Weight Loss

Should I use a weight loss medication?”

November 2, 2023

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I'm Michelle — health coach for women who want to escape diet culture and find the health they deserve.

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Today, we are delving into a topic that has gained significant attention recently: Ozempic and other GLP-1 inhibitors as weight loss medications. To help me broach this topic, I recently spoke with Heidi Karner, a dietician with a Masters in Health Promotion, who practices through an anti-diet, size-inclusive lens. 

Through sharing Heidi’s expert insights, I hope to encourage people to own their body health decisions and provide a better understanding of what these medications are designed to do and how they function within the body. We’ll be diving into the reasons why someone might need or want to use weight loss medications, the reality of the side effects of drugs like Ozempic, how the weight loss effects do not last after use of the medication ends, and how we as a society approach body image as a whole. 

Reminder: It’s important to note that while Heidi and I are healthcare professionals, we are not your healthcare professionals. If you are considering these medications, please consult your own doctor.

Understanding GLP-1 Inhibitors

Medications like Ozempic fall into the category of GLP-1 inhibitors. One of the first FDA-approved drugs in this class was Trulicity, which marked a significant step in diabetes treatment. These medications were primarily designed to help people with diabetes by controlling blood glucose levels.

GLP-1 inhibitors work by mimicking incretins, hormones in the body released in response to eating. These hormones signal the pancreas to produce insulin, which helps reduce blood glucose levels. This mechanism effectively manages diabetes.

However, the key to Ozempic’s potential for weight loss lies in its multifaceted action. Apart from the pancreas, it affects the hypothalamus, slowing gastric emptying, and influencing the liver’s storage of glucose. This combination can lead to decreased hunger, delayed digestion, and better blood sugar management. The unintended consequence of these effects is weight loss.

The Complexities of Weight Loss and Medication

The idea of using GLP-1 inhibitors like Ozempic for intentional weight loss raises concerns, mainly due to a lack of research outside of diabetes treatment. In the initial phases of development, these drugs were primarily associated with diabetes management, not weight loss.

What’s important to understand is that while these medications can result in weight loss, it is not a permanent solution. Studies have shown that once you stop taking these medications, the lost weight tends to return. This weight cycling can contribute to chronic diseases often associated with higher weights, which raises a question about whether prescribing these medications solely for weight loss is doing more harm than good.

Advice for Those Considering Ozempic

Many people have legitimate reasons for seeking short-term weight manipulation. Whether it’s health concerns, social pressures, or pre-pregnancy weight loss requirements, there are many factors that can motivate individuals to consider Ozempic.

The need for informed consent and ensuring a thorough understanding of the risks associated with these medications is crucial when making decisions around drugs like Ozempic (especially for people who are not looking through the lens of blood glucose control or stability).

A Personal Perspective on Ozempic

I personally felt a lot of social pressure to consider Ozempic. Even my family doctor was confused as to why I didn’t immediately rush to take it, but I had several concerns about the drug. I knew at the time when this first came up in discussion with my doctor that what causes me the most amount of stress in my life right now isn’t my weight–it’s everything that I’ve been doing to try to manage my weight. And I don’t wanna engage in that anymore. So one of the biggest concerns I had was that I wasn’t going to take this drug forever. And so when I stopped and got my appetite back and went right back into my old unhealthy relationship with food, how would I be any further ahead?

A I’m also in the throes of the perimenopause, I’m also concerned about muscle loss.One thing that the science has shown is that whenever we lose weight, there is a certain degree of muscle loss with that. But with ozempic, there is a greater proportion of muscle loss than with other methods of weight loss. And at this stage in my life, I need my muscles to keep my bones and my joints healthy.

So when it comes to the discussion of ozempic, it’s truly important to identify what you’re really wanting to achieve. And if your goal is to heal emotional eating, address disordered eating behaviors or just improve your relationship with food, then Ozempic is not going to accomplish that. In fact, it’s actually going to get in the way of that happening.

The Reality of Side Effects

While the potential for weight loss with Ozempic and GLP-1 inhibitors is enticing, it comes at a price. The side effects of these medications can be severe, and for some, they’re more than just a minor inconvenience. Nausea, abdominal pain, and vomiting are common side effects that can become so intense that people end up seeking emergency care.

For a lot of people, it tends to be fairly severe at the beginning and then it may dissipate over time, but it’s still there. It is rare to not have any side effects. Nausea and vomiting, dehydration, headaches, and really low energy are often the result of restriction and not having any desire for food. 

But if we’re not getting the blood glucose management out of it like diabetics do, we’re enduring these incredibly distressing side effects as a result. This begs the question: what are we willing to do to achieve thinness?  But in reality, we can’t fix our body image by trying to fix our body. Most of us assume that we’re going to be able to trust our bodies more if we’re in a thinner one.

But that’s not how we cultivate trust in our body. 

When you work on the relationship of listening to your body and your body listening to you through your behavior and the way that you take care of it, you can really start to trust your body to know what’s best for it. Only then can we make an informed decision about whether or not this is a medication that would serve us.

Navigating Healthcare Provider Recommendations

One of the challenges people face when considering medications like Ozempic is the stark contrast between the perspectives of healthcare professionals well-versed in Health at Every Size, weight-inclusive care, and intuitive eating, and those who advocate for weight-centered approaches. Many healthcare providers promote Ozempic as a miraculous solution for health, especially for patients deemed “overweight” or “obese”.

If you’re feeling on the fence about this decision, research shows that we actually have to go through this process of ambivalence and feeling torn because that’s how we make the most informed and cognizant decisions. You have body autonomy and you have agency over your body, what you do with it, and how you take care of it. And I invite you to weigh up all of the messages you hear and then tap into your own values and goals to do what feels right for you.

I also encourage you to really ask questions of your physician about the side effects, the rebound weight gain, the muscle loss, and everything I have mentioned today so that you are making an informed decision and can advocate for yourself.

Rethinking Health and Weight

In conversations surrounding intentional weight loss, whether through restrictive diets, strenuous exercise, or medical interventions like medications and bariatric surgery, it’s common to feel a sense of hopelessness. The deeply ingrained connection between weight and health often leads us to question if we can ever truly be healthy without conforming to certain body standards.

When we view health through a Health at Every Size (HAES) lens, we see that promoting health isn’t contingent on the size or shape of your body. You can still focus on vital aspects of well-being such as managing diabetes, cholesterol, heart health, and more, regardless of your body size.

For those who worry that relinquishing a sole focus on weight means neglecting your health, rest assured that many avenues still exist to support your well-being. Building positive relationships with food, embracing movement, managing stress, and improving sleep can all contribute to better health. While some of these changes may result in shifts in body size, the primary goal is to nurture your health through actionable behaviors.

The key takeaway is that your health journey can be independent of the pursuit of a specific body size. It’s about embracing a holistic approach that prioritizes your well-being, regardless of the number on the scale. Ultimately, you have the agency to make choices that align with your values and health goals, breaking free from the rigid confines of weight-centric thinking.

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