or pain spreading to the back or shoulder. These symptoms should be checked by a physician right away.

GLP-1 drug labels also warn about the risk of sudden pancreatitis and say to get medical help for severe, ongoing belly pain. The overall risk is low, but older adults may have additional risk factors, such as gallstones or high triglycerides. Severe belly pain in later life should always be checked quickly.

Then there’s the risk of blood sugar dropping too low. GLP‑1s don’t usually cause hypoglycemia by themselves, but the risk rises when combined with insulin or sulfonylureas. Semaglutide labeling warns that concomitant use with an insulin secretagogue or insulin may increase the risk of hypoglycemia and may require dose reductions of those agents.

In older adults, hypoglycemia can be particularly dangerous: it can cause falls, confusion, fainting, and cardiac stress. It’s also easier to miss, because symptoms may look like “just being tired” or “a little off today,” especially in someone who already has memory or balance problems.

Eyes and vision deserve special attention. Semaglutide labeling includes a warning about diabetic retinopathy complications and recommends monitoring patients with a history of retinopathy. Beyond labeling, post‑marketing safety monitoring continues to explore visual signals.

A 2025 analysis of FDA adverse event reporting data found a potentially elevated risk of vision‑impairment reports with semaglutide use compared with some other diabetes and weight‑loss medications, and it called for vigilant surveillance and further research. That doesn’t prove the drug causes vision loss in an individual patient, but it is enough to justify a cautious posture: new blurring, blind spots, or sudden changes deserve a same‑week medical call, not a “let’s see if it passes.”

5) Surgery and sedation: delayed stomach emptying can cause problems

GLP‑1 medications slow stomach emptying — one reason people feel full sooner. But that same effect can complicate anesthesia and deep sedation if food remains in the stomach despite standard fasting. A 2024 review describes the connection between GLP‑1 medications, delayed gastric emptying (including gastroparesis), and increased risk of aspiration during anesthesia, as well as possible effects on the absorption of other medications.

This issue has become important enough that several medical groups have created guidelines for surgery. The 2024 guidance says many people can continue taking GLP-1s, but doctors should look for higher-risk situations, such as people with stomach problems or other risks of food entering the lungs, and adjust plans as needed.

This is important for older adults because they are more likely to undergo procedures requiring sedation, such as colonoscopies, joint injections, cardiac procedures, dental work, or surgeries. The easiest and most often missed safety step is to tell every physician involved — surgeon, anesthesiologist, endoscopist, dentist — that you are taking a GLP-1 medication and when you last took it. Do not assume it will be clear in your medical chart.

6) A senior‑friendly “yes, with a plan” approach

If you’re an older adult considering a GLP‑1 (or already taking one), a safer approach often looks like “yes, with monitoring.” That means starting with function, not just the scale: tracking energy, steadiness, and strength in everyday life, not only pounds.

It also means treating hydration as a real medical concern. Ongoing nausea, vomiting, or diarrhea is not just part of getting used to the medicine. These symptoms can affect blood pressure and kidney function, especially when changing doses.

Because muscle matters so much in later life, protecting it should be part of the prescription. That can include discussing protein intake, adding a realistic strength plan (even chair‑based work or physical‑therapy guided resistance), and reassessing the medication if weight loss is accompanied by weakness, poor balance, or reduced stamina.

Older adults should also have their medications reviewed with a focus on preventing low blood sugar. If insulin or a sulfonylurea is being used, doses may need to be adjusted as appetite decreases and blood sugar improves.

Finally, it is important to take symptoms seriously. New stomach pain, ongoing vomiting, or sudden vision changes should be checked by a doctor right away. Before any procedure with anesthesia or deep sedation, make sure to tell the medical team about your GLP-1 use — do not assume they already know.

The GLP-1 medications can help some older adults, but there is less room for mistakes. Side effects can quickly lead to dehydration, frailty, falls, or problems during procedures. The safest approach is not just ‘yes’ or ‘no,’ but ‘yes, with a plan’ — one that protects hydration, nutrition, muscle, vision, and safety during medical care.

The post GLP‑1 Medications in Later Life: Why the “Miracle Shot” Needs a Senior‑Specific Safety Lens appeared first on Medika Life.

If you’re an adult in the U.S., you can expect to gain 10 to 25 pounds between your 20s and your 40s. Starting between ages 30 and 40, you may find losing weight and exercising more challenging. The exercise you do may not have the same effect as before. It’s not necessarily a sign that something is wrong. This weight gain in middle age—known as “middle-age spread”—is a natural consequence of aging.

“Your metabolism tends to slow down as you get older,” says NIH’s Dr. Rafael de Cabo, an expert on aging. “But your appetite and your food intake do not. So, you have a steady increase of body weight with age.”

Much of the weight gain comes in the form of fat tissue. The distribution of fat in your body also shifts. There’s less under your skin and more around your internal organs. Meanwhile, you start to lose lean muscle with age. Many people also become less active as they age, especially if they have a job that involves a lot of sitting. This can lead to further fat gain and muscle loss.

Those extra pounds have consequences beyond your clothes not fitting. The risk of many chronic diseases, such as diabetes, heart disease, and neurodegenerative diseases, goes up with age. Excess weight can further heighten these risks.

