Tag: body weight

Is Fasting an Effective Treatment for Diabetes? | NutritionFacts.org

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By losing 15% of their body weight, nearly 90% of those who have had type 2 diabetes for less than four years may achieve remission.

Currently, more than half a billion adults have diabetes, and about a 50% increase is expected in another generation. I’ve got tons of videos on the best diets for diabetes, but what about no diet at all?

More than a century ago, fasting was said to cure diabetes, quickly halting its progression and eliminating all signs of the disease within days or weeks. Even so, starvation is guaranteed to lead to the complete disappearance of you if kept up long enough. What’s the point of fasting away the pounds if they’re just going to return as soon as you restart the diet that created them in the first place? Might it be useful to kickstart a healthier diet? Let’s see what the science says.

Type 2 diabetes has long been recognized as a disease of excess, once thought to afflict only “the idle rich…anyone whose environment and self-support does not require of him some sustained vigorous bodily exertion every day, and whose earnings or income permit him, and whose inclination tempts him, to eat regularly more than he needs.” Diabetes is preventable, so might it also be treatable? If we’re dying from overeating, maybe we can be saved by undereating. Remarkably, this idea was proposed about 2,000 years ago in an Ayurvedic text:

“Poor diabetic people’s medicine
He should live like a saint (Munni);
He should walk for 800–900 miles.
Or he shall dig a pond;
Or he shall live only on cow dung and cow urine.”

That reminds me of the Rollo diet for diabetes proposed in 1797, which was composed of rancid meat. That was on top of the ipecac-like drugs he used to induce severe sickness and vomiting. Anything that makes people sick has only “a temporary effect in relieving diabetes” because it reduces the amount of food eaten. His diet plan—which included congealed blood for lunch and spoiled meat for dinner—certainly had that effect.

Similar benefits were seen in people with diabetes during the siege of Paris in the Franco‐Prussian War, leading to the advice to mangez le moins possible, which translates to “eat as little as possible.” This was formalized into the Allen starvation treatment, considered to be “the greatest advance in the treatment of diabetes prior to the discovery of insulin.” Before insulin, there was “The Allen Era.”

Dr. Allen noted that there are clinical reports of even severe diabetes cases clearing up after the onset of a “wasting condition” like tuberculosis or cancer, so he decided to put it to the test. He found that even in the most severe type of diabetes, he could clear sugar from people’s urine within ten days. Of course, that’s the easy part; it’s harder to maintain once they start eating again. To manage patients’ diabetes, he stuck to two principles: Keep them underweight and restrict the fat in their diet. A person with severe diabetes can be symptom-free for days or weeks, but eating butter or olive oil can make the disease come raging back.

As I’ve said before, diabetes is a disease of fat toxicity. Infuse fat into people’s veins through an IV, and, by using a high-tech type of MRI scanner, you can show in real time the buildup of fat in muscle cells within hours, accompanied by an increase in insulin resistance. The same thing happens when you put people on a high-fat diet for three days. It can even happen in just one day. Even a single meal can increase insulin resistance within six hours. Acute dietary fat intake rapidly increases insulin resistance. Why do we care? Insulin resistance in our muscles, in the context of too many calories, can lead to a buildup of liver fat, followed by fat accumulation in the pancreas, and eventually full-blown diabetes. “Type 2 diabetes can now be understood as a state of excess fat in the liver and pancreas, and remains reversible for at least 10 years in most individuals.”

When people are put on a very low-calorie diet—700 calories a day—fat can get pulled out of their muscle cells, accompanied by a corresponding boost in insulin sensitivity, as shown below and at 4:43 in my video Fasting to Reverse Diabetes.

The fat buildup in the liver has then been shown to decrease substantially, and if the diet is continued, the excess fat in the pancreas also reduces. If caught early enough, reversing type 2 diabetes is possible, which would mean sustained healthy blood sugar levels on a healthy diet.

With the loss of 15% of body weight, nearly 90% of individuals who have had type 2 diabetes for less than four years can achieve non-diabetic blood sugar levels, whereas it may only be reversible in 50% of those who’ve lived with the disease for longer than eight years. That’s better than bariatric surgery, where those losing even more weight had lower remission rates of 62% and 26%, respectively. Your forks are better than surgeons’ knives. Indeed, most people who have had their type 2 diabetes diagnosis for an average of three years can reverse their disease after losing about 30 pounds, as you can see below and at 5:37 in my video.

Of course, an extended bout of physician-supervised, water-only fasting could also get you there, but you would have to maintain that weight loss. One of the things that has been said with “certainty” is that if you regain the weight, you regain your diabetes.

To bring it full circle, “the initial euphoria about ‘medicine’s greatest miracle’”—the discovery of insulin in 1921—“soon gave way to the realisation” that, while it was literally life-saving for people with type 1 diabetes, insulin alone wasn’t enough to prevent such complications as blindness, kidney failure, stroke, and amputations in people with type 2 diabetes. That’s why one of the most renowned pioneers in diabetes care, Elliott Joslin, “argued that self-discipline on diet and exercise, as it was in the days prior to the availability of the drug [insulin], should be central to the management of diabetes….”

Doctor’s Note

Check out Diabetes as a Disease of Fat Toxicity for more on the underlying cause of the disease.

For more on fasting for disease reversal, see:

Fasting is not the best way to lose weight. To learn more, see related posts below.

What is the best way to lose weight? See Friday Favorites: The Best Diet for Weight Loss and Disease Prevention.

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Michael Greger M.D. FACLM

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January 22, 2026
Wegovy injections vs. pills: Doctors explain the differences
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Wegovy injections vs. pills: Doctors explain the differences

When it comes to GLP-1 pills vs. injections, doctors share which form may be best for you.

