The alternative to Ozempic: a Mediterranean diet with fewer calories and a little exercise

In the age of Ozempic, Mounjaro , and other anti-obesity drugs that allow effortless weight loss and prevent the complications of excess weight, a team of more than two hundred Spanish researchers has demonstrated that almost the same benefits can be achieved with small lifestyle changes. The proposal is more economical and does not require weekly injections. All that is needed is to follow a Mediterranean diet rich in olive oil, legumes, vegetables, and limited red meat, do a little weekly exercise, and modestly reduce calories.

"Applied on a large scale, these small changes in at-risk populations would have a significant clinical impact. This would be achieved without major sacrifices because it would only require reducing about 600 calories a day. And this is achieved by eating fewer refined carbohydrates (white bread and rice or potatoes...) and eating red meat only once a week," Miguel Ángel Martínez, who has just coordinated a new study showing that small changes multiply the benefits of the Mediterranean diet, told ABC.

This professor of Public Health at the University of Navarra has spent nearly three decades searching for scientific evidence to support the benefits of the traditional Spanish diet, the culinary treasure. He achieved this with the Predimed study, the largest ever conducted. After following 7,500 participants for a decade, he demonstrated that it could reduce circulatory problems by 66 percent, heart attacks and strokes by 30 percent, and prevent the onset of diabetes and breast cancer. He thus demonstrated that a high-fat diet based on extra virgin olive oil or nuts yielded more benefits than other, lower-fat diets.

After that research, he set himself another challenge. He wondered if he could go further and improve his Mediterranean diet advice. Thus, Predimed-Plus was conceived, thanks to a question and an ERC grant, one of the most prestigious grants awarded by the European Research Council. Now, ten years later, the Annals of Internal Medicine is publishing the results of that study, which also features Professor of Preventive Medicine Miguel Ruiz-Canela as first author.

It concludes that an obese person would only need to eat a Mediterranean-style diet, reduce calories slightly, and exercise to reduce their risk of type 2 diabetes by 31% and lose weight. They just needed to make a small lifestyle change.

The research has been published in an editorial highlighting how good habits are still important for achieving long-term health outcomes, despite the popularity of anti-obesity medications.

This is the largest European nutritional study, designed as a clinical trial for a drug. For six years, 4,746 people aged 55 to 75 who were overweight or obese, had metabolic syndrome, and had no history of cardiovascular disease or diabetes were followed. Two groups were compared: an intervention group that followed the low-calorie Mediterranean diet with 600 fewer kcal per day and a moderate exercise plan (brisk walking or strength and balance exercises), and a group that maintained the traditional Mediterranean diet.

The results show that in addition to reducing the risk of diabetes, the intervention group lost an average of 3.3 kg and reduced their waist size by 3.6 centimeters. In short, this plan was shown to be an effective preventive tool against the risk of diabetes, one of the pandemics of the 21st century. What surprised Professor Martínez, the study coordinator, was that the benefits were also achieved quickly: "From the beginning, we saw a divergence in the curves of the two groups." And he insists, "without medication."

He's convinced that GLP-1 agonists, like Ozempic, "are wonderful drugs, necessary for some people." "But 50% stop taking them after a year. They don't learn how to take care of themselves, they rely on injections for everything, and when they stop injecting themselves, things get much worse," he insists. However, the biggest argument for making small lifestyle changes "is that no healthcare system will be able to afford the cost of the medications."