The latest research shows that measuring your waistline and keeping your BMI (body mass index) at a reasonable number will help keep you alive and healthy, while reducing your chances of developing cancer or cancer returning after treatment.^[1] Research also shows that certain foods improve your health even if they don’t help you lose weight. This article will focus on eating habits that help you lose weight, but will also include information about the kinds of foods that are good for your health even if they don’t affect your weight.

Let’s start with the obvious: Sticking to a healthy diet in order to lose weight is hard for almost everyone. Keeping track of calories and fat can be confusing, and the nutrition labels on the foods we buy aren’t always that helpful. How are consumers supposed to figure out which diet advice is just hype – that ultimately doesn’t contribute to better health – and which advice offers good, medically sound information?

Here are some basic guidelines to keep in mind:

• Calories matter
• Serving size matters
• Fats and cholesterol matter
• Fruits, vegetables and whole grains matter
• Exercise matters
• Sticking to it matters

The Key to Losing Weight is to Eat Fewer Calories than You Burn in a Day- But There is More to it than That

Simply increasing your activity level might be enough if you only need to lose a few pounds to get your BMI into a healthy range. Most of the time, however, eating fewer calories is also going to be needed. Scientists have found that, in order to lose weight, a person must burn more calories than they consume.^[2] Unfortunately, calories add up quickly!  For example, have you eaten at a fast food chain recently?  To work off the calories from a double cheeseburger, extra large fries and a 24 ounce soft drink – about 1500 calories – you would have to run for two and half hours at a ten minute mile pace! (For more information, see Fast Food Facts: Calories and Fats).  And some chain restaurants offer meals that have much more calories for lunch or dinner than an average person should eat in an entire day!

What happens if you exercise without lowering the calories you’re eating? A 2009 study found mixed results: some lost a significant amount of weight while others gained weight.^[3] Although some weight loss strategies are effective for some people but not others, eating fewer calories and increasing exercise is most likely to help most people shed pounds.

Eating Fewer Calories Doesn’t Necessarily Mean Eating Less

The trick to dieting without being hungry is to choose foods that contain fewer calories and also fill you up. An example would be having a piece of fruit instead of fries with lunch.  It helps to remember that not all foods are created equal!  Some foods, such as nuts, are high in nutrients and essential vitamins, while others lack nutritional substance, such as products containing added sugars. “Nutrient-dense food” provides substantial amounts of vitamins and minerals and relatively few calories, but leaves you feeling fuller while also supplying valuable fuel for your body.  A person is more likely to stick to a diet if calories are nutrition-dense and offer variety.^[4]

Empty calories from foods with processed and refined sugars, such as candy, pasta and bread made from white flour, and many energy drinks and soft drinks, leave you hungry again soon after, craving more food.  In contrast, the “complex carbohydrates” in vegetables, whole-grain breads and cereals, and low-fat yogurt and milk, provide long-lasting nutrients, improve digestion, help stabilize blood sugar, and keep your energy at an even level.  Although fruits are also considered simple carbohydrates, they contain vitamins and nutrients that occur naturally, unlike those found in processed and refined foods.

A 2011 study in the respected New England Journal of Medicine found that certain foods were linked to weight change more than others.^[5] After following participants for an average of 17 years, researchers found that gaining weight was most strongly linked to foods such as potato chips, sugar-sweetened beverages, and red meat.  People who ate more vegetables, whole grains, nuts, fruits, and yogurts were less likely to gain weight over the years, even though some of those foods are quite high in calories.

What about low-carb diets versus low-fat diets? A 2014 study compared the effects of both diets on body weight and cardiovascular health. They found that the low-carb diet was much more effective than the low-fat diet for losing weight and reducing cardiovascular risks.^[6] So hold back on the white bread, but don’t feel bad about eating some olive oil.  But if you want to maintain that weight loss, remember that variety in your diet as well as exercise are also important.

Don’t Assume that Foods Marketed as “Healthy” Really Are or Will Help You Lose Weight

Don’t fall for the “health halo” effect: assuming that all foods at restaurants marketed as “healthy” or all foods of a category labeled “healthy” (e.g., salads) are actually better for you.  Research shows that customers at fast food restaurants underestimate the calories in their meals ^[7] and most consumers underestimate the calorie content of foods that are labeled “low-fat.”^[8] For example, if you look at a bag of potato chips, you will probably see that the “low fat” ones almost have the same number of calories as the regular chips made by the same company.

The choices that will keep your calories down are not always obvious.  For example, a 2013 study found that adolescents ordered about the same number of calories at Subway as they did at McDonald’s.^[9] Try to check the nutritional contents of your meal options and make an informed decision. If nutritional information is not posted in the restaurant, it is probably available on the restaurant’s website.

Eating 5 Small Meals Is Not Better than Eating 3 Larger Ones

For several years, some experts have claimed that eating 5 or 6 times a day can be a better way to lose weight than eating only 3 times a day.  However, the latest research indicates that is not true.^[10]

Studies have found that eating off of smaller plates or bowls helps people eat less, because most of us tend to fill our plate and then finish what is on it.^[11],[12] Unfortunately, portion sizes for restaurant meals, baked goods, other prepared foods, and even homemade meals – everything from breakfast muffins to a plate of spaghetti – have grown to very unhealthy proportions in the last few decades. This is contributing to the obesity epidemic.

In addition to adjusting your portion size, limiting the hours when you eat can also help you maintain a healthy weight. In a study published in British Journal of Nutrition in 2013, researchers followed a group of healthy men for four weeks. They ate their normal diets during all four weeks, but for 2 of those weeks, they fasted for 11 hours at night (from 7 pm to 6 am). The study found that under the time-restricted conditions, the men consumed approximately 200 fewer calories per day and lost weight during the two weeks of nightly fasting compared to the two weeks when they did not fast at night. The researchers believe that it was the combination of few calories and night-time fasting that resulted in the weight loss.^[13]

What About Fats?

