In early 2021, feeling deflated about my menopausal weight gain that was seemingly impervious to both diet and exercise, I talked to my primary care doctor about it, and she immediately recommended Ozempic for off-label use, off-label because it’s for type 2 diabetes which I don’t have, at least not yet, but I’m working on it. She had used it herself to lose weight. I was just freaking out over having a BMI that was over 25 for the first time in my life, and not being able to work my way out of it. Unfortunately, after the free one-month trial, my insurance would not cover it, so I only got to take it for the one month. I lost 13 pounds, which was pretty damn good, and even when I quit taking it, the weight did not return.
Can Ozempic cure obesity, without the slog of diet and exercise, and without the difficulty of legislating food in this wealthy country of ours so that we aren’t ingesting so much corn starch and corn syrup?
There’s a bit of a moral panic right now about the Ozempic trend. First, let me explain what it is and how it works. Ozempic (semaglutide) is a medication used to treat type 2 diabetes. It belongs to a class of drugs called glucagon-like peptide-1 (GLP-1) receptor agonists, which work by mimicking the action of the natural hormone GLP-1 in the body.
GLP-1 is produced by the intestine in response to food intake, and it helps to regulate blood sugar levels by increasing insulin secretion and reducing the production of glucose by the liver. GLP-1 also slows down the rate at which food leaves the stomach, which can help to reduce appetite and promote weight loss.
Ozempic works in a similar way to GLP-1 by stimulating the insulin-secreting cells in the pancreas to release more insulin in response to rising blood sugar levels. It also reduces the amount of glucose produced by the liver and slows down the rate at which food leaves the stomach.
Ozempic is administered once a week by subcutaneous injection (subcutaneous shots are no big deal–kind of like a bug bite), and it has been shown to be effective in improving blood sugar control, reducing the risk of cardiovascular events, and promoting weight loss in people with type 2 diabetes. It is usually prescribed as part of a comprehensive diabetes management plan that includes a healthy diet, regular exercise, and other medications as needed.
I’ve heard some stories that some people who take it get very sick, experiencing nausea, vomiting or diarrhea. I did not have these symptoms. What was weird was that sweets and “junk food” didn’t look better to me when I was taking it. Healthy foods just looked better, so that’s what I ate. I also couldn’t finish a meal. I would stop about halfway through and push my plate toward my husband to see if he wanted the rest. I didn’t feel like snacking. I just wasn’t hungry.
If not covered by insurance, the monthly cost of Ozempic is usually around $880 in the US (that’s the cost I was quoted). There is now a generic version called Wegovy which has a slightly higher dosage of semaglutide and is specifically designed for weight loss rather than Type 2 diabetes. The monthly cost in Mexico for these products runs closer to $150, and it does not require a prescription. It can also be purchased from Canadian suppliers and shipped to your house for a lower rate, but a prescription is required. Because of its off-label use for weight loss, there have been shortages of Ozempic for those using it to treat diabetes, particularly in Mexican border towns and tourist destinations.
So what’s the controversy? There are several ethical angles to consider:
- Moral panic over the idea that we can lose weight and keep it off through medication rather than diet and exercise.
- The accompanying moral panic that we are continuing to fill ourselves with unhealthy food rather than changing and regulating the food industries in the US.
- That the medication costs so much in the US vs. Mexico points to issues surrounding Big Pharma in the US, including the complicity of many of our politicians in keeping the cost of medications high to enrich their donors.
- That the medication doesn’t require a prescription in Mexico, and there have also been reports of “counterfeit” product being sold in Mexican pharmacies under the manufacturer’s label; the manufacturer has replaced these fakes with actual product when notified, but that doesn’t mean some unwitting vain tourist isn’t injecting something that is not Ozempic!
- Whether it’s ethical to take a medication like this for off-label use, particularly narcissistic celebrities buying up the entire Tijuiana market, when there is a shortage.
