I have been overweight or obese since I hit puberty. I have gained and lost the same 60 pounds half a dozen times in my adult life. I’ve never been one to try a fad diet – I research the data and follow a scientifically sound plan. I understand that the only way to lose a pound is to have a 3,500-calorie deficit. Losing weight is actually quite simple. But it isn’t easy.
I recently started taking a GLP-1 receptor agonist (think Mounjaro, Ozempic, Wegovy), a weekly subcutaneous injection that has gained social media notoriety due to many celebrities and “influencers” who have lost significant body weight on one of these medications. For weight loss, the major mechanisms of action are to increase insulin sensitivity (great for those with insulin resistance from polycystic ovarian syndrome or type 2 diabetes) and delay gastric emptying (to make you feel full sooner and longer). But another effect of the GLP-1 medication has me convinced we’ve been thinking about obesity the wrong way for all these years. There has been an overlooked component of the biological driver of obesity. I didn’t know about this driver, despite struggling (yes, struggling) with my weight for my entire adult life and even though I am highly educated. I didn’t recognize this driver of the problem until the driver was gone, effectively nonexistent on the GLP-1.
I call that driver “brain chatter,” but I have seen other GLP-1 users describe it as “food noise.” I can now recognize that “brain chatter” – the nearly constant thoughts about food, the rarely-overcomeable internal dialogue of “what does it matter if I eat this now, I’m never going to be able to lose this weight,” the struggle to not eat that after dinner snack only to have my brain think about the snack nonstop until I finally give in – is a major factor in my obesity. The desire for food, facilitated by the brain chatter, is so powerful I now understand how I’ve never been able to sustain weight loss. Sure, I could willpower my way down 60 pounds; I am a type A personality physician who has always accomplished her goals. But willpower is an exhaustible resource, and the weight easily comes back on once exhausted. Every time. Now that the desire for food has eased and the brain chatter is gone, I understand: This is how naturally thin people go about their lives! They eat to live as opposed to live to eat. They eat when they are hungry and stop when they are full. They don’t have a brain-chatter devil on their shoulder sabotaging them left and right. And now that I’ve experienced life without brain chatter, I will never go back. (Brain chatter explains why many people who have had weight loss surgery regain weight – it’s not just about making the stomach smaller so less food will fit in there. Anyone with unregulated brain chatter can overeat their way through a small stomach.)
Evidence shows that up to 95 percent of Americans that lose weight regain it within a few years. Evidence would probably also show that many (maybe even 100 percent) Americans who stop their blood pressure medication will fail to maintain blood pressure control. But we haven’t done that study because the medical community recognizes hypertension as a chronic disease needing lifelong therapy (barring extreme circumstances). The medical community needs to recognize that obesity is also a chronic disease. This is not a laziness problem. This is not purely an overeating problem (although technically, overeating is at the crux of the problem, the cause of overeating is complex).
Those who have used anti-obesity medications to lose weight have done so because they have no other options. Anti-obesity medications like GLP-1 receptor agonists work by addressing the underlying biology and pathophysiology of overeating – encouraging early satiety, delaying gastric emptying, sensitizing cells to insulin, and perhaps most importantly, controlling brain chatter. I will not stop taking a GLP-1 medication when I reach a healthy weight because I finally understand what I’ve been missing my entire adult life – a life free of brain chatter. So let’s treat obesity like the chronic disease it is, let’s stop blaming Americans with obesity for their chronic medical problem, and stop telling people with obesity to “eat less and move more.” You should recognize now that there is a lot more to achieving and maintaining a healthy weight than that.
Jennifer Gauntt is a pediatric critical care physician.