Updated: 3:01 PM PST Jan 15, 2026

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GLP-1 (glucagon-like peptide-1 receptor agonists) like Ozempic and Wegovy continue to make headlines as more research points to the benefits of taking these medications. Traditionally, patients administer these via injection, but now, one medication in particular is available to take in pill form. So, which works best: Wegovy injection vs. pill? And is the answer the same for all GLP-1s?First, GLP-1s are a class of drugs that mimic the GLP-1 hormone that’s naturally released in your GI tract when you eat, explains Mir Ali, M.D., medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, CA. These medications help to moderate blood sugar levels, reduce feelings of hunger in the brain, and delay emptying in the stomach, making you feel fuller, longer. As a result, a side effect is weight loss. There are some buzzy GLP-1 medications that have become household names, like Wegovy and Ozempic, but there are also other options you may not have heard about.Ultimately, the best GLP-1 medication is one that you and your healthcare provider agree will best serve your needs. But learning more about the medication you intend to use can’t hurt. Here, find the major differences between GLP-1 injections and pills.There are a lot of medications that fall into the GLP-1 class, including injectable drugs and pills. Some popular ones include Ozempic, Rybelsus, and Wegovy.It’s worth noting that Wegovy (the main active ingredient of which is semaglutide) is the only GLP-1 pill that’s approved for weight loss by the U.S. Food and Drug Administration (FDA). While Rybelsus is sometimes used off-label for weight loss, it’s technically FDA-approved for blood sugar management in people with type 2 diabetes (the same goes for Ozempic). So, keep in mind that the information ahead speaks primarily to Wegovy.Wegovy injection vs. pill: How does each work? GLP-1 injectable medications are usually injected into the belly. “GLP-1 injections deliver the medication into the subcutaneous fat, where it is slowly absorbed,” explains Christoph Buettner, M.D., Ph.D., chief of the division of endocrinology at Rutgers Robert Wood Johnson Medical School. “These drugs have a long half-life, about five to seven days, which is why they only need to be taken once a week.”After they’re injected, the medication steadily enters the bloodstream and activates the GLP-1 receptor, Dr. Buettner explains. Once it’s in your body, the medication signals to your brain to take in less food, says Martin Binks, Ph.D., professor and chair of the Department of Nutrition and Food Studies at George Mason University College of Public Health. “They also help delay stomach emptying, which ultimately improves satiety and reduces hunger,” he says. “The combined influences of these medicines regulate metabolism and appetite.”The GLP-1 pills work similarly, but these contain a higher dose of medication to compensate for absorption into the digestive tract, Dr. Binks says. (The injectable medications have lower doses of medication because they’re slowly released into the bloodstream and bypass the gastrointestinal tract, Dr. Ali explains.)These medications are taken by mouth once a day. They usually need to be taken on an empty stomach, and you can’t eat or take most other medications for up to an hour afterward, Dr. Buettner points out. “These requirements can be inconvenient for many patients,” he says.Which is most effective for weight loss?It depends. There have been a few clinical trials on the impact of GLP-1 injectable medications on weight loss with different results. However, People usually lose about 15% of their body weight while using semaglutide medications like Wegovy.Meanwhile, during clinical trials for the Wegovy oral route, people who took the pill lost about 16.6% of their body weight. (That’s compared to 3% weight loss achieved by people who used a placebo.)While Rybelsus isn’t FDA-approved for weight loss, people typically lose around eight pounds while taking this medication.Which works best?There are a few things to consider. “Both injectables and pill forms can be helpful,” says Dina Hagigeorges, PA.-C., a physician assistant who specializes in weight and wellness at Tufts Medicine Weight + Wellness – Stoneham. “Unfortunately, cost and insurance coverage are a huge deciding factor, as not all insurance plans cover these medications for people.” When paid for out of pocket, injectable GLP-1 medications are usually much more expensive than their oral counterparts.There’s a larger body of research to support injectable medications for weight loss, although the Wegovy pill shows promise, Dr. Ali says. “If someone can tolerate injections, it’s usually the better way to go—they’re taken less frequently,” he says. But these medications aren’t a good fit for people who are scared of needles, and they have to be refrigerated, Dr. Ali points out.“The pills are a good option for people who don’t like injections, and you can easily take them with you when you travel,” Dr. Ali says. “But they have to be taken daily, which is not for everyone.”Side effectsThe side effects are similar for both medications, Dr. Buettner says.These side effects may include:NauseaVomitingDiarrheaConstipationUpset Stomach “The most important thing is choosing a medication that you can use consistently and that aligns with your personal priorities—whether that’s maximum weight loss, convenience, avoiding injections, or simplifying your routine,” he says. “Many patients try one form first and later switch based on their experience.”So, talk to your healthcare provider and keep the line of conversation open. You may find one form of GLP-1 feels like a more natural fit over another.
GLP-1 (glucagon-like peptide-1 receptor agonists) like Ozempic and Wegovy continue to make headlines as more research points to the benefits of taking these medications. Traditionally, patients administer these via injection, but now, one medication in particular is available to take in pill form. So, which works best: Wegovy injection vs. pill? And is the answer the same for all GLP-1s?

First, GLP-1s are a class of drugs that mimic the GLP-1 hormone that’s naturally released in your GI tract when you eat, explains Mir Ali, M.D., medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, CA. These medications help to moderate blood sugar levels, reduce feelings of hunger in the brain, and delay emptying in the stomach, making you feel fuller, longer. As a result, a side effect is weight loss.

There are some buzzy GLP-1 medications that have become household names, like Wegovy and Ozempic, but there are also other options you may not have heard about.

Ultimately, the best GLP-1 medication is one that you and your healthcare provider agree will best serve your needs. But learning more about the medication you intend to use can’t hurt. Here, find the major differences between GLP-1 injections and pills.

There are a lot of medications that fall into the GLP-1 class, including injectable drugs and pills. Some popular ones include Ozempic, Rybelsus, and Wegovy.

It’s worth noting that Wegovy (the main active ingredient of which is semaglutide) is the only GLP-1 pill that’s approved for weight loss by the U.S. Food and Drug Administration (FDA). While Rybelsus is sometimes used off-label for weight loss, it’s technically FDA-approved for blood sugar management in people with type 2 diabetes (the same goes for Ozempic). So, keep in mind that the information ahead speaks primarily to Wegovy.

Wegovy injection vs. pill: How does each work?

GLP-1 injectable medications are usually injected into the belly. “GLP-1 injections deliver the medication into the subcutaneous fat, where it is slowly absorbed,” explains Christoph Buettner, M.D., Ph.D., chief of the division of endocrinology at Rutgers Robert Wood Johnson Medical School. “These drugs have a long half-life, about five to seven days, which is why they only need to be taken once a week.”

After they’re injected, the medication steadily enters the bloodstream and activates the GLP-1 receptor, Dr. Buettner explains. Once it’s in your body, the medication signals to your brain to take in less food, says Martin Binks, Ph.D., professor and chair of the Department of Nutrition and Food Studies at George Mason University College of Public Health. “They also help delay stomach emptying, which ultimately improves satiety and reduces hunger,” he says. “The combined influences of these medicines regulate metabolism and appetite.”

The GLP-1 pills work similarly, but these contain a higher dose of medication to compensate for absorption into the digestive tract, Dr. Binks says. (The injectable medications have lower doses of medication because they’re slowly released into the bloodstream and bypass the gastrointestinal tract, Dr. Ali explains.)

These medications are taken by mouth once a day. They usually need to be taken on an empty stomach, and you can’t eat or take most other medications for up to an hour afterward, Dr. Buettner points out. “These requirements can be inconvenient for many patients,” he says.

Which is most effective for weight loss?

It depends. There have been a few clinical trials on the impact of GLP-1 injectable medications on weight loss with different results. However, People usually lose about 15% of their body weight while using semaglutide medications like Wegovy.

