Column: GLP-1s change game in medical weight loss

A new family of breakthrough medicines for weight loss and diabetes management, GLP-1s, has the potential to restore normal weight and blood sugar for millions of Americans. Doing so will reduce the risk of cancer, heart disease, stroke, hypertension, arthritis, sleep apnea, chronic pain and depression. In addition to minimizing collateral disease, potential benefits include enhanced quality of life, greater longevity and a substantial reduction in the global cost of health care. However, to ensure sustainable outcomes, in addition to medication, patients must also be offered dietary education, therapeutic movement and meaningful tools for behavioral change.

More than 70% of adults in the U.S. are overweight or obese, according to the Centers for Disease Control and Prevention. In 2019, Hawaii ranked among the most affected states for its rate of obesity. The pandemic added to the problem. A survey of more than 3,400 adults found that 48% reported weight gain during the first 12 months of the pandemic. Furthermore, obesity is a risk factor for more severe symptoms of COVID-19 and for hospitalization and death.

Obesity and diabetes also increase the risk of dying from the majority of the top 10 leading causes of death in the U.S. Health care costs in the U.S. are astronomical and rising. Health care in 2020 hit 19.7% of GDP with a price tag of $4.1 trillion. At nearly $12,000 per capita, U.S. costs are twice that of the average of wealthy nations.

The GLP-1s are superior to so many previous regimens for weight loss because they work directly to normalize blood sugar, which also helps control diabetes. They also reduce the drive to eat and slow down the rate of digestion. So many previous weight loss medicines and supplements rely on burning calories by increasing metabolism, which bumps heart rate and increases blood pressure, raising the risk of heart attack and stroke. In the 1990s, Fen-Phen was all the rage until it was pulled from the market because of its risk to heart valves.

Instead, GLP-1s essentially reduce available calories in the bloodstream. Currently, there are a handful of these medications on the market and more in clinical trials. They can be taken orally or with an easily self-administered, weekly injection into the skin. At Manakai o Malama we have seen weight loss of up to 20% in the more motivated population. However, without a whole-person, integrative approach, patients tend to regain lost weight or must resort to taking these medications long term, which comes with potential health risks and substantial medical costs.

Manakai recently hired a new integrative family medicine physician, Jeanette Qablawi, trained at Columbia University, who is passionate about culinary medicine. This is an evidence-based field that blends the art of nutritious food and cooking with the science of medicine. Patients on GLP-1s learn how to prepare delicious food at a reasonable cost that maintains health and optimal weight. According to Qablawi, “one of the principle aims of culinary medicine is to bring patients back into their kitchen and empower them to take their health back into their hands.”

With this integrative strategy, as weight comes off and diabetes begins to improve, medicines taken to manage high cholesterol and blood pressure, as well as treatments for sleep apnea, may be tapered. Successful and sustainable treatment for obesity and diabetes will likely, over time, actually reduce the need for bariatric surgery. During the past 10 years, Manakai o Malama has also offered Platelet Rich Plasma treatments, especially for knee joint arthritis, and has seen patients defer the need for joint replacement. GLP-1s for weight loss and diabetes are likely to have a similar or greater impact in the management of other chronic disease.

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Ira Zunin is a practicing physician. He is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center. Please submit your questions to info@manakaiomalama.com.