Recent research has shown that eating foods high in cholesterol don’t necessarily contribute to a person’s cholesterol levels.  The past focus on fats is also being questioned, especially in light of an investigation indicating that the original reports that blamed fats were written by researchers paid by the sugar industry.^[14]

Fats are high in calories, but some fats are more dangerous for you than others.  The least healthy ones include saturated fats and of trans fats. These tend to be the kinds of fat that are solid at room temperature – like the fat in meat products, butter, margarine, shortening and lard – and the fats that come from baked goods and fried foods.  The fats that are good (in moderation) are “unsaturated” or “polyunsaturated” fats. These tend to be liquid at room temperature, like canola oil, olive oil and some of the other vegetable oils. There are exceptions, however, such as coconut oil, which is high in saturated fats. Diets such as the Mediterranean diet, which includes more unsaturated fats and plant-based foods, can lower the chances of cardiovascular diseases. So, for people who find it difficult to stick with a low-fat diet, such as a vegan or vegetarian diet, there are other healthy alternatives.^[15] Check the nutrition label before you buy, to be sure that you’re choosing the product with the lowest possible saturated fat content.

Eat More Fruits, Vegetables, Whole Grains, and Low- or No-Fat Dairy Products Every Day

There are many good resources to help you learn about healthy eating, such as the US Department of Agriculture website at My Plate. Nutritionists at the Harvard School of Public Health have similar (but not identical) healthy food guidelines. What these diets have in common includes recommendations to:

• Aim for at least five servings of fruits and vegetables a day. Usually, the more colorful the fruit or vegetable, the more nutritious. For example, dark green spinach has more nutrients than light green iceberg lettuce. In 2023, an analysis of studies of 2372 adults with mean ages 20 to 67 reported that a vegan or vegetarian diet can help people reduce their risk of developing cardiovascular diseases.^[15] However, research has also shown that any diet that replaces at least some fats, carbohydrates, and foods high in added sugar with fresh fruits and vegetables is likely to improve your health.^[16]
• Try and choose whole grain cereal, pasta, rice, and bread. Many foods that claim “whole wheat” or “whole grain” on the front of the package actually contain very little, but breads that are truly high in whole grains now give the exact amount in a very obvious place on the label.  Be sure to see if the amount listed is for one slice or two – in many cases, a “portion” is listed as 2 slices for the amount of grains but only one slice when listing calories per portion!  And don’t be fooled by bread color: dark brown breads are often colored with coffee or other dyes, not whole grains.
• Avoid food that is high in sugar, such as pastries, sweetened cereal, and soda or fruit-flavored drinks.
• Reduced-fat or no-fat (skim) milk, reduced-fat cheese, and low-fat or no-fat yogurt are good sources of the protein and calcium we need. Try to eat 2-4 servings of low-fat or no-fat dairy products each day.
• Fruits and vegetables often cost less than unhealthy foods.^[17],[18] By buying healthy food options, you’re doing both your body and your wallet a favor!

Exercise Does Burn More than Calories

Increasing the amount of exercise you do each day means you burn more calories to help you lose weight.  And it doesn’t take much; just 30 minutes of moderately strenuous daily exercise helps prevent heart disease, which is the #1 killer of women and men in the U.S..^[17] The exercise you choose doesn’t need to be elaborate either, or even take place in a gym.  Walking, biking, swimming, or gardening can do the trick, and getting a friend or family member to exercise with you can turn this into a valued part of your daily routine.  Learn more about the health benefits of physical activity and how to get started from the CDC.

Staying Healthy is a Life-Long Proposition

Don’t think about dieting as a short-term weight loss goal.  Instead, ask yourself the question: How long do I want to live and how sick do I want to be?  Scientists have found that one of the keys to success is to think about these goals every day.^[18] For example, people who get on a scale and check their weight daily are more successful at keeping their weight under control than people who don’t.^[18]

Don’t Waste Your Time and Energy and Money on “Quick Fix” Solutions

For some people, there may be faster ways to lose weight than following the diet suggestions listed here.  But those quick solutions tend to be temporary; even bariatric surgeries don’t necessarily provide long-term solutions.  Learning to eat in a healthier way allows you to sometimes indulge in foods that aren’t so healthy, while still being healthier than you ever were before, and living longer.

All articles are reviewed and approved by Dr. Diana Zuckerman and other senior staff.