Meanwhile, during clinical trials for the Wegovy oral route, people who took the pill lost about 16.6% of their body weight. (That’s compared to 3% weight loss achieved by people who used a placebo.)

While Rybelsus isn’t FDA-approved for weight loss, people typically lose around eight pounds while taking this medication.

Which works best?

There are a few things to consider. “Both injectables and pill forms can be helpful,” says Dina Hagigeorges, PA.-C., a physician assistant who specializes in weight and wellness at Tufts Medicine Weight + Wellness – Stoneham. “Unfortunately, cost and insurance coverage are a huge deciding factor, as not all insurance plans cover these medications for people.” When paid for out of pocket, injectable GLP-1 medications are usually much more expensive than their oral counterparts.

There’s a larger body of research to support injectable medications for weight loss, although the Wegovy pill shows promise, Dr. Ali says. “If someone can tolerate injections, it’s usually the better way to go—they’re taken less frequently,” he says. But these medications aren’t a good fit for people who are scared of needles, and they have to be refrigerated, Dr. Ali points out.

“The pills are a good option for people who don’t like injections, and you can easily take them with you when you travel,” Dr. Ali says. “But they have to be taken daily, which is not for everyone.”

Side effects

The side effects are similar for both medications, Dr. Buettner says.

These side effects may include:

Nausea

Vomiting

Diarrhea

Constipation

Upset Stomach

“The most important thing is choosing a medication that you can use consistently and that aligns with your personal priorities—whether that’s maximum weight loss, convenience, avoiding injections, or simplifying your routine,” he says. “Many patients try one form first and later switch based on their experience.”

So, talk to your healthcare provider and keep the line of conversation open. You may find one form of GLP-1 feels like a more natural fit over another.
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January 15, 2026
Ozempic Makes You Lose More Than Fat

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The newest and much-hyped obesity drugs are, at their core, powerful appetite suppressants. When you eat fewer calories than you burn, the body starts scavenging itself, breaking down fat, of course, but also muscle. About a quarter to a third of the weight shed is lean body mass, and most of that is muscle.

Muscle loss is not inherently bad. As people lose fat, they need less muscle to support the weight of their body. And the muscle that goes first tends to be low quality and streaked with fat. Doctors grow concerned when people start to feel weak in everyday life—while picking up the grandkids, for example, or shoveling the driveway. Taken further, the progressive loss of muscle can make patients, especially elderly ones who already have less muscle to spare, frail and vulnerable to falls. People trying to slim down from an already healthy weight, who have less fat to spare, may also be prone to losing muscle. “You have to pull calories from somewhere,” says Robert Kushner, an obesity-medicine doctor at Northwestern University, who was also an investigator in a key trial for one of these drugs.

Kushner worries about patients who start with low muscle mass and go on to become super responders to the drugs, losing significantly more than the average 15 to 20 percent of their body weight. The more these patients lose, the more likely their body is breaking down muscle. “I watch them very carefully,” he told me. The impacts of losing muscle may go beyond losing just strength. Muscle cells are major consumers of energy; they influence insulin sensitivity and absorb some 80 percent of the glucose flooding into blood after a meal. Extreme loss might alter these metabolic functions of muscle too.

Exactly how all of this will affect people on Wegovy and Zepbound, which are still relatively novel obesity drugs, is too early to say. (You may have heard these same two drugs referred to as Ozempic and Mounjaro, respectively, which are their names when sold for diabetes.) These drugs cause a proportion of muscle loss higher than diet and exercise alone, though roughly on par with bariatric surgery. Lifestyle changes can blunt the loss, but pharmaceutical companies are on the hunt for new drug combinations that could build muscle while burning fat.

The arrival of powerful weight-loss drugs has moved the field beyond simple weight loss, Melanie Haines, an endocrinologist at Massachusetts General Hospital, told me. That challenge is largely solved. Instead of fixating on the number of pounds lost, researchers, doctors, and ultimately patients can focus on where those pounds are coming from.

Doctors currently offer two pieces of standard and unsurprising advice to protect people taking obesity drugs against muscle loss: Eat a high-protein diet, and do resistance training. These recommendations are perfectly logical, but their effectiveness against these drugs specifically is unclear, John Jakicic, a professor of physical activity and weight management at the University of Kansas Medical Center, told me. He is now surveying patients to understand their real-world behavior on these drugs.

Fatigue, for example, is a common side effect. “When you’re tired, and you’re fatigued, do you really feel like exercising?” he said. Haines wonders the same about eating enough protein. The drugs are so good at suppressing appetite, she said, that some people might not be able to stomach enough food to get adequate protein. (Food companies have started pitching high-protein snacks and shakes to people on obesity drugs.)

Read: The Ozempic plateau

If patients stop taking Wegovy and Zepbound—and about half of patients do stop within a year, at least in real-world studies of people taking this class of drugs for diabetes—the weight regained comes back as fat more than muscle, says Tom Yates, a physical-activity professor at the University of Leicester. Muscle mass tends not to entirely recover. It’s “almost as if you’re better off staying where you are than going through cycles of weight loss,” he told me.

Yet, he pointed out, the U.K. recommends Wegovy for a maximum of two years. In the U.S., patients who can’t afford the steep out-of-pocket price have been forced to stop when insurance companies abruptly cut off coverage or a manufacturer’s discount coupon expires. These policies are likely to trigger cycles of weight loss and gain that lead, ultimately, to net muscle loss.

Meanwhile, drug companies are already thinking about the next generation of weight-loss therapies. “Wouldn’t it be great to have another mechanism that’s moving away from just appetite regulation?” Haines said. Companies are testing ways to preserve—perhaps even enhance—muscle during weight loss by combining Wegovy or Zepbound with a second muscle-boosting drug. Such a combination could, in theory, allow patients to lose fat and gain muscle at the same time.

Years ago, scientists first became interested in potential muscle-enhancing drugs that mimic mutations found in certain breeds of almost comically ripped dogs and cattle. At the time, they hoped to treat muscle-wasting diseases. The drugs never quite worked for that purpose, but the trial for one such drug, an antibody called bimagrumab, found that patients also lost fat in addition to gaining lean mass. A start-up acquired the drug and began testing it for weight loss in combination with semaglutide, the active ingredient in Wegovy, or Ozempic. And last year, Eli Lilly, the maker of Zepbound, snapped up that company for up to $1.9 billion—in hopes of making its own combination therapy.

Read: Are you sure you want an Ozempic pill?

Pairing bimagrumab with an existing obesity drug could potentially maximize the weight loss from both. Losing weight tends to get harder over time; as you lose muscle, your body burns fewer calories. A drug that minimizes that muscle loss—or even flips it into muscle gain—could help patients boost the amount of energy their body expends, while Wegovy or Zepbound suppresses calories consumed. The mechanisms of how this might actually work in the body still need to be understood, though. Previous studies of bimagrumab found that patients grew more muscle, but they didn’t necessarily become faster or stronger. Haines, who is planning a small study of her own with bimagrumab, is most interested in how the combination affects not the structural but the metabolic functions of muscle.

