An article posted on Medscape compared the results of plant-based eating, bariatric surgery, and drugs like GLP-1 inhibitors for weight loss to determine which option led to the most long-lasting results. The clear winner: plant-based eating.[1] The article included data from several studies to support this conclusion. A systematic review and meta-analysis showed that 49% of patients who underwent bariatric surgery regained at least some of the weight they lost, and many patients regained a significant amount of weight. Those who were the worst off had Roux-en-Y bypass surgery, with 64% of those patients regaining weight.[2] I’ve written before about the dismal results for GLP-1 inhibitors, and the author of the Medscape article shares my concerns. One trial showed that patients taking the drugs lost weight, but one year after discontinuation, participants regained 2/3 of their weight back.[3] This is not surprising. Permanent weight loss can only take place when people commit to changing their habits, when they learn to make time for self-maintenance, and when they develop a normal relationship with food. Obviously, drugs cannot and do not result in these types of changes. Additionally, the side effects are heinous. Side effects include low blood sugar, nausea, heartburn, vomiting, stomach pain, diarrhea, constipation, sore throat, symptoms of stomach flu, dizziness, thoughts about self-harm, signs of thyroid tumor-like swelling or lump in the neck or trouble swallowing, symptoms of pancreatitis, gall bladder disease, kidney disease, and stomach paralysis.[4] The meds increase the risk for vision loss, which is not usually regained after discontinuation.[5] All of this sounds dismal, but there is a much better way to lose weight – plant-based eating, as the Medscape author concludes. A five-year study led by Dean Ornish, and published in 1998 compared a group of patients who consumed a plant-based diet, engaged in aerobic exercise, received training in stress management, and who had group support with a usual-care control group. The plant-based group lost almost 24 pounds at the end of one year and kept over half of it off 5 years after the intervention. The control group experienced worsening health with continued progression of coronary atherosclerosis.[6] Another study compared outcomes for patients who were obese or overweight with at least one comorbidity. One group consumed a low-fat whole food plant-based diet while the other received standard care. At 6 months, BMI reduction for the plant-based group was 4.4 vs 0.4 for the standard care group.[7] Other studies have shown similar results,[8] [9] and many report not only weight loss, but lower plasma cholesterol, lower blood pressure, reduced fasting glucose levels and other improvements in markers of health. These studies are over 20 years old, and none of them included portion control, which people do not like and almost never maintain. We don’t need more research; rather we just need to pay more attention to the existing body of evidence for guidance on how to help patients lose weight and improve their health. A major impediment is that there is so much less money to be made teaching people how to eat plants than there is in making, distributing and prescribing drugs. This can be changed, however, by forcing medical institutions and health professionals to follow informed consent laws. There are two ways to accomplish this; one is to teach patients to demand objective information from their providers BEFORE making any health-related decisions in non-emergency situations. We teach our members to do this on their own since real INFORMED discussions rarely take place in medical offices. The other option is lawsuits against health professionals and institutions that do not do this. If failure to make informed consent an integral part of medical care becomes expensive enough, providers and institutions likely will change. In the meantime, here is what a doctor SHOULD tell an overweight or obese patient about his/her situation and choices. "I’m concerned about your weight, because it places you at significantly higher risk of coronary artery disease, cancer, diabetes, musculoskeletal disorders, and premature death. I strongly encourage you to do something about this before it gets worse. There are three options. I’ll tell you about each and then send you home with some written material to study. #1: Bariatric surgery. There are significant side effects, and you will likely gain back some or all of the weight you lose. You will suffer from severe nutritional deficiencies that cannot be resolved with supplements. You will eat tiny amounts of food for the rest of your life and if you revert to eating larger portions you will feel sick for a while, stretch out the stomach again, and end up back where you started from. #2 Weight loss drugs, like GLP-1 inhibitors. Side effects include low blood sugar, nausea, heartburn, vomiting, stomach pain, diarrhea, constipation, sore throat, symptoms of stomach flu, dizziness, thoughts about self-harm, signs of thyroid tumor-like swelling or lump in the neck or trouble swallowing, symptoms of pancreatitis, gall bladder disease, kidney disease, and stomach paralysis. If you stop taking the drugs, you’ll likely regain most if not all of the weight you lost, and the side effects may not go away. #3 I can teach you how to eat delicious, low-fat plant food 3-6 times per day – as much as you want of it. You’ll need to invest some time in learning how to do it right, and how to shop and cook. You’ll have to change your mindset about food, and perhaps address psychological issues that cause you to overeat. But if you do this and stick with it, you’ll achieve normal weight, and if you are taking drugs for conditions like blood pressure and type 2 diabetes, you will probably be able to discontinue them. Which would you like to do?" I think most people would choose option three. From Pam Popper, President Wellness Forum Health [1] Betya Swift Yasgur. Nutrition, Drugs, or Bariatric Surgery: What’s the Best Approach for Sustained Weight Loss? Medscape Jan 10 2025 https://www.medscape.com/ [2] Reis MG, Guimaraes LF, Moreira G et al. "Weight regain after bariatric surgery: A systematic review and meta-analysis of observational studies." Obesity Med 2024 Jan;45:100528 [3] Wilding JPH, Batterham RL, Davies M et al. "Weight regain and cardiometabolic effects after withdrawal of semaglutude." Diab, Obes, Metab 2022 Apr;24(8):1553-1564 [4] https://www.drugs.com/ozempic. [5] Hathaway JT, Shah MP, Hathaway DB. Et al. "Risk of Nonarteritic Anterior Ischemic Optic Neuropathy in Patients Prescribed Semaglitude." JAMA Ophthalmol 2024 Jul;142(8):732-739 [6] Ornish D, Scherwitz LW, Billings JH et al. "Intensive Lifestyle Changes for Reversal of Coronary Heart Disease." JAMA 1998;280(23):2001-2007 [7] Wright N, Wilson L, Smith M, Duncan B, McHugh P. "The BROAD study: A randomised controlled trial using a whole food plant-based diet in the community for obesity, ischaemic heart disease or diabetes." Nutr Diabetes 2017 Mar;7(3):e256 [8] Barnard N, Scialli A, Turner-McGrievy G, Lanou A, Glass J. "The effects of a low-fat, plant-based dietary intervention on body weight, metabolism and insulin sensitivity." Am J Med Sept 2005;118(9):991-997 [9] Barnard N, Scialli A, Turner-McGrievy G, Lanou A, Glass J. "The effects of a low-fat, plant-based dietary intervention on body weight, metabolism and insulin sensitivity." Am J Med Sept 2005;118(9):991-997 |
The objective of Nurture Your Health is to learn how to remain or become a healthy person, rather than to remain or become a sick patient. Most people do not pay attention to their health until they are sick. It is important to prioritize learning about health and investing time and resources in adopting the right diet, engaging in the right exercise, and paying attention to other factors that lead to optimal health. Make learning about health interesting and fun. Use this information to take control of your health and make better and informed decisions about what you eat, which lifestyle choices you make, and the medical care you receive.
This information is not a substitute for medical advice.
Liz Fattore
Nurture Your Health
Licensed Food Over Medicine Professional
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