1. For more information about BMI and how it is calculated, see Obesity in America: Are You Part of the Problem?
2. Thomas, D.M., Bouchard, C., Church, T. et al. Why do individuals not lose more weight from an exercise intervention at a defined dose? An energy balance analysis. Obes Rev. 2012; 13: 835–847
3. Church, TS, Martin, CK, Thompson, AM et al. Changes in weight, waist circumference and compensatory responses with different doses of exercise among sedentary, overweight postmenopausal women. PLoS ONE. 2009; 4
4. Vadiveloo M, Sacks, FM, Champagne, CM, et al. Greater Healthful Dietary Variety Is Associated with Greater 2-Year Changes in Weight and Adiposity in the Preventing Overweight Using Novel Dietary Strategies (POUNDS Lost) Trial. J Nutri. 2016, doi: 10.3945/jn.115.224683
5. Mozaffarian D, Hao T, Rimm, EB, et al. Changes in Diet and Lifestyle and Long-Term Weight Gain in Women and Men. The New England Journal of Medicine. 2011;364:2392-404.
6. Bazzano LA, Hu, T, Reynolds, K et al. Effects of Low-Carbohydrate and Low-Fat Diets: A Randomized Trial. Annals of Internal Medicine. 2014;161(5):309-310
7. Block, JP, Condon, SK, Kleinman, K, et al. Consumers’ estimation of calorie content at fast food restaurants: cross sectional observational study. BMJ 2013; 346
8. Ebneter, DS, Latner, JD, Nigg, CR. Is less always more? The effects of low-fat labeling and caloric information on food intake, calorie estimates, taste preference, and health attributions. Appetite 2013. 68(1): 92-97)
9. Lesser LI, Kayekjian K, Velasquez P, et al. Adolescent purchasing behavior at McDonald’s and Subway. J Adolesc Health. 2013 Oct; 53(4):441-5.
10. Varady KA. Meal frequency and timing: impact on metabolic disease risk. Curr Opin Endocrinol Obes. 2016 Jul 21.
11. Hanks, A, Kaipainen, K, Wansink, B. The Syracuse Plate: Reducing BMI by Introducing Smaller Plates in Households. J of Nutrition Education and Behavior. 2013, 45 (4), Supplement, S41
12. Wansink, B, Painter, JE, North, J. Bottomless Bowls: Why Visual Cues of Portion Size May Influence Intake. Obesity Research. 2005,13 (1)
13. LeCheminant, JD, Christenson, E, Bailey, BW, Tucker, LA. Restricting night-time eating reduces daily energy intake in healthy young men: a short-term cross-over study. British Journal of Nutrition. 2013, 110 (11)
14. Connor, Anahad. How the Sugar Industry Shifted Blame to Fat. The New York Times. 2016. http://www.nytimes.com/2016/09/13/well/eat/how-the-sugar-industry-shifted-blame-to-fat.html?_r=0
15. Koch, C., Kjeldsen, E., Friikkle-Schmidt, R. Vegetarian or Vegan Diets and Blood Lipids: a Meta-Analysis of Randomized Trials. European Heart Journal. 2023, ehad211. https://doi.org/10.1093/eurheartj/ehad211
16. National Institute of Diabetes and Digestive and Kidney Diseases. Take Charge of Your Health: A Guide for Teenagers. U.S. Department of Health and Human Services. Available https://www.niddk.nih.gov/health-information/weight-management/take-charge-health-guide-teenagers
17. Bishop, K., Wootan, MG. Healthy bargains: Fruits and vegetables are nutritious and economical. A Center for Science in the Public Interest study. Available https://cspinet.org/healthybargains.pdf.
18. Carlson A, Frazao E. Are Healthy Foods Really More Expensive? It Depends on How You Measure the Price. Washington, D.C.: United States Department of Agriculture. May, 2012. Report No. EIB-96.
19. Pandey, A, Garg, S, Khunger, M, et al. Dose Response Relationship Between Physical Activity and Risk of Heart Failure: A Meta-Analysis. Circulation. 2015; http://dx.doi.org/10.1161/CIRCULATIONAHA.115.015853
20. Bertz, F, Pacanowski, CR, Levitsky, DA. Frequent Self-Weighing with Electronic Graphic Feedback to Prevent Age-Related Weight Gain in Young Adults. Obesity. 2015; 23(10): 2009-2014

Jenny Niwa

You have probably heard about several very popular new weight loss drugs, such as Wegovy, Ozempic, Mounjaro, and Zepbound.  Although Ozempic and Mounjaro are specifically approved by FDA for treating diabetes and not for weight loss, all four are being used by people who want to lose weight. Before you decide whether to take these drugs, here are some things you should know.

What are these drugs and how do they work?

The FDA approved Ozempic in 2017 for the treatment of type 2 diabetes and Wegovy in 2021 for weight loss for adults with obesity or who are overweight and have at least one weight-related health condition.  Although these drugs have been on the market for several years, their popularity really exploded in 2023. Mounjaro was approved in the spring of 2022 for Type 2 diabetes and Zepbound was approved in late 2023 for those with obesity or who are overweight with an additional chronic condition such as hypertension. While Ozempic and Mounjaro are not approved specifically for weight loss, doctors may prescribe them anyway – that’s called prescribing it off-label. All four curb hunger and reduce the intake of food. The medications are currently administered by injection once a week, but they may soon be available in pill form.

Both Wegovy and Ozempic  are made of semaglutide. Mounjaro and Zepbound are made of tirzepatide.  Both mimic the GLP-1 hormone, which is made naturally by the body. GLP-1  does 2 things: 1) It One is to slow the passage of food through the stomach, which helps people feel fuller longer; and 2) it promotes insulin release and helping reduce blood sugar.

What do research studies say? 

In August 2023, Wegovy’s maker, Novo Nordisk, claimed in a press release that the drug reduced the risk of serious heart problems. The company described a randomized trial of 17,500 patients with obesity and heart disease, although patients with diabetes were excluded.^[2] Half of the participants received regular injections of Wegovy and the other half received a placebo. Rather than publish the results in a peer-reviewed journal, Novo Nordisk publicized their research in a press release that claimed that Wegovy reduced heart attacks, strokes, and deaths by 20% compared to placebo, and this was widely reported in the media. However, this statistic is misleading because it is a relative risk. When the study was finally published in the New England Journal of Medicine on November 11, 2023, the results did not sound as impressive:  8% of the people in the placebo group had had a nonfatal stroke or heart attack or died due to cardiovascular causes, compared to 6.5 percent in the Wegovy group. ^[3] That decrease from 8% to 6.5% is a 20% decrease, but the difference is only 1.5% for patients considering whether it is a meaningful difference for them.

In August 2023, a study published in the New England Journal of Medicine found that the medication reduced the risk of heart problems for diabetes patients who were at high risk for cardiovascular complications. ^[4] This study included more than 3,000 patients with type 2 diabetes, who were randomly assigned to receive once-weekly Ozempic or a placebo for 2 years. Results showed that 108 of 1648 patients (6.6%) taking Ozempic either died, had a nonfatal heart attack, or nonfatal stroke, compared to 146 of 1649 patients (8.9%) who took the placebo.  This was statistically significant (which means it did not occur by chance), but is a difference of only 2.3%.

Mounjaro has been found to reduce blood pressure, which could improve health, but no published studies have provided evidence that it reduces heart disease.

What are the side effects?

The most common side effects of these GLP-1 medications include stomach issues such as nausea and diarrhea. Some patients experienced persistent vomiting or cyclic vomiting syndrome and severe gastroparesis. Gastroparesis is stomach paralysis and occurs when there is a delay or stopping in food movement from the stomach to the small intestine.

