Dear Lizzy,
A friend of mine recently started taking the weight loss drug Ozempic with great results. She has lost significant weight, and fast! She doesn't really look super overweight in my opinion, but I guess technically she's “obese” on the BMI scale. The problem is, I'm “overweight” on the BMI scale. I try to eat healthy and exercise, and I don't care about my figure, but it's hard because I see my friends lose weight. Should I see a doctor and prescribe me medication, or should I go on a diet or get over myself? please help!
make an effort to stay physically active
Dear Striving to Be Body Positive,
As a human female who has weighed many different weights in my life on earth, I understand how you feel. If there was a perfect, fruitless way to make my body fit society's definition of attractiveness, why didn't I sign up right away?
But, of course, nothing is without consequences. Maybe “society's definition of attractiveness” isn't the right target anyway.
For those who don't know: Ozempic, a semaglutide for diabetes, and a similar drug, Wegovey, are making waves on social media, with celebrities using it for one of its side effects: weight loss.
I hired an expert to help me understand the Ozempic/Wegovy craze. This expert is someone I know, in fact someone I look up to all my life, my illustrious cousin Dr. Maggie Landers. Landes (I usually just call her “Maggie”) is a non-diet doctor and health educator of all sizes, and she has a podcast called “Health Can't Lose Weight,” which is better than “Maintenance Phase” because , um, she doctor.
Here's what Maggie had to say:
A couple of things to unpack… BMI is a completely outdated and ineffective tool that we (the medical profession) just can't seem to let go of. When you research the history of BMI, you quickly realize that it is fraught with bias, racism, weight stigma, and is doing nothing for patients or providers other than dividing people into arbitrary groups to sell more Very poorly done on helpful things like supplements, medications, diets, etc.
One also has to understand that the reason Ozempic came to market was as a chronic diabetes drug – it ended up doing great in a specific patient population…but it didn't take long for our slimming obsessed culture to notice a side effect in some patients weight loss. Before long it was in such high demand simply because of side effects of weight loss that many patients who needed the drug to manage their diabetes could not find a supply of it anywhere as “boutique prescriptions” were emptying out pharmacies shelves.
I have a lot to think about the doctors who prescribe the drug factory for people who don't have a clinical indication in the hope of getting the drug just to shrink some pants sizes, but that's another topic…
For your readers, I'd start by investigating yourself why “it's hard to watch your friends get thinner”… this comment is filled with multiple layers of anti-fat bias, a very pervasive, I'd even say in culture on the dominant belief system. Do you believe that the thinner the better? Healthier people? More valuable friends?
Can understand why you might answer yes to these…but the truth is there are all kinds of healthy and unhealthy people, who inhabit bodies of all sizes – and there is little (little) evidence that any of these people Any one of is causal. There are healthy fat people and unhealthy thin people, and vice versa. If you or any patient wants to actually determine the quality of their health, it needs to be addressed with the healthcare provider through various assessments. BMI itself is a poor indicator of health.
Also know that your friend may have lost weight, but you cannot infer her current or future health based on her current response to using Ozempic. Her size has a lot to do with her health, just like your size has a lot to do with your health, but I can confirm that, yes, the side effects (including weight loss) will only last as long as you keep taking the medication. It's a very expensive injectable drug, and we have very little long-term data. Do you want to put yourself in this situation? Pay hundreds of dollars a month, if not thousands of dollars to lose a few pounds forever? For what benefit? What is the price?
I also encourage you to rethink the idea that you need to “get over yourself”. You are a worthy human being who deserves respect, love, and inclusion in this world, big or small. Remember body neutrality doesn't mean you'll never have bad body thoughts or a bad body image… it's knowing that you are more than your body and that your body shape doesn't guarantee or preclude health – just Respect like health is not a prerequisite for health.
I hope you will consider your options wisely with the help of a doctor of great integrity who is very knowledgeable about the health of all body types and the issue of weight stigma in our culture and profession.
Lizzy at it again – get what I mean? outstanding. She also has an entire podcast episode where she and another doctor go deeper on the topic.
Take care of yourself and remember what Maggie said: “You are a valuable human being who deserves respect, love and inclusion in this world no matter how big or small you are.”
Good luck!
Lizzy
Have a burning problem?email me at lacker@oregonian.com or tweet @lizzzyacker!
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This is the latest installment of “Why Tho?”, The Oregonian/OregonLive's advice column. Lizzy Acker. Lizzy's advice also appears in our weekly advice newsletter. Want to get it? Subscribe now.
