Understanding Weight Gain and How to Manage It Holistically

Weight gain is a complex issue influenced by various factors that often interact in intricate ways. Understanding these causes and their underlying mechanisms is crucial for developing effective weight management strategies. This blog post will explore the causes of weight gain, the pathophysiology behind it, and how to incorporate a holistic lifestyle and natural remedies to lose weight healthily (Want to know more about GLP1 use for weight loss? See my previous post!).

Causes of Weight Gain

  • Poor diet and nutrition
  • Physical inactivity
  • Genetics
  • Hormonal imbalances
  • Medication use
  • Sleep deprivation
  • Stress

According to the Centers for Disease Control and Prevention (CDC), over 42% of American adults are obese, largely due to poor dietary choices and excessive calorie intake. The World Health Organization (WHO) reports that 1 in 4 adults globally are not active enough, contributing to the rising obesity rates. Genetics can account for 40-70% of individual variations in BMI (Body Mass Index), indicating a significant hereditary component. Hormonal imbalances, such as those seen in conditions like hypothyroidism and polycystic ovary syndrome (PCOS), can affect metabolism and contribute to weight gain. Certain medications, including antidepressants, antipsychotics, and corticosteroids, are also associated with weight gain. Furthermore, the National Sleep Foundation states that adults who sleep less than 7 hours per night are more likely to have a higher BMI. These factors collectively contribute to the complexity of weight management.

Pathophysiology of Weight Gain

Weight gain occurs due to an imbalance between calorie intake and energy expenditure, but the underlying mechanisms are more complex. Stress, poor sleep, poor diet, gut dysbiosis, hormones, genetics, and certain medications, hydration status can all lead to changes in our body that promote weight gain.

Stress can increase cortisol levels, which promotes fat storage, particularly around the abdomen.

Poor sleep affects hormones like ghrelin and leptin, which regulate hunger and satiety, leading to increased appetite and weight gain.

Poor diet, especially one high in processed foods and sugars, can lead to insulin resistance and metabolic syndrome.

Gut dysbiosis, an imbalance in gut bacteria, can impair digestion and increase fat storage. A diverse and balanced gut microbiota is essential for efficient digestion and metabolism. Probiotics (such as those found in yogurt, kefir, and fermented vegetables) and prebiotics (found in foods like garlic, onions, and bananas) can promote a healthy gut microbiome.

Hormonal imbalances, such as those seen in hypothyroidism or PCOS, can slow metabolism and promote weight gain. Insulin resistance, often seen in Type II Diabetes, leads to elevated blood sugar levels and increased fat storage. Leptin, a hormone that signals satiety, can become dysregulated in obesity, leading to overeating.

Genetics can influence how our body stores fat and responds to food.

Hydration is also crucial, as dehydration can be mistaken for hunger, leading to overeating.

Certain medications can alter metabolism, appetite, and fat storage. For instance, antipsychotic medications can increase appetite and lead to weight gain. It’s important to work closely with healthcare providers to find the most weight-neutral medications when possible.

“Losing weight is hard. Being overweight is hard. Choose your hard.” – unknown

Incorporating a Holistic Lifestyle and Natural Remedies

Adopting a holistic lifestyle involves making sustainable changes that address the root causes of weight gain. Here’s how you can incorporate natural remedies and healthy habits to manage weight effectively:

Behavior Modification

  • Mindful Eating: Pay attention to hunger and fullness cues to prevent overeating. Eat slowly, savor each bite, and avoid distractions during meals.
  • Consistent Sleep Patterns: Establish a regular sleep schedule and ensure adequate sleep to support metabolic health.

Stress Management

  • Techniques: Engage in stress-reducing activities like yoga, meditation, and deep breathing exercises.
  • Herbs and Supplements: Ashwagandha and Rhodiola can help manage stress levels and balance cortisol.

Good Gut Health

  • Probiotics and Prebiotics: Consume probiotics found in yogurt, kefir, and fermented vegetables, and prebiotics found in garlic, onions, and bananas to promote a healthy gut microbiome. The probiotic Akkermansia has specifically found to be useful in those that struggle with their weight.
  • Diet: Eat a diet rich in fiber, fruits, vegetables, and whole grains to support gut health.

