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Lewiss on Lifestyle Medicine
August 18, 2026
4 min learn
Lewiss on Lifestyle Medicine
Key takeaways:
- View GLP-1s as an adjunct to an weight problems discount plan— not THE plan
- Pair a GLP-1 with maintaining on dietary protein consumption, resistance train and medical monitoring.
GLP-1 receptor agonists are among the many most progressive and transformative medicines to come back in the marketplace in my skilled lifetime.
The potential well being advantages embody weight reduction, blood sugar management (for diabetic and nondiabetic sufferers alike), diminished ruminations about meals, decreased alcohol cravings and improved sleep apnea.
Nonetheless, these medicines usually are not a one-stop resolution. There must be a concomitant dedication to lifestyle and behavioral changes. I spoke with Lucy McBride, MD, a main care doctor in Washington, DC, about the place GLP-1s are enjoying a job in her apply.
Lewiss: I’m interested by your strategy to affected person care and GLP-1 medicines.
McBride: GLP-1 medicines are subtle thoughts/physique medication. I prescribe them when the affected person understands them as a device within the toolbox and never a panacea — and when they’re paired with actual consideration to dietary protein consumption, resistance train and medical monitoring. What makes these medicines extraordinary isn’t simply the load loss; it’s the discount in ruminations about meals, or what is usually generally known as “food noise,” the fixed psychological calculation about what they need to and shouldn’t eat. I hear about it almost day by day.
Lewiss: The place do you see and prescribe them as an adjunct to a weight reduction/weight problems discount plan?
McBride: For my sufferers who’ve struggled with weight problems, GLP-1 medicines might be transformative.
I consider Rachel, a 42-year-old lawyer who’d tried all the pieces. She had heard the chorus “weight loss plan and train” from docs since she was in her teenagers, so she left most appointments feeling worse than when she got here in. She did train and she or he did eat a nutritious diet, and nothing labored. Her battle was by no means about willpower; it was a neurobiological sample many years within the making, with a household historical past of diabetes and habit. Inside weeks of beginning a GLP-1, she instructed me that for the primary time in her grownup life, her mind was quiet between meals. The drug hadn’t simply modified her urge for food; it liberated her from disgrace and self-loathing.
However not everybody with a weight concern wants medicine. A lot of my sufferers must eat on a extra common schedule, not Ozempic, to expertise satiety and curb their cravings for calorie-dense meals. Some want therapist, not Ozempic, to make peace with their physique picture. Some simply want extra time of their day to arrange wholesome meals. The artwork of drugs is assembly sufferers the place they’re, determining the drivers of illness — is it organic? psychosocial? behavioral? — after which addressing root causes and the issue they really have.
Lewiss: The place do you see and prescribe these medicines for sufferers with insulin resistance prediabetes and diabetes?
McBride: Right here the science is much more settled, as a result of that is the place these medication began. They enhance insulin sensitivity, decrease blood sugar and A1c, and — per the SELECT trial — scale back the danger for coronary heart assault and stroke in folks with cardiovascular threat. That’s not a minor footnote. If we had a most cancers drug this efficient, nobody could be standing on the entrance of the room shouting, “Get to the basis trigger first!”
These medicines might be genuinely disease-modifying. However I attempt to not attain for them reflexively, as a result of the numbers often have a narrative behind them.
I consider Michael, a 52-year-old government with early kind 2 diabetes. Once I requested about his ingesting, he talked about two beers most evenings — “reasonable,” he figured. His alcohol was spiking his blood sugar, working towards his medicine and wrecking his sleep, which worsened his insulin resistance. He moved his one drink earlier and in the reduction of to twice every week. Two months later his A1c normalized. “I assumed the issue was what I used to be consuming,” he instructed me, “not what I used to be ingesting.”
That’s the “each/and” I attempt to maintain. Typically the reply to insulin resistance is the GLP-1. Typically it’s one thing else you weren’t . Usually, it’s each. Metabolic well being isn’t about one lever.
Lewiss: I’m hopeful and to learn concerning the position of GLP-1s and lowering alcohol craving. And as a possible remedy for sufferers with alcoholism. What do you see in your apply?
McBride: That is the latest and most fascinating frontier. The mechanism makes intuitive sense: these medication act on the mind’s dopamine reward circuitry. The identical wiring that quiets meals noise appears to dampen the pull towards alcohol and, for some folks, different compulsive behaviors like pores and skin selecting. Sufferers report it with out my asking.
The early observational information are promising, and the trials are underway. However I’d put an actual caveat on it: habit is a bio-psycho-social phenomenon. Concentrating on one neurotransmitter addresses a part of the image, not the entire of it. Treatment alone is unlikely to be a magic bullet.
So, in apply, I’m prescribing GLP-1s off-label to deal with alcohol dependence — however solely together with different psycho-social helps, resembling Alcoholics Nameless, or psychotherapy and shut medical monitoring. What’s extra widespread, although, is sufferers taking a GLP-1 for another purpose reporting a discount of their curiosity in alcohol. That’s not a aspect impact to gloss over. It’s a door. It opens a dialog about what the alcohol was doing for them within the first place.
If a drug may also help the tens of millions of people that battle with substance use, with out doing extra hurt than good, I welcome it. However I’d inform any affected person the identical factor: the craving going quiet is the opening, not the treatment. What you construct in that quiet is what lasts.
For extra info:
Resa E. Lewiss, MD, DipABLM, is a life-style medication and emergency medication doctor. She is an adjunct professor of emergency medication on the Warren Alpert Medical Faculty of Brown College. She produces and hosts The Visible Voices Podcast and is the co-author of the management e book MicroSkills: Small Actions, Big Impact. She might be reached by way of her web site resaelewissmd.com.
Lucy McBride, MD, is a Harvard and Johns Hopkins skilled PCP. She is the creator of Past the Prescription: A Physician’s Information to Taking Cost of Your Well being. She might be reached at info@lucymcbride.com or by way of her web site www.beyondtheprescriptionbook.com.
Lewiss on Lifestyle Medicine
Sources/Disclosures
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Disclosures:
Lewiss and McBride report no related monetary disclosures.
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