Weight Loss Without Weight-loss Drugs: Fasting, Healthy Eating and a Return to Real Food

GLP-1 medications have become extremely popular because they can significantly reduce appetite and lead to substantial weight loss. It is important to be fair about what these medicines are. They act on hormones involved in regulating appetite and digestion. They slow gastric emptying and reduce hunger and food cravings which can make it easier to eat less. It would be simplistic to call them ‘bad’ drugs, but they are also not necessarily appropriate for everyone. Current NICE (US National Institute for Health Care Excellence) guidelines recognise these medications to be undertaken as part of an overall supervised plan for certain people with severe overweight or obesity, particularly where there are weight-related health conditions such as type 2 diabetes, hypertension and sleep apnoea. That plan would most likely include dietary changes, increased physical activity and other lifestyle changes and not be a substitute for them. This is very different from taking a weight-loss injection simply because you would like to lose five or ten kilos.

It is also worth remembering that these medicines are still relatively new as a widespread approach to long-term weight management. This is particularly relevant when considering their potential long-term use by people who are not living with obesity or significant weight-related disease. Another important consideration is what happens when these medications are stopped. Weight regain can occur after any significant weight loss, no matter how it is achieved. The same goes for these drugs once treatment ends. This raises the question of whether they need to be continued for the long term to maintain their effects. These medicines have been studied and are licensed for appropriate medical use, however, we do not yet have the decades of experience that we have with many established approaches to weight management. Important questions about very long-term use, particularly in people who are not living with obesity or significant weight-related disease, remain. Could it potentially create an addictive cycle?

These drugs also list several potential side effects. Nausea, vomiting, diarrhoea and constipation are among the common effects, while more serious problems can occur, including gallbladder disease and pancreatitis. Dehydration can also become a concern when gastrointestinal side effects are severe. These medicines therefore need to be treated as medical treatments, rather than as harmless lifestyle products. There is no doubt that these medications can help you to lose weight. The issue is what effects the body may be experiencing that could have consequences for our health further down the line. Not everyone who wants to lose weight needs a drug to do it.

We seem to have become even more focused on the number on the scales. However, your weight is only one aspect of your health. Is it not more important to ask yourself how much healthier you could be rather than the quick fix of how much weight you can lose? Imagine two people who each lose ten kilos. One does so by eating better-quality food, becoming more active, improving sleep, reducing stress and developing habits they can continue for years. The other loses the same amount of weight but remains inactive, eats a highly processed diet and relies on medication to suppress their appetite. The scales show the same result. The underlying health picture may be very different.

Healthy weight management should therefore be about much more than losing weight as quickly as possible. It should be about improving the things that influence our health in the first place: nutrition, movement, sleep, stress, metabolic health, muscle mass and our relationship with food.

GLP-1 medications may be able to improve a number of measures associated with metabolic health, although it is not always possible to separate the effects of the medication itself from the effects of losing weight. What is undeniable is that many of the improvements we are seeking, better blood sugar regulation, healthier body composition, improved fitness and greater metabolic health, can be achieved through changes to the way we live. Eating nourishing food, becoming more active, building and maintaining muscle, sleeping well and reducing chronic stress can all contribute to better health, without relying on medication.

Modern food has changed dramatically. Many of us now have access to an almost endless supply of foods that are inexpensive, convenient, highly palatable and designed to encourage us to eat more. Ultra-processed foods are not necessarily unhealthy simply because they have been processed. But diets containing large amounts of ultra-processed food have been associated with poorer health outcomes, and experimental research has provided some fascinating insights. In a controlled NIH (US National Institutes of Health) study, people eating an ultra-processed diet consumed considerably more calories and gained weight compared with when they ate a minimally processed diet. Importantly, the meals were matched for many nutritional characteristics, including calories offered, carbohydrate, fat, protein, sugar and fibre.

This does not mean that every processed food is harmful or that we need to eliminate every packaged food from our lives. However, the quality and nature of the food around us does influence how much we eat.

