With the rapid proliferation of modern anti-obesity medications, the increased access to food-as-medicine programs, and digitally-enabled behavior change solutions, the need for personalized exercise and strength interventions has never been more important.
Metabolic health issues are on the rise, and so are the costs
The stats are everywhere, and they are alarming.
According to researchers at the University of North Carolina at Chapel Hill’s Gillings School of Global Public Health, only 1 in 8 Americans is achieving optimal metabolic health, which carries serious implications for public health. Poor metabolic health leaves people more vulnerable to developing Type 2 diabetes, cardiovascular disease and other serious health issues.
1 in 8. That is a scary number. The burden being placed on our healthcare system is tremendous, and it's only increasing as the obesity epidemic grows. Our collective understanding of obesity has evolved – long looked at as a simple fix (i.e. exercise more, change diet, and other related lifestyle interventions), obesity is now recognized as a much more complex, nuanced and chronic disease.
From Healthcare Huddle:
“Obesity is a national epidemic, affecting two out of five adults and one out of five children and adolescents. Untreated obesity leads to cardiovascular disease, cerebrovascular disease, and type 2 diabetes (which, itself, leads to a range of adverse health effects like renal disease, retinopathy, and microvascular disease). Given these downstream effects, it’s no surprise medical costs for obesity are over $170 billion annually. To say obesity is simply caused by “eating too much” and “lack of physical activity” would be naive and ignorant.”
Anti-obesity medications are everywhere
You are likely familiar to some degree with the anti-obesity medications generating a lot of interest in the health industry, as well as in mainstream media coverage. Medications such as Ozempic and Wegovy, among others, have arguably been the biggest trend in healthcare over the past 12 months, and they won’t be going away any time soon.
These drugs are classified as GLP-1 receptor agonists. They have shown great efficacy in numerous clinical trials at reducing both body weight and BMI across vast populations. Here is more from Healthcare Huddle, written by Dr. Jared Dashevsky:
“These anti-obesity medications target three types of receptors throughout the body: GLP1R, GIPR, and glucagon-R.
There’s still a lot of unknown regarding how manipulating GLP1, GIP, and glucagon receptors induce weight-loss effects. However, we do know that activating or blocking some of these receptors increases insulin secretion, decreases blood glucose, and suppresses appetite. Consequently, weight loss and improvement in cardiometabolic health are achieved.”
Weight loss on its own can bring about tremendous health benefits, but losing weight rapidly can also have a negative impact on lost muscle mass, bone density, and musculoskeletal function.
Our goal today is not to provide (just) another overview of these drugs (their incredible potential, as well as the potential risks and drawbacks), but to dig into what the research is saying around the role of movement and exercise alongside these interventions.
Weight loss has been a focal point of our society for decades. As the obesity epidemic has worsened, the coverage it has received has only increased. Technology has enabled the scale of behavior change and weight loss coaching platforms that were mostly 1-to-1 in the past, and the rising popularity of the aforementioned medications have accelerated the importance and attention being placed on obesity and weight loss exponentially.
The market is moving
Thanks to our partners like Wondr Health, we are learning about the health goals, struggles and challenges of tens of thousands of consumers each and every day. We have seen the attention being given to this new class of drugs – not only because of the consumer interest, but because of the efficacy they have shown at helping people to lose weight and keep it off over the long term.
Obesity is no longer looked at as something controlled just by discipline and willpower. It is a medical condition that individuals have far less control over than we had previously thought, and many medical experts are looking to anti-obesity medications as a metabolic reset – providing a foundation for people to get on a healthier path – that includes diet changes and personalized, appropriate exercise interventions.
Here is more on their wide-ranging benefits from Wondr Health’s Chief Medical Officer, Dr. Tim Church:
When we analyze modeled data, it becomes evident that these medications could prevent a staggering 70 to 80% of new diabetes cases and even put type 2 diabetes into remission in 50-70% of cases. Even if these estimates turn out to be conservative, the reduction in human suffering and economic impact is substantial. Preliminary findings indicate a 20% reduction in cardiovascular disease events associated with a new weight loss agent (a full report pending). Furthermore, recent clinical trial data reveals benefits in treating congestive heart failure and fatty liver disease.
