lessthanhalf said:
GLP drugs do actually fix a lot of the underlying metabolic problems , they reduce blood sugar, blood pressure, lipids and insulin resistance both as a direct action of the drugs themselves as well as secondary to the lost weight.
The problem with diet and exercise as a solution to obesity, however well optimised, is the long term. Maintaining that takes conscious cognitive effort or restraint, or at least nearly always, it is not impossible to turn those better health behaviors into new unconscious habits, but it is difficult and most people do not succeed. And the problem with cognitive effort as a strategy to fix a long term problem is that people just have limits on their resources of it, it just runs out eventually. It is mentally and physically tiring to maintain that effort, so sooner or later people revert to old patterns of behavior. And to be fair people with especially severe obesity are on average probably less good than average at maintaining healthy eating patterns and exercise, no doubt part of the reason they became obese. This is not a moral failing , it is just part of normal variation in people, plus an obesogenic environment, and once obesity sets in, it becomes harder to exercise, and the appetite regulation system starts to progressively malfunction as hormonal and neurotransmitter regulatory systems fail to function correctly under the metabolic stress of obesity.
Prior to the availability of GLP drugs long term weight loss of 5% or more rarely 10% was considered a great success in diet and exercise based therapy for obesity, as this small loss does significantly reduce long term health consequences. All the evidence I have ever seen is that any intervention short of surgery for weight loss, fails in the long term with nearly everyone putting the weight back on eventually after the intervention ceases, and maintaining any intervention in the long term runs into the cognitive effort or cognitive restraint problem .
GLP drugs completely bypass the cognitive effort issue as one injection a week is not exactly hard compared to sticking to a 1600 or 1800 calorie diet long term, and in the long term they just keep on working so long as you keep taking them. I think the evidence seen in the studies and on this forum provide good evidence of their effectiveness and that it is maintained long term. Better diet and exercise is important, but people taking GLP drugs for obesity without any special effort put into lifestyle changes lose weight anyway. And there is evidence that GLP drugs improve people's food choices, and just from personal experience it is much easier to exercise at normal or near normal weights than when severely obese.
My opinion is that diet and exercise are a largely ineffective therapy for obesity, based on long term results from thousands of studies over decades, not completely useless or pointless, but with very poor long term success rates. GLP drugs just work, except for a few who get bad side effects, or who respond poorly to them. But for the large majority they enable significant weight loss of 10-30% long term, with added bonus health benefits.
I am
aligned with a lot of what you said, especially around how hard long term weight loss is and how much GLP meds help with appetite and adherence. For most people.... they’re a game changer.
And yes, they absolutely improve things like blood sugar, insulin resistance, and lipids, both directly and from the weight loss.
But I think it goes too far to say they basically replace the need for lifestyle or that diet and exercise are mostly ineffective.
Even with something like Reta or other GLP based meds, they’re not fully correcting the underlying system, they’re helping regulate it. That’s a big difference.
The “people regain weight” piece is real, but a lot of that comes from how people were doing it in the first place. Chronic under eating, no resistance training, losing a lot of lean mass, and not adjusting intake as they go. That sets people up to regain.
Muscle is one of the biggest drivers of metabolic rate and glucose disposal. If you're not protecting it and even changing it, the result is an even slower metabolic rate, making plateaus more likely, and making regain easier later on.
Strength training three times a week is not optional if you care about insulin sensitivity, bone density, testosterone tone, and your ability to be physically powerful in your 60s and 70s.
So it’s not just about losing weight, it’s about what kind of weight you’re losing, and what your metabolic health looks like at the end. Muscle is not aethetic, it is metabolic currency.
When you actually support the medication properly with enough protein, resistance training, and not driving calories too low, you’re not just losing weight, you’re changing that very foundation in a way that’s more sustainable. The med can't do that alone.
So, the idea that meds completely bypass effort isn’t totally true. They lower the barrier, for sure, but people still plateau, people still lose more muscle than they should, and people still regain if nothing else changes and the med is stopped.... Or even if it isn't.
So I don’t really see it as meds vs lifestyle.
It’s more that the meds make it possible for lifestyle changes to actually stick, especially for people who’ve struggled for years. But how far someone goes and how well they maintain still depends a lot on what they do alongside it.