Warnings about other possible serious side effects that are listed on the companies’ websites include inflammation of the pancreas, gallbladder problems, increased risk of low blood sugar, kidney problems, serious allergic reactions, change in vision for people with type 2 diabetes, increased heart rate, and depression and thoughts of suicide.^[5]

In January 2024, a new FDA report listed potential links between the medications and extensive hair loss (called alopecia), a swallowing problem that can occur during surgery called aspiration, and thoughts of suicide.^[14]  A few days later, the FDA announced that their preliminary review did not support an increase in thoughts of suicides among patients taking these drugs, but the FDA also said they had drawn no conclusions based on their preliminary findings and would continue to review new data.

An even more serious side effect is the risk of thyroid cancer. According to a study conducted by the European Medicines Agency (EMA, which is the European version of the FDA), researchers found that using GLP-1 medications for 1-3 years may increase the risk for all types of thyroid cancers.^[6]

Concerns about aspiration and suicidal thoughts are not new. For example, in 2023 there were media reports about potential complications from anesthesia for people taking these drugs. The American Society of Anesthesiologists advises that people taking these drugs should make sure to stop taking the medication a week before surgery. People who know they are going to have surgery are advised not to eat for 24 hours before surgery, but since these drugs affect how long food stays in the stomach, a 24-hour fast is not enough to prevent regurgitating food during the operation. This is dangerous because vomiting under anesthesia can cause pneumonia and other fatal problems due to the food and stomach acid getting into the lungs.^[7]  This risk may be impossible to prevent if someone taking the drug requires emergency surgery.

What Happens if You Lose Weight and Want to Stop Taking the Drug?

Most weight loss strategies work for a limited time; when people stop dieting or exercising, they gain the weight back. Is the same true for the new weight loss drugs such as semaglutide and tirzepatide? Unfortunately, most patients take these drugs for less than 3 months and the number still taking the drug after 1 year is even lower. A study of more than 1,900 patients by researchers at the Cleveland Clinic found that patients’ use of semaglutide and several other weight loss medications dropped from 44% at 3 months to 33% at 6 months and just 19% at 12 months.^[8]  Regardless of whether they stopped taking the drugs due to side effects, cost, or other reasons, the long-term benefits of these drugs are limited because when they stop taking the drugs, their stomach no longer feels full. A study conducted with almost 2,000 adults without diabetes found that one year after no longer taking Wegovy, participants regained two-thirds of their prior weight loss.^[9]  

There is still much that is unknown about these drugs. It is unclear how these drugs affect patients after years of use, whether the drugs are effective at maintaining a certain weight after long-term use, and whether most patients will benefit from taking the drugs for a limited period of time or if they need to stay on for the rest of their lives. Current literature suggests that such medications may need to be taken life-long to experience long-term benefits and prevent any negative consequences that come from discontinuing use. ^[8]

Other Questions to Consider

In 2022, Novo Nordisk spent a total of $11 million to promote their Ozempic and other weight-loss drugs, including $9 million on meals and $2 million on travel for thousands of doctors to promote their weight-loss drugs.^[10] That included more than 457,000 meals; nearly 12,000 prescribers had food paid for by the company more than a dozen times in that one year. Buying meals for doctors is not illegal, but this extreme level of “generosity” raises concerns. If these drugs are so effective, why did the company think it necessary to provide all these free meals?  And since the drugs became much more popular after the company spent all that money providing free meals to doctors, do you wonder if doctors are prescribing these drugs because they have they been unduly influenced to prescribe them?

Is taking these weight loss drugs right for you?

Ozempic is FDA approved for patients with type 2 diabetes and is not approved for weight loss. Due to the risk of thyroid cancer, if you or any family member has ever had a type of thyroid cancer, taking any of these 4 drugs may be dangerous. Similarly, if you have sensitivity to gastrointestinal problems, these drugs may not be right for you.

In January 2024, Eli Lilly, the maker of Mounjaro and Zepbound, warned against their use for cosmetic reasons. The company reminded physicians and patients that GLP-1 drugs are meant for serious diseases (obesity or Type 2 diabetes) and not for cosmetic weight loss. ^[15]

Another thing to consider is the cost, which is much higher in the U.S. compared to other countries.^[11] If insurance does not cover the cost, one monthly dose of Ozempic costs about $900, and the cost for Wegovy is about $1,350 per month.^[12],[13] The cost of Mounjaro is similar to Ozempic and Zepbound costs somewhat less than Wegovy. Since they are relatively new, there are no generic versions. You may be able to lower the costs of these drugs through savings programs or through coverage on your health insurance plan. Many private insurance providers cover these drugs to treat Type 2 diabetes. When used for weight-loss purposes, it is much less likely to be covered. Medicare does not cover these drugs, although patients, doctors, and Congress are pressuring Medicare to do so.

The media attention to these 4 drugs makes it seem that they are the only FDA-approved weight loss drugs. They are not. However, all weight loss drugs have unpleasant and potentially serious side effects, and these 4 seem to be more effective.

If you are eligible and interested in taking these drugs, you should first and foremost make sure to talk to your physician and discuss what to expect, the possible side effects, and your medical history. If you are not eligible for these drugs or are not interested in using them, there are other methods available that can help you lose weight and improve your health if you stick with them. These include exercising daily or regularly, developing healthier eating habits, and knowing when to eat.

[1] Hoffman, S. (2023) The Differences between Saxenda and Wegovy. Very Well Health. https://www.verywellhealth.com/the-differences-between-saxenda-and-wegovy-7564310

^[2] Chen, E., and Joseph, A. (2023). Novo’s obesity drug Wegovy lowers cardiovascular risk by 20%, landmark trial finds. STAT+. https://www.statnews.com/2023/08/08/novo-nordisk-wegovy-cardiovascular-risk/

^[3] Lincoff, A. M., Brown-Frandsen, K., Colhoun, H. M., Deanfield, J., Emerson, S. S., Esbjerg, S., Hardt-Lindberg, S., Hovingh, G. K., Kahn, S. E., Kushner, R. F., Lingvay, I., Oral, T. K., Michelsen, M. M., Plutzky, J., Tornøe, C. W., & Ryan, D. H. (2023). Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes. New England Journal of Medicine. https://doi.org/10.1056/NEJMoa2307563

^[4] Marso, S., Bain, S., Consoli, A., & Eliaschewitz, F. (2016). Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes. The New England Journal of Medicine. https://www.nejm.org/doi/full/10.1056/nejmoa1607141

^[5] Novo Nordisk. (n.d.). Tips for managing common side effects. https://www.wegovy.com/dashboard/my-library/week-02-tips-for-managing-common-side-effects.html#:~:text=thoughts%20of%20suicide.-,The%20most%20common%20side%20effects%20of%20Wegovy%C2%AE%20may%20include,runny%20nose%20or%20sore%20throat.

