Medical weight loss – why the controversy?
You only have to glance at the press regarding the new weight loss medications to see that their release hasn’t gone down universally positively. Articles about “ozempic face” or how people with type 2 diabetes are being denied their medications because “fat people” are using them up are everywhere. These articles are often written with an underlying negative moralising tone. Not often do we read about the positive lifechanging effects that these medications are having and how people are improving their health and enjoying life as a result of taking them. Like all medications, there are benefits and risks, and it is vital that people get expert help before taking them to treat their overweight and obesity, to ensure it is safe for them to do so.
At the moment it is estimated that there are between 500 thousand and 900 thousand people taking them privately, from a variety of sources. Some are safer than others, and some people are taking versions of the meds that are “compounded”, which means that they are not the actual branded drug, but one made to act like them – these are not regulated in the same way, or subject to the same stringent trials.
It is almost certainly true that not everyone who is taking them have shared this with their nearest and dearest. It is also true that many have not been entirely truthful with their provider of these medications because they didn’t want to disclose other medical conditions or medications, or even stuffed pillows up their jumpers to make themselves look bigger in the photos they have sent in! How have we ended up in this rather strange situation? We shall look at these reasons below…
Obesity stigma
As mentioned in our first blog, although the reasons for obesity are now much more scientifically understood, this knowledge is still not widely shared or known about, even within the medical profession. Instead, there is still the feeling that those who live in bigger bodies should just have more self-control and try harder. This is perpetuated by widespread societal obesity stigma. Research shows that this begins early in life. Nursery aged children are shown to exclude peers with obesity and children and adolescents with obesity and overweight do less well in school and exams. Adults with obesity are less likely to be employed and those who are, are paid less than their “normal weight” colleagues. In the media people with obesity are often discussed using photographs or film without their heads showing. This enables the discussion to be critical because no heads equals depersonalisation. In TV, film and books, characters with obesity or overweight are more often made to be greedy, lonely, stupid or objects of pity.
It is no wonder then, despite the body positivity movement, that people with overweight and obesity are usually living with what is called “negative inner weight bias” – the horrible inner monologue that tells them they are not worthy of love, respect or even medical attention. This unsurprisingly leads to greater rates of anxiety and depression, in both children and adults.
A reliance on “traditional” methods
Whether it is the 1st weight loss attempt someone is undertaking, or their 10th, there is never any shortage of advice from well-meaning people. Try low-carb, try intermittent fasting, try mediterranean diet, try taking up triathlons – the suggestions are never ending. What worked for their mum, their uncle, themselves, their partner. Here are some facts about traditional weight loss methods:
there is no one way of eating that is more effective for weight loss than any other at 12 months
exercise alone, in the amounts most people can do, doesn’t help with weight loss
for those with obesity, there will rarely be a one-off intervention that will last forever, they will need different methods at different times in their lives
The vast majority of people (approx. 93%) will regain their lost weight by 5 years
The first change - surgery
Metabolic bariatric surgery (weight loss surgery) provides good weight loss and health gains and remains the best treatment for Type 2 diabetes in the form of a gastric bypass. Many people go abroad for this surgery as it is cheaper than privately in the UK (£3k vs £10k) because access to this surgery is severely restricted on the NHS, with many hoops to jump through if you can get on a waiting list.
Even people who have made this very brave and evidence-based choice have been accused of “cheating” despite the change to their way of eating and life-long adaptations that they have had to make.
The medications and how they have changed the narrative
With the release of semaglutide and tirzepatide, suddenly people were able to access medication THAT WORKED. People taking them describe the “turning off of the food noise” and suddenly not being hungry all of the time. For many, this has been truly lifechanging. There are side effects, which some people experience more than others, but for those who tolerate them, the weight loss is fast and easy compared to anything they have tried previously. Instead of fighting their biology, they are able to work with their bodies to nourish them when they need food and not feel in constant conflict with their psyche. This is, when thought about, completely incredible, and should be welcomed and those who need the medications, encouraged to use them.
But that isn’t what is happening in many cases.
The negative inner weight bias that those with overweight and obesity have, means they may not feel that they deserve the medications as it is too easy, and weight loss should be some sort of difficult punishment for having got fat in the first place. These feelings may be further reinforced by those around them and the press making judgements, that these are cheating and the easy option and not “real” weight loss. And because weight is regained if you stop the medications (as it is with any form of weight loss method), this somehow proves that they are not worth taking.
Not only does this devalue the life-changing benefits of the medications on both weight and health, but it also perpetuates the moral judgement on those with overweight and obesity. Why are they not like slimmer people who don’t eat too much and why should they get a “pass” to make weight loss easy?
So, people hide their use of the medications. They don’t tell their loved ones, they hide the meds in the fridge behind the orange juice and they are suitably vague when people comment on their weight loss….” oh thank you, I have just changed the way I eat”. Some people have only disclosed their use when loved ones have been concerned their weight loss is due to cancer.
They don’t tell their GP or any health care professionals they are seeing, because unfortunately healthcare is not free of weight stigma, which risks missed side effects or serious complications.
At Genwell we believe that these medications are like medications for any other chronic condition, such as asthma or type 2 diabetes. People with the disease of obesity or overweight should have access to the medications and expert guidance on the safe way of using them. There should be absolutely no shame in having obesity OR using the medications to treat them. They should have advise on how to maximise their health gains from the medications and they should have expert help on their long-term use to prevent regain. We are a weight-stigma free service, we know that it is brave to make the decision to ask for help to lose weight and we are committed to ensuring that you get the support you deserve. We want you to be able to tell us your worries, fears and concerns, we want to help you discuss your plans with your friends, family and children and we want to ensure that you feel safe to be honest with us about any medical conditions you may have – we will look after you, we are experts and we’ve got your safety and wellbeing in our hands.
We are also committed to advocating for the reduction of weight-stigma in society and medicine and the belief that people should be free to live happily in whatever body-size they have. If they wish to improve their health, there should be no shame or guilt, and the medical profession should support them. We will participate in research and ensure we live by these values.
