Reacción a "Medicines for obesity control are associated with a healthier shopping basket"

I like the study; it is ingenious, even though it is an observational study with the consequent limitation that causality cannot be attributed, only association. The choice of two populations, one taking GLP-1 medication and the control group, together with the analysis of shopping receipts, provides a fairly interesting approximation of reality. Have we found the vaccine for ultra-processed foods? It seems so. UNICEF already declared war on ultra-processed foods in its latest report on malnutrition two months ago, pointing out that obesity was the leading cause of malnutrition in the world.

What the study does show is nothing we don't already know in real life. A patient taking this type of medication tends to make healthier choices, even with a simple nutritional prescription, in a fairly automated way. This is related to the areas of the brain on which these drugs act. In animal experiments, we have known for a long time that laboratory rats stopped running towards Nutella and Coca-Cola and went for grain instead. In clinical trials, which is where we can establish causality, we have also collected patterns of eating behaviour and analysed that there is a lower intake of ultra-processed foods and a higher intake of healthy products in patients taking these drugs.

What is interesting about this study is the approach they use to shed light on the problem: the analysis of shopping receipts. What interests me most here is that it emphasises that patients taking the drug consume foods with lower energy density, less sugar, fewer carbohydrates, less saturated fat, slightly more protein and, very interestingly, less ultra-processed foods. It is not that they eat less, but that the quality of what they consume is better. Logically, patients who put themselves in the hands of an endocrinologist want to change their lives and also receive nutritional advice, although this has not been measured in the study. Therefore, it is not possible to say how much is attributable to the drug and how much is due to the endocrinologist or nutritionist who helps them make this lifestyle change.

Drugs are not the ultimate solution to obesity, far from it: they are the beginning of the solution. Patients must be very clear about this. The drug is a facilitator for adopting healthy lifestyle habits, which our biology and genetic programming make very difficult for us. These drugs are vaccines against ultra-processed foods; they are facilitators of a healthy lifestyle. We recently learned about their rebound effect with the publication in the British Medical Journal. It is important to note, and this is a very important message for the population, that people who use them well—and there are many who do—use them as a long-term health tool, always implementing healthy lifestyle habits. At the beginning of a new life, the rebound effect is prevented by a very good long-term health vision, incorporating habits. It is important that these drugs are not used lightly, but rather that they are used by specialised multidisciplinary groups, with a long-term health vision and good use, which much of the population—I would say the majority—does, although we often focus on misuse.

In summary, the study is interesting, I think it sparks many conversations and also reminds us that, in the end, we are the product of our biology. The neuroscience part, the brain part, the obese brain, continues to have a lot of power in leading us to an unhealthy weight.