Bimagrumab is the furthest along of several drugs that tinker with the same pathway for muscle growth. The biotech company Regeneron recently published promising data on two of its muscle-enhancing antibodies paired with semaglutide in primates; a trial in humans is due to begin later this year. The start-up Scholar Rock is testing another antibody called apitegromab. Other companies are interested in combining the obesity drugs with different potential muscle boosters that work by mimicking certain hormones such as apelin or testosterone. If they succeed, the next generation of drugs could help sculpt a more muscular body, not just a smaller one. Eating less can only do so much to better your health.

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Sarah Zhang

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February 2, 2024
The Ozempic Plateau

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The latest weight-loss drugs are rightly hailed as game changers for obesity, but in an important way, they are just like every other method of managing weight: They work only to a point for weight loss. The pounds melt off quickly at first and then gradually and then not at all. You can’t lose any more no matter what you do. You’ve hit the weight-loss plateau.

It happens with dieting. It happens with bariatric surgery. And it happens now with both semaglutide (better known as Ozempic or Wegovy, depending on whether it’s prescribed for diabetes or weight loss) and tirzepatide (better known as Mounjaro or Zepbound). Weight loss triggers a set of powerful physiological changes in the body, which evolved over millions of years to keep us alive through periods of food scarcity. “Everybody plateaus,” says Jamy Ard, an obesity doctor at Wake Forest University. Exactly when varies quite a bit from person to person, but it happens after losing a certain percentage of body weight—meaning some people might plateau while still meeting the criteria for obesity.

For Wegovy, it’s after losing, on average, 15 percent, usually more than a year into starting the drug. For Zepbound, it’s about 20 percent. These numbers are higher than is sustainable through diet and exercise alone, but they also do not reach the 30 percent achievable via the gold standard of bariatric surgery.

These differences matter because they suggest that the level of the plateau is not permanently fixed. Recent advances in understanding the gut hormones that these drugs are designed to mimic hint at a possibility of even more powerful weight-loss drugs. Scientists are now testing ways to push the plateau down further; a drug could one day be even more effective than bariatric surgery.

Read: Ozempic is about to be old news

All of this raises an unsettled question: “How much weight loss is enough?” says Jonathan Campbell, who studies gut hormones at Duke. In studies, even 5 to 15 percent weight loss can substantially reverse high blood pressure, high blood sugar, and high cholesterol. Yet a patient who starts at 375 pounds with a BMI of 60 might still find themselves ineligible for a joint replacement that requires a BMI below 40, flawed as BMI may be. Or they may simply want to look thinner. The explosion of weight-loss drugs has reopened thorny questions about how they should be used, but nevertheless, pharmaceutical companies are racing ahead to develop more and more powerful ones.

Weight loss is easiest at the beginning, before your body starts actively working against it. “Your brain doesn’t know you’re trying to lose weight on purpose,” Ard says. And once it notices, “it thinks that something is wrong.” So your body tries very, very hard to compensate.

First of all, you become hungrier, obviously. And not just because you want to eat as much as you did before; you actually want to eat more than you did prior to losing weight. “With every one kilogram you lose, your appetite goes up above baseline by 90 or so calories per day,” says Kevin Hall, who studies metabolism at the National Institute of Diabetes and Digestive and Kidney Diseases. At the same time, your body looks for ways to conserve energy. Your muscles work more efficiently, for example, Ard says, so walking that normally burned 100 calories might now burn only 90. By making you want to eat more and burning fewer calories, your body is eventually able to slow weight loss down to zero. Here is your plateau. This is, all told, a remarkably elegant and robust system, if what you wanted to do is to maintain your weight.

If you’re in fact trying to lose more weight, the plateau is psychologically frustrating. The same diet, the same exercise routine, the drug on which you were just losing weight will seem to have stopped working—but they haven’t. (If they did actually stop working, you would be regaining weight.) But your body is now fighting so hard against the weight loss that it requires a persistent effort just to keep the weight off, Hall says. Should you ease up, the weight will come right back, as seen in yo-yo dieting or weight regain after stopping Wegovy or Zepbound.

The only way to get past a plateau is to up the intensity or number of interventions. Doctors might recommend, for example, bariatric surgery and a weight-loss drug. But in the future, novel drugs might be able to pharmacologically up the intensity. The progression from Wegovy to the more effective Zepbound has in fact already brought us one step closer.

Wegovy and Zepbound both belong to a class of drugs that mimic a gut hormone called GLP-1. Both of these drugs bind GLP-1 receptors in the brain, which seems to reduce hunger. Zepbound goes a step further, though. It can also bind receptors for a second gut hormone, called GIP. Years ago, researchers noticed that bariatric surgery changes the balance of gut hormones in the body, including GLP-1 and GIP. This—and not just the physical shrinking of the stomach—is now understood to be a key driver of weight loss, to the point that bariatric surgery is sometimes called “metabolic surgery.” These observations inspired research into drugs that target not just GLP-1 but also GIP and other hormones. Essentially, they’re performing metabolic surgery with a drug rather than a scalpel.

Read: Did scientists accidentally invent an anti-addiction drug?

Exactly why Zepbound outperforms Wegovy is still unclear. One obvious hypothesis is that it mimics a second gut hormone; the more hormonal pathways it can influence, perhaps, the more body parts it affects and the more weight loss it triggers. And a recent clinical trial of retatrutide, a further modified derivative of Zepbound that mimics a third hormone called glucagon, demonstrated even greater weight loss: 24 percent at the highest dose.

A second hypothesis suggests that the difference between Wegovy and Zepbound still goes back to GLP-1. Although both drugs bind that receptor, they tickle it slightly differently, setting off slightly different chain reactions. Wegovy seems to also activate some cellular machinery that acts as a break, possibly limiting its efficacy. This suggests another strategy for fine-tuning gut-hormone drugs: Companies have so far focused on trying to design one drug that binds to multiple hormone receptors, like a master key that can open three different locks. This was a practical choice, Campbell says, because trying to study three separate new drugs in clinical trials would be a logistical “nightmare.” But the optimal combination for weight loss might actually require individual keys that can jigger individual receptors in just the right way—that is, a double or triple combination of drugs.

It may also eventually be possible to keep increasing the dosage of GLP-1 drugs to push the weight-loss plateau down. Right now, the dose is limited by what people are willing to tolerate. The drugs can cause severe nausea, vomiting, and diarrhea, so they have to be ramped up slowly over many weeks to induce tolerance and minimize side effects. But Novo Nordisk is trialing the drug in Wegovy at up to 16 milligrams a week, more than six times the current maximum dose. Tinkering with other gut-hormone pathways could also help with side effects. GIP receptors, for example, are found in neurons whose activation might suppress nausea, which may in part be why Zepbound seems to have slightly milder side effects.