Fortunately, you can take steps to maintain a healthy weight as you age. Your diet can play a key role. Having a slower metabolism means you’ll need fewer calories. But you also want to make sure you still get all the nutrients your body needs. Get tips on healthy eating as you age.

De Cabo studies the effects of dietary changes on health and longevity. One example is intermittent fasting, in which meals are interspersed with long fasting periods. For example, you might limit eating to only eight hours per day. Studies suggest intermittent fasting may help some people to eat less and keep weight off. But De Cabo and others have been finding that it might also have benefits for your metabolism.

His work has shown that mice live longer and stay healthier when they go for long periods between meals. This was true even if they were eating the same amounts and types of foods as mice that ate whenever they wanted. Other studies have also suggested that periods of fasting may bring benefits beyond weight loss.

Physical activity is important for combating the changes that come with aging, too.

“The key is to maintain an active lifestyle,” de Cabo says. “Try to incorporate daily walks or daily visits to the gym. If you have an office job, get a standup desk, so you spend a few hours a day standing instead of sitting. Small doses of exercise throughout the day will help tremendously.”

Visit: https://newsinhealth.nih.gov/2024/10/stopping-middle-age-spread for more information.

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I was standing in my kitchen at 1:07 a.m., the only illumination a cold rectangle from the refrigerator.

It felt like a reversed Caravaggio scene. Darkness everywhere, a harsh pool of light on a plate of leftovers.

I was not hungry.

The light wired me awake. It felt like an invitation to eat.

I am a radiation oncologist.

I discuss circadian clocks with patients more often than most in my specialty because I’ve seen, over decades, how sleep, light, food timing, stress, and movement influence recovery, inflammation, and weight.

When you sit in a treatment room for a long enough time, you start to notice patterns.

People who live in bright evenings and dim mornings often struggle with appetite, cravings, and maintaining a healthy body composition.

They are swimming upstream against their biology.

This is the essay I wish someone had handed me ten years ago.

Light is not neutral.

It is a metabolic signal.

And the way we dose it each day can quietly nudge our insulin, our melatonin, our leptin and ghrelin, our brown fat, and even the clocks inside our liver and pancreas.

Let me show you how to use that to your advantage.

The Night I Realized Light Exposure Could Make You Fat.

In the clinic, I began asking a new question: not just how many hours you sleep, but how much light hits your eyes after sunset.

Most patients stared. Then came the stories: three glowing screens, bright LEDs in the bedroom, a dog walk under sodium street lamps.

Late light. Fragmented sleep.

Late eating. Creeping weight.

Our fat cells tell time. So do our mitochondria. So does your gut microbiome.

Light at the wrong time scrambles those clocks. Scrambled clocks change how you store energy.

Your Fat Has a Clock: Circadian Rhythm, Metabolism, and Weight Gain.

Every cell in your body keeps time.

Morning light anchors the master clock in your brain, which in turn syncs the clocks in your organs and fat cells.

Weak morning light and strong evening light throw those clocks out of phase.

The result is a subtle metabolic jet lag that never ends.

Quiet jet lag doesn’t show up on your calendar. It shows up on your scale.

Melatonin, insulin, and the late-night snack

Melatonin is not just a sleep hormone.

It cross-talks with insulin.

When melatonin levels are high, your ability to handle glucose decreases.

That is adaptive if you are asleep.

It is not adaptive if you are scrolling with a bowl of cereal near midnight.

Bright light at night suppresses melatonin, delays sleep, and shifts appetite later.

You wake underslept, with more ghrelin, less leptin, and a stronger drive to eat ultraprocessed food.

Rinse. Repeat.

Want to reset your metabolism?
→ Get my Micro-Habits bundle for daily light protocols, circadian checklists, and the exact scripts I give patients.

Morning light is metabolic medicine.

Ten minutes of unfiltered outdoor light soon after waking can move your circadian clock earlier, deepen your sleep that night, and improve next-day insulin sensitivity.

Morning light is rich in wavelengths your brain needs to set the day. Indoors, even bright-looking rooms are often one or two orders of magnitude dimmer than outside.

Your brain can tell the difference. So can your pancreas.

If you do one thing after reading this, step outside within 30 minutes of waking.

If it is cloudy, go anyway. If it is winter, aim longer. Treat it as you would a prescription.

Darkness is a habit

We talk about sleep hygiene.

We rarely talk about darkness hygiene.

Your retina is exquisitely sensitive to blue light, but even dim bulbs can disrupt your sleep cycle.

Swap bedside LEDs for warm, low-lux bulbs.

Set your phone to grayscale and enable a screen sunset. Cover the power lights with black tape.

Close the fridge quickly. Dim your home two hours before bed until it resembles a Rembrandt painting.

Your metabolism prefers Rembrandt over Times Square.

What I tell patients in the clinic

1. See the morning light early and consistently.
2. Eat most of your calories in the daylight zone.
3. Dim the house two hours before you want to sleep.
4. Stop eating at least two to three hours before going to bed.
5. Keep the bedroom dark, cool, and free of screens.
6. Anchor wake time seven days a week.
7. Move your body in the day, not at midnight.
8. Treat shift work like altitude. You need extra recovery, extra discipline, and a plan.