Holistic Diet

  • Whole Foods: Focus on a balanced diet rich in whole foods, including lean proteins, healthy fats, and complex carbohydrates. Stay away from highly processed food like sweets or fast-food.
  • Hydration: Drink plenty of water to aid digestion and prevent overeating.

Fitness

  • Regular Exercise: Incorporate both aerobic exercises (like walking, cycling, or swimming) and strength training to build muscle mass and boost metabolism.
  • Consistency: Aim for at least 150 minutes of moderate aerobic activity or 75 minutes of vigorous activity per week.

Natural Remedies for Weight Loss

I always get asked what are some natural remedies for losing weight. This is a loaded question as the root cause of the weight gain must be discovered first. For example, if a person is exhibiting signs that their thyroid may need to support, then it may be prudent to start with iodine and/or selenium supplementation. If a person shows signs of being androgen-heavy, then using balancing herbs like spearmint may be beneficial. Care should always be individualized and the root cause should never be assumed. Some of my favorite natural options are:

  • Herbs: Green tea extract, Garcinia cambogia, and cayenne pepper can help boost metabolism and aid in weight loss.
  • Homeopathics: Remedies like Calcarea Carbonica and Natrum Mur have been traditionally used to support weight management.
  • Teas: Herbal teas such as dandelion, ginger, and peppermint can support digestion and help with weight management.
  • Probiotics/Gut Health: marshmallow root and/or licorice for healthy gut lining, probiotics like Akkermansia, and polyphenols.

Conclusion

Weight gain is a multifaceted issue influenced by diet, physical activity, genetics, hormones, medication use, sleep patterns, and stress. Understanding the underlying causes and incorporating natural remedies can help manage and prevent weight gain. By adopting a holistic lifestyle and making sustainable changes, individuals can achieve and maintain a healthy weight, improving their overall well-being. For those on a weight loss journey, remember to give yourself grace and celebrate small victories along the way. Every step towards a healthier lifestyle is a step in the right direction.

Written By: Roxanne Oliver, DNP, APRN, FNP-BC

*The information contained in this post is for information only. It does not replace routine follow-up and/or care with a certified and licensed medical provider

References

Centers for Disease Control and Prevention. (2020). Adult obesity facts. Retrieved from https://www.cdc.gov/obesity/data/adult.html

World Health Organization. (2018). Physical activity. Retrieved from https://www.who.int/news-room/fact-sheets/detail/physical-activity

National Sleep Foundation. (2020). How much sleep do we really need? Retrieved from https://www.sleepfoundation.org/how-sleep-works/how-much-sleep-do-we-really-need

Bray, G. A., & Ryan, D. H. (2020). Update on obesity pharmacotherapy. Annals of the New York Academy of Sciences, 1464(1), 78-93. https://doi.org/10.1111/nyas.14332

Kelly, S. A., Neale, M. C., Kendler, K. S., & Eaves, L. J. (2019). Genetics of obesity and body mass index: A review of behavioral genetic research. Current Opinion in Behavioral Sciences, 7, 76-82. https://doi.org/10.1016/j.cobeha.2015.12.001

Shulman, G. I. (2014). Ectopic fat in insulin resistance, dyslipidemia, and cardiometabolic disease. New England Journal of Medicine, 371(12), 1131-1141. https://doi.org/10.1056/NEJMra1011035

Turnbaugh, P. J., Ley, R. E., Mahowald, M. A., Magrini, V., Mardis, E. R., & Gordon, J. I. (2006). An obesity-associated gut microbiome with increased capacity for energy harvest. Nature, 444(7122), 1027-1031. https://doi.org/10.1038/nature05414

Sarris, J., Logan, A. C., Akbaraly, T. N., Amminger, G. P., Balanzá-Martínez, V., Freeman, M. P., … & Mischoulon, D. (2015). Nutritional medicine as mainstream in psychiatry. The Lancet Psychiatry, 2(3), 271-274. https://doi.org/10.1016/S2215-0366(14)00051-0

