https://www.npr.org/sections/health...EgvbYEXAfTOMJ5o

I try to be a body-positive doctor. It's getting harder in the age of Ozempic
UPDATED FEBRUARY 26, 20242:09 PM ET
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Mara Gordon

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Ozempic and other weight-loss drugs present a dilemma for some doctors who don't want to talk about weight in a stigmatizing way with patients.
Nicole Xu for NPR
Right around the time Ozempic came out, I started to change the way I practice medicine. As the new class of weight-loss drug ushered in a highly medicalized era of Americans' obsession with being thin, I decided I was done with trying to get my patients to lose weight.

Sometimes I call myself a "body-positive doctor," but that isn't it, exactly, because I don't expect all of my patients to love their bodies at all times. With my students, I call it practicing "weight-neutral medicine." I've found a great community of like-minded health care providers with the Health at Every Size movement, which promotes the idea that people can be healthy without focusing on weight loss.

This change started for me, as many of my major realizations do, from reading. I read memoirs by fat authors like Roxane Gay, Lindy West, and Kiese Laymon, who wrote about the many ways they were made to feel terrible about their bodies, often at the doctor's office.

It was unsettling to recognize myself in some of the encounters they described. I had told my own patients, dozens of times: "Your knee pain might get better if you just lost a few pounds." As if my patients hadn't thought of that already. As if they hadn't already tried.

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Reading these books also forced me to reckon with my own relationship to my weight and my experiences in health care.

As a chubby teen, I remember a visceral unease before each appointment at the pediatrician's office, the fear I felt stepping on the scale. I remember the doctor who chided my mom for buying 2% milk, not skim.

Then, when I lost weight in my 20s, appointments with the doctor were transformed. I could focus on the issues I wanted to discuss, rather than visits being dominated by talk of cutting calories.

My body continued to change over time, as most bodies tend to do, and in my 30s, my weight again became the focus of visits to the doctor.

When I was close to giving birth to my son, I remember a midwife telling me, "Nice work on not gaining too much weight during pregnancy!" I had spent the last nine months vomiting, paralyzed by perinatal anxiety, unable to eat much more than Saltines. This was what I was being congratulated for?

Changing how I talk about weight
Somewhere along the way, I vowed to no longer put my own patients through that same gauntlet. I had to change the way I talked about their weight.

Part of what made me change my approach, at least before Ozempic came on the scene, was realizing how ineffective I was. Most primary care weight counseling – that is, a doctor like me suggesting my patients hop on the treadmill more often – simply doesn't work.

I also started reading more about the history of the body mass index and exactly how unscientific it is. The concept of BMI – weight relative to height – was developed in the 19th century by a Belgian astronomer and mathematician who wanted to define the "average man." But his "average" was white, European and male, and didn't take into account genetic differences or muscle mass.

If the origin of BMI sounds like quackery, that's because it is.

Yet the field of medicine is fixated with this measure. In the electronic medical record I use at work, a patient's BMI is labeled like a vital sign, highlighted red if it's above 26. It's the focus of countless lectures and test questions in our medical training. Weight is a cornerstone of our culture from day one of medical school.

Talk to any clinician, however, and they'll share plenty of examples of how BMI misses the mark. I've cared for countless patients with a high BMI who have perfect blood pressure and glucose control, and thin patients with advanced diabetes. And major medical organizations are finally starting to acknowledge that a patient's BMI isn't always predictive of how healthy they are.

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Mostly, I stopped fixating on weight because I want my patients to feel welcome in my office. Me telling them to lose weight isn't effective, and those conversations often make them feel horrible. It can detract from more important medical issues we need to work on together. So why do it?

There's a large body of research showing that doctors are some of the worst offenders when it comes to weight stigma, and patients are less likely to get the medical care they need when they feel judged for their body size. They're also less likely to exercise and more likely to experience depression. I didn't want to be a part of that.

I now try to focus on more rigorous measures of health and well-being: blood pressure, insulin resistance, joint pain.

I don't pretend that diet and exercise are unrelated to those metrics. Cutting back on processed foods is a great way to prevent hypertension and diabetes. Getting active is the cornerstone of a healthy lifestyle – it can help you sleep, improve your mood, stop back pain. These things might help you lose a few pounds. But as a doctor – and in my own life – I try to focus on the health benefits, rather than making a certain body weight the goal.

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The change in my clinical practice has been palpable. I see relief in my patients' faces when they realize I'm not going to lecture them about their weight. I see how they confide in me and respect my advice.

"That's why we like coming to you, Dr. Gordon," said the mom of one of my teenage patients, when she told me her son finally felt enough confidence in his body to start playing sports. That's the great irony of all of this: When doctors stop shaming patients about their weight, that's often when they feel ready to make a change.

Ozempic forces new, difficult conversations
Then, of course, came Ozempic. A medicine that can make people thin, its introduction marked a new moment in our diet-obsessed culture: a treatment that actually works, unlike all the scam diets and supplements that don't. Slowly but surely, my patients started asking for it, and I've had to think hard about how it fit into my new, weight-neutral approach.