Micro-habits that fix your light diet

• Lux-before-latte rule: no coffee until you have been outside.
• Two-switch protocol: one button that turns off all bright overheads at 8 p.m., one that turns on warm lamps. Make darkness effortless.
• Yellow-card your phone: night shift mode, grayscale, and a screen curfew you respect.
• Front-load protein: bigger breakfast and lunch, smaller dinner. Your insulin sensitivity is higher earlier.
• Walk after dinner: even ten minutes blunts the glucose spike and helps your clock wind down.
• Bedroom audit: cover LEDs, use blackout curtains, move chargers to the hallway.
• Weekend consistency: Social jet lag is a form of metabolic jet lag. Keep your wake time within 60 minutes of weekdays.

The lab evidence in plain English

Animal models demonstrate that mistimed light exposure leads to weight gain, even without consuming extra calories.

Human studies have linked nighttime light exposure to a higher BMI, poorer sleep, and worse glucose control.

Shift workers have higher risks of obesity, diabetes, and some cancers.

These conditions are not destiny. They are signals you can change.

If you still want numbers

Chronobiology papers repeatedly show that eating the same calories at night causes a higher postprandial glucose and insulin response than eating them in the morning.

Timed light therapy can correct delayed sleep phase and improve metabolic markers.

Dim light at night correlates with higher rates of depression and weight gain.

Again, correlation is not causation, but the mechanisms are biologically sound.

A one-week protocol to test on yourself

Day 1 to 2

• Wake at the same time both days.
• Get 15 minutes of outdoor light within 30 minutes of waking.
• Track meals. Eat 80 percent of calories by 4 p.m.
• Dim the house lights at 8 p.m. Aim for minimal screen time.
• Sleep in full darkness.

Day 3 to 7

• Extend morning light to 20 minutes.
• Add a 10-minute post-dinner walk.
• Keep dinner smallest and earliest.
• Keep wake time strict.
• Note morning hunger and energy. By day 4, many people report fewer nighttime cravings.

How this plays out in the real world

A patient with breast cancer told me she could not lose weight despite “doing everything right.”

She tracked calories, lifted weights, and avoided ultraprocessed foods. She also answered emails at midnight under bright LED downlights and ate a second dinner at 10:30 p.m.

We moved her dinner to 6 p.m., instituted a house-wide dim at 8 p.m., added morning light exposure, and asked her to maintain a stable wake time, even on weekends.

Six weeks later, she had lost six pounds without changing her total calorie intake.

Her sleep improved. Her cravings diminished.

The scale finally listened.

The broader stakes of light exposure and weight gain

We are the first species to flood the night with light and the day with dimness.

We built a 24-hour culture and then wondered why our biology pushed back.

Weight gain is not a character flaw.

It is often a circadian mismatch.

Fix the light. Observe the effects on hunger, sleep depth, glycemic control, and weight.

Final Thoughts

Light is a drug.

Dose it wisely.

Morning heals.

Evening disrupts.

Darkness is a habit, not a switch.

If your weight has been creeping up, remember this: your first diet is not on your plate.

It is in your eyes.

→ Want my full circadian reset, daily checklists, and Micro-Habits plan? Get the Micro-Habits bundle today.

→ Follow me here on Medium for more science-backed, story-driven guides to living longer and better.

Author bio: I am a radiation oncologist who writes daily about longevity, cancer prevention, and the small habits that change health trajectories.

The post The Strange Link Between Light Exposure and Weight Gain appeared first on Medika Life.

I have about seven weeks to the competition.

This approach is my battle plan, not a quick fix.

Here are my five tips for getting rid of belly fat.

1. I Am Reducing Calories in a Smart Way

We’ve all heard the “eat less, move more” mantra, but it’s not about punishing yourself.

Generally, weight loss should lead to a drop in abdominal fat.

I target my entire body and health, not my belly in isolation.

I think of my body as an engine needing the right fuel to run efficiently.

Instead of drastic cuts, I focus on swapping out the junk for the good stuff.

The cutting phase is when I try to pile my plate with brightly colored, lean protein like chicken and fish and healthy fats from avocados and nuts.

This approach keeps me full and satisfied, which is key.

As the American memoirist, poet, and civil rights activist Maya Angelou observed,

“Nothing will work unless you do.”

And smartly doing it is even better.

2. Protein: My Belly Fat’s Kryptonite

Protein is my not-so-secret weapon.

It boosts those “full” hormones, keeping me away from the snack drawer. Less snacking means less belly fat.

I admit it’s not that simple.

I imagine protein as my body’s construction crew.

It repairs and builds muscle, which burns more calories.

As bodybuilder Arnold Schwarzenegger opined,

“Strength does not come from winning. Your struggles develop your strengths. When you go through hardships and decide not to surrender, that is strength.”

Protein helps me build that strength and, in turn, helps me shed belly fat.

3. Fruits and Vegetables: Nature’s Candy & Cleansers

Then, there is the nutrient-dense nature and fiber content of fruits and vegetables.