For some people, the first step towards weight loss may therefore not be counting calories. It may simply be learning to eat more real food. More vegetables, fruits, legumes, whole grains, nuts, seeds and good sources of protein. Less confectionery, sugary drinks, highly processed snacks and foods that are easy to consume in large quantities without ever feeling particularly satisfied. Often changing what we eat can be more sustainable than continually trying to eat less. This is likely to be particularly relevant for people who are not medically obese but have gradually gained weight as a result of modern eating habits. Before reaching for medication, we should be asking ourselves if changing the food we eat is possible and sustainable and what would happen if we did.

Fasting is not new. Humans have always experienced periods without food. What is relatively new is having access to food around the clock. Nowadays most of us can eat from the moment we wake up until the moment we go to bed. We can snack at our desks, in the car, while watching television and whenever we feel bored, stressed or simply see something tempting. Intermittent fasting offers one possible way of breaking that pattern. Usually this means having a shorter eating window within a day of say only 8 hours with 16 hours without food. So that could mean eating from 10am to 6pm with nothing outside of that. Or it could mean fasting for one day a week.

Prolonged fasting of longer than 3 days can induce weight loss but more importantly, it also helps with detoxification. After 3 days of no food, the body enters a state of autophagy, its own cellular recycling process. Anahata offers several prolonged fasting programmes (https://www.anahatasamui.com/anahata-wellbeing-retreats/weight-loss-detox/). The components within these programmes that help aid detoxification are our intestinal cleanser supplements, colon cleansing and detox drinks made with psyllium husk and bentonite clay which help flush out toxins from your system.

For many people, fasting can also be a useful way of learning that feeling hungry for a while does not mean that we need to eat immediately. Hunger is a sensation, not necessarily an emergency. Learning to experience it without automatically responding to it can change our relationship with food.

There can also be something surprisingly enjoyable about eating after a period without food. Simple, natural foods can taste extraordinary when we have not been eating constantly. A piece of fruit, a fresh salad or a simple whole-food meal can become something to savour rather than just another item to consume.

It can help us rediscover hunger, appetite, satiety and the pleasure of eating real food. Fasting and healthy eating can work together. Periods without food can provide structure. Healthy food provides nourishment. The combination can help us move away from the idea that weight management is simply about restricting calories. The goal is not simply to spend fewer hours eating. It is to develop a way of eating that supports health.

This is the part of weight management that deserves much more attention. Many people know exactly what they should eat. They know they should exercise. They know they should sleep more. They may even have tried fasting however, knowing what to do and being able to do it are two very different things.

Stress can make healthy choices considerably harder. When life becomes overwhelming, food can become a form of comfort. We may eat because we are tired, anxious, bored, lonely or simply looking for a moment of pleasure after a difficult day.

The pattern can become self-perpetuating:

Stress → poor sleep → cravings and reduced energy → less healthy food choices → overeating → feeling unhappy about our choices → more stress.

At that point, telling someone simply to "eat less" may completely miss the point. Sometimes the food is not the underlying problem. The stress is.

And this is why weight management cannot always be separated from the rest of our lives. If someone is exhausted, burnt out and using food to cope with the pressures of everyday life, another strict diet or demanding exercise regime may simply become another source of stress. This is why a healthy lifestyle has to be realistic because there is another danger in the modern obsession with health, we can turn healthy living into another source of stress. We can become obsessed with calories, fasting windows, step counts, exercise targets, supplements and lists of foods we are supposedly not allowed to eat. If becoming ‘healthy’ makes you miserable, anxious and exhausted, it is not healthy at all.

The best approach is one that fits your life. For one person, that might mean beginning with better food. For another, it might mean reducing alcohol. Someone else may need to move more. Another person may need to address chronic stress or poor sleep before they can make lasting changes to their diet. Sometimes the most important first step is simply to stop trying to change everything at once. The question is not “What is the perfect health regime?” but “What changes are possible for me without creating another source of stress?” It is important to look at your lifestyle as a whole rather than searching for one perfect diet or fasting protocol. Look at the bigger picture. Anahata’s Burnout and Stress Management Detox can help to answer these questions (https://www.anahatasamui.com/anahata-wellbeing-retreats/burnout-stress-management-detox/).