When patients tell me they want to lose weight, I ask them why. Weight loss isn't always the cure-all they're looking for.

Some tell me they want to be able to keep up with their kids. (Taking small steps to get more active is the way to do that.) Some tell me they're worried about developing diabetes. (Cutting out soda is a better approach.) And some are brutally honest: "I want to be hot, Dr. Gordon." That is hard to argue with. I hadn't intended to practice cosmetic medicine, but here I am.

Still, I started to understand that it wasn't my job to withhold Ozempic from my patients simply because it didn't align with my ethos.

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SHOTS - HEALTH NEWS
There's a way to get healthier without even going to a gym. It's called NEAT
I remember tears streaming down the face of one patient, who had tried for years to make peace with her bigger body, but said she was sick of fighting for body acceptance. Even though her blood pressure and blood sugar levels were well-controlled, she was ground down by the fatphobia she experienced every day. She wanted Ozempic.

So when patients ask for it, I usually prescribe it. Part of practicing weight-neutral medicine, I've realized, is supporting my patients' own sense of what their bodies need.

The medication is a mixed bag, it turns out. Some of my patients can't stand the side effects. They tell me the nausea and vomiting aren't worth it, that they'd rather stay fat than feel sick all the time.

Others lose weight quite easily, like one of the patients I first prescribed Ozempic for. Having lost close to 50 pounds, he came to see me the other day, bewildered. "People treat me like I'm a different person now that I'm thin," he told me. That day, he wanted to talk about a new problem he was facing, something the Ozempic had unveiled: depression. He wasn't fat anymore, but he still lives in a society that hates fat people, and he was seeing it with new eyes.

Many of my patients – and my physician colleagues – believe that losing weight will solve every problem, medical and otherwise. But weight loss isn't always the miracle they assume it will be. It can be a distraction from the real issues.

We need more holistic approaches to health and wellness. We also need to end the shame of being fat, which makes it so much harder for people in bigger bodies to do the very things that keep them healthy: exercising, socializing, living life free of self-hatred.

Being a body-positive doctor in the age of Ozempic has made me realize, sadly, that I alone can't stop the fatphobia that permeates our culture. As long as it exists, we'll have a market for medicines that make people thin.

What I can do is try, with each patient I see, to make them feel comfortable and safe, and help them realize that being healthy may have little to do with how much they weigh.

Mara Gordon is a family physician in Camden, N.J., and a contributor to NPR. She's on Twitter as ~MaraGordonMD.

This story was edited by Carmel Wroth of NPR. Nicole Xu created the illustration, with art direction from Pierre Kattar.

According to many who have spoken out, the Ozempic has side effects. Many doctors are saying stay clear.

Obsession with thin. Or is it a desire to be less fat when the percent of overweight and obese categories continue to climb? Hardly see thin people. Its a rarity. To the point that my kids were criticized for being too lean. When pediatrician consulted, he said my son was fine as is.

Are we obsessed with" thin" because too many of us are far from that?

Article lacked substance. Disappointed in NPR.

From what I've read, people who lose weight and then quit the drug will regain the lost weight quickly and not regain the muscle they have lost. That's not a healthy thing to do.

In a way, I feel for this Dr. I think she has very good intentions, not stigmatizing or pressuring her patients to lose weight simply for the sake of a healthy BMI - there are very few doctors like that. Most will look at BMI and it doesn't matter if you're otherwise in perfect health, you MUST lose weight.

I just feel like she's the one under pressure to prescribe a drug which even if it works for weight loss, it's not a panacea - a doctor who knew that if she didn't give in and prescribe it for these patients, they'd either go to a Dr who would prescribe it, or else they'd order some "compounded" version online, and at least she cares enough about her patients to want to be the one who sees them through their experience with the drug.

She seems to also fully realize that losing weight won't magically fix other issues in your life (even issues that the patient firmly believes are due specifically to being overweight), and may bring underlying issues to the forefront, such as the guy who suddenly realized he was depressed - although it doesn't say whether he realized after losing weight that he'd been depressed all along, or if the drug or perhaps the weight loss itself caused him to become depressed.



ETA:I also feel like the whole point of the article was to point out the psychological reasons for wanting to lose weight using this drug, and the psychological results of losing weight using a drug - some of which apply to any weight loss intervention. There are articles about the physical side effects while taking it and potentially dangerous or irreversible side effect, as well as how unlikely it is that you'll be able to keep the weight off after discontinuing the drug. But this is the first one I've seen that deals primarily with the mental and emotional experience of being overweight, and the patient approaching a doctor (who has not made your weight front and center of your entire health profile) about wanting to lose weight.

Exactly.

I would like to keep muscle mass!! 💪

Other sources say a very liw carb diet is better, as it preserves muscle.

Color me cynical, but she "started to understand that it wasn't my job to withhold Ozempic from my patients simply because it didn't align with my ethos."
Her ethos being making money?

Maker of Wegovy, Ozempic showers money on U.S. obesity doctors

https://www.reuters.com/investigate...ordisk-doctors/

Investigative article by Reuters how drug companies can still influence doctor's interest in a new drug. Having only recently read the 2021 book, Empire of Pain, are WL doctors the new "Dr Pain"?