^[6] Bezin, J., Gouverneur, A., Penichon, M., Mathieu, C., Garrel, R., Hillaire-Buys, D., Pariente, A., & Faillie, J.L. (2022). GLP-1 Receptor Agonists and the Risk of Thyroid Cancer. Diabetes Care. https://diabetesjournals.org/care/article-abstract/46/2/384/147888/GLP-1-Receptor-Agonists-and-the-Risk-of-Thyroid?redirectedFrom=fulltext

^[7] Goodman, B. (2023). They took blockbuster drugs for weight loss and diabetes. Now their stomachs are paralyzed. CNN. https://www.cnn.com/2023/07/25/health/weight-loss-diabetes-drugs-gastroparesis/index.html

^[8] Most Stop Taking Weight Loss Drugs Within 1 Year. (n.d.). Medscape. Retrieved December 12, 2023, from https://www.medscape.com/viewarticle/most-stop-taking-weight-loss-drugs-within-1-year-2023a1000uiq

^[9] Wilding, J. P., Batterham, R. L., Davies, M., Van Gaal, L. F., Kandler, K., Konakli, K., Lingvay, I., McGowan, B. M., Oral, T. K., Rosenstock, J., Wadden, T. A., Wharton, S., Yokote, K., &  Kushner, R. F. (2022). Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. Diabetes, Obesity and Metabolism, 24(8), 1553–1564. https://doi.org/10.1111/dom.14725

^[10] Florko, N. (2023). Novo Nordisk bought prescribers over 450,000 meals and snacks to promote drugs like Ozempic. STAT+. https://www.statnews.com/2023/07/05/ozempic-rybelsus-novo-nordisk-meals-for-doctors/#:~:text=Novo%20Nordisk%20bought%20prescribers%20over,to%20promote%20drugs%20like%20Ozempic&text=WASHINGTON%20%E2%80%93%20Novo%20Nordisk%20spent,weight%20loss%2Dinducing%20diabetes%20drugs

^[11] Amin, K., Telesford. I., Singh, R., & Cox, C. (2023). How do prices of drugs for weight loss in the US compare to peer nations’ prices? Health System Tracker. https://www.healthsystemtracker.org/brief/prices-of-drugs-for-weight-loss-in-the-us-and-peer-nations/?utm_campaign=morning_rounds&utm_medium=email&_hsmi=270760455&_hsenc=p2ANqtz-_P2SZN9DLjS_l7fSn8hrgS8xRf4YvJIonV0X-iRtKF3FtcWbgsMJd-K6tDV2u12XNFMEesDCulwlbdwkw74D1S-2WqXQ&utm_content=270760453&utm_source=hs_email#List%20prices%20of%20drugs%20used%20for%20weight%20loss%20in%20the%20U.S.%20and%20peer%20nations

^[12] Wilson, A. (2023). How much does Ozempic cost without insurance?. RO. https://ro.co/weight-loss/ozempic-cost-without-insurance/

^[13] Wilson, A. (2023). How much does Wegovy cost? RO. https://ro.co/weight-loss/wegovy-cost/

^[14]  FDA Looking Into New Risks With Popular Weight-Loss Drugs. (n.d.). Retrieved January 9, 2024, from https://www.usnews.com/news/health-news/articles/2024-01-04/fda-looking-into-new-risks-with-popular-weight-loss-drugs

^[15]  Open Letter Regarding the Use of Mounjaro® (tirzepatide) and Zepbound^TM (tirzepatide) | Eli Lilly and Company. (n.d.). Retrieved January 12, 2024, from https://investor.lilly.com/news-releases/news-release-details/open-letter-regarding-use-mounjaror-tirzepatide-and-zepboundtm

Danielle Pavliv, Laura Gottschalk, PhD, and Amanda Chu

When people want to treat themselves to something sweet without having to treat themselves to a larger pants size too, they often reach for low-calorie, artificial sweeteners. But do artificial sweeteners actually help you lose weight? The answer is not necessarily. As for their safety, the answer becomes more complex.

What are Artificial Sweeteners?

The most popular types of sugar substitutes in the US and many other countries are artificial sweeteners. Artificial sweeteners are typically made in a laboratory and don’t contain calories or supply your body with energy, vitamins, or anything else nutritious. These sweeteners are many times sweeter than sugar, so less is needed to reach the same level of sweetness as something containing sugar. Sweeteners can be used in the home for baking and cooking, and they can also be found in soft drinks, candy, and canned foods that are not necessarily sweet. These artificial sweeteners are considered to be “ultra-processed” and in addition to being used as sweeteners in foods that are marketed as “low-sugar” or “sugar-free” are also used to mask the taste of preservatives or other ingredients in foods that are not sweet.^[10]

There are six types of artificial sweeteners currently approved by the FDA.

TTwo “natural” sugar substitutes have also been approved by the FDA. Brand names such as Truvia, PureVia, Enliten (Steviol glycosides), Nectresse, Monk Fruit in the Raw, PureLo (monk fruit extract) are all made from plants. But before being sold in the store, they must first be highly processed in a laboratory. So don’t be fooled into thinking that the word “natural” means that it comes straight from nature to your table.

Do Artificial Sweeteners Help You Lose Weight?

