Ever since college, Brad Jobling struggled with his weight, fluctuating between a low of 155 pounds when he was in his 30s to as high as 220. He spent a decade tracking calories on WeightWatchers, but the pounds he dropped always crept back onto his 5-foot-5-inch frame.
A little over a year ago, the 58-year-old Manhattan resident went on a new weight-loss drug called semaglutide (Wegovy). He’s lost 30 pounds, and has started eating healthier food and exercising — the habits behind many commercial diet plans and decades of conventional wisdom on sustainable weight loss.
Yet Jobling’s experience also has altered his perspective on dieting. He now sees obesity as a disease that requires medical intervention, not just behavioral changes. In fact, he thinks he will need to stay on a drug like semaglutide for the rest of his life even though it has taken some of the joy out of eating.
“I don’t see how you can maintain (the weight) without medication,” Jobling said. “Obviously, it’s all about self-control. But I think it’s less of a struggle to really maintain healthy eating when you got that assistance.”
Like the lives of the people taking them, recent injected drugs like semaglutide, which was first approved for diabetes under the brand name Ozempic, are reshaping the U.S. health and fitness industries. They have proven successful in eliminating unwanted pounds more quickly and easily than consuming fewer and burning more calories alone. Such is their disruptive power that even established diet companies like WeightWatchers and brands like Lean Cuisine are getting makeovers.
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Although celebrities like Oprah Winfrey have spoken publicly of the drugs as revolutionary, some health experts worry that businesses without any expertise will start dispensing the prescription medications along with bad advice and unproven therapies.
A Demand Too Big to Ignore
At least 3 million prescriptions for the class of medications known as glucagon-like peptide 1 (GLP-1) agonists were issued each month in the U.S. during the 12 months that ended in March, according to data from health technology company IQVIA. They include semaglutide and tirzepatide (Mounjaro, Zepbound). Morgan Stanley research analysts have estimated that 24 million people, or 7% of the U.S. population, will be using GLP-1 drugs by 2035.
The world’s leading diet programs have taken note of such statistics and incorporated the popular drugs into their existing subscription plans.
WeightWatchers, which was founded in 1963, last year acquired telehealth provider Sequence, enabling members to get prescriptions for weight-loss drugs. WeightWatchers is sticking with its focus on behavior change as the cornerstone of weight reduction but launched virtual clinics that provide customized exercise and nutrition plans, as well as prescription care, for individuals who want to lose 20% of their body weight on average.
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“The weight loss space will be led by the acknowledgement that weight loss is a matter of healthcare,” WeightWatchers CEO Sima Sistani told analysts earlier this year. “This is a paradigm shift because weight loss has been and, unfortunately, often still is viewed as a vanity issue.”
The Mayo Clinic, which first offered a weight management plan in book form in 1949, has published an updated version of the longtime bestseller, titled “The Mayo Clinic Diet: Weight-Loss Medications Edition.”
The Mayo Clinic Diet program also has expanded to include access to weight-loss drugs and advice on managing any side effects, according to Digital Wellness CEO Scott Penn, whose company developed an online platform for the original program.
The new drugs have made being very overweight “feel more medical as a condition,” he said.
Gym and Diet Food Companies Look to Muscle In
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Luxury athletic club operator Life Time launched a membership program last year that offers comprehensive medical testing, personalized training, and a host of alternative therapies like cryotherapy. Members of the Miora program also can get semaglutide and other weight-loss drugs through the medical staff of a clinic that opened in Minneapolis last year.
Jeff Zwiefel, executive director of Life Time Miora, called the new drugs a “game changer” for the fitness industry.
“We have an opportunity and an obligation and a responsibility to help people achieve results in conjunction with medical providers and make sure that that’s the way to go,” he said.
Fitness chains are banking on the idea people on the drugs will lose enough weight to overcome any self-consciousness or physical limits that kept them from exercising. The gym franchise Equinox started a new personal training program in January for prescription-holders who want to preserve or build muscle mass as they shed unwanted pounds.
The world of drug-assisted weight loss also is altering the ambitions of food companies. Sales of SlimFast, a line of meal replacement shakes and snacks sold at supermarkets, have dropped as people turn to weight-loss drugs and retailers cut shelf space for diet products, the brand’s parent company, Glanbia, told investors in February.