Zepbound is likely the first of many leveling-ups from single-action GLP-1 drugs. Even as the science advances, no safe method of losing weight is meant to eliminate the weight-loss plateau—and indeed, you wouldn’t want to keep losing weight indefinitely. But lose more weight? Pharmaceutical companies are betting on a market for that. With obesity drugs projected to become a $100 billion industry by 2030, they are eager for a slice of that massive pie. “The dollar signs are so big now,” Campbell says. Zepbound is the newest weight-loss drug on the block, but it too may eventually be old news.

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Sarah Zhang

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January 17, 2024
The Future of Obesity Drugs Just Got Way More Real

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A wild idea recently circulated about the future of aviation: If passengers lose weight via obesity drugs, airlines could potentially cut down on fuel costs. In September, analysts at Jefferies Bank estimated that in the “slimmer society” obesity drugs will create, United Airlines could save up to $80 million in jet fuel annually.

In the past year, as more Americans have learned about semaglutide, which is sold for diabetes under the brand name Ozempic and for obesity under the name Wegovy, hype has become completely divorced from reality. For all the grand predictions, just a fraction of Americans who qualify for obesity drugs are on them. With a list price of roughly $1,350 a month, Wegovy is far too expensive, under-covered by insurance, and in limited supply to be a routine part of health care.

But that possibility is beginning to seem very real. The results of a highly anticipated study published on Saturday indicate that Wegovy can have profound effects on heart health, which potentially opens up the drug to even more patients. A few days earlier, the FDA approved Zepbound, an obesity drug that is a bit cheaper and appears more potent than Wegovy. If there was any doubt before, now it is undeniable: Obesity drugs “are here to stay,” Kyla Lara-Breitinger, a cardiologist at the Mayo Clinic, told me. “There’s only going to be more and more of them.” They are now poised to become deeply entrenched in American health care, perhaps eventually even joining the ranks of commonly used drugs such as statins and metformin.

Considering that obesity is linked to all sorts of major heart ailments, it is no big surprise that a weekly shot for weight loss might have some cardiovascular benefits. But because this class of obesity drugs, known as GLP-1 agonists for the hunger hormone they target, is so new, doctors did not know that for sure. Starting in 2018, Novo Nordisk, the company that manufactures semaglutide, began to look for answers in a study of more than 17,600 people with obesity and cardiovascular disease. In this group, results of a trial named SELECT show that Wegovy reduced the risk of major cardiac events—stroke, heart attack, death—by 20 percent. Even compared with studies on common heart medications such as Praluent and Repatha, the Wegovy results are “impressive,” Eugene Yang, a cardiologist and professor of medicine at the University of Washington, told me.

How exactly the drug prevents major cardiac events isn’t fully understood. Some of the effects can likely be chalked up to weight loss itself, which is associated with improvements in metrics that influence heart health, such as blood pressure, Yang said. But mechanisms independent of weight loss may also be at work. In the trial, lower rates of cardiovascular events began showing up before participants lost weight. One explanation is the drug’s impact on inflammation, which is associated with heart disease: C-reactive protein, a rough proxy for inflammation, dropped by nearly 40 percent in study participants.

Regardless of how Wegovy works, Yang said, “it has the potential benefit of being very significant” as a new line of treatment for heart disease, the leading cause of death nationwide. Novo Nordisk has already applied for expanded FDA approval and anticipates receiving it within six months. Approval would also show that Wegovy has a medical benefit beyond weight loss, pressuring insurers to cover it. Right now, for instance, Medicare does not, in part because obesity has long been viewed as a cosmetic issue, not a medical one. Even with private coverage, the drug is still frequently out of reach. The SELECT trial makes it “unequivocally clear” that obesity is a health condition that can be treated with drugs, Ted Kyle, an obesity-policy expert, told me. Still, the study leaves room for pushback: The absolute risk reduction of cardiovascular events was 1.5 percent, which is, by some reckonings, quite small. A higher risk reduction would have “put more pressure” on insurers and manufacturers to make the drugs more affordable for Americans, Lara-Breitinger said.

Still, the findings are robust enough that it seems likely that the heart benefits of obesity drugs will lead more Americans to take them—if not immediately, then eventually. The approval of a new drug could do the same. Tirzepatide, which Eli Lilly has sold as a diabetes drug under the name Mounjaro, will be marketed as Zepbound for obesity—and it is coming for Wegovy’s throne. In one study, people on tirzepatide lost an average of 18 percent of their body weight; for comparison, in another study patients on Wegovy lost an average of 15 percent. At a little over $1,000 a month, Zepbound is not cheap, but its list price is hundreds of dollars lower than that of Wegovy. (The manufacturers of both drugs have said that most insured patients pay far less than that.)

Zepbound’s approval is just the beginning. Unlike semaglutide, which targets only one hormone, GLP-1, to exert its effects on appetite and fullness, tirzepatide targets two. Other drugs that target two or even three hormones are in the works, as are versions that come in a more appealing pill format rather than as an injection. Generic versions of these drugs, likely beginning with liraglutide, a predecessor to semaglutide sold as Saxenda, could become available soon, Yang said. This competition will help bring down costs, but it will go only so far. Drug pricing is “a little bit screwy,” Kyle said, complicated by the wide gap between the list price and the net price created by manufactures, insurers, and intermediaries between them.

Each new competitor and new study is a step toward a future in which a substantial proportion of Americans with obesity are routinely prescribed these drugs. In a single week, obesity drugs leapt a new era—one in which they are about to become significantly more mainstream. No doubt that future is a bright one for millions of people who might benefit from treatment. Still, many questions about the drugs remain unanswered, such as their long-term safety and endless supply shortages.

But the potential for obesity drugs to truly change America has never felt closer—with all of the dizzying questions this creates about what “a slimming society” might mean for exercise, the food industry, and apparently even airline jet fuel.

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Yasmin Tayag

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November 15, 2023
You Really Don’t Want to Be Thirsty in a Heat Wave

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The heat—miserable and oppressive—is not abating. Today, a third of Americans are under a heat alert as temperatures keep breaking records: Phoenix has hit 110 degrees Fahrenheit for two weeks straight, while this weekend Death Valley in California could surpass the all-time high of 130 degrees.

Even less extreme heat than that can be dangerous. Recently, in Texas, Louisiana, part of Arizona, and Florida, there have been reports of deaths from heat, and many more hospitalizations. The toll of a heat wave is not always clear in the moment: A new report suggests that last summer’s historic heat wave in Europe killed more than 60,000 people.