It makes sense that eating and drinking fewer calories by switching to sugar substitutes should lead to weight loss. However, there are several studies that found that people who drink diet drinks weigh more than those who don’t.^[1] However, that does not mean that the sugar substitutes cause weight gain, since people who are overweight may choose diet drinks in an effort to lose weight.

Researchers are questioning whether these products may actually make it more difficult to lose weight, perhaps because sweet drinks and foods make people crave more sweets.  For example, research published in 2021 found that drinking beverages sweetened with the artificial sweetener sucralose, led women and people with obesity to eat larger amounts of food at their next meal.^[11] That would definitely stand in the way of people trying to lose weight.

The best way to study if artificial sweeteners help people lose weight is known as a randomized controlled trial. People in the trial would be randomly put into groups—one group uses artificial sweeteners while the other group uses sugar. Then, the two groups can be compared to see if using artificial sweeteners had a different impact than sugar. However, randomized clinical trials would be very difficult to conduct on artificial sweeteners because they are in so many different types of food, not just diet drinks.

In 2023, the World Health Organization (WHO) scrutinized scientific reviews of the effect of artificial sweeteners on weight control and concluded that artificial sweeteners do not help people lose weight.^[2]

Are Artificial Sweeteners Safe?

A 2020 study published in the journal Cell Metabolism by a group of Yale researchers found that the consumption of the common artificial sweetener sucralose (found in Splenda, Zerocal, Sukrana, SucraPlus) in combination with carbohydrates can turn a healthy person into one with high blood sugar.^[3]

You may have heard claims that artificial sweeteners could change hormone levels ^[4], increase the risk of heart problems ^[5], and cause higher rates of type II diabetes.^[6] An important 2022 French study of more than 100,000 adults followed for a median of 9 years found that consuming artificial sweeteners was associated with a very slight increased likelihood of experiencing newly diagnosed cardiovascular conditions such as heart attacks and stroke. The study identified three artificial sweeteners that seem to cause the greatest increases. People taking aspartame (NutraSweet, Equal) were more likely to have a stroke, while people taking acesulfame potassium (Sunnett, Sweet One) or sucralose (Splenda) were more likely to develop coronary artery disease.^[7]

The reasons why artificial sweeteners might harm cardiovascular health are unclear. However, experts suggest that these sweeteners could increase inflammation, metabolic disruptions, and alterations in the gut microbiome and blood vessels. That may increase the chances of developing conditions such as type 2 diabetes, unhealthy cholesterol levels, and high blood pressure.

Artificial sweeteners also increase the chances of being depressed, according to a study published in 2023 on 31,712 women aged 40-62. After statistically controlling for other traits such as age, smoking, and BMI, women who consumed larger quantities of artificial sweeteners and artificially sweetened beverages were more likely to be depressed. While the reasons are not fully understood, the use of these artificial sweeteners can lead to changes in the brain that could contribute to the development of depression.^[8]

For many years, there were concerns about whether artificial sweeteners cause cancer. A recent study by the WHO’s International Agency for Research on Cancer (IARC) has found a possible link between aspartame and liver cancer. While the risk of cancer from aspartame is considered low for most consumers, those who consume large quantities could be harmed. In addition, children may reach the daily recommended limit more easily due to their lower body weight. In fact, a 44-pound child would only need to drink approximately four cans of Diet Coke per day to exceed the maximum recommended limit. That is why it is so important to be very careful to consume as little aspartame as possible, especially for children, to reduce the chances of developing cancer.^[9]

Should You Use Artificial Sweeteners?

Does the increased risks of obesity, diabetes, and heart disease from consuming large amounts of sugary drinks may outweigh the risks posed by artificial sweeteners?  That is still now clear, but based on the research so far, it makes sense to avoid the largest drink sizes, whether sugary or artificially sweetened. There is growing evidence that consuming even small amounts of artificially sweetened beverages may result in similar health risks to sugary drinks, and they apparently do not help with weight loss. Finding healthier alternatives, such as making your own coffee or tea, or flavoring water with slices of lemon, lime, watermelon, or apple, is a good strategy for your health. And, keep in mind that you should never consume more calories in other food because you “saved” some by drinking a non-caloric drink!^[7]

All NCHR articles are reviewed and approved by Dr. Diana Zuckerman and other senior staff. 

The National Center for Health Research is a nonprofit, nonpartisan research, education and advocacy organization that analyzes and explains the latest medical research and speaks out on policies and programs. We do not accept funding from pharmaceutical companies or medical device manufacturers. Find out how you can support us here.

References

1. Anderson GH, Foreyt J. Sigman-Grant M, Allison DB, The use of low-calorie sweeteners by adults: impact on weight management. J Nutr. 2012 Jun;142(6):1163S-9S.
2. The World Health Organization. WHO advises not to use non-sugar sweeteners for weight control in newly released guideline. May 2023. Retrieved from https://www.who.int/news/item/15-05-2023-who-advises-not-to-use-non-sugar-sweeteners-for-weight-control-in-newly-released-guideline
3. Dalenberg JR, Patel BP, Denis R, Vinke PC, Luquet S, Small DM. Short-Term Consumption of Sucralose with, but Not without, Carbohydrate Impairs Neural and Metabolic Sensitivity to Sugar in Humans. Cell Metabolism. Clinical and Translational Report, Volume 31, Issue 3, P493-502E7. March 03, 2020. https://www.cell.com/cell-metabolism/fulltext/S1550-41312030057-7
4. Brown RJ, Walter M, Rother KI. Effects of diet soda on gut hormones in youths with diabetes. Diabetes Care. 2012 Mat;35(5):959-64.
5. Vyas A, Rubenstein L, Robinson J. et al. Diet drink consumption and the risk of cardiovascular events: a report from the Women’s Health Initiative. J Gen Intern Med. 2015 apr;30(4):462-8.
6. Suez J, Korem T, Zeevi D, et al. Artificial sweeteners induce glucose intolerance by altering the gut microbiota. Nature. 2014 Oct 9;514(75210:181-6.
7. Corliss, Julie. Sugar substitutes: New cardiovascular concerns? Harvard Medical School. January 1, 2023. https://www.health.harvard.edu/heart-health/sugar-substitutes-new-cardiovascular-concerns
8. Florko, Nicholas. WHO says aspartame might cause cancer–but that most adult consumers don’t need to worry. STAT. July 13, 2023. https://www.statnews.com/2023/07/13/who-says-aspartame-might-cause-cancer-but-that-most-adult-consumers-dont-need-to-worry
9. Florko, Nicholas. WHO says aspartame might cause cancer–but that most adult consumers don’t need to worry. STAT. July 13, 2023. https://www.statnews.com/2023/07/13/who-says-aspartame-might-cause-cancer-but-that-most-adult-consumers-dont-need-to-worry
10. Look for these 9 red flags to identify food that is ultra-processed. (2024, January 2). Washington Post. https://www.washingtonpost.com/wellness/2024/01/02/ultra-processed-foods-identification/
11. O’Connor, A., Steckelberg, A., & Reiley, L. (n.d.). How fake sugars sneak into foods and disrupt metabolic health. Washington Post. Retrieved January 11, 2024, from https://www.washingtonpost.com/wellness/interactive/2023/sugar-substitutes-health-effects/