Here’s my take on these issues. First, while I agree that the food we are buying and eating in the US is often terrible for us, so far nobody’s making any improvements on that, and we have a lot of people in this country who are either obese or overweight who can’t seem to keep the weight off for a variety of reasons. The deck is stacked against us in our wealthy country, and we’d be healthier at a lower weight, so why not use Ozempic to achieve better health and to avoid (not just treat!) Type 2 Diabetes!
Next, I’m not sure how to solve the political problem that is Big Pharma. Big donors across various industries are a huge problem and are ruining lives. I’d love to see us not live in a country where donors (small or large) are a factor in politics (e.g. in Germany, candidates are given an equal fund for their campaigns so you aren’t buying support or being bought either), but that’s the system we have. Nobody is motivated to change it. It’s utterly ridiculous that this is where we are.
Mexican medicine intrigues and scares me. Living in a border state as I do, I’m aware of many people who go to Mexico for medical or dental procedures (a lot of small business owners do this) to avoid having to pay for health insurance. And it’s true that Mexico doesn’t have the regulatory control that we have in the US and Canada, but given the cost difference, it might be worth the risk. From my time living in Asia, I also saw (and benefitted from) these types of differences. My son’s eczema creme was $110 in the US. The identical creme in Singapore cost $60 a tube. When we were hiking in Nepal, I stopped in a pharmacy, and the exact same creme was 60 CENTS a tube. So, AITA because I literally bought every tube on the shelf? Maybe.
As to the issue of Ozempic shortages, that feels like another Big Pharma problem, not a consumer problem. Make more of it. Make more Wegovy. It’s all supply and demand. But yes, it’s a shame that all “miracle” drugs end up going to the rich first. I still haven’t figured out how to solve capitalism.
What’s your take?
- Do you believe that taking a medication as a means to lose weight is bad because you should have to lose & maintain weight through diet & exercise only, so shortcuts are morally wrong?
- What do you think about Big Pharma’s influence on this and other medications?
- How do you feel about medical tourism morally? Are rich people robbing from the poor? Or is this just a free market thing, and they can get more product from the manufacturers?
- Have you tried Ozempic? Would you?
Discuss.
Wheat & Tares 
First of all, the recent kidnapping and murder of Americans crossing the Mexican border for
a cosmetic procedure certainly highlights the dangers involved. Fear is a great motivator, and sometimes safeguard.
Beyond that whole issue, though, why must we so often revert to moral judgments when so many other factors may be involved? Oh, I know, because we’ve been taught/indoctrinated from an early age that an institution ‘s concept of morality trumps everything else, including a healthy self-image.
I’m intrigued. My BMI is currently 27.8, down from 29.7 before Christmas by Weight Watchers and increased exercise. I thought BMI had to be above 30 for Ozempic, and I’m jealous that I’m not heavy enough for medical intervention.
I should be able to maintain my mental health through diet, exercise, and positive lifestyle choices. I’m on generic Lexapro and it helps. I did manage to decrease my dosage last year and I’m very proud of that. I do still feel guilty that my bootstraps aren’t strong enough, and my therapist and I discuss that regularly. Interestingly, I feel no guilt that I wear glasses instead of learning to squint better.
As I researcher in a non-medical field, I know research is expensive and a gamble. But the government pays for my research, while (hopefully) everyone can benefit from the resulting advances. If the government won’t fund pharmaceutical research to match the level of demand, then it makes sense that Big Pharma wants profits in return for their risk. To me, the solution to Big Pharma would be government-funded research.
I’m too risk-adverse for medical tourism, but I think it could be done well. The problems are when corners are cut.
My experience briefly working for big pharma is that they are genuinely interested in two things: 1) improving lives 2) making big money. The people I worked with legit believed in helping people, but 1 and 2 are not (always??) mutually exclusive, and one will tend to take precedence. Agree that the economics of pharma in the US is messed up but I don’t have an answer.
