Written by Joseph Zucchi, PA-C, CPT – Clinical Supervisor and Physician Assistant at Transition Medical Weight Loss in Salem, NH
Every time a new article concerning obesity graces my screen, I brace myself before venturing into the comments section, only to be greeted by a familiar wave of misunderstanding and criticism. The narrative remains unchanged – “If only they could muster a little self-discipline, or perhaps stop reaching for the cookie jar.” The old adage, ‘walk a mile in someone else’s shoes before you judge them,’ seems to have fallen on deaf ears.
I am a medical weight loss provider, and every day, I engage with the reality of obesity – a reality that is a far cry from the indolence and gluttony narrative that is often peddled by society. The intricacies of obesity extend far beyond simple notions of willpower or dietary choices; it’s a multifaceted issue that demands a deeper understanding.
Once, I too was perched on the simplistic notion that a calorie deficit, coupled with an active lifestyle, was the golden recipe to conquer obesity. However, years of clinical practice have painted a more nuanced picture, revealing a complex interplay of genetics, hormonal imbalances, and environmental factors that drive the relentless cycle of weight gain, weight loss, and the dreaded yo-yo dieting that leaves many in despair. Although a caloric deficit is indeed required to shed pounds, adhering to it can be a very difficult task due to the biology of obesity. Losing weight can trigger a compensatory response that escalates hunger, making the journey towards a healthier self a battle against one’s own physiology.
Amidst the bitter pill of stigma, there emerged a beacon of hope – new anti-obesity medications such as semaglutide (Wegovy) and tirzepatide (Zepbound). These GLP-1 and GLP-1/GIP medications have been game-changers in counteracting the hunger, cravings, and the incessant food “noise” that plagues those striving for weight loss. And recent studies have even showcased their benefit in reducing the risk of cardiovascular events such as heart attacks and strokes. Yet, instead of embracing this advancement, we are entangled in a web of accusations and fallacies. The disdain towards weight loss medications, labeling them as a ‘cop-out’ or ‘quick fix’, is a reflection of our deeply ingrained biases. We don’t reprimand individuals for taking blood pressure or cholesterol medications, despite lifestyle factors being significant contributors to these chronic conditions. Why then, do we stigmatize anti-obesity medications? Since 2013, obesity has been officially recognized as a disease state by the American Medical Association and deserves proper treatment options.
Fearmongering by some critics about the side effects of anti-obesity medications adds fuel to the fire, overshadowing the fact that these medications are well-tolerated by many. One could be led to believe that GLP-1 medications are brand new due to their recent media spotlight. Yet, in reality, this class of medications has been in use since 2005, supported by a wealth of research and advancements over the years. While side effects warrant monitoring, and patients may respond differently, addressing them is part of our duty as medical providers. We see each patient as an individual, weighing the pros and cons, and understanding that not treating obesity can culminate in an alarming risk for cardiovascular disease, diabetes, sleep apnea, cancer, and more. I must stress, though, that these medications are most appropriate for those grappling with the complexities of obesity and the myriad comorbidities that often accompany it. They should not be trivialized as a solution for quick weight loss pursued by a Hollywood figure merely looking to shed 10 pounds. Their purpose is profound, addressing deep-rooted health challenges, not fleeting aesthetic desires.
At Transition Medical Weight Loss, our approach transcends the narrow lens of vanity weight loss. We foster a comprehensive program that emphasizes nutrition education, exercise, and lifestyle modifications, aligning these elements with the judicious use of weight loss medications to enhance our patients’ journey towards a healthier self. About half of our patients are finding success without medications, showcasing that they are not a mandatory component but an available aid. If opted for, these medications are used alongside, not in lieu of, lifestyle changes, nutrition adjustments, and exercise. The decision to incorporate medication is a patient-provider discussion laden with contemplation. Many patients have navigated the tumultuous waters of numerous diets, losing and regaining weight. Telling them to ‘try harder’ is not only disheartening but unjust. Withholding a medication that could genuinely pivot their lives towards better health would be wrong.
These medications are not a crutch, but a powerful tool that, when used alongside lifestyle changes, can catalyze profound transformations. I have witnessed patients, who once were shackled by their weight, flourish into embodiments of health and vitality. They aren’t just shedding pounds; they are shedding the shackles of societal judgement and self-doubt. Importantly, these medications often lead to a reduction in the need for other medications, further enhancing their overall health. The anti-obesity medications have enabled them to better succeed at making healthier food choices and increase their physical activity as part of their new healthy lifestyle. It’s essential to understand that the journey towards better health is not merely about reducing the number on the scale. It encompasses gains in overall health, enhanced quality of life, positive shifts in body composition, and the mental and emotional well-being that comes with feeling good in one’s body.
However, the journey is far from over. Our food environment is not just a minefield of unhealthy temptations, but also a marketplace dominated by oversized portions and ultra-processed foods. Beyond dietary hurdles, psychosocial factors, such as stress, depression, and lack of sleep compound the problem. Socioeconomic constraints further complicate matters, restricting access to nutritious foods and perpetuating an ever-more sedentary lifestyle that many of us find ourselves ensnared in. The rate of obesity in our nation persistently rises each year. While medications provide a potential tool for some, their high cost combined with inadequate insurance coverage remains a significant barrier for many. A multifaceted approach is imperative to truly address this epidemic.
Each day, as I witness the metamorphosis of my patients, I am reminded of the profound impact of a little understanding and the right support. It’s an honor and a privilege to play a part in their journey. Their stories are a testament to the efficacy of a holistic approach towards obesity treatment, an approach that marries medical innovation with a kind-hearted understanding of the human experience.
In our quest to ‘shed criticisms,’ we must recognize that the heaviest load many carry isn’t physical weight but the weight of societal misunderstanding. A compassionate dialogue on obesity isn’t just beneficial—it’s essential. By prioritizing empathy, understanding, and open-mindedness, we can uplift those navigating this journey, ensuring they receive the support and respect they rightfully deserve.
