Everything You Need to Know

If you live in a larger body, sometimes it feels like you can’t win.

If you don’t lose weight, people will criticize you for being “lazy,” “unhealthy,” or “lacking willpower.”

But if you take medication to help you, you’ll be criticized for “cheating” or “taking the easy way out,” even if you’ve tried for decades to manage your weight through diet, exercise, and lifestyle changes (sometimes extreme ones).

In this article, we’ll be talking about a highly contentious group of medicines—GLP-1 receptor agonist drugs such as semaglutide (Ozempic, Wegovy, Rybelsus) or tirzepatide (Mounjaro, Zepbound).

And people have lots of opinions about them.

But the opinion that matters most? Yours.

At PN, we’re medication agnostic.

We’re not here to judge whether a person should or should not take medication for weight loss. Ultimately, that’s a choice left up to you, with the guidance of your primary care physician.

Either way, we’re here to support our clients and elevate their results.

Whether you take medication or not, a coach can help you optimize nutrition and satiety with the right foods, find exercises that work with your changing body, and help you navigate the emotional ups and downs that come when you attempt to tackle a big, meaningful, long-term goal.

However, we also understand that if you’re debating the pros and cons of beginning (or continuing) medication, you might have mixed feelings.

If you’re not sure if these new medicines are right for you, we have your back. In the following article, we’ll give you the honest, science-backed information you need to make a confident decision.

You’ll learn…

• Why it’s so hard to lose (and keep off) fat
• Why taking medication isn’t “cheating,” nor is it the “easy way out”
• How GLP-1 drugs work, and the health benefits they can have (aside from weight loss)
• How to determine if you’re at a “healthy weight” (it’s not just about BMI)
• What actions you can take to minimize side effects and maximize long-term health, if you do decide to take these medications

Let’s begin.

First, why is it so hard to lose fat?

Fat loss is hard. Period.

But for some people, it’s harder still—because of environmental, genetic, physiological, social, cultural, and/or behavioral factors that work against them.

Here are a few of the contributing factors that can make fat loss so challenging.

We live in an environment that encourages a caloric surplus.

Imagine life 150 years ago, before cars and public transit were invented. To get from point A to point B, you had to walk, pedal a bicycle, or ride a horse.

Food was often in short supply, too. You had to expend calories to get it, and meals would just satisfy you (but not leave you “full”).

Today, however…

“We live in an obesogenic environment that’s filled with cheap, highly-palatable, energy-dense foods [that make overeating calories easy, often unconsciously],” says Karl Nadolsky, MD, an endocrinologist and weight loss specialist at Holland Hospital and co-host of the Docs Who Lift podcast.

“We also have countless conveniences that reduce our physical activity.”

Of course, even in such an environment, we have people in lean bodies, just as we have people who struggle to stop the scale from continuously creeping up.

Why?

Genetically, some people are more predisposed to obesity.

Some genes can lead to severe obesity at a very early age. However, those are pretty rare.

Much more common is polygenic obesity—when two or more genes work together to predispose you to weight gain, especially when you’re exposed to the obesogenic environment mentioned earlier.

People who inherit one or more of these so-called obesity genes tend to have particularly persistent “I’m hungry” and “I’m not full yet” signals, says Dr. Nadolsky.

Obesity genes also seem to cause some people to experience what’s colloquially known as “food noise.”

They feel obsessed with food, continually thinking, “What am I going to eat next? When is my next meal? Can I eat now?”

Physiologically, bodies tend to resist fat loss.

If you gain a lot of fat, the hormones in your gut, fat cells, and brain can change how you experience hunger and fullness.

“It’s like a thermostat in a house, but now it’s broken,” says Dr. Nadolsky. “So when people cut calories and weight goes down, these physiologic factors work against them.”

After losing weight, your gut may continually send out the “I’m hungry” signal, even if you’ve recently eaten, and even if you have more than enough body fat to serve as a calorie reserve. It also might take more food for you to feel full than, say, someone else who’s never been at a higher weight.

Being in a larger body often means being the recipient of fat stigma and discriminatory treatment.

Until you’ve lived in a larger body, it’s hard to believe how different the world might treat you.

Our clients have told us stories about being bullied at the gym, openly judged or lectured at the grocery store, and otherwise being subjected to innumerable comments and assumptions about their body shape, health, and even worth.

Even in medical settings, people with obesity are more likely to receive poor treatment.^{1, 2} Healthcare providers may overlook or downplay symptoms, attributing health concerns solely to weight. This can lead to delayed- or missed diagnoses or just plain old inadequate care.

All of this combined can add up to an incredibly pervasive and ongoing source of stress.

This stress—in addition to being socially isolating and psychologically damaging—can further contribute to increased appetite and pleasure from high-calorie foods, decreased activity, and poorer sleep quality.³

Which is why…

Taking medication isn’t an “easy way out.”

In 2013, the American Medical Association categorized obesity as a disease.

And yet, many people still don’t treat it as such, and rather consider obesity as a willpower problem, and the consequence of simply eating too much and moving too little.