Hormonal
Biological mechanisms, specifically a defended weight set point driven by genetic and epigenetic factors, actively oppose weight loss maintenance by altering hunger hormones and reducing energy expenditure, making long-term weight loss difficult without continuous intervention.
Accept that maintaining weight loss is biologically harder than losing it due to hormonal defenses. Do not rely on short-term diets; instead, focus on long-term strategies like preventing 'weight creep' (0.5-1kg/year gain) through low-intensity lifestyle changes or considering long-term pharmacological support (like GLP-1 agonists or metformin) if indicated, rather than expecting a one-time fix.
This weight set point is believed that the body seeks to maintain the body weight at a stable range by moderating energy intake and metabolism... After weight loss, the levels of hunger controlling hormones such as leptin, cholecystokinin and GLP-1 change in a direction to make the individual more hungry... and there is a reduction in energy expenditure... changes that are long lasting, still present at 6 years to account for weight regain.
Why this rating
Based on a narrative review citing multiple systematic reviews, meta-analyses, and long-term follow-up studies of bariatric surgery and drug trials.
Source
Our biology working against us in obesity: A narrative review on implications for management of osteoarthritis
Flavia Cicuttini et al. · Osteoarthritis and Cartilage Open · 2023
DOI 10.1016/j.ocarto.2023.100407
More from this paper
- GLP-1 agonists (e.g., semaglutide, liraglutide) and metformin can aid in weight management, but GLP-1 agonists do not reset the weight set point, leading to significant weight regain upon discontinuation.Good
- Preventing 'weight creep' (0.5-1 kg/year gain) through low-intensity lifestyle interventions is a more achievable and effective strategy for OA management than focusing solely on significant weight loss in already obese individuals.Moderate
Related findings · Hormonal
- Initial treatment for type 2 diabetes should be a combination of metformin and either an SGLT-2 inhibitor or a GLP-1 receptor agonist to achieve cardiorenal protection, rather than monotherapy or older agents like sulfonylureas.Strong
- For patients with specific monogenic obesity syndromes (leptin deficiency, POMC/PCSK1/LEPR mutations), targeted pharmacotherapy (recombinant leptin or setmelanotide) is highly effective and should be prioritized, unlike in polygenic obesity.Strong
- Continued weekly administration of 2.4 mg subcutaneous semaglutide prevents weight regain and promotes further weight loss in adults with overweight or obesity, whereas switching to placebo results in significant weight regain.Strong
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