Leave it to the American College of Cardiology to out American physicians for what so many of them have become: drug pushers.

The College this week declared that “NuSH therapies” – short for “nutrient-stimulated hormone (NuSH) therapies” – should now be used to treat obesity because “parmacotherapy strikes the balance between effectiveness and invasiveness.”

Or, in short, GLP-1 receptor agonists like Liraglutide and Semaglutide and the GLP-1/GIP receptor agonist Tirzepatide – the hot, new weight-loss drugs – are in and the old advice on diet and exercise is out.

This is because, according to the College, “lifestyle therapy achieves insufficient long-term weight loss to resolve complications and comorbidities for a majority of patients.”

Thus the learned physicians of the time dedicated to restoring peace in the human body and saving all from evil have nicely positioned GLP-1s to become the opioids of the future.

To be clear here, GLP-1s are not physiologically addicting as are opioids, but psychologically, it’s likely to be a different story given that most of the people who obtain that nicely slimmed down body while on GLP-1s risk losing it if they quit taking the drug.

As MedPage Today headlined last year,  “The Data Are Clear: Patients Regain Weight After Stopping GLP-1 Drugs. Other than staying on drug, there’s no evidence-based strategy to maintain weight loss.”

The psychological implications of this are hard to ignore with researchers only weeks ago warning that testing people for protein amyloid β (Aβ), a possible predictor of Alzheimer’s disease, might relieve the anxiety of some but also “lessen their motivation to maintain a healthy lifestyle.”

Why would GLP-1s people behave any differently when a once weekly or once monthly injection, or soon a pill, makes losing weight much easier than dieting, which is hard, and exercising, which is sweaty?

If thin “seems to be very in,” as the New York Times reports, some people – possibly many – could end up hooked on GLP-1’s until thin is out, if this ever goes out. The “fat acceptance” movement of recent years has made some progress toward pushing it out, but thin, or at least not fat, has remained in because, at a fundamental physiological level, it is unhealthy be fat.

Obesity is often linked to metabolic syndrome, and metabolic syndrome was one of the major comorbidities linked to a lot of Covid-19 deaths during the pandemic in this country. 

Money, money, money

None of this is meant to suggest the medical community and big pharma have turned to GLP-1s solely because drugging people is easier than changing their unhealthy behaviors or because there is a huge amount of money to be made from a drug that once prescribed has to be consumed for life.

There might be some of that in play, but most doctors prescribing GLP-1s for obesity are likely doing so with the best of intentions. Then again, they had the same view of opioids, and look what happened with that almost magical painkiller.

“Prescribing soared from the 1990s to early 2000s. (And) by 2015, more than one in three U.S. adults received an opioid prescription,” according to the Mayo Clinic, and “multiple early studies have shown more than 80 percent of individuals who move to illicit opioids – particularly heroin – started on prescription opioids.”

The result has been what the Centers for Disease Control now calls an “opioid overdose epidemic.” That epidemic was estimated to have killed almost 108,000 Americans in 2023, the last year for which complete data is available.

Big pharma made tens of billions off of opioids, enough that drug companies decided in 2023 they could settle lawsuits by offering to pay state and local governments $50 billion over the next 18 years to reimburse their costs of dealing with an epidemic of opioid-linked crimes and deaths, PBS reported.

GLP-1s, which started off as a treatment for diabetes, and are now being hawked as a treatment for obesity, dementia, cardiovascular disease and more, would appear to have all the do-gooding and money-making benefits of opioids without the downside, although the long-term consequences are a little unclear.

GLP-1s lead to the loss of muscle, which is not good, along with body fat. Whether the muscle loss is greater than that related to dieting is a subject of considerable debate as is the question of how to prevent this muscle loss. 

And there are questions about long-term effectiveness. The pill pushers once thought they could wholly solve the problem of heart disease, still the nation’s number one killer, with drugs. It hasn’t worked out that way.

“Starting in the late 1960s, cardiovascular disease deaths fell and fell,” Jacob Sweet writes in The Harvard Gazette. “Mortality decreased by 70 percent – from 206 deaths per 100,000 in 1968 to 62 deaths in 2017. The share of all premature deaths attributable to heart disease fell, too.”

