Weight Loss Drugs Are Not Enough: Patients Need Rehabilitation

Robin Mesnage

Abstract

Metabolic syndrome leading to type 2 diabetes has become one of the defining health challenges of our time. It emerges from the interaction between genetic susceptibility, behavior, and the exposome. Glucagon-like peptide-1 (GLP-1) receptor agonists represent a major pharmacological advance, inducing marked weight loss and improved glycemic control. However, their long-term effectiveness remains limited by poor adherence, high cost, and relapse after discontinuation. Pharmacotherapy alone addresses symptoms, not causes. Sustainable recovery from metabolic disorders therefore requires a rehabilitative approach. This includes structured behavioral change, nutritional adaptation, and metabolic re-education. Therapeutic fasting provides a model for such rehabilitation, promoting rapid metabolic improvements through energy deficit, hepatic lipid mobilization, and enhanced insulin sensitivity. Emerging evidences suggest that repeated fasting interventions can induce durable remission of type 2 diabetes. Beyond individual biology, true sustainability demands that medicine itself reduce its ecological footprint, as pharmaceuticals and other xenobiotics increasingly contribute to global pollution and greenhouse gas emissions. Integrating pharmacological and non-pharmacological strategies offers a pathway toward a medicine of recovery rather than dependency.

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