Ideally, you’d stay in the air-conditioned indoors as much as possible. That’s not an option for everyone. The other thing to do is stay hydrated. The importance of getting enough fluid is hard to overstate—and often underappreciated: Last month, the Texas state legislature banned local governments from mandating water breaks for construction workers. In the heat, hydration “impacts everything,” Stavros Kavouras, the director of the Hydration Science Lab at Arizona State University, in Phoenix, told me. And with temperatures continuing to rise, it’s essential to get it right.

Serious dehydration is really, really bad for you. Your blood volume decreases, which makes your heart work less effectively. “Your ability to thermoregulate declines,” Kavouras told me, “so your body temperature is getting higher and higher.” You might feel weak or dizzy. Your heart rate rises; it gets harder to focus. The worst-case scenario is heatstroke, when your body stops being able to cool itself—a potentially fatal medical emergency.

In extreme temperatures, heat injuries can happen quicker than you might think. Given that the human body is mostly water, you might assume that there is some to spare, but inconveniently, this is not the case. “If you lose even 10 percent of [the water] your body has, you are entering the zone of serious clinical dehydration,” Kavouras said. “And if you look at optimal health, even losing just 1 percent of your body weight impacts your ability to function.” There are two basic ways your body cools itself when it gets hot. One is to send more blood to the skin, which releases heat from the core of your body, and is the reason you turn red when you’re overheated. The other is to sweat. It evaporates off your body, and in the process, your body loses excess heat. You can’t cool yourself as effectively if you’re not properly hydrated. At the same time, one of your main cooling mechanisms is actively dehydrating, which means the goal is not just to be hydrated, but to stay that way.

What that takes depends on many factors rather than a single universal rule, but in general, the danger zone is “high humidity with anything above 90 degrees,” Kavouras said, at which point, “it’s actually dangerous” just to be outside. The more active you are in the heat, and the hotter and more humid it is, the greater the risk—and the more important proper hydration becomes. The standard water target in the U.S. during non-heat-wave times is 3.7 liters a day for men and 2.7 liters for women. When it’s very, very hot out, you need more. Even if you spend most of the day in the bliss of AC, you are almost certainly leaving the house at some point.

Instead of trying to figure out what that precise amount should be, Kavouras recommends you focus on two things instead. “No. 1, keep water close to you. If you have water close to you, or whatever healthy beverage, you’ll end up drinking more, just because it’s closer,” he said. And second: Keep an eye on how often you pee—pale urine, six to seven times a day, or every two to three hours, is good. You want it to be “basically like a Chablis, a Riesling, Pinot Grigio, or champagne-colored,” John Higgins, a sports cardiologist at McGovern Medical School at UTHealth, in Houston, told me. “If you notice the urine is getting darker, like a Chardonnay- or Sauvignon Blanc–type of thing, that generally means you are dehydrated.”

Certain groups are especially at risk. Older adults are more prone to dehydration, as are young children, people who are pregnant, and people taking certain medications—blood-pressure medications, for example. None of this requires you to take in extra fluids per se, just that you need to be even more careful that you’re getting enough.

As for what to drink, as a go-to beverage, straight water is hard to beat. Water with fruit slices floating in it has the benefit of feeling like something from a luxury hotel. Carbonated water is also good—you might not be able to drink quite as much of it, which is a potential drawback, but “there is no mechanism in your GI system that will make sparkling water less effective at hydrating you,” Kavouras said. You probably want to avoid downing giant buckets of coffee—caffeine is a diuretic in large quantities and Higgins warns against sugary drinks for the same reason. (A daily iced coffee is fine.) If you’re doing hours of heavy sweating, then you might work in some (less sugary) sports drinks. But for the majority of people, water remains the ideal. Food can also be a fluid source: “Make sure you’re eating a diet that’s rich in vegetables and fruits that have water content,” William Adams, the director of the University of North Carolina at Greensboro’s Hydration, Environment and Thermal (H.E.A.T) Stress Lab, advised. Alcohol, which causes you to lose fluid, is definitively unhelpful.

There are lots of water myths out there. Can you go too hard? Technically, it’s possible to over-hydrate, causing an electrolyte imbalance, but all three experts agreed that for most people, this isn’t really a concern. You can find arguments for drinking hot drinks in the summer—the idea being that they increase the amount you sweat, thereby promoting cooling. But Kavouras is emphatic that you’re better off with cold drinks, which cool your body, he said. In the moments before a race, marathon runners will sometimes take it one step further, slurping ice slurries to lower their body temperature. For good old-fashioned drinking water, about 50 degrees Fahrenheit is best—roughly the temperature of cool water from the tap.

One final key to staying hydrated: Start early. A lot of people, Higgins said, are lightly dehydrated all the time, heat wave or not. “So particularly when you first wake up in the morning, typically you are in a dehydrated state.” Accordingly, he recommends that people drink about a standard water bottle’s worth—roughly 17 ounces—as soon as they wake up. The other thing people forget about, he said, is what happens when they come back inside after enduring the outdoors. “You keep sweating,” he pointed out. In other words: hydrate, and then keep hydrating.

As crucial as hydration is, it is not a miracle. “It doesn’t mean that you can say, ‘I hydrate well, so I’ll go out for a run in the 120-degree weather, and I’ll be fine because I’m drinking a lot,’” Kavouras said. “It doesn’t work this way.” Still, it is a simple but effective tool. As heat waves like this one become even more frequent, many more people will need to learn how to become attuned to their hydration. And perhaps adequate water can be a perverse sort of comfort: You can’t control the unrelenting heat, but you likely can control your water intake. In a heat wave, it helps to have a glass-half-full attitude—and an emptied glass of water.

This story is part of the Atlantic Planet series supported by HHMI’s Science and Educational Media Group.

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Rachel Sugar

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July 14, 2023
Bodyweight Workout for Beginners: 20-Minute at Home Routine | Nerd Fitness
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So you want to lose weight and get in shape, but don’t want to leave your house?

Well, as your fitness Yoda, I will teach you a great bodyweight workout routine that you can do ANYWHERE: In your living room, at a park, or in a galaxy far, far away…

These are the types of workouts we build for our busy Online Coaching Clients, and I’m pumped to share it with you today!

Let’s dig into the different parts of this workout and get to the action:

Make sure you also download the Beginner Bodyweight Workout PDF so you can track your progress and level up at home.

I’ll send it on over when you join the Nerd Fitness Rebellion in the box below:
Grab Your Beginner Bodyweight Routine Worksheet. No Gym Required!

Complete this workout at home, no equipment required

Avoid the common mistakes everybody makes when doing bodyweight exercises

Learn how to finally get your first pull-up
Let’s jump right in!

Can You Build Muscle Mass With Bodyweight Exercises?
You want to know:

Can you build muscle mass with bodyweight exercises?

Yep, bodyweight exercises can build muscle mass, as long as continuously challenge your muscles by:

Increasing reps.