Sweet ignores the U.S. running boom that started late in the 1960s and ran into the early 2010s. It obviously played some role in driving down deaths from cardiovascular disease, given the well-documented benefit of physical activity in the prevention of that disease. But let’s ignore that because of what began to happen in the 2010s.

As Sweet writes, “the trends no longer look so promising. Around 2010, the long decline in cardiovascular deaths began to level off and appears stalled. Some studies find that they’re increasing year over year for the first time since the 1950s.”

The latest peer-reviewed research published late this month suggests that all doctors have managed to do is move deaths from one category to another category.

“…We found that from 1970 to 2022, the distribution of deaths within heart disease has shifted; in 1970 ischemic heart disease comprised 91 percent of all heart disease deaths, but only 53 percent in 2022, whereas other heart disease subtypes have increased from 9 percent of all heart disease deaths in 1970 to 47 percent in 2022,” they reported in the Journal of the American Heart Association.

They linked much of the increase to a rise in “obesity, diabetes, hypertension, and physical inactivity in the United States” where one of the chief goals of many has been to avoid any form of physical exertion.

This certainly raises a question as to whether the widespread use of GLP-1s to treat obesity could follow a track similar to that of the widespread use of drugs used to treat heart disease.

The College tried to temper thoughts of this by saying patients should still be encouraged to pursue the lifestyles changes known to improve health. But, as Dr. Olivia Gilbert, speaking for the College, informed MedPage earlier in the week, “patients should not be required to ‘try and fail’ lifestyle changes prior to initiating pharmacotherapy.”

Or in other words, the easiest path to weight loss should be pursued first because, well, it’s easy.

“Nonetheless,” Gilbert added, “lifestyle interventions should always be offered in conjunction with NuSH therapies.”

One can only wonder if North Carolina, where Gilbert lives and works, is still in the United States of America, because in the U.S., it has in recent years become abundantly clear that many, possibly a majority now, aren’t interested in the health benefits of exercise and a sensible diet.

Fat-laced French fries, fat-heavy fried chicken and fat-soaked hamburgers remain the country’s three favorite foods, according to the data-tracking website Statista. And the Tasting Table website presents the country’s favorite “snacks” as a laundry list of unhealthy, ultraprocessed foods – chips, Cheetos, Reese’s Peanut Butter Cups, Goldfish (the cheesy snack, not the fish in a tank), Fritos and more.

Trail mix and popcorn (depending on how it is prepared) are about the only non-ultra-processed foods on the website’s list of the country’s top 31 snacks.

As for exercise, it has become something many Americans now seem to think you need to go to a club to do, but only about one in five Americans belong to a health or fitness club, according to the Health and Fitness Association.

Club failures

Fifty-eight percent of gym members are there only twice per week, too, according to the Smart Health Clubs blog, which adds that “many (members) don’t stick around. Research shows that nearly 50 percent of new gym members quit within six months. That’s a huge problem for gym owners.

This might help explain why the CDC reports that three out of four Americans now fail to meet the recommended, barebones “physical activity guidelines for aerobic and muscle-strengthening activities.”

It says Americans need “at least 150 minutes a week of moderate-intensity (aerobic) activity such as brisk walking. (Plus) at least two days a week of activities that strengthen muscles.” 

The science itself says more would be better.

A systematic review of studies of physical activity and health reported in the peer-reviewed Medicine & Science in Sports & Exercise six years ago found that any “moderate to vigorous physical activity any is better than none,” but added that current exercise guidelines only provide about 75 percent of the possible risk reduction for death by heart disease or any other cause.

Physical activity (PA) amounts above guideline levels “reduces risk even more, ” they wrote, “but greater amounts of PA are required to obtain smaller health benefits.”

Wear yourself out myth

It is possible to overdo it, they conceded, but “there is no evidence of excess risk over the maximal effect observed at about three to five times the amounts associated with current guidelines.”