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Since the drugs suppress the appetites of people taking them, Glanbia and other companies are marketing their products as a source of adequate nutrients for people taking GLP-1s. Swiss multinational Nestle SA thinks it can benefit from the drugs’ popularity and is expanding its Lean Cuisine frozen meals and OPTIFAST protein shakes.
“Diets are cool again,” Nestle SA CEO Ulf Mark Schneider told analysts in February. “It’s something that people used to do quietly on the side, uncertain about their outcomes.”
Promising Results and a Wealth of Unknowns
Research has shown that about a third of people lose 5% or more of their body weight with diet and exercise alone, according to Louis Aronne, MD, director of the Comprehensive Weight Control Center at Weill Cornell Medical school. In comparison, tirzepatide helped people with obesity or who are overweight lose at least a quarter of their weight when combined with restricted calories and exercise, a new study showed.
But some experts worry about businesses marketing the drugs or serving as fitness coaches for patients on the medications. Cian Wade, BMBCh, MPH, a healthcare consultant for the global strategy and management firm Kearney, said he’s concerned about a proliferation of clinics that don’t have as much experience with obesity and related health conditions.
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“There’s a potential worry that for some patients, (the clinics) will not have the right expertise at hand to be able to appropriately manage the side effects, nutrition-related issues,” he said.
Since GLP-1 medications are so new, it’s unclear how many patients will stick with their drug regimens, which produce intolerable side effects for some people. Another reason patients may drop the drugs is cost. A month’s supply of the weight-loss formulation of semaglutide costs $1,300, and tirzepatide’s is priced at $1,000.
‘The New Version of Me’
Lisa Donahey, 54, an actress and singer who lives in Los Angeles, started tirzepatide under a doctor’s care a year ago to address her type 2 diabetes. At the time, Donahey, who is 5-foot-7-inches tall, weighed 260 pounds and was a veteran of diet plans like Jenny Craig, WeightWatchers, and Nutrisystem.
Her weight has since dropped to a little less than 190 pounds. She goes to a gym. After always being cast as a character actor, she’s looking for new roles. Having used the medication to give her “a kick-start,” Donahey said she plans to wean herself off tirzepatide once she loses another 40 pounds.
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“I had a sense of hopelessness that I was destined to be this way and just could not do it by myself,” she said. “Now, with my weight being managed and the new version of ‘me’ is emerging, I just feel so empowered, excited, and hopeful.”
A dedicated runner’s last 121 runs culminated in a TikTok video where a stick figure appears to dance on a map of his neighborhood.
Duncan McCabe tracked 10 months of runs using Strava, an app that’s part exercise tracker, part social media. McCabe posted his runs to Strava, which records metrics like distance, calories, time, and average space. Strava also outlines movement in each exercise session with an orange line on a map.
McCabe’s route took the intentional shape of a stick figure man wearing a cap, whose pose changed slightly every session. After 121 sessions, McCabe was ready to compile each route display into a masterpiece.
“Strava art animation through the streets of Toronto!” reads the caption. “This took me 121 runs from January to October 2024.”
Set to music with a steady beat, the orange stick figure appears to dance across the map for 20 seconds.
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Over the summer of 2023, McCabe compiled a series of routes he ran in shapes that included dinosaurs, sharks, and even the letters to spell out Toronto.
Eager fans will likely need to exercise patience until McCabe releases the next elaborate compilation in his running series.
TUESDAY, Nov. 26, 2024 (HealthDay News) — It’s common to find a pitcher soaking their elbow in an ice bucket following a baseball game, in an effort to save their arm for tomorrow’s innings.
But athletes about to hit the turf would be better off soaking their aching muscles and joints in a hot tub rather than an ice bath, researchers report in a new small-scale study.
A hot soak appears to improve exercise performance among athletes, researchers found.
On the other hand, cold soaks are better for lowering inflammation, swelling and fatigue, results show.
“While post-exercise [cold water immersion] is common on the sports field, cooling does not always have a positive effect on exercise capacity,” lead researcher Mamoru Tsuyuki, a master’s student in sports and health science at Ritsumeikan University in Shiga, Japan, said in a news release.
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For the study, researchers asked a small group of endurance athletes to perform 50 minutes of high-intensity interval running, followed by 20 minutes of either a cold-water soak at 59 degrees Fahrenheit or a hot-water tub at 104 degrees F.