Decreasing your rest periods.

Performing more difficult variations.

Increasing your time under tension (by going slower).
Just ask our friend Jimmy here, who got in great shape using bodyweight exercises in his apartment:

You just need to make sure you have the right program to follow.

Enter the Beginner Bodyweight Workout.

I’m going to take you through a basic home workout today that can be completed anywhere – in your house, apartment, out at a park, in your basement, on the moon, wherever.

Beginner Body Weight Workout Video & exercises
This is the Beginner Bodyweight Workout (3 Circuits):

20 Bodyweight squats.

10 Push-ups.

10 Walking lunges (each leg).

10 Dumbbell rows (use a milk jug or other weight).

15 Second Plank.

30 Jumping jacks

We turned this bodyweight workout into a fun infographic, because that’s how we roll around here:
Jump to the “Best Bodyweight Exercises” section for a full breakdown of each movement.

In a circuit routine, you’ll do each exercise in succession without a break in between (if you’re able).
- Once you’ve finished all exercises in the circuit, do it again.
- If you’re still able after the 2nd run through, go for a third.
Because all of these exercises come one after another, you’re bound to get tired – and that’s okay!

It’s better to stop and take a break than to do an exercise incorrectly.

Before you start, don’t forget to do a Dynamic Warm-Up – Make sure to get your heart rate pumping and get your muscles warmed or you’re just asking for injury.

You can run in place, jump rope, do a few push-ups, pedal on a stationary bike, do some punches and kicks, jog up and down your stairs, and/or twist and swing your arms and legs to get them moving!

Here’s a beginner warm-up you can try:

After you’ve completed your workout at home, feel free to cool down and stretch.

“HOW OFTEN SHOULD I DO THE BEGINNER BODYWEIGHT WORKOUT?”

Do this routine 2-3 times a week, but never on consecutive days.

You don’t build muscle when you’re exercising, you build muscle when you’re resting, so try not to do a strength training routine (of the same muscle groups) two days in a row.

I like to follow a training pattern of:

Alternatively, pick one of these fun exercises to do on your off days instead!

In addition to checking out our Online Coaching Program, make sure you download the worksheet for this workout by joining the Rebellion (our free online community)!

I’ll send it to you right away when you sign up in the box below:
Grab Your Beginner Bodyweight Routine Worksheet. No Gym Required!

Complete this workout at home, no equipment required

Avoid the common mistakes everybody makes when doing bodyweight exercises

Learn how to finally get your first pull-up
The 12 Best Bodyweight Exercises For Beginners

As laid out above in our Beginner Bodyweight Workout video, there are some key movements you can work on to help you get started strength training!

Here’s how to do every bodyweight exercise covered today:

#1) KNEE PUSH-UP

#2) ELEVATED PUSH-UP

#3) REGULAR PUSH-UP

We have a whole article on how to do a proper push-up, but we also cover it extensively in this 5-minute video:

#4) ASSISTED BODYWEIGHT SQUAT

Use this variation if you can’t do regular bodyweight squats yet.

#5) BODYWEIGHT SQUAT:

If you want even more instruction, here’s how to do a proper bodyweight squat:

#6) SUPPORTED LUNGES:

#7) REGULAR LUNGES:

Here’s how to properly perform lunges.

#8) ONE ARM ROW

Use a milk jug, suitcase, or actual dumbbell.

#9) PLANK

#10) SIDE PLANK

#11) WALKING JACKS

Use this variation if you can’t do jumping jacks yet.

#12) JUMPING JACKS

If you are looking for even MORE bodyweight exercises you can use in your workouts, make sure to check out our mega-resource:

“The 42 Best Bodyweight Exercises You Can Do Anywhere.“

Note: We have helped hundreds of 1-on-1 Coaching clients get started with strength training and other awesomeness – but EVERYBODY starts with bodyweight training like these movements and this workout!

Is Bodyweight Training Effective for Weight Loss?

The question of the day is:

Is bodyweight training effective for weight loss?

Yep! Bodyweight training can be great for weight loss, as long as you have your nutrition dialed in.

If you don’t…then no, it won’t be your magic bullet.

That’s because a good workout and a crappy diet won’t help you lose weight.

After all, one of the Rules of the Nerd Fitness Rebellion is “you can’t outrun your fork” and you can’t out-train a bad diet!

This means if you don’t ALSO fix your relationship with food, then all the exercise you do won’t help you get in shape.

It’ll just make you frustrated…

So if you are trying to lose weight, then you need to fix your nutrition first and foremost.

Remember, when it comes to fitness, eating healthy is key!

You have two options here to dial in your nutrition:

We’ve actually developed our own 10-level nutrition system and mindset blueprint in Nerd Fitness Prime, but let me break this down into some basics:
- Eat natural, whole foods whenever possible.
- Cut back on sugar and liquid calories wherever you can. The stuff is in everything!
- Put vegetables and fruit on your plate!
- Know your fats and carbs – these are the foods we can overeat without realizing it.
- Make sure you get enough protein each day (meat, chicken, fish) – this helps with rebuilding muscles and things like that.
You can download a Free 10 Level Diet Guide too when you join the Rebellion and sign up in the box below:
Download our free weight loss guide

THE NERD FITNESS DIET: 10 Levels to Change Your Life

Follow our 10-level nutrition system at your own pace

What you need to know about weight loss and healthy eating

3 Simple rules we follow every day to stay on target
The raw honest truth: how you eat will be responsible for at least 80% of your success or failure.

If you’re doing bodyweight workouts because you’re interested in losing weight, know that training is only 10-20% of the puzzle!

If you need help figuring this all out, or you just want your own Yoda to tell you what to do, you’re in the right place!

We’ve been helping busy people like you train at home and make better food decisions without hating life! It’s our 1-on-1 Online Coaching Program, and it might be a great fit for you.

Schedule a call with us to learn more by clicking on the image below:

After the Beginner Bodyweight Workout: Next Steps!

Do this Beginner Bodyweight Workout for the next 4-6 weeks and focus on getting better.

If doing just one circuit of the workout was really challenging, no big deal!

Write down how you did, and try to do just 1 more rep or exercise next time through.

The whole point is “do a bit more than last time.”

I also have MULTIPLE options for you to take for your next step too. Pick the option below that best aligns with your goals and timeline:

1) If you want step-by-step guidance on how to lose weight, eat better, and get stronger, check out our killer 1-on-1 coaching program:

2) If you want a daily prompt for doing workouts at home, check out NF Journey. Our fun habit-building app helps you exercise more frequently, eat healthier, and level up your life (literally).

Try your free trial right here:

3) Join the Rebellion! We need good people like you in our community, the Nerd Fitness Rebellion.

Sign up in the box below to enlist and get the Beginner Bodyweight Workout sheet so you can print out the sheet and train at home!
Grab Your Beginner Bodyweight Routine Worksheet. No Gym Required!

