By Jeff Fiddler
Obesity is not a personal failure, it’s an out-of-control public health crisis. In the U.S., 72% of adults are overweight and 42% are obese, and without intervention, they’re at significantly increased risk of death, heart disease, and more. GLP-1 agonists, like Ozempic and Wegovy, have been billed everywhere as “miracle drugs,” enabling people to achieve upwards of 20% weight loss without imposing major detrimental side effects. However, those taking or considering them often meet accusations of seeking ‘shortcuts’ or the ‘easy way out,’ casting doubt and shame onto the use of a medication that could likely benefit them in the short and long term.
On a Sunday Podcast released April 20th, Ari and Isaac were discussing ADHD when Ari mentioned his belief that “we are an overmedicated society.” I messaged Tangle on Instagram asking for clarification, and Ari featured my question in the newsletter a week later on April 28th. He summarized statistics illustrating that, compared to peer nations, Americans tend to take more medications such as opioids, painkillers and “the grandaddy of them all: weight-loss drugs.”
It was jarring to hear, but his argument was familiar. Over the years, in person and online, I’ve heard this repeatedly any time the drugs are mentioned, but especially in the fitness / wellness community. It seems well intentioned, to come from a place of rationality, but after the experiences in my own life and the lives of my family members I find these arguments serve only to create guilt and shame, to perpetuate a negative cycle causing more harm than good on the balance.
As someone who’s lost over 100 pounds without medication and kept it off for nearly two decades, I know how challenging significant weight loss and maintenance can be. I’m frustrated by the stigma against these medicines; it must end to enable more people to get life extending care.
I was a fat kid in elementary school. My weight grew as I aged, and by 16 I was around 100 lbs overweight. Around age 20 I lost it all and attained a ‘healthy’ weight (by the BMI metric), and for the last 18 years I have been various kinds of fitness junkie. I've run numerous half marathons (best time 1:36), 10ks, 5ks, cycled in competitive groups, trained with a rowing team, and now I'm a gym rat that spends most early mornings in my home gym while I raise my kids. I've done all of this with no medication to support my weight loss.
As someone that spent a decade (age 10-20) of my life with obesity, I promise you I was highly motivated (intense shame, no dating, suicidal ideation) and educated (doctors, friends, teachers) on the problem with being obese and how to 'fix' it. The common assumption is that overweight people like me were that way due to ignorance or laziness. As someone who’s lived it, I promise that every person that's been overweight after the age of 6 has felt highly motivated and been told the 'simple' advice in some format: eat less; move more.
My own story reflects a broader epidemic that’s only worsened. Obesity was common when I was a teenager, but it’s far more common now. In the last 20 years the prevalence of obesity in the USA has grown from 27% to 42%. In 2050, in most states, a projected one in three adolescents (aged 15–24 years) and two in three adults (≥25 years) will have obesity. Left unmanaged, these people will be at significantly increased risk of cancers, heart disease, stroke, diabetes, arthritis, and more.
So why can’t we reverse this problem? The cause is well known and simple: overconsumption of calories relative to expenditure. Unfortunately, the solution has seemed more elusive, despite the known risks and how motivated people with obesity are to lose excess weight. Research from the Centers for Disease Control has found “the overall chances of a man with obesity obtaining a normal body weight were 1 in 210. For women, it was 1 in 124."
The argument against pharmaceutical intervention is generally that people could and should achieve long term healthy outcomes with high quality nutrition and effective exercise programming. However, the added efficacy of weight GLP-1 medication is undeniable: Even when we offer this kind of intervention the medication-assisted group has significantly better outcomes than the lifestyle-only cohort (16% vs 5.7% weight loss).
Another argument is ‘it’s a temporary crutch, once you take it you’ll gain weight back if you quit.’ This is certainly valid, but that’s equally true of lifestyle modifications. Depending on the person, lifestyle modification probably would include breaking decades old habits and comforts, overhauling dietary patterns, reallocating energy and time to exercise, addressing psychological issues, learning about nutrition, improving cooking abilities, and even removing people or groups from your life. That’s what it took for me, and I was lucky to make most of these changes when I was young and unburdened with family and career pressures. Permanently changing some or all of those lifestyle factors for most people has proven to be unrealistic.
The other common argument is that ‘we don’t know the side effects.’ Side effects are a serious concern, but nausea and diarrhea would be much less harmful than atherosclerosis or diabetes.
With lifestyle approaches falling short, we must rethink how we address obesity. Given the danger of unmanaged obesity, low success rate of lifestyle methods and high success of GLP-1 agonists, I feel strongly that stigmatizing an incredibly promising lifeline to a dire crisis is a terrible mistake. Imagine going to the doctor for a serious ailment and their best 'prescription' had a success rate of 1 in 210 — you'd look at them like they were absolutely insane, right? And yet, that's effectively what the ‘lifestyle-only’ advocates are suggesting we do.
Instead of stigmatizing these drugs, I propose we take a sober and realistic view of the obesity issue and recognize that most people need help to address this problem. Most will not be able to attain and maintain a healthy body weight regardless of education and motivation they receive. They aren’t ignorant or lazy; they are, like all of us, animals built for scarcity and endurance forced to exist in a digital world of caloric abundance. Of course they need help.
Now that help is available, imperfect as it is, we should welcome it instead of pretending we’re just fine without it.
Jeff is a solutions architect working from home and raising two young children with his wife, Sarah. He has no free time, but if he did, he’d enjoy cooking, fitness, trivia, and listening to KEXP.
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