Stenholm, S., Head, J., Aalto, V., Kivimäki, M., Kawachi, I., Zins, M., … & Vahtera, J. (2015). Sleep duration and sleep disturbances as predictors of healthy and chronic disease-free life expectancy between ages 50 and 75: a multi-cohort study. International Journal of Epidemiology, 44(1), 71-83. https://doi.org/10.1093/ije/dyu235

van der Klaauw, A. A., & Farooqi, I. S. (2015). The hunger genes: Pathways to obesity. Cell, 161(1), 119-132. https://doi.org/10.1016/j.cell.2015.03.008

The Power of Intermittent Fasting (IF): Your Guide to Incorporating an IF Lifestyle

Intermittent fasting (IF) has garnered significant attention in the wellness community for its potential health benefits. By alternating periods of eating and fasting, IF promises to aid in weight loss, improve metabolic health, and enhance overall well-being. I have personally found that incorporating an intermittent fasting plan that is individualized makes a huge difference during times of weight loss plateaus and when the food noise feels out of control. This blog post delves into the different types of intermittent fasting, the cellular mechanisms at play, the latest research on its efficacy, its suitability for different individuals, pros and cons, contraindications, signs of its effectiveness, and practical tips for incorporating it into your lifestyle.

Types of Intermittent Fasting

There are a few different types of IF that you may hear about in research and/or on social media platforms. I always caution my patients that although these are fairly set plans, there is always room to individualize them to meet your needs. No matter what type you choose, it needs to be something that you can do consistently and that fits your lifestyle to promote success. Some of the more popular types include:

  1. 16/8 Method: This method involves fasting for 16 hours and eating within an 8-hour window. For example, eating only between 12 PM and 8 PM.
  2. 5:2 Diet: This approach involves eating normally for five days a week and restricting calorie intake to 500-600 calories on the other two days. On the reverse side, some individualize this and eat a 16/8 IF on weekdays and allow more flexibility on the weekend days.
  3. Eat-Stop-Eat: This involves fasting for 24 hours once or twice a week.
  4. Alternate-Day Fasting: Alternating between days of normal eating and days of fasting or significantly reduced calorie intake.
  5. Warrior Diet: Involves eating small amounts of raw fruits and vegetables during the day and a large meal at night, typically within a 4-hour window.

No matter what type you choose, it needs to be something that you can do consistently and that fits your lifestyle to promote success.

How Intermittent Fasting Works on a Cellular Level

There are many benefits of IF on a cellular and metabolic level. Some of the key benefits include:

  • Glucose and Insulin: During fasting, blood glucose levels drop, leading to decreased insulin secretion. Lower insulin levels facilitate the breakdown of fat for energy. This process can improve insulin sensitivity over time.
  • Autophagy: Fasting triggers autophagy, a cellular cleanup process where cells remove damaged components and regenerate new ones. This can enhance cellular function and longevity.
  • Hormones: Fasting affects several hormones, including ghrelin (hunger hormone), leptin (satiety hormone), and norepinephrine (which increases metabolic rate). These hormonal changes can reduce appetite and increase fat burning.

Additionally, IF can promote consistency in one’s eating schedule and remove the stress of figuring out when to eat something. This is commonly an overlooked aspect when a person begins any lifestyle change. The stress of knowing where to start can be overwhelming. If you only have to worry about eating 8 hours out of the day that can be a significant stress reducer for some.

Latest Research on Intermittent Fasting

Recent studies indicate that intermittent fasting can be effective for weight loss and improving metabolic health. Research shows potential benefits such as reduced inflammation, improved brain health, and extended lifespan in animal studies. However, human studies are still evolving, and long-term effects need more exploration. Notably, IF has shown promise in improving cardiovascular health by reducing risk factors such as hypertension and high cholesterol levels.