One hour after the workout, researchers measured the athletes’ jump height and blood levels of enzymes that indicate muscle soreness.
The athletes jumped higher after a hot soak compared to a cold soak, results show.
“The novel findings from our study are that post-exercise hot water immersion promoted recovery of muscle power output compared to post-exercise cold water immersion,” Tsuyuki said. “The findings will be useful for people who conduct multiple sessions of exercise or competition within a day.”
Hot water increases blood flow to damaged muscle fibers, helping them repair themselves and become stronger, Tsuyuki told NBC News.
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“When you need to perform twice in the same day, such as in sports that have a halftime, heat is better,” Tsuyuki said. “During the 15 or 20 minutes, if you can immerse yourself in hot water, you can probably perform better in the second half.”
Experts said that both hot and cold baths have an impact on blood flow to the muscles, and are likely useful depending on an athlete’s circumstances.
“I wouldn’t throw out cold baths,” Dr. Spencer Stein, an assistant professor of orthopedic surgery at the NYU Grossman School of Medicine, told NBC News. “There are studies that show cold baths can decrease soreness.”
However, “my experience with pro teams is they like warm baths before games,” Stein added. “If there’s a halftime, they don’t do a cold plunge.”
David Putrino, director of rehabilitation innovation at the Mount Sinai Health System in New York City, recommends that people soak either in 98- to 104-degree water for 10 to 20 minutes if they want a hot soak, or 10 to 15 minutes in 50- to 59-degree water for a cold soak.
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Some folks love cold plunges because they feel energized afterward, Putrino said.
“Once they get out, their body is flooded with endorphins, the feel-good chemicals, and they get an immense rush of energy,” Putrino told NBC News.
“My recommendation is to use your own data to understand what works for you,” he said. “Don’t believe what you’re hearing on podcasts.”
Researchers presented these findings Thursday at the 2024 Integrative Physiology of Exercise conference at State College, Penn.
Because these findings were presented at a medical meeting, they should be considered preliminary until published in a peer-reviewed journal.
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More information
Stanford University has more on cold water immersion.
When most people think of a strong core or achieving abs, the first exercise that comes to mind is often sit-ups. While sit-ups have long been a go-to for strengthening the core, they’re not always the most effective or safest option for everyone. Proper form and technique are key to maximizing the benefits of sit-ups while avoiding strain on the back and neck.
To provide a well-rounded perspective on how to do sit-ups, we spoke with three experts who shared their insights on the benefits and potential risks of sit-ups, as well as alternative exercises that can help build a strong core without the same level of stress on the body. Their advice offers a balanced view of how to approach core training, ensuring safety, effectiveness, and overall fitness progress. Whether you’re a beginner or a seasoned athlete, understanding how to incorporate sit-ups — or how to replace them with other movements — can help you reach your fitness goals more efficiently and safely.
Many expectant mothers, especially, wonder if sit-ups are safe during pregnancy and whether they should incorporate them into their fitness routines. To provide expert guidance, we spoke with a specialist who will weigh in on the safety and recommendations for core exercises during pregnancy.
Experts Featured in This Article:
Leia Rispoli, MD, is a double board-certified interventional pain management specialist and physiatrist at DISC Sports & Spine Center.
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Anna Larson, PT, DPT, is a doctor of physical therapy at Fusion Wellness and Femina Physical Therapy in Los Angeles, CA.
Meleen Chuang, MD, is a clinical associate professor for the Department of Obstetrics and Gynecology at NYU Grossman School of Medicine, chief of Obstetrics and Gynecology at NYU Langone Hospital Brooklyn, and medical director of Women’s Health, Family Health Centers at NYU Langone (FHC).
Todd Sinett, DC, is the CEO of Tru Whole Care and founder of Backbridge, a back pain device. Dr. Sinett has published four books on treating back pain, available on Amazon.
Sit-Ups: Muscles Worked and Benefits
Most people might assume crunches and sit-ups are the same exact exercise. However, there are a few key differences to note for each movement, particularly when it comes to the muscles involved. “While the terms ‘crunches’ and ‘sit-ups’ are sometimes used interchangeably, sit-ups are usually hinged from the waist, and crunches can be more of a curling of a spine, but it really depends on who you talk to and how people use these terms,” Leia Rispoli, MD, says. “Classically, a crunch is more of a curled movement from a flat position where your elbows meet your knees vs. a sit-up, which is a hinge from the waist with a persistent stable and flat spine.”