Fruits and vegetables keep my gut happy while filling me with fewer calories.

I think of fruits and vegetables as nature’s multivitamins.

My apologies, but I can’t resist loading today’s piece with quotes, so here is another one (from Hippocrates):

“Let food be thy medicine and medicine be thy food.”

4. Move Your Body, Change Your Body.

Small changes — like taking the stairs or parking further away — add up.

Exercise Snacks: 7 Tiny Workouts for Big Results

medium.com

However, I aim for a weekly minimum of 300 minutes of moderate activity for serious fat loss.

That’s double the standard recommendation, but I aim for a competition-ready physique.

I also incorporate HIIT (high-intensity interval training) — short bursts of intense activity — to burn calories.

HIIT and Fitness: The Verdict is In

DO SHORTER VERSIONS of high-intensity interval training improve health? Researchers have recently analyzed short…

medium.com

Think of exercise as your daily dose of energy and confidence.

You guessed it: I am going to offer another quote, this one from Muhammad Ali:

“I hated every minute of training, but I said, ‘Don’t quit. Suffer now and live the rest of your life as a champion.’”

5. Strength Training: Build Muscle and Burn Fat

Lifting weights isn’t just for building muscle; it helps shrink belly fat too.

Combining aerobic and strength training leads to the biggest reduction in visceral fat for me.

Think of strength training as building your fat-burning furnace.

Yes, I offer another quote!

Henry Ford:

“Whether you think you can, or you think you can’t — you’re right.”

So think of strength training as a way to say “I can” to a leaner, healthier you.

Bonus Tips for Maximum Impact

Finally, here are some additional things I do to get my abs ripped:

• Limit sugary drinks: Water is my best friend. I ditch the sugary sodas and juices.
• Get sugar from whole foods: An apple is better than apple juice. Fiber is my friend.
• I avoid ultra-processed foods, including crackers, chips, and frozen dinners, which contain unhealthy fats, sugar, and sodium.
• Add in healthy fats: Nuts and avocados reduce inflammation.
• Eat more probiotic-rich foods: Yogurt, kefir, and sauerkraut improve gut health.
• Limit stress: Cortisol is a belly fat magnet. Yoga and meditation may help.
• Focus on sleep: I aim for 7 to 8 hours of quality sleep.

Consistency is key.

These tips aren’t magic bullets but are a solid plan for reaching my fitness goals.

The post 5 Tips For Getting Rid of Belly Fat appeared first on Medika Life.

Over a thousand epidemiologic papers were examined, including clinical trials of weight-loss or weight-control therapies. These investigations included observational studies on cancer risk and fat excess. Because of this, the assessments focused on the dangers of being overweight rather than the benefits of preventative measures.

Studies varied in their risk assessments; most focused on adults’ body mass index (BMI), while others looked at childhood or adolescent BMI or body shape, weight or BMI changes over time, or other measures of adiposity, such as waist circumference.

The analysis considered relative-risk estimates where sufficient analyses of observational data were accessible. The absence of extra body fat, it was concluded, reduces the risk of cancer at previously described organ sites. In addition, study results point to the fact that being lean reduces the incidence of eight more cancers: gastric, cardiac, liver, gallbladder, pancreatic, ovarian, thyroid, multiple myeloma, and meningioma. Once again, however, we must understand that correlation does not equal causation. But the indicators are of concern and great interest.

If the newly introduced GLP-1 medication can control obesity, which, in turn, may reduce the incidence of cancer, researchers are now questioning whether these drugs may serve other purposes in healthcare. There is a belief that GLP-1 medication use may extend beyond obesity and weight control. What areas are they currently considering for studies with these medications?

GLP-1 for Addiction?

The World Health Organization (WHO) found that 2.6 million people die each year because of alcohol intake (or 4.7% of all deaths), and 0.6 million people die because of the use of psychotropic drugs. Men accounted for 0.4 million drug-related fatalities and 2 million alcohol-related fatalities. But while alcoholism remains a serious health hazard, there are other addictions to street or prescription drugs that are also of concern to healthcare professionals and patients.

Cocaine use disorder affects an estimated 5 million people. Worldwide, the death toll from cocaine overdoses is rising at a faster rate than that from opiate overdoses.

But there is an intriguing relationship between obesity and addiction. Substantial evidence in the literature linking obesity to substance use disorders supports a link of sorts. Studies have shown that when people are exposed to meals that are very tasty, certain hormones in the brain are triggered, which makes consuming unhealthy choices more likely.

This is analogous to what occurs in the brains of those who suffer from substance abuse disorders. Behaviors comparable to addiction to foods high in fat and sugar have led to studies employing animal models of obesity, discovering typical neurobiological features of addiction in the brain systems. The reward system that is engaged, and that perpetuates a preference for specific types of foods, may also be involved in addiction disorders.

The conclusion, currently, is that there is a viable solution for addiction through the use of the GLP-1 medications. Researchers must further investigate these specific connections and detail their interrelationships.

Since the discovery of GLP-1 medications for obesity, several off-label uses have also been shown to be useful. Researchers are actively exploring the growing number of diseases that these medications might treat, which is extremely promising.