Ask yourself:

How am I eating?

Am I eating mostly real, nourishing food, or has ultra-processed food become a significant part of my diet?

When am I eating?

Am I eating because I am genuinely hungry, or have snacking and grazing become habitual?

How am I moving?

Am I maintaining strength, fitness and muscle as I get older?

How am I sleeping?

Am I giving my body enough opportunity to rest and recover?

How stressed am I?

Could stress, anxiety or emotional pressure be influencing the way I eat?

What could I realistically change?

Perhaps this is the most important question of all.

Weight loss is often just another source of stress. No single solution is necessarily the answer for everyone. For some people, a period of fasting can provide a useful starting point or a powerful tool for weight loss and changing their relationship with food. For others, learning how to eat nourishing, minimally processed food may make the biggest difference. Some people need to rebuild strength and fitness, others need to step away from work and everyday pressures and give themselves time to recover.

For many people it is the need to address their relationship with food, stress and their own expectations that makes the difference. It is a good idea to take the time to understand what it is you may need. But most importantly a healthy lifestyle is built of many of these components. Food, fasting, movement, sleep, stress management and emotional wellbeing are not separate boxes. They influence one another.

The healthiest way to move forward would be to stop asking yourself what is the fastest way to lose weight and start asking what changes to my lifestyle might make me healthier, happier and more energetic and could I realistically achieve them. This could involve fasting, changing how or what you eat, exercise, meditation, yoga, relaxation, getting more into nature or all of the above.

And for someone living with obesity or an obesity-related medical condition, it may also involve appropriate medical treatment. Weight-management medicines have an important place in modern medicine, but even NICE recommends that they are used alongside dietary, physical-activity and behavioural approaches.

The aim should therefore not be to create a battle between medication and lifestyle. It should be to understand which tools are appropriate for which person. Before you reach for a weight-loss injection, ask yourself five questions:

1. Do I actually need medical treatment for obesity, or am I simply unhappy with my weight?

2. How much of my diet consists of ultra-processed food?

3. Am I eating because I am hungry, or because eating has become a response to stress, boredom or habit?

4. Have I explored healthy eating, increased movement and an appropriate fasting approach before turning to medication?

5. What changes could I realistically maintain without creating more stress in my life?

These questions are not intended to replace medical advice. Anyone with obesity, diabetes or another medical condition should discuss appropriate treatment with a qualified healthcare professional.

But for someone who is otherwise healthy and simply wants to improve their weight and wellbeing, they may be a very good place to start. Changing your lifestyle is not always easy when you are surrounded by the same routines, pressures and temptations that created your habits in the first place. Sometimes you need to step away. A change of environment can give you the opportunity to slow down, sleep properly, eat differently, move your body, reduce distractions and discover what actually makes you feel better.

At Anahata, we believe that weight management is not simply about food. It is about the whole person. Our six programmes, Juice, Weight Loss, Fitness, Stress & Burnout, Ageing and Diabetes, (https://www.anahatasamui.com/anahata-wellbeing-retreats/) each approach wellbeing from a different perspective, but they share an underlying philosophy: helping you understand your body, develop healthier habits and discover changes that can continue long after you return home.

The healthiest weight is not necessarily the lowest weight. We live in a world that constantly tells us to become smaller; however, health is about much more than size. It is about having energy, strength, nourishing your body, sleeping well, managing stress and feeling comfortable with food rather than constantly fighting it. The goal should be to find a way of living that supports your health without becoming another source of pressure. Weight loss may be part of that but maybe the real goal is not simply to lose weight but to become healthier in a way that makes weight loss and the ability to maintain a regular weight natural consequences of a healthier life.

When we eat better, move more, sleep well, manage stress and feel happier and more balanced in our lives, our relationship with food often changes too. Sometimes the weight we have been struggling to lose begins to fall away almost as a by-product of those changes. The goal is not simply to be lighter. The goal is to be healthier, stronger, more energetic and more at ease with the way we live.