Suitability and Efficacy

Intermittent fasting can be suitable for many people, particularly those looking to lose weight or improve metabolic health. However, it’s essential to approach it with caution and preferably under medical supervision if you have underlying health conditions. IF might not be suitable for:

  • Pregnant or breastfeeding women
  • Individuals with a history of eating disorders
  • Those with certain medical conditions such as diabetes, unless closely monitored by a healthcare provider (A continuous glucose monitor (CGM) can be a wonderful tool for someone that is a diabetic so that blood glucose can be monitored closely).
  • Those with chronic stress and/or anxiety.
  • History of eating disorders

Pros and Cons of Intermittent Fasting

As with any lifestyle change, it is always important to weight the pros and cons. For some, IF works very well and the benefits are plentiful, whereas, for others it increases stress and just doesn’t work for them. At the end of the day, remember that you can always individualize your plan and make adjustments along the way if need be. Some of the pros and cons of IF include:

Photo by picjumbo.com on Pexels.com

Pros:

  • Potential for weight loss and fat loss
  • Improved insulin sensitivity and metabolic health
  • Enhanced brain function and neuroprotection
  • Simplified eating schedules

Cons:

  • Initial adjustment period can be challenging
  • Possible side effects like headaches, dizziness, or irritability
  • Social and lifestyle constraints due to eating windows

Signs of Effective Intermittent Fasting

Everyone likes results. So how do you know if IF is working for you? Again, I feel its important to reiterate that everything should be individualized. Knowing if intermittent fasting is working for you can be observed through:

  • Steady weight loss and fat reduction
  • Improved energy levels and mental clarity
  • Better blood sugar and insulin levels
  • Reduced cravings and improved appetite control

Its always important to know what your goals are so that when you incorporate something new, like IF, you can measure if it is working for you. When I use IF, it is typically to break a cycle of bad cravings (usually around Thanksgiving/Christmas time!). I know that IF is working for me when I feel in control of my eating choices and my food noise isn’t driving me crazy.

Incorporating Intermittent Fasting into Your Lifestyle

So how do you incorporate IF into your daily lifestyle? Here are some tips I have learned along the way to ensure my success:

  1. Start Slowly: Begin with a method like 16/8 and gradually increase fasting periods as your body adapts.
  2. Stay Hydrated: Drink plenty of water and non-caloric beverages during fasting periods.
  3. Balanced Diet: Focus on nutrient-dense foods during eating windows to ensure adequate nutrition.
  4. Listen to Your Body: Pay attention to how your body responds and adjust your fasting schedule as needed.
  5. Consistency: Like any dietary change, consistency is key to seeing results.
Photo by Jenna Hamra on Pexels.com

Let’s bring it all together!

Intermittent fasting can be a powerful tool for improving health and wellness when done correctly. By understanding the different types of IF, how it works on a cellular level, and its potential benefits and drawbacks, you can make an informed decision about incorporating it into your lifestyle. Always consult with a healthcare provider before starting any new dietary regimen, especially if you have underlying health conditions. With the right approach, intermittent fasting can be a sustainable and effective strategy for achieving your health goals.

Written By: Roxanne Oliver, DNP, APRN, FNP-BC

*The information contained in this post is for information only. It does not replace routine follow-up and/or care with a certified and licensed medical provider

References

Anton, S. D., Moehl, K., Donahoo, W. T., Marosi, K., Lee, S. A., Mainous, A. G., … & Mattson, M. P. (2018). Flipping the metabolic switch: Understanding and applying the health benefits of fasting. Obesity, 26(2), 254-268. https://doi.org/10.1002/oby.22065

Harvie, M. N., & Howell, A. (2017). Could intermittent energy restriction and intermittent fasting reduce cancer risk? A review of evidence and clinical potential. Molecular and Cellular Endocrinology, 455, 3-12. https://doi.org/10.1016/j.mce.2017.07.027

Longo, V. D., & Panda, S. (2016). Fasting, circadian rhythms, and time-restricted feeding in healthy lifespan. Cell Metabolism, 23(6), 1048-1059. https://doi.org/10.1016/j.cmet.2016.06.001