Andrea Sun, Avery Nork, Jenny Niwa

Fast Food Facts (download pdf)

Let’s face it:  With so much to do, it’s hard to eat right. And even though you know that fast food tends to be more fattening and less healthy, fast food chains are convenient and avoiding them may not be the most realistic. However, obesity is linked to a wide range of health problems, including breast cancer, endometrial cancer, colon cancer, and liver cancer, and knowing your healthiest options can go a long way for your overall health.

There is good news. The FDA implemented the new menu labeling rule in 2018 after facing delays and challenges since it was finalized in December 2014.^[1]

As a result, chain restaurants with 2 or more locations under the same name have to provide accurate information about calories and other nutritional information. Many changed their ingredients or made portions smaller to reduce calories. Customers can now consume fewer calories without dramatically changing their eating habits.^[2] Consumers now are empowered to make more informed choices about their food and it is easier to choose healthier eating habits.

How Many Calories Should I be Consuming a Day?

The United States Department of Agriculture (USDA) has recommended dietary guidelines that include the number of calories you should consume a day, depending on your age, level of activity, and whether you are a man or woman.^[3] The chart below will help you find out how many calories you should be getting.^[3] If you regularly consume more than the recommended amount, you will probably gain weight.

Recommended Daily Calorie Intake by Gender and Age Based on Activity Level

Source: HHS/USDA Dietary Guidelines for Americans, 2005 ^[3]

Sedentary means a lifestyle that includes only the light physical activity associated with typical day-to-day life. Moderately active means physical activity equal to walking about 1.5 to 3 miles per day at 3 to 4 miles per hour, in addition to the light physical activity typical of day-to-day life. Active means physical activity equal to walking more than 3 miles per day at 3 to 4 miles per hour, in addition to the light physical activity typical of day-to-day life. The calorie ranges are different for different age groups. For children and adolescents, more calories are needed at older ages. For adults, fewer calories are needed at older ages. ^[3] The National Center for Health Research wants to give you examples of menu choices offered by some of the most popular fast food chains. Take a look — you may be surprised!

Fast Foods by Category:

Where to Find This Information?

Don’t fall for the “health halo” effect by assuming that all foods at restaurants marketed as “healthy” or salads and other foods you assume are healthy are actually better for you. Several fast food chains and restaurants have their nutrition information on their websites. If your favorite foods are not listed above, go to the chain’s website and look for the calorie information. You may be shocked…or pleasantly surprised! Remember: knowledge is power. Knowing how many calories are in your favorite snack or meal-on-the-go can help you watch your weight and stay healthy.

All articles are reviewed and approved by Dr. Diana Zuckerman and other senior staff.

References:

1. Federal Register. Food Labeling; Nutrition Labeling of Standard Menu Items in Restaurants and Similar Retail Food Establishments. National Archives. 2014. Access from https://www.federalregister.gov/documents/2014/12/01/2014-27833/food-labeling-nutrition-labeling-of-standard-menu-items-in-restaurants-and-similar-retail-food

2. Evich, Helena. Obama’s calorie rule kicks in thanks to Trump. Politico. 2018. Access from https://www.politico.com/story/2018/05/07/fdacalories-food-labels-obama-trump-517191

3. U.S. Department of Agriculture. Dietary Guidelines for Americans 2020-2025. Access from https://www.dietaryguidelines.gov/sites/default/files/2020-12/Dietary_Guidelines_for_Americans_2020-2025.pdf

Danielle Pavliv, Sandy Wang and Varuna Srinivasan, National Center for Health Research

Wouldn’t it be great if we could each shed a couple of inches off our waist without having to diet or exercise?  For years, millions of Americans have tried pills, injections, “natural” herbs, and even berries that are supposed to help us shed pounds.  Unfortunately, these usually don’t work.

The latest magical way to lose weight is infrared light, also known as “red light therapy” or “low light therapy”

Infrared therapy is also suggested for pain management, jaundice, eczema, wrinkles, scars, improved blood circulation, and to help wound and burns heal faster. That doesn’t mean it actually works for any of those things. But in this article, we’re focusing on whether it works to help you look thinner. ¹

Light therapy uses near infrared light, usually from lasers, lamps, or tanning bed-like devices. The patient is told to either lie down or sit in front of the light for a specific amount of time on a regular basis (usually once a day). One popular device is the infrared body wrap, consisting of large silicone bandages or pads that emit infrared light around the legs, torso and arms. In addition, patients are told that red light therapy is supposed to improve the appearance of cellulite and help shape the body.