I tend to think that if pharmaceuticals can help people, let’s do it. There’s a spectrum of critical-to-optional medications. A low-risk weight loss drug will certainly help millions of people but there’s also opportunity for inappropriate use, as with many medications. I know a person who takes Adderall solely to try to improve cognitive function and we all know people (prolly some of us, no judgement) who take alcohol to relax at night even if it’s unhealthy. The answer may be one that people don’t love – regulation. That won’t entirely fix the problem, especially in other countries, and is some ways may exacerbate it, but there it is. Part of the solution will be to help people understand that beauty comes in many shapes and sizes. *That* is a difficult problem to solve.
The specter of Americans becoming ravenous, consequence-free gluttons – a la residents of the Capital in Hunger Games – does worry me. There will always be people who try to short cut but Karma will sometimes unfortunately wiggle its way into their lives. I have recurring visual migraines which really suck, and I live near Mexico. I once bought a potent headache medication there and it worked 10 times better than the myriad medications I had already tried through my primary care provider. When I showed the pill to my American doctor he told me “don’t ever take that again – it’s addictive.” I guess it had a dose of codeine along with the Imitrex. Caveat Emptor.
Weight gain is caused by hormonal problems. Your weight gain after menopause illustrates that. So does mine. I gained 10 pounds in one month without changing my exercise or eating in any way the month after I went through menopause.
My son was overweight, 250 pounds at 6’1″ at age 17. He had been depressed and sleeping all day since he was 14. Antidepressants didn’t help. He didn’t exercise at all and ate mostly processed carbohydrates. The pediatrician told him to exercise and eat right over and over. He couldn’t change.
Eventually overtime we uncovered a bunch of medical problems affecting his hormones. He had severe sleep apnea, type 2 diabetes, hypothyroidism, hypogonadism and an autoimmune condition similar to lupus, MCTD. He had surgeries which corrected the sleep apnea, and now takes medication and hormones to correct each problem. The type 2 diabetes disappeared, and he has lost weight down to 180 pounds.
The kicker? He still doesn’t exercise at all and he still overeats processed carbohydrates. Hmmm…. So eating and exercise control weight. I don’t buy it.
Sure, for many people (including me) better exercise and eating can help them with weight, but mostly exercise and eating support good general health. God general health supports good exercise and eating as well. It’s circular in some ways.
It’s so hard to lose weight in certain situations and there’s so much pressure to lose weight for many reasons, there’s no reason people shouldn’t try a medical intervention if they have a serious situation.
Heavy people deal with a lot of prejudice and judgement from others. It’s wrong. We really don’t know why someone is heavy. We don’t.
“Do you believe that taking a medication as a means to lose weight is bad because you should have to lose & maintain weight through diet & exercise only, so shortcuts are morally wrong?”
Nope. I don’t. Why does everything have to be hard? Why can’t some things be easy? Statements like this infuriate me. Daily exercise time is really hard for most of us because we have jobs and kid duties and church duties. Not all of us can sit at the gym all day creating content and being online fitness coaches. I similarly hate the way we market food. Clean eating is expensive and those that promote it are (intentionally or not) shaming those without means. I hate it.
To quote Elle Woods “Exercise gives you endorphins. Endorphins make you happy. Happy people just don’t shoot their husbands, they just don’t.” I exercise for this reason. Lose weight by whatever means necessary.
I have been on Ozempic and lost about 40 lbs. Studies show the weight does return if you stop Ozempic unless you otherwise change your eating and exercise pattern.
Speaking as a (former) Registered dietitian, I do believe there can be a genetic component to health and disease.
Generally I’m not in favor of off-label use of medicine—particularly if it is causing shortages for people with the particular medical condition that medicine treats. (I object to people using Ozempic for vanity sake—ie taking off a few pounds so one can look like a model).
On the other hand, if one is overweight, they are at higher risk of developing diabetes and other health issues.
Diet is a more effective tool to losing weight than exercise. However, exercise is most useful in maintaining that weight loss. (The more muscle mass one has, the higher one’s metabolism rate can be—which is why males burn more calories than females).