The potential utility of GLP-1 disorders of addiction and others include: food addiction (binge eating), alcoholism, Parkinson’s disease, depression, anxiety, heart disease, hypertension, fatty liver, polycystic ovarian syndrome, chronic kidney disease, inflammation, and opiate and narcotic addictions.

Addiction regulation, inflammation reduction, dopamine pathway modulation, and insulin sensitivity are just a few of the many physiological consequences of these receptor agonists. Because of these processes, they are promising candidates for the treatment of diseases outside of their original indications.

Medical and scientific communities are highly intrigued by the prospect of GLP-1 medicines potentially treating this wide array of illnesses, but research into these uses is still in its early phases.

The future, however, appears promising as new indications come to light, and as research reveals the areas where they may be brought into a treatment regime that is successful. At this juncture, however, it is not always apparent which biological pathways are being affected and that is a remaining question for future research efforts.

The post The Weight Loss Drugs That Refuse to Recognize Boundaries appeared first on Medika Life.

Thanks to viral social media posts and constant press coverage, Ozempic and Wegovy have become almost household names, and many primary care providers face questions — some based on social media misinformation — from patients eager to give these new medications a try. The following are common questions I’m asked, and suggested context to frame a response.

• “Can you write me a prescription for Wegovy?”

Patients should understand that it’s not just a matter of writing a prescription. Obesity is a complex, chronic disease, and many interrelated factors, including genetics, environment, sleep patterns, stress, medications, hormonal imbalances, and other health conditions, need to be considered to determine the best treatment. Wegovy isn’t suitable for everyone who has obesity; there may be other, more appropriate medications. It’s also important to provide education and ongoing support for sustainable dietary, physical activity, and behavior changes. Lifestyle interventions are rarely sufficient on their own, but they’re always essential components of any effective weight management plan. A successful weight loss strategy needs to address all these factors comprehensively and in a personalized way as part of a long-term care plan. There’s no quick fix for obesity.

• “I don’t want to resort to medication. It feels like cheating. Why won’t diet and exercise work for me?”

Most people with obesity cannot lose significant weight and keep it off long-term with lifestyle changes alone. This is because weight loss triggers the body’s physiological “anti-starvation” mechanisms, leading to increased hunger and cravings and a lower metabolic rate. With obesity, the area around the hypothalamus (the energy regulatory center in the brain) becomes inflamed, interfering with feedback signals from the gut and fat cells. Anti-obesity medications address these underlying dysregulated hormonal and metabolic pathways. Semaglutide, for example, mimics the GLP-1 hormone, which helps people feel full sooner after eating and slows the passage of food through the gastrointestinal tract. It targets areas of the brain that control appetite and influence eating decisions. Other anti-obesity medications work differently, but they all help the body overcome its anti-starvation responses to enable weight loss and weight maintenance.

• “Are the horror stories about Ozempic’s side effects — abdominal pain, constipation, diarrhea, and vomiting — typical? I don’t want to feel miserable.”

These are known adverse events associated with semaglutide, and it’s to be expected that as more and more people take these medications, we hear more about the side effects, including the rare ones. Symptoms may be worse when the medication is not used appropriately — if the dose is too high or it’s escalated too quickly, if the medication is prescribed without adequate screening (for example, to identify people who have risk factors for these symptoms), or if patients aren’t given the necessary education and support (dietary and behavioral modifications can minimize symptoms). When best practices are followed, patients generally tolerate semaglutide well.

There’s a risk-benefit calculation when prescribing any medication, of course, but for people with a high BMI, who face elevated risk of many serious weight-related conditions, the benefits may outweigh the risks.

• “What about aesthetic changes? I’ve heard about ‘Ozempic face.’ Will my skin get saggy?”

Loose skin is common with major weight loss, regardless of how it’s achieved, especially if the weight is lost rapidly. But this aftereffect is highly variable, with age, diet, and genetics among the factors that play a role. Some people lose 100 pounds and have no loose skin, and others develop a significant amount of loose skin after losing much less weight.

It’s important to note that weight reduction involves the loss of muscle as well as fat, so I always recommend and regularly encourage  patients to incorporate strength training into their weight management program in order to maintain as much lean body mass as possible.

• “How long will I need to take Wegovy?”

Patients should expect to take the medication for the foreseeable future. Obesity is a chronic disease., We don’t counsel patients with other chronic illnesses about weaning medications once their condition is controlled. When a person with diabetes stops taking an antidiabetic medication, we expect blood sugar to increase. And when someone with high blood pressure stops taking an antihypertensive medication, we expect blood pressure to rise. Obesity is the same. The FDA has approved these medications for long-term use for this reason. Weight gain isn’t just possible after stopping an anti-obesity medication discontinuation, it’s expected.

• “Why doesn’t my insurance cover Wegovy?”

For years, weight loss was considered strictly “cosmetic,” and obesity was attributed to individuals’ poor lifestyle choices. Today, most industry players — including insurers — recognize that obesity is a complex, chronic disease. But the new anti-obesity medications are extremely costly, especially considering the huge number of potential users (more than 42% of U.S. adults have obesity).