Mattson, M. P., Longo, V. D., & Harvie, M. (2017). Impact of intermittent fasting on health and disease processes. Ageing Research Reviews, 39, 46-58. https://doi.org/10.1016/j.arr.2016.10.005

Patterson, R. E., Laughlin, G. A., LaCroix, A. Z., Hartman, S. J., Natarajan, L., Senger, C. M., … & Marinac, C. R. (2015). Intermittent fasting and human metabolic health. Journal of the Academy of Nutrition and Dietetics, 115(8), 1203-1212. https://doi.org/10.1016/j.jand.2015.02.018

Sutton, E. F., Beyl, R., Early, K. S., Cefalu, W. T., Ravussin, E., & Peterson, C. M. (2018). Early time-restricted feeding improves insulin sensitivity, blood pressure, and oxidative stress even without weight loss in men with prediabetes. Cell Metabolism, 27(6), 1212-1221.e3. https://doi.org/10.1016/j.cmet.2018.04.010

Tinsley, G. M., & La Bounty, P. M. (2015). Effects of intermittent fasting on body composition and clinical health markers in humans. Nutrition Reviews, 73(10), 661-674. https://doi.org/10.1093/nutrit/nuv041

Varady, K. A. (2011). Intermittent versus daily calorie restriction: Which diet regimen is more effective for weight loss? Obesity Reviews, 12(7), e593-e601. https://doi.org/10.1111/j.1467-789X.2011.00873.x

Wilkinson, M. J., Manoogian, E. N., Zadourian, A., Lo, H., Fakhouri, S., Shoghi, A., … & Panda, S. (2020). Ten-hour time-restricted eating reduces weight, blood pressure, and atherogenic lipids in patients with metabolic syndrome. Cell Metabolism, 31(1), 92-104.e5. https://doi.org/10.1016/j.cmet.2019.11.004

Zehtabchi, S., Sinert, R., Kish, K., & Mattu, A. (2020). Fasting and metabolism: The biology of intermittent fasting. Emergency Medicine Clinics of North America, 38(1), 1-12. https://doi.org/10.1016/j.emc.2019.09.002

Understanding GLP-1 Medications: How They Work and Their Role in Weight Loss

In recent years, GLP-1 medications such as Ozempic, Wegovy, and Mounjaro have garnered significant attention for their role in aiding weight loss and managing Type 2 Diabetes; most recently, research has even shown their benefit in those with heart disease. While these medications offer promising benefits, it is crucial to understand their limitations and the importance of a comprehensive approach to health and wellness.

Photo by SHVETS production on Pexels.com

The Physiology and benefit of GLP-1 Medications

GLP-1 stands for glucagon-like peptide-1, a hormone produced in the gut that plays a significant role in regulating appetite (as well as cravings!) and blood glucose levels. Specifically, GLP-1 medications interact with the gut microbiome and influence the following:

  1. Appetite Regulation: GLP-1 medications mimic the action of the natural GLP-1 hormone. When these medications are introduced into the body, they bind to GLP-1 receptors in the brain, particularly in areas that control hunger and satiety. This interaction helps reduce appetite and increase feelings of fullness, leading to reduced food intake. This effect is a favorite of many as it forces one to eat less and not have as much “food noise” when deciding food options.
  2. Slowing Gastric Emptying: These medications slow down the rate at which the stomach empties food into the small intestine. This delayed gastric emptying helps prolong the feeling of fullness after eating, further aiding in appetite control and reducing overall calorie intake.
  3. Insulin Secretion: GLP-1 stimulates the pancreas to release insulin in response to food intake, helping to lower blood sugar levels. It also suppresses the release of glucagon, a hormone that increases blood sugar levels. This dual action helps maintain better glucose control, which is particularly beneficial for individuals with Type 2 Diabetes. This also reduces cravings due to the lack of up and down spikes in glucose.
  4. Reduction of Glucose Production: By inhibiting glucagon release, GLP-1 medications also reduce the liver’s production of glucose, contributing to lower blood sugar levels.