All weight loss is not created equal
The studies around these drugs point to incredible weight loss potential, but two recent studies also show the potential for rapid loss of lean mass (i.e. healthy weight being lost). It’s important to provide context around this, but let’s look at the studies first:
“In 2021’s STEP 1 trial – the first trial demonstrating the efficacy of semaglutide as a treatment for adult obesity – a subset of 140 patients underwent DEXA scans for body composition analysis. Among these patients, lean mass accounted for approximately 39% of total weight loss – substantially higher than ideal. In a substudy of 178 patients from the SUSTAIN 8 trial on semaglutide as a diabetes treatment, the average proportion of lean mass loss was nearly identical at 40%, despite lower doses and less total weight loss than in the STEP 1 trial.”
Dr. Peter Attia is well-known in the metabolic health community, and he is not the first doctor to raise concerns about the lean mass loss that has accompanied many people who have taken semaglutide drugs.
Since these drugs in a weight-loss setting are still new, the data is in its early days, but this is an important consideration. There is no “standard” goal for lean mass loss, but experts would like to see a number closer to 25% rather than the 39 and 40% shown in the subgroups pulled from the two studies referenced above.
All else equal, weight loss has tremendous health benefits; but, as we know by now, it is rarely ever equal.
“Endocrinologists and obesity medicine specialists say that while muscle mass loss can be a side effect of semaglutide, it is not unique to the drug or the GLP-1 agonist drug class.
Karl Nadolsky, an endocrinologist and obesity medicine specialist at Holland Hospital, noted that "all weight-loss interventions result in some lean mass loss." According to Nadolsky, lean mass loss involves both muscle loss and things like fluid loss.”
All weight loss will include some level of “healthy” weight. Rapid weight loss brought on by anti-obesity medication has shown the potential to drive “healthy” weight loss in excess of normal ranges.
What does this all mean?
The importance of movement and exercise
If you have read anything from us at this point, you know our stance on movement and exercise. Any amount helps, and the best kind is accessible, personalized, and evidence-based (i.e. it will work for your body and your goals). This is even more true for weight loss populations.
But don’t just listen to us. Here’s the conclusion from a 2019 study, well before these drugs were in the mainstream:
“Strategies to preserve skeletal muscle and improve physical function, for example through structured exercise, are of great importance.”
And beyond these drugs themselves, the importance of an incremental, daily mindset when it comes to movement and exercise is backed up by recent studies.
Just 11 minutes of moderate-to-vigorous intensity aerobic activity per day could lower your risk of cancer, cardiovascular disease or premature death, a large new study has found. Compared with inactive participants, adults who had done 150 minutes of moderate-to-vigorous aerobic physical activity per week had a 31% lower risk of dying from any cause, a 29% lower risk of dying from cardiovascular disease and a 15% lower risk of dying from cancer.
We first built movr because we saw a gap in the market to provide personalized, evidence-based movement health and exercise, delivered digitally and dynamically, at scale.
As our offering has evolved and we have learned alongside our partners, we continue to see this need and its importance for anybody on a weight loss journey, especially one aided by anti-obesity medications.
Where do we go from here
The early results point to anti-obesity medications having life-saving and life-changing potential for millions of people, if prescribed right.
I've seen my fair share of medical drug developments, and I'm usually the most skeptical of skeptics when it comes to clinical claims. However, this time feels different. Why, you ask? Well, GLP's (Glucagon-like peptide-1) are not a new class of medications; we have years of experience and data from millions of patients. The physiology and mechanisms of action behind these medications make logical sense, and, most importantly, positive clinical trial data continues to pour in, with numerous ongoing trials.
Several medical experts, including Dr. Church, point to the fact that the drugs themselves aren't a behavioral intervention and need to be matched with lifestyle changes that improve function and quality of life in addition to rapid, and hopefully sustained, weight loss.
Exercise is a key pillar of intensive lifestyle interventions for obesity care. Companies deploying programs focused on food-as-medicine, weight loss coaching, or prescribing anti-obesity medications can use movr to help.
We offer a simple, evidence-based approach to help mitigate the loss of lean muscle mass, reduce the risks of MSK injury and dysfunction, and enable a more sustainable path to better physical function during weight loss, through personalized strength routines and movement health prescriptions.
movr is designed with simplicity in mind, built for the general population and people with lower physical literacy. Our approach to intelligent exercise dynamically adapts movement and strength prescriptions throughout a person's weight loss and exercise journey.
We work with leaders in digital health by integrating third-party exercise solutions into your platform. Our research-backed approach has been validated through 350,000+ movement assessments and personalized exercise recommendations to date.
Interested in learning more? Reach out here.