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A recent conversation I had with my patient, Sarah*, exemplifies the internal struggle many patients face when considering medication for weight management. It went something like this:

Sarah: I'm seeing some progress with the lifestyle changes we discussed, but I'm still fighting an uphill battle to lose weight. Whenever I try, I end up struggling with food cravings and hunger and slowly fall back into old habits. I know there are medications available, and honestly, I'm a little relieved it's an option, but...what would I tell people?

Me: I can see this is concerning you. What makes you hesitant?

Sarah: It feels like admitting defeat, you know? Like I'm not strong enough to do this on my own. Everyone will think I'm taking the easy way out.

Me: Let me ask you this: If you had high blood pressure, would you consider taking medication "cheating?"

Sarah: Well, no, but that's different...

Me: Is it? Obesity is a chronic medical condition too, just like hypertension. The medications we have now are tools to help manage it, not a shortcut. It's not about taking the "easy" way out; it's about finding the most effective path to a healthier you.

Sarah: I guess. But what if people judge me? My sister always says people just need more willpower to lose weight.

Me: Unfortunately, that's a common misconception. Obesity is far more complex than just willpower. These medications can help regulate hunger and cravings, making it easier to implement the lifestyle changes we've discussed. They're not a magic solution, but a valuable tool in our toolkit. It works alongside lifestyle changes, not in lieu of them. You've been working so hard, and medication can be a powerful tool to support those efforts, not replace them.

Sarah: That's a good way to put it. I just want to feel like I'm not constantly battling my own body.

Me: Exactly. And remember, you're not obligated to share your medical information with anyone. But if you choose to, you could say you're working with a healthcare provider on a comprehensive plan that includes nutrition, exercise, and medical management. Your health journey is personal, and you should be proud of taking proactive steps to improve it.

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It's amazing how often this sentiment comes up. Weight stigma is pervasive in our society, along with misconceptions about obesity treatment and a fear of judgment that often prevents patients from seeking or accepting effective medical interventions. This is why it's crucial to reframe the conversation around obesity as a medical condition deserving of compassionate, evidence-based care.

Like many in our society, I, too, once believed the simplistic notion that eating less and moving more was the golden recipe to conquer obesity. However, years of clinical practice have painted a 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 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 physiology.

Amidst the bitter pill of stigma, there emerged a beacon of hope -- new anti-obesity medications. These GLP-1 medications have been game-changers in counteracting the hunger, cravings, and the incessant food "noise" that plagues those striving for weight loss. And studies have showcased their benefit in reducing the risk of cardiovascular events such as heart attacks and strokes. Yet, some patients remain hesitant.

Providers, too, are often accused of simply being "puppets" for big pharma. But our allegiance is to our patients.

Moreover, the disdain towards weight loss medications, labeling them as a "cop-out" or "quick fix," reflects society's deeply ingrained biases. Patients on blood pressure or cholesterol medications aren't criticized, despite lifestyle factors being significant contributors to these chronic conditions. Why then, do we stigmatize anti-obesity medications?

Another barrier to patient uptake is fearmongering about the side effects of anti-obesity medications. While side effects warrant monitoring, addressing them is part of our duty as medical professionals. Moreover, many patients tolerate these medications well.

Part of our role is also to help our patients understand the importance of these medications for their health when diets and behavioral interventions alone aren't enough. It's not just about weight -- it's about achieving health. This sentiment can help them overcome the stigma they face. I have witnessed patients who once were shackled by their weight vastly improve their health metrics and vitality. The medications have enabled them to make healthier food choices and increase their physical activity as part of their new lifestyle.

Of course, the journey is far from over – GLP-1 medications are not the end all. Our food environment is a minefield of unhealthy temptations, oversized portions, and ultra-processed foods. Additionally, psychosocial factors such as stress, depression, and lack of sleep compound the problem. Socioeconomic constraints limit access to nutritious foods and promote a sedentary lifestyle.

The rate of obesity in the U.S. has been trending upwards for decades. While medications provide a potential tool, their high cost, combined with inadequate insurance coverage, remains a significant barrier. 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 to play a part in their journey. 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.

*Patient's name has been changed.

is a physician assistant and the clinical supervisor at Transition Medical Weight Loss in Salem, New Hampshire.

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