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When it comes to performing sit-up exercises, the main muscles used are the rectus abdominis, obliques, transverse abdominis, and hip flexors. “The specific muscles that are worked and utilized involve your core muscles (mostly your anterior core muscles), so all your abdominal muscles, and hip flexor muscles,” Dr. Rispoli says.
A sit-up exercise “involves your abdominals and hip flexors as well because it combines spinal flexion and hip flexion,” Anna Larson, PT, DPT, says. “While crunches involve mostly your abdominal muscles, because the motion is achieved only with spinal flexion.”
There are benefits of sit-ups that relate to movements in everyday life. “A lot of core muscle strength and stability helps protect and preserve the spine,” Dr. Rispoli says. “In general, this helps establish a persistent habit of good posture, which ultimately puts the spine in a protective mode against years of degeneration.”
“Our abdominal muscles form a large part of our core, which give us stability, balance, and improved posture,” Dr. Larson adds. “Strengthening your abdominal muscles also will increase your pelvic floor strength. Improved pelvic floor strength will help to decrease the risk of urinary incontinence and prolapse.”
How to Do Sit-Ups Safely
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Start by lying on the floor, with your back against the ground, knees bent and feet flat on the floor.
Place both arms crossed at the front of the chest.
Bring your upper body and torso up towards your knees.
Slowly lower yourself back down to the floor, with control.
Some might want to start out with both hands behind your neck, but for safety, try to keep the arms crossed at the chest first, especially if you’re a beginner. “You want to keep your lumbar spine and your neck and your head all in one plane,” Dr. Rispoli advises. “You don’t want to put any extra flexion or strain on the neck, and you don’t want to use your arms that are positioned behind your head to hinge your neck in a flexion position and pull from there.” She adds: “If the initial engagement of the muscles is too difficult to get off of the floor immediately for those first few degrees, then you should use some sort of propped mat to help eliminate those first few degrees of difficulty.”
Note for beginners: “When starting out with this exercise, it is helpful to have someone stabilize your feet or place your feet under something sturdy such as a couch,” according to Dr. Larson. “Placing a small ball or a couple of pillows behind the back can help to engage the deeper abdominal muscles and help increase your strength gradually over time.”
“The best starting position is with a pillow behind the back or small ball, as this will help encourage spinal flexion, and the engagement of the abdominals instead of overrecruiting the hip flexors. This also decreases the load to the neck as the angle takes some of the strain from the neck muscles and focuses more on the abdominals,” Dr. Larson adds.
Sit-Up Alternatives
Todd Sinett, DC, believes you can do much more than sit-ups to help your core. “I wrote a book entitled ‘Sit-Ups Are Stupid and Crunches Are Crap,’ which provides an outline of exercises and stretches that help to strengthen our core,” he says. “To name a few I love: dead bugs, bird dog, leg raises, planks. You want to focus on exercises that elongate the body and spine.”
Dead bugs: “Anything laying on your back while alternating moving your legs or arms, such as a dead bug, is a great way to build deep core strength,” Dr. Larson says.
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Bird dogs: “Another way to challenge core stability is on hands and knees alternating reaching your opposite arm and leg, also called a bird dog.” Dr. Larson adds.
Leg raises or planks: For pre- or post-natal women, “pelvic tilts, modified planks, leg raises, side-lying exercises can help strengthen core while also ensuring safety during pregnancy. Light aerobic exercises, weightlifting, moderate brisk walking, and cycling on a stationary bike are good options,” Meleen Chuang, MD, says.
Pelvic tilts: “An alternative exercise can be something like a pelvic tilt, where you’re in a sit-up position, but instead of raising your upper trunk, you’re just flattening your back to the floor and contracting and engaging your core and abdominal muscles,” Dr. Rispoli, MD, says.
Jade Esmeralda (she/her), MS, CSCS, is a health and fitness staff writer and a strength and conditioning specialist. A lifelong martial artist and dancer, Jade has a strong passion for strength and conditioning, sports science, and human performance. She graduated with a Master of Science degree in exercise science and strength and conditioning from George Washington University.
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