New obesity drugs come with a side effect of shaming
Eileen Isotalo was always able to lose weight, but always put it back on. Now 66, her first diet was with Weight Watchers at age 14. She went on one diet after another and bought so many weight loss books that she thinks she has more than the public library.
In desperation, she eventually went to a weight management clinic at the University of Michigan. She had sleep apnea and sore knees, but couldn’t control her appetite.
“It’s just this urge to eat,” says Ms. Isoltalo, a retired interior design coordinator. “It’s almost like this panic feeling when you start craving food.”
“My mental shame was deep,” she said.
But since she started taking Wegovy, one of a new class of anti-obesity drugs her doctor prescribed at the clinic, that craving has disappeared. She’s lost 100 pounds and has ditched the dark clothes she wore to hide her body. Her obesity-related medical issues have disappeared, along with much of the stigma that caused her to withdraw from family and friends.
But like others at the clinic, she still struggles with the fear that others will judge her for taking injections to treat her obesity instead of finding the willpower to lose weight and keep it off.
But the drug, she said, “changed my life.”
Wegovy and similar drugs make this “a very exciting time in the field,” said Dr. Susan Yanovski, co-director of the obesity research office at the National Institute of Diabetes and Digestive and Kidney Diseases.
About 100 million Americans, or 42 percent of the adult population, are obese, according to the Centers for Disease Control and Prevention. For the first time, obese people, who have been in a lifetime of medical danger, can escape the relentless trap of fruitless dieting and reduce their obesity-related health problems along with the weight loss.
But there is still the blemish.
“There’s a moral component to it,” said Dr. Yanovski. “People really believe that obese people just need to summon their willpower and they think taking a drug is the easy way out.”
Unlike other chronic diseases, obesity is in full public view, said Dr. Yankovsky. “Nobody looks at you and knows you have high cholesterol or high blood pressure,” she said.
Obesity, she added, “is one of the most stigmatized conditions out there. “
Wegovy and a similar but less effective drug, Saxenda, are the only drugs in their class approved to date for the treatment of obesity — others such as Ozempic and Mounjaro are diabetes drugs, but also boost weight loss.
Novo Nordisk, the maker of Wegovy, reports that doctors in the United States have written about it 110,000 recipes for the drug. Citing huge demand, the company recently put its advertising for Wegovy on hold.
“We can’t earn enough,” said Ambre James-Brown, a spokeswoman for Novo Nordisk. Stocks are so limited that the company only sells the drug in the United States, Norway and Denmark, the company’s headquarters. Its high list price of $13,492 per month makes it out of reach for most whose insurance won’t cover it. But more and more insurers are doing that.
The drugs come at a time when researchers have documented the risks of obesity and the futility of prescribing only diet and exercise as treatment. Decades of studies have consistently shown that very few people can lose excess weight and keep it off by making lifestyle changes alone.
Obese people are at risk for a variety of serious medical conditions, including diabetes, hypertension, high cholesterol, sleep apnea and non-alcoholic fatty liver disease, a leading reason for liver transplants in the United States.
Losing weight can make some of these complications go away.
Still, the belief remains — fueled by diet gurus, influencers, and an industry that sells supplements and diet plans — that if people actually tried, they could lose pounds.
So those who use a drug like Wegovy often find themselves in uncomfortable situations influenced by the common perception that obesity is a lifestyle choice.
At the University of Michigan clinic, there are people like Ms. Isotalo whose reluctance to admit she takes Wegovy stems from her belief that people who take it are often viewed as cheating.
But another patient, Katarra Ewing of Detroit, readily tells anyone who asks that she takes the drug. She tried dieting, but it was Wegovy who enabled her to lose 90 pounds.
She came to the weight management clinic after her night shift at a Ford factory, exuberant and lively, wearing a bright green sweater. She has more energy now that she has lost weight, her mood is better, her high blood pressure is gone.
But she discovered an unintended social consequence of weight loss, as many old friends fell away.
“Only my real friends are left and that’s a very small number,” said Ms. Ewing.
Obesity medicine specialists say they’re not surprised — they’re seeing the same thing after people lose weight with bariatric surgery.
Relationships shift because obesity is such a defining condition. Normal weight people can feel superior to an obese friend and that helps define a relationship – until the friend loses weight. Other friends who are themselves obese may use the condition as a bonding factor in the relationship. Now that’s gone.
Another problem is the drug’s reputation as a vanity medication, which has been bolstered by the punchline of comedians at the Oscars and in other high-profile settings.
But when Samuel Simpson came to the weight management clinic, he considered losing weight a matter of life or death.
Mr. Simpson was terrified that he would suffer the fate of his mother, brother and sister, all of whom had obesity and diabetes. They all developed kidney failure from which they eventually died, and they all died at age 59.
His first appointment with Dr. Amy Rothberg was in the clinic almost two years ago when he was 58. He was obese and diabetic. Although he took high doses of insulin to lower his blood sugar, his kidneys began to fail.
“I was so scared,” he said. “Will I have dialysis like everyone else? I would be history.”
He started with a diet and then Dr. Rothberg added Mounjaro, a drug from Eli Lilly that appears to be even more potent than Wegovy in inducing weight loss, but has so far only been approved for people with diabetes.
Now he’s lost 44 pounds, 20 percent of his original weight, and his diabetes is in remission. The weight loss, he said, “changed my life.”
He will tell those who ask how he lost the weight,
“I’m not like the roadside preacher, but if someone asks me how I did this, I’ll tell them,” he said.
Art Regner had another problem. He was a garrulous color commentator for the Detroit Red Wings hockey team and said he was not ready to resort to drugs. But when he got to Dr. Rothberg came, he was disappointed. He had regained 22 of the 76 pounds he lost dieting.
Dr. Rothberg, who is also the medical director of Rewind, a company that counsels diabetes patients, suggested Wegovy or Mounjaro. But Mr. Regner thought he should have enough willpower to go it alone. He knows that his blood sugar is high and is aware of the consequences of diabetes.
Dr. Rothberg kindly explained to him that it wasn’t his fault that he gained weight every time he lost something.
“I think biology is conspiring against you,” she said. “I don’t think it’s a matter of willpower.”
Mr. Regner was unaffected. “I believe in myself,” he said. “I wake up in the morning and look in the mirror and say, ‘Are you going to do it or not?'”