******


No, it isn’t. It was never intended to be a means of medical assessment. On a general population basis, it is a method of statistical analysis that can work to find the Association of BMI with Overall and Cause-Specific Mortality. It can be misused, but even Keys explicitly judged BMI as appropriate for population studies and inappropriate for individual evaluation.
Optimal BMI for Longevity and Optimal Health (And How to Achieve It)
https://optimisingnutrition.com/what-is-a-healthy-bmi/

"A good way to cross-check your BMI is your waist-to-height ratio. As shown in the chart below, a waist-to-height ratio of around 0.5 is also a pretty healthy place to be. A fasting glucose of less than 100 mg/dL or 5.6 mmol/L is also a good cross-check. A lower fasting glucose indicates that you’re below your Personal Fat Threshold and the energy from your diet isn’t overflowing into your bloodstream."

The doctor in the article mentioned Health at Every Size, a book from 2010 which claimed excess body weight is not, in itself, harmful. The movement itself is supposed to be older, and connected with "eating and moving right" without a fixation on a number. I can see the appeal. I lost all of my weight without owning a scale. While I had access to them, it couldn't be an everyday, fixated, thing as it had been when I was a teen.

Since then, we have observed so much more support to view overweight is a symptom of metabolic dysfunction, with most of the blame pointing to industrial food and its increasing presence.

HAES has a soothing purpose to stop the "diet obsession" but that's an obsession with fad dieting, not healthy eating. But they have distorted that concept to mean "okay if it's good for your mental health." Fads still appeal to people because it holds out the promise that after they "diet" away all the weight they can go back to the "normal" which caused the problem.

It is very difficult to pry away the mindset that got us here when it has a full-body hold on our minds. I can understand the appeal of not changing the way we eat, but we can't be lied to about it.

Still, if influential people are making so very much money making and selling industrial food, they will use some of that money to create "social movements" like this. Paying influencers, flooding popular airwaves, and boosting ads everywhere, aimed at making young people relax and choose the explanation they prefer.

Young people can stay active and show healthy lab numbers into their twenties, even thirties, but I've seen videos from people who were nearing forty when it all fell apart. Knees they can't repair until down to a safer weight, circulatory problems, cancer diagnoses, and after years of mental and physical pain. Under this influence insecure women seem especially willing to believe them. Some of then are under thirty and getting hormonal cancer problems. The kind fueled by overweight.

All from listening to HAES, the Health at Every Size "movement." Based on cherry picked studies that are decades old, and ignoring eating disorders, which are a real danger all by themselves. (The Youtube channel Sam at Every Size is a excellent resource on how this #HAES started and what it turned into.)

It seems reasonable, and kind-hearted, and we certainly shouldn't bully people in any case. But it's not fat-phobic (their word) or prejudiced or intrusive to recognize the health dangers of overweight, because what it means metabolically. It's a symptom, not a genome (as they claim.)

This is a bought and paid for overweight-normalization system that NPR got, even if it's a well-meaning attempt to sympathize with a global struggle. What started as body-positivity, to remove any differences as an excuse for bullying and worse, has become an excuse for people to grab, even if their issue is of their own making, as in this case.

Having listened to many people on Youtube, who now have an addiction of long standing and its serious health problems, it's terribly sad. Their mistake was believing "I'm big, so what?" and going on with their life. This led them into needing serious medical intervention.

And some of them can't stop, and die prematurely. What a terrifying position for anyone to be trapped in.

It's a chicken/egg situation. Back in the day, someone learned how to freeze vegetables to retain the nutrients, and it was a great thing. We'll pay for that. Good use of business practices. Now they sell meals made of unknown numbers of fillers, binders, flavorings, etc. Soon, we will be sold a bag of mock-brocc nuggets, or powdered corn with flavoring, which are plant-based, and so they have to be good for us. And told constantly that nothing that is wrong with us could possibly be caused by diet. I've met people who believe that. "It's just fuel, I pick fuel I like, everyone does..."

They mess with macros that are essential nutrients, like protein and fat. (Carbs are not an essential nutrient.) Pritikin founded a whole movement on low fat, and it didn't work long term, and probably killed many. He suffered from severe mental illness. But none of it was science! While all the paleo/primal/carnivore people who picked up the torch from Atkins, worked from a science-based perspective. That's not a depressed person seeing fat as his enemy and starving himself with low low fat, like Pritikin.

The Ozempic craze shows that their HAES strategy worked for a while. I'm sure they got back all that money. But it will stop now, since this phenomenon shows people never wanted to be overweight, and all that comes with it. They simply felt helpless to change.

And many of their HAES Influencers have died.

All people, at whatever size, deserve to be treated with kindness and compassion and all people, of whatever size, deserve to be given the facts. Unfortunately both kindness and compassion as well as facts are often in short supply so people get shamed and blamed and are given erroneous and often dangerous information about nutrition and health along with erroneous information about weight and health. Those of us here, who have been fortunate enough to figure out how to clear away the weeds and figure out what works and what doesn’t work, are indeed in the minority. It makes me sad.