If it sounds too good to be true, it probably is. There is little scientific evidence supporting the claims that infrared light, whether administered by lamp, laser or while in a body wrap, can help people lose weight or shape their body. Nevertheless, in 2010, the FDA cleared a laser called Zerona, manufactured by Erchonia Medical Inc., which uses red light therapy to remove “unwanted” fat without surgical procedures. This device is not approved by the FDA – it is “cleared for market”, which is a different cleaning service process that does not require that a device be proven safe or effective.  Since 2010, several devices using the same technology have been cleared for marketing in the U.S. for body contouring and fat reduction. ²

Light therapy has been tested in clinical trials of patients, but these studies were not as scientific as they would need to be to prove safety or effectiveness. Most studies have few patients who have very similar demographics. Since the patients and clinicians know that the patient is being treated, and in most studies the patients getting treatment weren’t compared to patients getting a different treatment, this could result in a type of “placebo effect.” The placebo effect is when patients believe in a treatment and for that reason it seems to help even if the treatment isn’t actually effective. Also, the companies that make the light therapy devices provided funding to conduct the studies, which can result in overly optimistic results.

Despite all these substantial shortcomings, the studies showed only a small benefit from the light therapy.  So, even if the treatment has some benefit, which is doubtful, the benefit may not be substantial enough to be worth the time and money for the treatment.

In addition, all of the studies were short – none were more than 4 months long, and none followed up with the patients for more than a few weeks after treatment. So, we cannot know how long even small changes might last or what might happen if patients continued the treatment for years.

And what about the risks? Almost all of the studies did not provide any information about potential side effects of the therapy. However, one study done in Poland looked at the effects of LLLT used in close contact with the skin.  They found that patients developed skin ulcers as a result of certain types of lasers. ³

What exactly do the studies show?

A study funded by Erchonia (the company that makes Zerona) included 54 overweight or obese patients.⁴ Most of the patients were Caucasian men which is odd, since most weight loss patients are women. The patients were treated weekly for 6 weeks. The study found a significant reduction in the combined circumference of hips, waist, thighs, and upper abdomen by 13 cm (about 5 inches) after 6 weeks. Two weeks after the final treatment, patients lost another 2 cm (about 0.8 inches). However, patients knew that they were getting this treatment and may have changed their diet or exercise in an effort to succeed. These patients were not compared to a control group, so we can’t tell how much patients would have changed without the treatment. Also, patients were only studied for two weeks after their last treatment, so we do know how long this reduction lasted.

Whether or not infrared therapy is effective on its own, some scientists are studying whether it can potentially boost the benefits of exercise. To do this, they study obese patients all of whom are in an exercise program. Half the patients also get light therapy and the other half don’t. Results in these studies show us that it is possible that infrared therapy boosts the effect of exercise on weight loss. However, the studies were not well designed so it is impossible to know.

 A study in Brazil tested whether LLLT and aerobic exercise could reduce the chances of obese women developing heart disease.⁵ It was a well-designed study: 62 women were given an exercise regimen and randomly assigned to either be exposed to LLLT or a placebo for 4 months. LLLT increased the effectiveness of aerobic exercise to improve the women’s heart health. The scientists reported that LLLT reduced the abdominal fat and the women’s total body fat as measured by waist circumference and other measures. However, the study did not follow the women after their 4 months of treatment, so we don’t know how long the effect lasted.

Another device using Water Filtered Infrared Radiation (known as wIRA) is currently being studied to see if it helps patients lose weight.⁶ In this study, all 40 patients engaged in aerobic exercise 3 times a week for 4 weeks, with some patients also treated with wIRA while exercising. Although they were able to show a statistical difference in weight loss between the two groups (p<0.001), there were so few people in the study to be certain, and not enough information about any benefits lasting more than 4 weeks.

The uses of wIRA are currently being studied for a variety of medical conditions.^7,8 However, there are currently not enough studies to conclude how effective it is for weight loss.

Bottom Line

Light therapy may possibly reduce fat in the short term, but studies are small and only follow patients for a few weeks or months. We don’t know if any likely benefit is large enough to be meaningful or how long it might last.  So, if you want to lose weight, sustain weight loss, and get fit, we suggest exercise and dieting in a healthy manner. These tried and tested methods are also shown to decrease the overall risk for heart disease and some cancers in the long term.

All articles on our website have been approved by Dr. Diana Zuckerman and other senior staff.

References:

1. LED light therapy accelerated healing pain reduction red near infrared. (2015). Retrieved fromhttps://www.elixa.com/light/healing.htm
2. Accessdata.fda.gov. (2018). 510(k) Premarket Notification. [online] Available at:https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm
3. Jankowski M, Gawrych M, Adamska U, Ciescinski J, Serafin Z, Czajkowski R. Low-level laser therapy (LLLT) does not reduce subcutaneous adipose tissue by local adipocyte injury but rather by modulation of systemic lipid metabolism. Lasers in Medical Science. 2017;32(2):475-479. doi:10.1007/s10103-016-2021-9.
4. Thornfeldt CR, Thaxton PM, Hornfeldt CS. A Six-week Low-level Laser Therapy Protocol is Effective for Reducing Waist, Hip, Thigh, and Upper Abdomen Circumference. The Journal of Clinical and Aesthetic Dermatology. 2016;9(6):31-35.
5. Duarte FO, Sene-Fiorese M, de Aquino Junior AE et al (2015) Can low-level laser therapy (LLLT) associated with an aerobic plus resistance training change the cardiometabolic risk in obese women? A placebo-controlled clinical trial. J Photochem Photobiol B 153:103–110. https://doi.org/10.1016/j.jphotobiol.2015.08.026
6. Möckel F, Hoffmann G, Obermüller R, Drobnik W, Schmitz G. Influence of water-filtered infrared-A (wIRA) on reduction of local fat and body weight by physical exercise. GMS German Medical Science. 2006;4:Doc05.
7. Hoffmann G. Principles and working mechanisms of water-filtered infrared-A (wIRA) in relation to wound healing. GMS Krankenhaushygiene Interdisziplinar. 2007;2(2):Doc54.
8. Al-Ahmad A, Bucher M, Anderson AC, et al. Antimicrobial Photoinactivation Using Visible Light Plus Water-Filtered Infrared-A (VIS + wIRA) Alters In Situ Oral Biofilms. Hamblin M, ed. PLoS ONE. 2015;10(7):e0132107. doi:10.1371/journal.pone.0132107.