Since Ozempic entered the cultural zeitgeist, I have been overwhelmed with requests from my patients – both those who meet criteria to start the medication and those who do not – for this new class of “miracle” drug. While it does work like a miracle for some, there are also those for whom the promise rings hollow – those who are unable to tolerate the medications due to side effects, who meet FDA criteria only to find that their insurance does not cover these medications, and who, believing they could maintain the weight off by force of will after stopping the medications, are frustrated when the weight comes back.
Beyond the individual impact of these medications, terrible or wonderful, I wonder at the unintended consequences the GLP-1 receptor agonists will have for us as a society.
The prevailing message in the media is that weight is a matter of personal responsibility and under an individual’s control. Any internet search on “how to lose weight” will reveal an abundance of websites and message boards discussing weight as a simple calories-in minus calories-out subtraction equation. The truth of the science is that weight is more akin to a complex form of calculus with multiple as yet unknown variables. One thing that is certain is that a great number of the factors that influence weight are beyond the control of the individual.
And yet, to a great extent, our society, including us as physicians, see obesity as at least partially the fault of the individual. Previous studies have shown that primary care physicians report less respect for obese patients, spend less time educating obese individuals about their health, and may overattribute symptoms and problems to obesity. These biases are not only implicit – in a 2012 study, physicians indicated a strong aversion to working with obese individuals when given the choice. Multiple studies show that obese individuals feel this stigma and avoid care because of it. Unfortunately, even when they do turn to their physicians for help losing weight, many feel their physicians are poorly educated and offer little actionable information on how to achieve that end.
Now with GLP-1s on the scene, medical weight management is within the reach of more individuals than ever before. As physicians and as a society, this is almost a relief. We can help our patients lose weight! Without extensive counseling! Without them having to completely change their life a-la the early 2000s The Biggest Loser! Indeed, this shift puts the work and responsibility of losing weight in the patient’s hands even more than before – if they can afford it or have good enough insurance, if they have a job, if they can tolerate any side effects, and if they want to be on medication forever. But I wonder, now that we are empowered with medications that finally work for (some) people, will our blame fall more fully on those who are obese?
Armed with these powerful new medications, policymakers, physicians, and society can further turn away from championing priorities that will combat the root causes of the obesity epidemic and lead to better health for all, such as restructuring the workweek to help individuals better manage stress and get sufficient sleep, making urban and suburban areas more walkable or rideable, eliminating food deserts, putting stricter regulations on the quality of our water and food, or limiting the quantities of chemicals such as BPAs (which have been implicated as a cause of obesity) in our natural environment.
As society and physicians get swept up in the excitement of this new paradigm of weight management, I fear this is exactly what will happen. We’re rejoicing that the rain is stopping, while overhead, dark storm clouds continue to gather.
Monica Ball-Zondervan is a family physician.