In the summer of 2022, I decided to try taking Ozempic to lose weight.
At the time, I was an early adopter. The media frenzy about GLP1 agonists hadn’t yet started. Even my own doctor was surprised at my request.
“I haven’t really prescribed them for weight loss much,” she told me. “Have you tried Noom? Or meals from HelloFresh?”
But I’m a primary care doctor, and I’d been following the scientific literature that showed GLP1 agonists could now be used specifically for weight loss. I wanted to try them.
In the end, I was also an early quitter: I stopped taking the drug within months of starting it. Ozempic made me nauseated, gave me heartburn, disrupted my sleep. It wasn’t worth it.
I was not alone, it turns out, in finding it difficult to stick with the Ozempic. New research shows the vast majority of people who try GLP-1 agonists for weight loss end up stopping them.
And while many people benefit from these medications, I think doctors can learn from the fact that so many people give up on them, too.
When I started thinking about giving Ozempic a try, I had given birth the year before. Like most women, I had gained weight in pregnancy. Also like most women, I thought I had to lose it all to “get healthy” again.
My doctor’s initial advice wasn’t terrible – eating vegetables and regular exercise are indeed good for you — but I had heard it before. I had doled out the same recommendations to my own patients a million times, without much success.
In the end, my doctor prescribed the Ozempic. When I gave myself my first injection, I was optimistic it would help me feel healthier.
Since then, I’ve started writing publicly about being a size-inclusive physician who doesn’t push my patients to lose weight. But at the time, I hadn’t yet fully embraced a weight-neutral approach to caring for my patients — and caring for myself. After all, I had spent years of medical training absorbing the message that the only way to be healthy was to get down to a body mass index of 25 or below.
But my experience with Ozempic made me realize I had confused two distinct issues: Being healthy is not always the same thing as being thin.
When I tried Ozempic, I had been struggling to get back into exercise after childbirth. With a baby at home disrupting my sleep, I felt sluggish all the time. I thought the medication might help me get more energized.
Instead, I started feeling almost immediately terrible. The heartburn was the first side effect I noticed, then the nausea. At a friend’s wedding that summer, I toasted the couple with a glass of champagne, then spent the entire reception vomiting in a bathroom stall. I felt too sick to exercise. It was hard to sleep because of the abdominal pain.
I felt, in a word, unhealthy.
I wasn’t exactly systematic when I stopped taking it. I definitely didn’t talk to my doctor about it. (Classic doctor behavior – we’re the worst patients.) I just made excuses about skipping a week, and then another.
And I’m not the only one.
My experience was not unique, new research shows. The majority of people who start GLP1 agonists end up stopping them, according to research published earlier this year in JAMA. The study authors found that nearly 65% of study subjects who were taking the medications explicitly for weight loss, rather than diabetes control, ended up going off them within a year.
It wasn’t clear why individual patients stopped the drugs, but researchers found some common reasons. Patients who experienced significant side effects were more likely to quit the medications.
Patients with lower income levels were also more likely to quit, presumably because they couldn’t afford them. (A growing number of insurers are no longer covering the medications, because they’re so expensive, which shifts the costs directly on to patients.)
People who lost a significant amount of weight were another group who quit at a higher rate.
Or maybe, like me, some of those quitters felt healthier when they weren’t taking the drugs.
When I stopped the Ozempic, I slowly found myself feeling better. I started exercising again, taking my son in the jogging stroller and hiking with my family on the weekends. My sleep was less disrupted by an upset stomach. I allowed myself to enjoy food.
I didn’t lose weight, but my blood pressure and glucose levels remained normal. I felt more vibrant and alive. My mental health was better. Was it possible that I could be healthy without a BMI of 25?
Lots of my fellow doctors don’t think so. “Greater efforts are needed to increase access and adherence,” the JAMA researchers wrote in their article about GLP-1 discontinuation rates, the assumption being that the goal of doctors everywhere should be to get patients to take the medications — and stick to them.
I’m not anti-Ozempic; far from it. I prescribe GLP-1s for many of my patients, and lots of them show improvement on metrics like blood glucose, hypertension, and kidney function. Many of my patients say the drugs help them lead much healthier lives.
But a narrow focus on weight — which, so often, our medical training still teaches — misses the point that there’s more to being well than a number on the scale. For me, I felt healthier at a higher weight because stopping Ozempic helped me exercise regularly, sleep better, and feel less pain.
Some of my patients tell me similar stories. One woman told me that having a peaceful relationship with food is more important to her than a few pounds of weight loss. Another patient told me that “being skinny isn’t worth feeling sick every day.”
I worry that in the age of Ozempic, we doctors have returned to a myopic obsession with weight as the definition of health. Instead of focusing on objective measures like kidney function or liver inflammation, doctors instead hone in on BMI, a metric that the American Medical Association has denounced as not rigorous enough to evaluate an individual patient’s health.
Just look at the hand-wringing in another recent paper that showed high rates of people quitting GLP1s: “Discontinuation could have policy and medication coverage implications, especially if the weight reduction is not sustained after medications are discontinued,” the authors wrote.
This comes even as major medical organizations are putting less and less emphasis on BMI and as new research emerges that shows cardiovascular fitness may be more important than body weight as a predictor of disease.
As I try to help my patients navigate decisions about these medications, I keep returning to the core value of bodily autonomy. Health is multidimensional and deeply personal. My patients decide what it means to be well — with or without a GLP-1 drug.
Mara Gordon is a family physician in Camden, N.J., and a contributor to NPR. She writes the Substack newsletter “Chief Complaint.”