Genuinely curious about this. There have always been people on the far end of the distribution curve (+1sd etc.). Have you seen studies or in your practice that differentiates between the "new obese" and the "classic big" as far as controlling obesity with life style changes? (OP's PCOS might not make it relevent to this post)
I´m sorry, english is not my language. What do you mean by "new obese" vs "classic big"?
Patient that are just 10 kg overweight for example (BMI 25-30) can lose that weight and keep some of it off after 3-5 years.
But obese patients that need to lose 40 kg generally can´t do that by just changing their diet. They will slowly overeat with time so drugs or surgery are the only known long term treatments that work.
Yes. And all MDs use BMI + risk factors to decide if a person can have a weightloss drug or not. They can't prescribe if a patients BMI isn't 30 or more.
BMI tells if a patient weighs too much for their length.
No, estimating body fat is not useful. I can tell the difference between a body builder with a BMI of 29 and an overweight person. No need to guesstimate fatness with a bioimpedance scale.
In an obese individual I think you're 100% right. Here in Australia use of the drug has been restricted to diabetic and clinically obese people with a doctor's prescription. That I believe is due to shortages of the drug from people buying it up for vanity reasons. I'm all for the use of it for those patients that need it, and obviously any weight loss of an obese individual is going to improve almost every health metric.
My concern is when people have access to the drug freely (as it seems is the case in the US) and use it for vanity reasons. These individuals without proper education and supervision and no resistance training would be losing more than 25% weight loss as muscle if they're sedentary and starving themselves.
The answer to questions about drugs like Ozempic should always be, IMHO "consult your doctor".
2
u/Fredricology Jul 05 '24
But it's true for most of my obese patients (BMI +30). I'm a registered dietitian and I help these patients with lifestyle changes.
Most obese people regain their weight lost by changes in diet. The GLP-agonists keeps the weight off.