In a conversation with Dr. Jorge Moreno, an expert in obesity and obesity-related conditions, we explore the impact of second-generation weight loss medications on health outcomes and our relationship with food.
Dr. Moreno, an assistant professor of medicine at Yale School of Medicine, has been treating obesity and chronic conditions for years. Drawing from his personal experience with obesity during college, which led to a 50-pound weight loss, Dr. Moreno relates to his patients’ struggles. “Obesity is often seen through a lens of stigma and blame, but we know the body works against those trying to lose weight,” he says. His approach to treating obesity focuses on preventing or managing complications before they arise.
Dr. Moreno discusses the advancements in weight loss medications, particularly second-generation GLP-1 drugs, and how they are changing treatment and perceptions of weight loss.
Advancements in Weight Loss Medications
While weight loss medications have been available since the 1950s, the newer GLP-1 medications are proving to be far more effective. “These medications can help patients lose 15% to 25% of their weight, compared to the 5% to 10% seen with older, first-generation oral medications,” Dr. Moreno explains. This breakthrough addresses a gap in weight loss treatment that has persisted until recent years.
With this more substantial weight loss, patients experience not just improved glucose control and better cholesterol levels, but a reversal or remission of conditions like type 2 diabetes. Some even manage to stop taking blood pressure medication, Dr. Moreno notes. “Our goal is not just to lower BMI or reduce the number on the scale—those things will happen, but the primary goal is to improve health outcomes,” he emphasizes.
Understanding Why These Medications Work
The success of GLP-1 medications lies in their ability to target the brain’s neuroendocrine pathways that influence appetite and fat storage. “Obesity is a complex condition influenced by both gut and brain interactions,” Dr. Moreno explains. These medications are particularly effective in resetting the body’s “set point”—the weight the body defends.
“When a patient loses weight, their hunger signals become heightened, making them feel like they are starving,” says Dr. Moreno. This biological response can cause weight regain, as the body seeks to restore fat mass for energy. “It’s not about willpower; it’s about the brain’s signals working against us,” he adds.
Impact on Other Health Conditions
Beyond weight loss, these medications have shown promise in addressing a range of related health issues. Visceral fat, which surrounds vital organs like the liver and heart, has been linked to increased inflammation, insulin resistance, and cardiovascular disease. GLP-1 medications help reduce inflammation, potentially improving these conditions.
Dr. Moreno notes that treating obesity can have a cascading effect on other health problems, including diabetes, high blood pressure, and sleep apnea. “By addressing obesity, we can improve multiple conditions simultaneously,” he states. Early research also suggests potential benefits for conditions like depression, Alzheimer’s disease, dementia, and Parkinson’s disease, though more studies are needed.
Transforming the Relationship with Food
One of the most significant changes for patients taking these medications is a shift in how they view food. “Many of my patients describe persistent thoughts about food, often referred to as food noise,” Dr. Moreno says. This constant preoccupation with eating—whether it’s planning their next meal or snacking—is a common experience.
GLP-1 medications, however, have been shown to reduce these intrusive thoughts. “Patients report feeling more in control of their relationship with food,” Dr. Moreno notes. By dampening the brain’s reward signals related to food, these medications help quiet the constant urge to eat. As a result, many patients feel less anxiety surrounding food, regardless of the amount of weight lost.
As weight loss medications continue to evolve, they not only help patients lose weight but also redefine their approach to food and health. Dr. Moreno’s work underscores the importance of treating obesity holistically—improving both physical health and mental well-being.
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