Notes before you read:
First, THIS IS NOT A MEDICAL RECOMMENDATION. IF YOU ARE CONSIDERING MEDICAL TREATMENT FOR OBESITY, CONSULT YOUR DOCTOR.
Second, GLP-1 agonists are medications like Ozempic and Wygovy
A friendocrinologist is an endocrinologist who no longer treats you clinically, but with whom you remain close
Like many of us, I have struggled with my weight for most of my life. And I can honestly say that I am one of the few for whom societal and family pressure (appearance had zero weight – pun intended -- in my family when it came to parental expectations, or grandparental expectations, for that matter) had exactly zero to do with it.
Lucky me.
No, these struggles are strongly rooted in and exacerbated by my other conditions. Meningitis knocked out my ability to be active for a long time, and then diabetes came along to mess with my body image and perception of healthy, as well as making activity more complicated. Asthma always hung over it all like a pall, and back then, allergies kept me indoors whenever someone was cutting grass, even during recess.
No matter how I came to it, my on-again-off-again relationship with nutrition and exercise is similarly reflected in the lives of millions of American. It is one of the harder circumstances to tackle because, up until recently, it was an on-your-own sort of thing. It was mostly based on lifestyle habits, and medication that could help was just as stigmatized as obesity itself. Either that or it, you know, killed people.
But then, in 2013, the American Medical Association recognized obesity as a chronic condition with definite and complex medical impacts. Of course, the public was slower to accept that obesity is a medical condition because we can’t resist using it to judge people and calculate what we think they deserve, but that is a rant for another time.
To be honest, I never viewed it that way, either. Primarily because it always felt temporary. I would guess I have been obese for approximately a third of my life (but perceived myself as overweight for closer to three quarters), but I always felt that I could do something about it.
If only I could get my life together more.
If only I were less lazy – I had all equipment I needed literally in my apartment. So, why didn’t I use it?
If only I would cook more instead of ordering in. I used to batch cook every week. Not only was it healthier and easier to track, it was also considerably less expensive.
I bought tools – crutches – to make it easier. I investigated short cuts. None of them worked, even (or especially) the expensive ones.
Then I had my annual Georgetown patient interview. Afterward, my “friendocrinologist” and I walked to lunch. It is only half a mile, but there are hills, and I was so out of shape, I had to stop and catch my breath a couple of times. He didn’t express it to me then, but he was so worried that he called me at 7:00 the next morning to tell me about an idea he’d had at 5:00. I am lucky he didn’t call then, lol.
Apparently, in his hospital system, there is a component to their bariatrics practice that is non-surgical. He knows surgery is a last resort for me, so this seemed like a good option.
I was skeptical. I had heard things about GLP-1s that made me disinclined to use them, and I also didn’t like the idea of yet another lifetime drug. But this was not an area of my expertise, and what could it hurt to talk about it?
I was impressed by my initial appointment. The doctor listened to my story, and then spoke to me at the level I was – educated beyond most patients, but not an expert -- not as an amateur. She went on to say a few things that really appealed to me:
· Their program viewed obesity as similar to addiction – a forever condition that would require different levels of care and attention over its course. The level of treatment would go up or down depending on how much you were struggling.
· GLP-1s didn’t necessarily come with the side effects I had heard about, and she was recommending one I could take daily, which came with greater control and smaller doses.
· The program’s goal was to treat obesity with medication for only about 12-18 months. At that time, we would assess where I was and whether medication was still needed. But even if it wasn’t, that didn’t mean that I would be cut off for all time. If circumstances dictated increased struggle with obesity controls, I could come in and discuss picking up treatment again.
The flexibility of it all appealed to me. The way they treated both obesity as a condition and me as a patient appealed to me. The adjustment to a viewpoint I had never considered appealed to me. So, I decided to give it a try.
As it turned out, that flexibility would be essential. As a Type 1 diabetic, I was ineligible for the GLP-1s, no matter how we appealed or I tried to use my connections to get around it.
This was because the FDA was tightening regulatory scrutiny due to all the celebrities and other folks without prescriptions getting them and causing a shortage for those who actually do need it. There was also the issue of online sales of counterfeit GLP-1s. (Are we really that desperate for a quick fix to a long-term problem that we would take unapproved drugs from sketchy people on the internet? Yes, yes, we are.)
So, we had to explore other options. The one we landed on is a medication that is primarily used in treatment for alcoholism. It lessens the dopamine release for the causal behavior, in my case overeating. It works for me because I eat my emotions. If there is no comfort in the comfort food, then why do it in the first place?
Plus, it is an older, established medication, so I can remove myself from the hassle of GLP-1s, even as they become more readily available for general weight loss, and not just Type 2 diabetes.
Even then, there were shortages at the end of last year and into this year, so it is hard to say how well it is working. Can’t judge something so inconsistent. But we appear to be in good supply now, so we’ll see.