Is it possible to maintain a healthy weight using GLP-1 medications, and what are the real trade-offs involved? For many, the journey to a healthier weight is a complex one, and new tools like GLP-1 drugs are entering the conversation. Take Christie Woodard, for instance. After undergoing bariatric surgery to address obesity, she found herself at a healthy weight of 125 pounds at 5 foot, 5 inches. To maintain this, she relies on a low-dose GLP-1 medication. "People question why I'm on the drug," she shares, "because they look at me and think I'm at a healthy weight, or maybe even thin."
What these observers don't see is Woodard's significant past struggle with obesity, which began in her 30s and led her to reach 260 pounds. Even with her passion for running half-marathons, her weight made it a painful endeavor, leading to constant physical therapy and even a torn meniscus. Now 53, Woodard had gastric bypass surgery four years ago, successfully halving her weight and inspiring her to set a goal of running half-marathons in all 50 states.
Her weight remained stable until recently, when it began to creep back up despite a rigorous diet and exercise regimen. "I feel it in my knees, and mainly I feel it in my soul," she explains. "I feel it in my confidence. It's messing with my head in a big way. I was terrified that I was going to go back to what I was."
This led her bariatric surgeon, Dr. Betsy Dovec, to prescribe a low dose of Zepbound, even though Woodard's Body Mass Index (BMI) no longer classified her as overweight. Dr. Dovec notes that Woodard isn't alone; she prescribes GLP-1s to a variety of patients, though she emphasizes she does not prescribe them for purely cosmetic reasons, such as shedding a few pounds before an event.
GLP-1 drugs are primarily intended for metabolic diseases like diabetes and obesity. However, their increasing availability has led some individuals without excess weight to seek them out for general slimming. With decreasing costs, pill forms, and numerous online sources offering both the drugs and compounded versions, obtaining a prescription for non-medically indicated uses has become easier. And this is the part most people miss... This accessibility for those without a clear medical need is a significant point of contention.
But here's where it gets controversial... Dr. Dovec argues that labeling the use of these medications for individuals with normal or mildly excess weight as purely "cosmetic" overlooks the multifaceted realities of patient health. She highlights that these drugs address more than just weight, impacting metabolic diseases like diabetes and high blood pressure. Some physicians even prescribe them off-label to help manage alcohol use disorder, with apparent success for some individuals. Furthermore, she posits that obesity is a chronic disease, and for patients like Woodard, a combination of strategies—including surgery, diet, exercise, and GLP-1s—may be necessary for long-term management. She stresses that these are not intended as a quick fix to start a diet and has not encountered patients using them for such purposes or to the extent that their BMI drops below normal.
However, Dr. Jennifer Manne-Goehler, an obesity specialist and consultant for the World Health Organization, expresses concern that individuals might use these medications to achieve an unrealistic thin ideal. This, she warns, comes with significant risks. Notably, users tend to lose muscle mass first, and then regain fat when they discontinue the medication. Periodic use, therefore, creates potential for yo-yo dieting effects known to be harmful to the body. Dr. Manne-Goehler states, "I think the problem with giving this medication to people who really don't have an indication for it is they assume all the risks of it, plus the risk of weight regain, which may be adverse for their health."
Furthermore, there are particular risks for individuals with disordered eating patterns when using GLP-1s, especially since patients are not routinely screened for these conditions before prescription.
Christie Woodard is no stranger to the judgment surrounding weight and its management. Initially, she felt a sense of shame in admitting her need for GLP-1s, especially after already undergoing bariatric surgery. "I didn't tell anybody at first. I felt like I'd failed," she confesses. However, she came to realize that surgery alone didn't eradicate the disease of obesity, which, in her case, also involves hormonal factors that make maintaining a healthier weight a constant challenge. "We don't judge people for being on statins for cholesterol," she wisely points out. "Why should GLP-1s be different?"
Woodard, who heads human resources for a major company, leveraged her new perspective to successfully advocate for GLP-1 coverage within her employer's health insurance plan—a rarity. She presented her own case, explaining that by taking these medications, she now requires fewer doctor's appointments, less physical therapy, and fewer medications to manage various obesity-related health issues. "The company I work for no longer pays any of that," she notes.
Moreover, Woodard shares that feeling in control of her weight has significantly boosted her happiness and effectiveness in all aspects of her life. "I can wear what I want and the confidence is there," she says. "That shows up in everything I do, whether I am negotiating rates with our health insurance company or whether I am talking to an employee about a delicate situation or whether I'm negotiating something with my boss."
To date, Woodard has triumphantly completed 34 half-marathons in as many states, and she's confident she'll achieve her goal of 50.
What are your thoughts on using GLP-1 medications for weight management, especially when individuals are already at a healthy weight? Do you believe the benefits for metabolic health and overall well-being outweigh the potential risks and the controversy surrounding their use? Share your perspective in the comments below!
