In the summertime of 2022, I made a decision to attempt taking Ozempic to shed weight.
On the time, I used to be an early adopter. The media frenzy about GLP1 agonists hadn’t but began. Even my very own physician was stunned at my request.
“I have never actually prescribed them for weight reduction a lot,” she informed me. “Have you ever tried Noom? Or meals from HelloFresh?”
However I am a main care physician, and I might been following the scientific literature that confirmed GLP1 agonists may now be used particularly for weight reduction. I wished to attempt them.
Ultimately, I used to be additionally an early quitter: I finished taking the drug inside months of beginning it. Ozempic made me nauseated, gave me heartburn, disrupted my sleep. It wasn’t value it.
I used to be not alone, it seems, to find it troublesome to stay with the Ozempic. New analysis exhibits the overwhelming majority of people that attempt GLP-1 agonists for weight reduction find yourself stopping them.
And whereas many individuals profit from these medicines, I believe docs can be taught from the truth that so many individuals quit on them, too.
After I began enthusiastic about giving Ozempic a attempt, I had given beginning the yr earlier than. Like most girls, I had gained weight in being pregnant. Additionally like most girls, I believed I needed to lose all of it to “get wholesome” once more.
My physician’s preliminary recommendation wasn’t horrible – consuming greens and common train are certainly good for you — however I had heard it earlier than. I had doled out the identical suggestions to my very own sufferers one million occasions, with out a lot success.
Ultimately, my physician prescribed the Ozempic. After I gave myself my first injection, I used to be optimistic it might assist me really feel more healthy.
Since then, I’ve began writing publicly about being a size-inclusive physician who would not push my sufferers to shed weight. However on the time, I hadn’t but absolutely embraced a weight-neutral method to caring for my sufferers — and caring for myself. In any case, I had spent years of medical coaching absorbing the message that the one solution to be wholesome was to get all the way down to a physique mass index of 25 or beneath.
However my expertise with Ozempic made me notice I had confused two distinct points: Being wholesome shouldn’t be all the time the identical factor as being skinny.
After I tried Ozempic, I had been struggling to get again into train after childbirth. With a child at dwelling disrupting my sleep, I felt sluggish on a regular basis. I believed the medicine would possibly assist me get extra energized.
As an alternative, I began feeling virtually instantly horrible. The heartburn was the primary aspect impact I observed, then the nausea. At a good friend’s marriage ceremony that summer time, I toasted the couple with a glass of champagne, then spent your entire reception vomiting in a toilet stall. I felt too sick to train. It was onerous to sleep due to the belly ache.
I felt, in a phrase, unhealthy.
I wasn’t precisely systematic once I stopped taking it. I positively did not discuss to my physician about it. (Traditional physician habits – we are the worst sufferers.) I simply made excuses about skipping every week, after which one other.
And I am not the one one.
My expertise was not distinctive, new analysis exhibits. The bulk of people that begin GLP1 agonists find yourself stopping them, according to research published earlier this year in JAMA. The research authors discovered that almost 65% of research topics who had been taking the medicines explicitly for weight reduction, reasonably than diabetes management, ended up going off them inside a yr.
It wasn’t clear why particular person sufferers stopped the medicine, however researchers discovered some widespread causes. Sufferers who skilled important uncomfortable side effects had been extra more likely to stop the medicines.
Sufferers with decrease revenue ranges had been additionally extra more likely to stop, presumably as a result of they could not afford them. (A growing number of insurers are not protecting the medicines, as a result of they’re so costly, which shifts the prices immediately on to sufferers.)
Individuals who misplaced a big quantity of weight had been one other group who stop at a better charge.
Or possibly, like me, a few of these quitters felt more healthy once they weren’t taking the medicine.
After I stopped the Ozempic, I slowly discovered myself feeling higher. I began exercising once more, taking my son within the jogging stroller and climbing with my household on the weekends. My sleep was much less disrupted by an upset abdomen. I allowed myself to take pleasure in meals.
I did not shed weight, however my blood strain and glucose ranges remained regular. I felt extra vibrant and alive. My psychological well being was higher. Was it attainable that I might be wholesome with out a BMI of 25?
Plenty of my fellow docs do not suppose so. “Higher efforts are wanted to extend entry and adherence,” the JAMA researchers wrote of their article about GLP-1 discontinuation charges, the belief being that the purpose of docs in every single place needs to be to get sufferers to take the medicines — and stick with them.
I am not anti-Ozempic; removed from it. I prescribe GLP-1s for a lot of of my sufferers, and plenty of them present enchancment on metrics like blood glucose, hypertension, and kidney perform. A lot of my sufferers say the medicine assist them lead a lot more healthy lives.
However a slender concentrate on weight — which, so typically, our medical coaching nonetheless teaches — misses the purpose that there is extra to being effectively than a quantity on the dimensions. For me, I felt more healthy at a better weight as a result of stopping Ozempic helped me train repeatedly, sleep higher, and really feel much less ache.
A few of my sufferers inform me related tales. One girl informed me that having a peaceable relationship with meals is extra necessary to her than a couple of kilos of weight reduction. One other affected person informed me that “being skinny is not value feeling sick on daily basis.”
I fear that within the age of Ozempic, we docs have returned to a myopic obsession with weight because the definition of well being. As an alternative of specializing in goal measures like kidney perform or liver irritation, docs as an alternative hone in on BMI, a metric that the American Medical Affiliation has denounced as not rigorous enough to guage a person affected person’s well being.
Simply have a look at the hand-wringing in another recent paper that confirmed excessive charges of individuals quitting GLP1s: “Discontinuation may have coverage and medicine protection implications, particularly if the burden discount shouldn’t be sustained after medicines are discontinued,” the authors wrote.
This comes at the same time as major medical organizations are placing much less and fewer emphasis on BMI and as new research emerges that exhibits cardiovascular health could also be extra necessary than physique weight as a predictor of illness.
As I attempt to assist my sufferers navigate selections about these medicines, I hold returning to the core worth of bodily autonomy. Well being is multidimensional and deeply private. My sufferers resolve what it means to be effectively — with or with no GLP-1 drug.
Mara Gordon is a household doctor in Camden, N.J., and a contributor to NPR. She writes the Substack e-newsletter “Chief Complaint.”
