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Key points
- New weight-loss drugs are causing dramatic physical transformations.
- But the emotional side effects can be just as dramatic.
- Enduring stigma is a key reason.
Unless you have been under a rock of late, you have probably heard of Ozempic or Wegovy, along with a wave of similar GPT-1 medications that are transforming how people can lose large amounts of weight. They also are increasingly recognized as being able to prevent and slow an array of chronic conditions, including diabetes, heart, and kidney disease. The drugs are currently in short supply due to accelerating demand, meaning that patients are not always sure if they will be available from one month to the next.
These GPT-1 medications aren’t for everyone, but for many who struggle with high body weight, they are proving to be personally transformative. Not only transformative in the sense of pounds lost, but in the way they feel about themselves. For those who have struggled for years to lose excess weight, the relief of finding a solution can be liberating, even joyful.
There are very few social science studies surrounding weight loss drugs at present, as the phenomenon is so new. But from what we have been able to observe so far, the emotional relationship between those working to lose weight and the drugs is intense. And, it may often be positive, but it can quickly turn negative as well. It’s a “side effect” we know very little about.
Stigma, Prescriptions, and the Clinic
In a recent commentary in Nature, we discussed some of the social costs of sudden and extreme weight loss. This was mostly based on our prior research with bariatric patients. Much of the focus in that thought piece was on how others react when people lose weight, such as the stigma that remains attached to bodies after they lose weight. A recurring theme was how patients were constantly reminded that there was a “right” way to lose weight, and it must include extreme self-control. That is, weight loss was only valued if you proved yourself through the “work” of diet and exercise.
So, we anticipate that the ways weight loss drugs are prescribed, dispensed, used, and discussed will reflect an enduring stigma of both weight and this widespread idea of “cheating” at weight loss by using a drug. Early signs of this are evident in a new study from Denmark. Wegovy was released nationally in early 2023, and what followed was its rapid and widespread legal prescription for weight loss. Clinicians described many of the discussions around prescription to be “patient-led”, meaning it wasn’t the doctor always suggesting the prescription. Rather, patients were explicitly requesting it. The topic of “obesity” has always been a sensitive one for doctors to raise, and patients often avoid or deflect it. So, doctors felt good about being able to support and assist patients when they raised the issue of weight loss themselves. Difficult conversations were becoming easier.
But, also, the Danish clinicians in the study deliberated about whether a patient “deserved” the medication as they considered prescriptions. “Deserving” meant that the motivation was morally appropriate — to look good in clothes was not considered a moral reason, but “being healthier” or playing with grandkids was. The moral messages underlying these comments lay bare that clinicians typically judge overweight patients, often intently. And what we know from our studies with bariatric patients is that patients easily read these signals of disapproval – however politely they are stated — which can be extremely emotionally painful.
Drugs, Love, and Despair
The drugs themselves are under careful scrutiny through clinical trials, which are tracking both the many benefits and side-effects. New results are released almost daily. But, there are many emotional effects from using these drugs we are yet to understand. We are not talking here about the side-effects of the drugs in standard clinical terms. We mean how they make people feel – both good and bad.
Last week Alex was talking with Wanda (not her real name) who has been on Ozempic for the last year. She had lost 45 pounds and was working out with a trainer four times a week. The food noise in her head was gone, and she felt healthier than she had in a long time. She had long struggled to lose weight, and finally, it was happening. Her reaction to discussing the drug included a heavy dose of love, joy, and gratitude. She felt confident and in control.
But when Alex heard from her this week, other emotions were kicking in. Her health insurance coverage was changing. The drugs would no longer be covered (an accelerating trend, given how expensive they are). She forwarded the email. Beyond ostensibly stating the reason as the high cost, there was further discussion of how people like her were the reason diabetics were being denied medication. The reason wasn't the drug company's supply chain issues. but, rather, patients. Beyond that, more stigma was apparent in the way her deservingness was discussed. She was told “you have to take a few extra steps to prove that you are serious about your weight loss and being successful with getting healthy.” She was frustrated and angry, feeling judged for what she used to weigh. If 45 pounds of weight loss wasn’t proof enough, how was she meant to perform – for those managing access to the medication – the right type of moral character? And why should she have to, for something prescribed by a doctor for good medical reason?
Combine that with patient anxiety that the drugs themselves are in very short supply, and you have a potent emotional cocktail for users. The threat of not having access – and likely rebound weight gain (clearly shown in the clinical trials) — was anxiety-provoking and even terrifying. To come all this way and go back is a hard prospect. If you have seen someone crying in a pharmacy lately (as I have), this may well be the reason. Everyone deserves better, and we need to get serious about understanding how to prevent these emotional side effects just as we are with the physical ones.