Access needs to improve, and it needs to improve dramatically, but simply handing out GLP-1 prescriptions left and right isn’t the answer either.

A comprehensive approach to weight management can improve health outcomes for more than 200 other conditions that obesity causes or worsens, from high blood pressure and type 2 diabetes to sleep apnea and certain types of cancer. It makes more sense — in terms of both patient health and economics — to treat the underlying obesity directly rather than waiting for these preventable obesity-related diseases to develop.

Now that we have a critical mass of patients taking these new, highly effective medications, we will have more comprehensive data demonstrating the mortality benefits of anti-obesity medications. For example, results from Novo Nordisk’s landmark SELECT trial, a five-year cardiovascular outcomes trial of Wegovy compared to placebo in individuals with overweight or obesity, recently found that semaglutide reduced the risk of major adverse cardiovascular events (heart attack, stroke, and cardiovascular deaths) by 20 percent. With this evidence from the SELECT trial, improved insurance coverage should be next.

• “If my insurance doesn’t cover semaglutide, are there alternatives?”

Semaglutide is an important part of our anti-obesity armamentarium, but we don’t automatically prescribe it to everyone who qualifies. Other options include Contrave, Saxenda, and Qsymia, for example. Any anti-obesity medication needs to be selected in the context of a comprehensive individualized evaluation and prescribed as part of a personalized treatment plan. Depending on a patient’s specific situation and risk factors, I prescribe many medications that are considerably less expensive than semaglutide, and individuals on these medications are still able to lose a significant amount of weight. Everyone’s situation is different, and individuals respond to different medications in different ways. Obesity is not a simple disease, and there’s no one medication that’s right for everyone.

• “What about supplements like berberine? Some people are calling it ‘nature’s Ozempic.’ Is it worth trying?”

I caution my patients about dietary supplements for weight management because we don’t have high-quality evidence demonstrating efficacy. Worse, the lack of regulatory oversight in the supplement market makes it challenging to know exactly what’s contained in any given product. The actual amount of berberine could be different from what’s claimed, and other undisclosed ingredients could be included as well. For example, some dietary supplements have been shown to contain amphetamines or anti-obesity medications that have been withdrawn from the market.

• “What about compounded semaglutide? Is it safe?”

When patients present to me on compounded semaglutide, I recommend that they stop. As with dietary supplements, these drugs are not regulated. We have no idea what the products contain, what the actual dose of the active ingredient is, or whether the product has contaminants. The FDA has issued a warning about compounded semaglutide.

• “I’m having surgery next month. Is it true that I need to suspend my Wegovy?”

Because GLP-1 receptor agonists are associated with increased risk of nausea, vomiting, and delayed gastric emptying, the American Society of Anesthesiologists recently issued guidance suggesting that individuals who take these medications daily should stop the medication the day of the surgery, or, if they take them weekly, hold the dose the week before surgery. People who are taking these medications for diabetes in addition to weight management may need to consult with their endocrinologist to identify an alternative diabetes medication to bridge the gap.

Wegovy and the other anti-obesity medications in the pipeline that are even more promising are and will be extremely important agents in our armamentarium, but successful weight management requires more than just one medication in isolation. Media coverage of these new medications sometimes creates the impression that obesity is a simple disease that can be treated with a one-size-fits-all, short-term approach. In reality, however, obesity is, a complex, multifactorial, relapsing chronic disease, and treating it requires a comprehensive evaluation and a customized treatment plan with education and long-term support.

The post Are Your Patients Asking about Wegovy? appeared first on Medika Life.

In fact, work has shown that, for individuals with depression, resetting their circadian rhythm through sleep deprivation may address their depression. This is interesting since we now know that the gut is also responsible for much of our emotional life.

Researchers discovered that sleep deprivation has a major impact on the composition of the gut microbiome. The lack of sleep might cause a bacterial imbalance in the gut, which may result in digestive disorders and other health issues. Now the research related to sleep and physical or emotional well-being has also entered the world of work where shift workers have been seen as more vulnerable to certain ailments because of their circadian disruption, but it might also be something in their gut.

The gut microbiome can affect sleep quality, and abnormalities in gut health may cause sleep disturbances. It has been noted that “…the gut microbiota (GM), a vast and extraordinarily complex ecosystem located in human gastrointestinal tract that oversees an array of critical bodily functions, has become a popular focus among researchers.” And one of the areas of interest is this sleep relationship.

The gut-brain axis, a network of communication between the gut and the brain, is crucial for controlling sleep. The relationships between the gut microbiota and the brain shed light on how the gut might affect sleep-wake cycles. And disorders including irritable bowel syndrome suffer from diminished sleep quality, which may be a two-way street between cause and effect.

Research highlights the impact of circadian rhythm disruption on gut health. Circadian disruption alters the microbiota in the gut and speeds up the pathogenesis of inflammatory bowel disorders, according to studies. In fact, it might be the microbiome that stabilizes circadian rhythm.

The connection between sleep and intestinal health is intricate and intertwined. Both sleep deprivation and gut health abnormalities can affect the composition of the gut microbiota. The circadian rhythm and the gut-brain axis both play significant roles in moderating this reciprocal link. For general health and well-being, it’s essential to take care of both gut health and sleep quality.