Five times the current guideline would require someone to engage in about 12.5 hours of aerobic exercise per week. It is hard to find many people in this country, aside from professional and serious recreational athletes, engaging in anywhere near that amount of exercise in a week.

I’m now putting in about 150 miles per week on the bike and that takes less than 10 hours per week, although some friends and family seem to think I’m riding “all of the time.” Ten hours per week is less than an hour and a half per day.

The average American spends more than three times that amount of time in front of a television every day, according to Nielsen, the TV-rating service. Its latest report said “the average U.S. adult spends about 32 hours each week with TV during warmer months and an additional two or three when the weather gets colder.”

According to Tech News World, Americans spend another “six hours and 40 minutes a day staring at the screens of their computers, phones, and other electronic devices.” And according to Geotab, a GPS-tracking website, Americans now spend about an hour per day commuting to and from work in motor vehicles. 

Some people, of course, roll their screen time into their drive time, which is why we are killing so many people on U.S. roadways. But that’s another story. This one is focused on the 10 to 12 hours per day, sometimes nearly 13, that Americans now spend sitting on their asses (4.6 to 5 for TV + 6.7 computerized devices + 1for commuting = 12.3 to 12.7).

The trendline here is not good either. The latest peer-reviewed study reporting the time Americans spend sitting concluded it “remained stable and high or increased.” That study, however, used data from just before the pandemic, during which sedentary times were reported to have again increased, especially among children in a country already facing an epidemic of childhood obesity.

That epidemic is partially linked to American urban design, which has made it unsafe to let the children out of the house to play, or so many parents fear, because of traffic. This is a fear with some basis in fact.

“Walking Shouldn’t Be So Dangerous in the U.S.,” Scientific American headlined in March. “About 20 people die every day in the U.S. after being hit by a car.”

 “In my big southern city, (walking) is a good way to get some exercise when the weather is nice or to run a nearby errand without having to waste gas or deal with parking,” reporter Megha Satyanarayana wrote.

She noted that in the Dallas area, where she lives, there are still sometimes a fair number of other walkers along her neighborhood streets, but then there are “the cars zooming down that same street. Drivers coast through stop signs or flat-out ignore flashing, newly installed crosswalk lights at one major intersection.

“I’ve seen more near-misses at that intersection than I care to remember – drivers who screech to a halt for a pedestrian in the crosswalk while the yellow beacons blink above, or who swerve around walkers rather than simply stopping, or my favorite, the ones who just speed through the crosswalk, forcing pedestrians to stop or jump out of the way.”

The situation in the third-largest city in Texas sounds a lot like that in the largest city in Alaska.

“This is absurd,” Satyanarayana added. “We should be able to walk in the U.S. without the fear of getting mowed down. But we can’t, largely because the problem has now become an ideological turf war. We cannot tamper with car culture.”

Motor vehicles have taken over the brains of Americans. The thinking among American cardiologists now seems to be that the cure to the problem that has done to our bodies is GLP-1s.

Maybe they’re right.

Maybe American society can continue to ignore the hundreds of thousands of years of evolution that made us what are, along with the reality that “exercise is medicine,” and live better lives through chemistry instead of worrying about getting healthy.

Then again, it was only a month ago that The Center for Infectious Disease Research and Policy at the University of Minnesota headlined “‘A national scandal’: US excess deaths rose even after pandemic, far outpacing peer countries.”

That story was linked to a study from Boston University that led one of the study’s authors, Dr. Jacob Bor to observe that “the U.S. has been in a protracted health crisis for decades, with health outcomes far worse than other high-income countries. This longer-run tragedy continued to unfold in the shadows of the COVID-19 pandemic.”

The study reported that a big part of the reason for the high American death rate was that 46 percent of all deaths among Americans under 65 years old would not have occurred if the U.S. had the age-specific death rates of its peers.

Could this possibly have anything to do with the American “health care” community preferring to medicate Americans rather than try to actually get them healthy?

Update: This story was edited on June 29, 2025 to include the latest peer-reviewed research from the American Heart Association on the shift in deaths linked to heart failures.