Complete this workout at home, no equipment required

Avoid the common mistakes everybody makes when doing bodyweight exercises

Learn how to finally get your first pull-up
I’d love to hear how this workout went for you, and how else we can help!

This is what we’ve dedicated our lives to, and you’re now part of a killer community.

Welcome to the Nerd Fitness Rebellion!

You can do this, we got your back!

-Steve

PS: If you’re looking for more workout routines to follow, I got you covered:

PPS: As a reminder, today’s bodyweight workout looks like so:

Click on it to pull up your own PDF of the infographic!

###

PHOTO SOURCES: Four Bricks Tall: “Follow or follow not. There is no follow for follow.” and “Morning run with the Fitbit“, Ekaterina Minaeva © 123RF.com, parilovv © 123RF.com.

INFOGRAPHIC SOURCES: superhero costume, male graphic, female graphic, various graphics, icon, milk jug, robot, comic background.
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Steve Kamb

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January 11, 2023
Thanksgiving’s Most Underrated Food

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Since the start of 2022, I’ve consumed more than my body weight in sweet potatoes. The average American eats closer to the equivalent of one (1) fry a day, but for the past decade, I’ve had at least half a pound of the roots at almost every dinner. I travel with sweet potatoes more reliably than I travel with my spouse. All I need in order to chow down is a microwave and something to cushion my hands against the heat.

Tomorrow, Americans will finally put sweet potatoes in the spotlight—and still not appreciate all that they’re worth. Families across the country will smother the roots with sugar and butter beneath a crunchy marshmallow crust. This classic casserole may be the only serving of sweet potatoes some people have all year—which is a travesty in terms of both quantity and (sorry) preparation style. Sweet potatoes deserve so much more than what Thanksgiving serves them. And maybe they’d get it, if they weren’t so misunderstood.

For starters, sweet potatoes are not potatoes or yams. Each belongs to a distinct family of plants. And although potatoes and yams are technically tubers, a riff on a plant stem, sweet potatoes are a modified root. The common name doesn’t exactly help, which is why many experts want to change it from sweet potato to … sweetpotato. Even in grocery stores, confusion abounds. A small part of Lauren Eserman-Campbell, a geneticist and sweet-potato expert at the Atlanta Botanical Garden, dies every time she spots a can of Bruce’s Yams.

Mostly, the sweet potatoes in American markets resemble Bruce’s (Not) Yams: orange-fleshed, brown-skinned, sugary, moist. But the plant’s true range is much more diverse. The outside comes in earthy umbers, ruddy reds and purples, and sandy beiges; the interior can be cream, buttercup yellow, cantaloupe, lilac, even a shade of violet that verges on black. Some are rather watery; others are almost as dry and starchy as bread. Not all of them are even perceptibly sweet. And thanks to the plant’s zany genetics—six copies of each of 15 chromosomes—nearly every combo of color, texture, taste, shape, and sugar and water content can spring out of a cross between, say, a dryish, veiny purple and a moist, smooth-skinned orange. Craig Yencho, a sweet-potato breeder and geneticist at North Carolina State University, told me that, given enough time, “I could find a sweet potato that would be enjoyable to just about any consumer.”

The common misconception that potatoes are fattening and devoid of nutrition (slander!) might make some people assume the same or worse of sweet potatoes. But that couldn’t be further from the truth. Pit their nutritional profile against other staple crops, such as rice, wheat, and corn—all of which command a larger share of the world market—and, in many respects, “sweet potato is on top,” says Samuel Acheampong, a geneticist at the University of Cape Coast, in Ghana. The orange-fleshed varieties, in particular, come chock-full of iron, zinc, and beta-carotene, a precursor to vitamin A; the purples are rich in cancer-fighting anthocyanins. Even sweet-potato leaves are a powerhouse, packed with folate and a surprising amount of protein. Also, they’re delicious stir-fried.

Read: America’s lost story of crops rewrites the history of farming

Sweet potatoes tend to get America’s attention only in November, but they’re hardy, flexible, and ubiquitous enough to be an anytime, anywhere kind of food. They’ve taken root on every continent, save for Antarctica; they’ve been rocketed into space. Acre for acre, sweet potatoes also yield edible crop far more efficiently than many other plants do, “and that is really important in families where they don’t have enough quality food,” says Robert Mwanga, a sweet-potato geneticist based in Uganda, where some locals eat the roots at nearly every meal. In Kenya, sweet potatoes have sustained communities when other crops have failed. Among some populations, the roots have earned an apt moniker: cilera abana, protector of the children.

But even among scientists, sweet potatoes get, if not a bad rap, at least an underwhelming one. “It’s a tiny community, and there’s not a lot of funding,” Eserman-Campbell told me. “I went to a sweet-potato breeders’ meeting one time, and I just thought there would be more people there.” It doesn’t help that the plants can be a bit of a genetic pain, Mwanga told me. Their many copied chromosomes make breeding tricky, and new sweet-potato varieties can be propagated only by clonal cuttings. Among consumers, the sweet potato has also struggled to shed its reputation as a poor person’s food, turned to in times of famine or war and culturally linked to rural, low-income farmers.

People in the Western world are catching on—especially now that nutritionists so often tout sweet potatoes as a superfood, says Ana Rita Simões, a taxonomist at Kew Gardens, in London. In the past decade, demand for Yencho’s sweet potatoes has tripled, maybe quintupled; “I have never seen a crop take off like that,” he said.

Read: The correct time to eat Thanksgiving dinner

Culinarily, though, Americans are still batting in the sweet potato’s minor leagues. The big hitter remains the Thanksgiving casserole—a dish Acheampong likes but remains a bit mystified by. “You guys add a lot of sugar,” he told me, which is amusing, considering that the orange-fleshed varieties are already plenty sweet. Plus, the casserole is (gasp) under the thumb of Big Confection: Its invention was commissioned as part of a ploy to sell more marshmallows. It’s sugar all the way down.

I am not here to yuck anyone’s yam; I celebrate any dish that features sweet potatoes. More preferable, though, would be casting these wonderful roots in a starring role. In other parts of the world, sweet-potato recipes run the gamut from sugary to savory, from appetizer to main to dessert. They’re pureed, stir-fried, noodle-fied; they’re blended into soups, beverages, and pastries. They’ve even found their way into booze. Imagine how they could dress our Thanksgiving tables: sweet potatoes roasted; sweet potatoes grilled; sweet potatofurkey—I mean, why the heck not.

Read: How to engineer the optimally delicious Thanksgiving plate

Or perhaps there is a more modest proposal to be made: Enjoy the roots all on their own. Yencho, like me, is a purist; he likes his sweet potatoes plain, baked until soft, no condiments necessary. They just don’t need anything else.

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Katherine J. Wu

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November 23, 2022