The post Sleep and Your Gut Could Be Doing Battle Against You appeared first on Medika Life.

We also classify several specific feeding or eating disorders as eating disorders, and they include pica, rumination disorder, avoidant/restrictive food intake disorder, and others. Although we think of pica as primarily associated with infants and toddlers, there are adults who consume non-nutritive substances such as clay, corn starch or laundry starch. According to medical professionals, a diet lacking in particular nutrients is the root cause of the desire to eat laundry starch.

According to the National Eating Disorders Association, anorexia, bulimia, and binge-eating disorders affect about 30 million people in the United States. Also, it is estimated that 28.8 million Americans, or 9% of the country’s population, will experience an eating problem in their lives.

A recent study of 12,000 teenagers ages 13 to 18 found that almost 4% of teenage girls and 1.5% of teenage boys have eating disorders. Also, according to a survey of 9,282 individuals, roughly 10 million men and 20 million women in the United States have an eating disorder that is clinically serious in their lifetime.

It is crucial to remember that not everyone who has an eating problem has a medical diagnosis of being underweight; in fact, less than 6% of eating disorder sufferers have this diagnosis. Genetic heredity also affects the risk for eating disorders, with 28–74% of the risk being genetic.

Overall, eating disorders are serious problems that can endanger a person’s health, emotions, and ability to do basic things that are necessary for life. It’s critical to get professional help if you or someone you love is dealing with an eating disorder in order to recover and control symptoms.

But now we also have to deal with avoidant/restrictive food intake disorder (ARFID) and atypical-type anorexia nervosa (AN), which are two more types of unusual eating. ARFIDs are mainly characterized by a clear lack of interest in food, avoiding food products because of their color, shape, or packaging, or avoiding food because of phobic-like symptoms, such as after-choking episodes.

ARFID, or avoidant/restrictive food intake disorder, makes it difficult to meet one’s nutritional and/or energy needs and results in at least: nutritional deficiencies, weight loss or failure to gain the right amount of weight, a need for enteral feeding or nutritional supplements, or significant disruption of daily activities.

Psychological symptoms of ARFID include avoiding or limiting certain foods or textures, feeling anxious around mealtimes, being sensitive to sensory input, being afraid of choking or throwing up, and other things.

People with ARFID may wear layers to hide weight loss or stay warm. They may also complain of constipation, abdominal pain, cold intolerance, lethargy, and/or too much energy, and they may have recurring gastrointestinal problems (upset stomach, feeling full, etc.) around mealtimes for no known reason.

Some people with ARFID may also show signs of anorexia nervosa, like worrying about their body size and weight, avoiding meals with a lot of calories, being against being fat, and having a bad body image that isn’t distorted.

It’s crucial to remember that ARFID can manifest in people of all ages and may share characteristics with other eating disorders like anorexia nervosa. In cooperation with a healthcare practitioner, a proper diagnosis and treatment strategy should be created.

The post Another Eating Disorder or Is This Diagnosis Gone Wild? appeared first on Medika Life.

Mirrors can play a destructive role in a psychiatric disorder, too. Known as body dysmorphic disorder (BDD) it affects how people view their own bodies and appearance. We sometimes refer to it as a somatoform disorder, which is a subtype of OCD. When someone has BDD, they focus too much on what they think are flaws in their appearance. This can have a negative effect on their lives and overall mental and physical health.

In samples that aren’t from a clinical setting, the rate of BDD is between 0.7% and 13%. It is called an obsessive-compulsive anxiety-linked condition and 1.7% of the general population has it at some point in their lives. Regardless of age, gender, or race, BDD can affect anyone.

An obsessive focus on a particular bodily part or feature, like the skin, hair, or nose, characterizes BDD symptoms. We’ve seen people become “addicted” to plastic surgery, hoping they will find that perfect body that eludes them. People with BDD can spend hours every day watching themselves, grooming themselves, or comparing themselves to others. They might avoid social situations, have trouble with anxiety or sadness, and do things like pick at their skin or groom themselves too much.

A mix of treatments and medications is frequently used to treat BDD. Cognitive-behavioral therapy (CBT) is the most effective way to treat BDD. The goal of CBT is to lessen the obsession with physical appearance and improve overall functioning. Exposure and Response Prevention (ERP) is another type of therapy that teaches the person how to control their urges while gradually exposing them to their fears. The most frequently given drug for BDD is an SSRI because research has shown that it is useful in easing the symptoms of anxiety and depression. But there’s an even greater risk these individuals may face.

People with body dysmorphic disorder (BDD) run a serious risk of suicide. Several studies have found that people with BDD are significantly more likely to consider suicide. One in four or more people with BDD report having tried suicide, and over 80% of individuals with BDD report having had suicidal thoughts. We know nothing about why BDD patients are more likely to commit suicide, although we know of its link to higher suicidality. In emergency psychiatric care, there’s evidence that BDD can contribute to a patient’s condition deteriorating.

