The Science of Weight Loss and GLP-1 Medications with Jon Bonnet, MD, MPH


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Episode Summary

Ozempic and Wegovy have garnered significant media attention as celebrity weight-loss medications and appetite suppressants. These drugs, classified as glucagon-like peptide-1 (GLP-1) receptor agonists, raise questions about safety, efficacy, and mechanistic functioning. To learn what’s truly behind these hot-topic headlines, I am joined by quadruple board-certified physician Jon Bonnet.

“Over 40% of adults over 20 are struggling with obesity. And almost three quarters of the country now are suffering from being overweight or having obesity.”

As Jon describes, obesity itself is a difficult disease to treat. Several factors, including underlying emotions, stressors, sleep, and additional medications, contribute to appetite control alone, so working toward a specific weight loss goal requires long-term physiological and behavioral change.

“Weight is not just a static thing you arrive at. It is a continuously changing balance and homeostatic proposition that moves over time.”

Jon discusses lifestyle-based weight loss strategies, like how to find and stick to a diet plan, what to expect when exercising for weight loss, and how to work toward adjusting your personal set point. He emphasizes that once these options have been exhausted, it may be appropriate to consider the role of medications.

“Medications are great, and they can be really good for certain people, but it’s definitely not the first thing you want to do.”

GLP-1s are a class of drug initially intended as a diabetes medication. They increase the hormone insulin, which tells the body to store fat, and in the process were found to decrease the hormone glucagon, which tells the body to burn fat. Additionally, GLP-1s slow the rate at which food leaves the stomach, effectively decreasing appetite and thirst.

“For about a third of the people who take Semaglutide (the drug name for Ozempic and Wegovy), you’re basically getting comparable results to having bariatric surgery… So that’s really exciting to have a drug that is almost as good, or comparable to, having an irreversible surgical procedure.”

Join us as we dive into the side effects and costs of GLP-1 medications, what happens when the medication is discontinued, obesity theory, and the science of weight loss.

Here are the details of our conversation:

[00:02: 11] Jon’s background in lifestyle and obesity medicine

[00:04:34] The science of obesity and the set point “thermostat”

[00:10:49] Inputs in weight loss [00:14:19] The exercise “lever”

[00:18:34] Battling the weight plateau

[00:20:38] Types of diets and how to choose them

[00:25:56] Building an exercise plan and how your body will respond to it

[00:30:54] The role of medication, why GLP-1s were developed, and how they work

[00:35:08] Side effects of GLP-1s

[00:40:42] Weight-loss drug brands and their efficacy

[00:45:28] Weight regain after medication

[00:52:04] “Fixing flowers” versus their environment

Episode Notes

Jonathan Bonnet is a board-certified family, sports, obesity, and lifestyle medicine. He is an associate professor (affiliate) at Stanford University School of Medicine and the program director of medical weight loss at the clinical resource hub weight management center at the Palo Alto VA. Jonathan has a background in exercise physiology and is a certified personal trainer.  He completed his undergraduate and medical school degrees at Ohio State University before finishing his family medicine residency at Duke University, and his sports medicine fellowship at the University of Florida. He also holds a master’s degree in public health from Harvard.

Jonathan serves on the board of the American Board of Lifestyle Medicine and co-chairs the American College of Lifestyle Medicine’s (ACLM) 30-hour CME board review course. He also serves as the advisor for the Emory University Lifestyle Medicine Interest Group and previously served on the board of the American College of Lifestyle Medicine. He has co-authored two editions of the Lifestyle Medicine Handbook and the first edition of the Medical Fitness Bible. He has published research in sleep medicine, nutrition, sports and exercise, obesity, and behavior change and serves on the editorial board of the American Journal of Lifestyle Medicine.


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