Many users of GLP-1 medications find that they experience significant weight loss, sometimes as much as 20% of their weight due to how they work in our bodies. Besides the weight loss, many find the decrease in “food noise” or the constant thinking of what to eat next to be comforting and helpful in making better, more healthy food choices.

Photo by Pavel Danilyuk on Pexels.com

Short-Term vs. Long-Term Use for Weight Loss

When considering GLP-1 medications for weight loss, it’s important to understand their role in both short-term and long-term use:

Short-Term Use

In the short term, GLP-1 medications can kickstart weight loss efforts by providing immediate benefits in appetite control and blood sugar regulation. This initial phase can be particularly motivating for individuals looking to make significant lifestyle changes. Additionally, I have also had success using GLP-1 medications in those that have reached a plateau in their weight loss and/or that have a small amount of weight to lose. However, the short-term use of these medications is generally not recommended as a standalone solution. Without ongoing support and lifestyle adjustments, the weight loss achieved may not be sustainable.

Long-Term Use

For sustained weight loss and health benefits, GLP-1 medications are often used as part of a long-term treatment plan. Long-term use helps maintain the physiological benefits of appetite regulation and blood sugar control, which can be crucial for individuals with chronic conditions like obesity and Type 2 Diabetes. It is important to note that long-term use of GLP-1 medications should always be supervised by a healthcare provider to monitor effectiveness, manage side effects, and adjust dosages as needed.

“Despite their benefits, GLP-1 medications are not a cure-all solution.”

The Importance of Professional Guidance

Despite their benefits, GLP-1 medications are not a cure-all solution. Working with a healthcare provider experienced with these medications is essential. I cannot stress this enough as there are many companies popping up across the nation that profess being an expert in obesity management and that are prescribing GLP-1 medications with little follow-up. Here’s why:

  1. Personalized Care: An experienced healthcare provider can tailor treatment to your specific needs, ensuring that the medication is used safely and effectively. When working with a provider, ask what framework they utilize to develop a plan for their patients. The Obesity Medicine Association (OMA) has developed the gold standard on obesity management and set the standard for providers offering obesity management services.
  2. Monitoring Side Effects: Common side effects include nausea, vomiting, and digestive issues. Those with a history of medullary thyroid cancer and/or frequent pancreatitis are not candidates for GLP-1 medications. A healthcare provider can help manage these side effects and adjust the treatment plan as needed.
  3. Comprehensive Approach: A healthcare provider can integrate GLP-1 medication into a broader wellness plan that includes diet, exercise, and mental health support. GLP-1 medications are NOT miracle drugs and should not be treated as such.

Maintaining Lean Muscle Mass

One of the concerns with rapid weight loss is the potential loss of lean muscle mass. Loss of muscle mass is not something to take lightly, which is why I wanted to specifically separately it out in this post. Maintaining muscle mass is crucial for overall health, metabolism, and functional strength. Recent studies have shown that muscle mass is linked to longevity, meaning that the more muscle mass a person has, the more likely they are to live longer and happier. Here are some strategies to ensure you preserve muscle while using GLP-1 medications:

  1. Protein Intake: Ensure you consume enough protein to support muscle repair and growth (approximately 0.8-1g/kg/day). Include high-quality protein sources such as lean meats, fish, eggs, dairy, legumes, and plant-based proteins in your diet.
  2. Resistance Exercise: Incorporate strength training exercises into your routine at least 2-3 times a week. Resistance exercises like weight lifting, bodyweight exercises, Pilates, and resistance band workouts help build and maintain muscle mass.
  3. Balanced Nutrition: In addition to protein, ensure your diet includes a variety of nutrients to support overall health. A balanced diet will provide the vitamins and minerals necessary for muscle maintenance and energy.
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The Road to Sustainable Health

GLP-1 medications can be a valuable tool in your weight loss journey, but they should be part of a comprehensive approach that includes lifestyle changes and ongoing support. Here are some key takeaways for achieving sustainable health and weight loss:

  1. Consistency is Key: Regular exercise, balanced nutrition, and adherence to medication are crucial for long-term success.
  2. Holistic Approach: Consider your overall well-being, including mental health, stress management, and sleep, as part of your health journey.
  3. Stay Informed: Continuously educate yourself about your health, medications, and wellness strategies to make informed decisions.
  4. Healthy Eating: A balanced diet rich in whole foods, lean proteins, healthy fats, and complex carbohydrates supports overall health and complements the appetite-regulating effects of GLP-1 medications.
  5. Regular Exercise: Incorporating both aerobic and resistance exercises helps maintain muscle mass, boost metabolism, and improve cardiovascular health. This is particularly important as muscle mass can decrease with rapid weight loss if not adequately supported by exercise.
  6. Behavioral Changes: Addressing psychological and behavioral aspects of eating through counseling, mindfulness practices, or support groups can enhance the effectiveness of GLP-1 medications and contribute to long-term success.

Conclusion

While GLP-1 medications offer promising benefits for weight loss and diabetes management, they are not miracle drugs and should not be used lightly. Sustainable health and weight loss require hard work, dedication, and a holistic approach. Many times I try to utilize a natural approach prior to medications and have found that many people do well with this. By working with a knowledgeable healthcare provider and taking steps to maintain lean muscle mass, you can achieve and maintain your wellness goals. Remember, true health is a lifelong journey, and every step you take towards a healthier lifestyle is a step towards a better you.


Stay informed, stay healthy, and embrace the journey to your best self! 🌿✨

Written By: Roxanne Oliver, DNP, APRN, FNP-BC

*The information contained in this post is for information only. It does not replace routine follow-up and/or care with a certified and licensed medical provider

References

Astrup, A., Carraro, R., Finer, N., Harper, A., Kunesova, M., Lean, M. E., … & Rossner, S. (2017). Safety, tolerability and sustained weight loss over 2 years with the once-daily human GLP-1 analog, liraglutide. International Journal of Obesity, 36(6), 843-854.

Buse, J. B., Wexler, D. J., Tsapas, A., Rossing, P., Mingrone, G., Mathieu, C., & D’Alessio, D. A. (2020). 2019 update to: Management of hyperglycemia in type 2 diabetes, 2018. Diabetes Care, 43(2), 487-493.

Davies, M. J., Bergenstal, R., Bode, B., Kushner, R. F., Lewin, A., Skjøth, T. V., … & Jendle, J. (2015). Efficacy of liraglutide for weight loss among patients with type 2 diabetes: the SCALE Diabetes randomized clinical trial. JAMA, 314(7), 687-699.

Drucker, D. J. (2018). Mechanisms of action and therapeutic application of glucagon-like peptide-1. Cell Metabolism, 27(4), 740-756.

Holst, J. J., Rosenkilde, M. M., & Deacon, C. F. (2020). Pharmacology of incretin hormones with special reference to clinical pharmacology of GLP-1 receptor agonists and DPP-4 inhibitors. Pharmacological Reviews, 72(4), 604-648.

Kushner, R. F., Calanna, S., Davies, M., Dicker, D., Garvey, W. T., Goldman, B., … & le Roux, C. W. (2020). Semaglutide 2.4 mg for the treatment of obesity in adults: A systematic review and meta‐analysis. Diabetes, Obesity and Metabolism, 22(10), 1901-1911.

Lean, M. E., Astrup, A., Roberts, S. B., & Hanson, R. L. (2019). Making progress on the global crisis of obesity and weight management. The Lancet, 394(10215), 206-210.

Müller, T. D., Finan, B., Clemmensen, C., DiMarchi, R. D., & Tschöp, M. H. (2019). The new biology and pharmacology of glucagon-like peptide-1. Mayo Clinic Proceedings, 94(1), 51-67.

Wilding, J. P., Batterham, R. L., Calanna, S., Davies, M., Van Gaal, L. F., Lingvay, I., … & Lau, D. C. (2021). Once-weekly semaglutide in adults with overweight or obesity. New England Journal of Medicine, 384(11), 989-1002.