Suicidality should be thoroughly evaluated and tracked in people with BDD as it is a major worry in this community and affects how people perceive and feel about their own bodies and looks. This makes people think and feel disturbing thoughts, which can seriously disrupt their lives and put their emotional and physical health at risk. It is also important, as mentioned above, to keep in mind that people with BDD may also have comorbid disorders, such as eating disorders, which can worsen suicidal thoughts and actions.

And remember one other thing. Not all mirrors are created equal. Quality mirrors give a more accurate reflection, but people with BDD will always see a distorted image of themselves in their minds, no matter how good the mirror is.

The post Mirror, Mirror on the Wall, I Hate You and the Way I Look! appeared first on Medika Life.

I worked with Allison to develop an individualized treatment plan that addressed nutrition (she wanted to adopt the Mediterranean diet since it seemed sustainable), exercise (we identified several forms of physical activity she enjoyed that fit her schedule) and behavior modification (for example, we shifted her meal timing earlier and discussed techniques to avoid stress-eating). As part of this plan, we also started on metformin, a great option in cases like hers, because it can help with weight loss, it can help restore ovulation, and it is generally considered safe to take during pregnancy.

After a few months, Allison had lost 20 pounds and she began to ovulate; however, she had not yet conceived so she elected to start fertility treatment.

This meant her weight management program would be even more critical.

Weight gain associated with fertility treatment

Since hormones affect weight, hormonal therapy to enhance ovulation (whether pills or the multiple shots that the in vitro fertilization process entails) often leads to weight gain. This gain can be significant, especially for patients with insulin resistance and patients who, like Allison, have overweight or obesity.

While we don’t want to add to patients’ anxiety during the stress of fertility treatment, it is important for us as providers to be mindful of the potential for weight gain. Fertility-treatment-related weight gain can have a long-term impact because successful treatment means pregnancy — and thus pregnancy weight gain — and it’s often difficult to lose the cumulative excess pounds afterward. For women with multiple pregnancies, the extra weight can add up quickly. One of my patients, for example, gained 70 pounds with her first pregnancy and then lost only 20 pounds before conceiving again. She presented to me during her second pregnancy, and we’re working on strategies to avoid excessive weight gain this time.

Excess weight is associated with various health complications during pregnancy, including hypertension, diabetes, obstructive sleep apnea and preeclampsia, as well as an increase in the child’s risk of congenital anomalies. Women’s healthcare providers often hesitate to bring up the topic of weight, but both mother and baby could benefit significantly if more fertility specialists and OB-GYNs (nonjudgmentally) asked patients’ permission to discuss the issue — and then monitored their weight at appointments and took appropriate action as needed.

Managing weight during fertility treatment

Cases like Allison’s are extremely common, so it’s important for women’s healthcare providers of all kinds to be aware of the options and limitations of weight management during fertility treatment. Most anti-obesity medications are off the table for patients during this time, but there are still a number of steps practitioners can take to help their patients avoid excessive weight gain:

• Optimize lifestyle interventions. Dietary strategies, physical activity and recommended behavioral modifications may be more effective when tailored to the patient’s specific lifestyle. Referrals to outside resources, such as a dietitian or behavioral therapist, for instance, can be great options if additional support is needed.

• Address other contributors to weight gain. Stress, lack of sleep and many factors unrelated to the conventional diet-and-exercise combo contribute to weight gain, and all of these contributors may be in play during fertility treatment. Patients benefit from a personalized plan that addresses these as well.

• Assess for drug-induced weight gain. Many medications are known to promote weight gain, so consider pausing these medications or reducing the dose during fertility treatment, if possible, when substitution with weight-neutral agents isn’t an option. Critical medications obviously need to be maintained, but a risk-benefit analysis might suggest that others should be discontinued.

• Consider prescribing metformin. Some gynecologists and reproductive endocrinologists may be comfortable prescribing the diabetes medication, metformin, for patients with overweight, obesity or insulin resistance, or for those at high risk of weight gain. In addition to improving insulin sensitivity and helping to balance hormones, metformin is a weight-loss-promoting medication and can thus help decrease weight gain associated with fertility treatment.

• Refer to an obesity medicine specialist. While we generally can’t use anti-obesity medications during fertility treatment, patients may benefit from a comprehensive medical evaluation and a personalized treatment plan. A thorough plan is particularly important when a patient is unable to conceive quickly and undergoes fertility treatment for a prolonged period. (I currently have one patient, for example, who has gained 40 pounds over the course of seven months of fertility treatments and still isn’t pregnant.)

Supporting better outcomes for mother and child

Women with overweight or obesity who plan to become pregnant are often counseled to lose weight before trying to conceive, both to enhance fertility and to reduce the risk of health complications for themselves and their babies. This recommendation often becomes more explicit before a woman begins fertility treatment — and obesity medicine specialists like me receive many referrals at this juncture.

The more time we have to treat a patient’s obesity beforehand, the more we can do, of course, but we can still help even after treatment begins. While managing weight during fertility treatment is a challenge, it’s not a lost cause. Taking steps to counteract the potentially weight-promoting effects of hormone therapy can significantly impact the health of the woman and her future child. This is a challenge that impacts many generations to come. We can do this together!

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