Foods higher in protein and foods higher in fiber make you feel fuller, more satisfied than refined carbohydrates. (Fat has twice the number of calories as protein or carbohydrates).
A few ideas:
Don’t bring food into the house that sabotages your self control.
Better to go out for ice cream once/ wk than buy a carton and have it every night.
Better to buy single serving sizes—so that at least when one is indulging in a treat one can be aware of what a serving size is.
It can be hard to establish an exercise routine. It can start as setting a goal to take a walk/bike/run/peloton—whatever— everyday or 5 out of 7 days for a month. Then continue that goal month by month. It doesn’t have to be a marathon—
take a walk around the block, with a friend or family member or listening to music you enjoy etc. Shoveling snow, yard work whatever—just spend time moving your body.
Of course eating healthy and exercise is the best way to lose weight when it works. It just flat out doesn’t work most of the time. Or rather, the most common result is yo-yo dieting.
I see absolutely no moral issue with using medicine to lose weight. Especially if combined with healthy eating and exercise. Yay for science!
I feel like we’re missing some info on ozempic though. Why is it off label to use it for weight loss? Is it just because it is new? Most off label use of other drugs that I am aware of is a result of the drug being cheap and available as a generic, so the drug companies don’t have a profit incentive to do the necessary studies. If ozempic is on brand, expensive, and workable for weight loss, drug companies should have no problem doing the research and promoting weight loss as an on-label use. There is a huge market for on label weight loss medication.
Speaking of off label use, it should be rare. In cases where generics are available and drug companies won’t research new uses, I think we should have federally funded research to study effectiveness of drugs for what would otherwise be off-label uses.
Jesus heals one person at a time and we call it a miracle. Jesus inspires modern doctors to invent medicine to help us and heal 1,000 and we won’t take it because its immoral.
I was on it for Type 2 diabetes. Yeah I lost weight – I was barfing all the time. More power to you if it works for you.
I don’t think “shortcuts” are morally wrong but I equating health with weight is morally wrong. Here are some resources for people interested in focusing on health outside of diet culture and fat phobia- the podcasts Food Psych and Maintenance Phase, books like Intuitive Eating, Anti- Diet, and Health at Every Size.
Why has the price of insulin (developed 100 yrs ago) increased so much? Three companies sell it—they just keep raising the prices with each other.
Btw
If one wants to know about possible side effects and how a particular medicine works, a helpful and reliable website to look up prescriptions etc is:
medlineplus.gov
(Btw. I’m not here to criticize people who’ve benefitted from Ozempic).
My original submission either got rejected by moderators or missed, so I’ll revise and try again.
My experience briefly working for big pharma is that they are genuinely interested in two things: 1) improving lives 2) making big money. The people I worked with legit believed in helping people, but 1 and 2 are not (always??) mutually exclusive, and one will tend to take precedence. Agree that the economics of pharma in the US is messed up but I don’t have an answer.
I tend to think that if pharmaceuticals can help people, means let’s do it. A low-risk weight loss drug will certainly help millions of people but there’s also opportunity for inappropriate use, as with many medications. The answer may be one that people don’t love – regulation. That won’t entirely fix the problem, especially in other countries, and is some ways may exacerbate it, but may help here at least. Part of the solution will be to help people understand that beauty comes in many shapes and sizes. That is perhaps the more difficult problem to solve.
I do worry about that potential for misuse. There will always be people who try to short cut or abuse and I think Karma will sometimes unfortunately wiggle its way into their lives. I have recurring visual migraines which really suck. I once bought a potent headache medication in Mexico and it worked 10 times better than the myriad medications I had already tried through my primary care provider. When I showed the pill to my doctor he told me “don’t ever take that again – it’s addictive.” I guess it had a dose of codeine along with the Imitrex. Caveat Emptor.
“How do you feel about medical tourism morally? ”
I’m for it 100%. For so many reasons. First, medical tourism often involves a patient seeing a highly skilled doctor in a poorer country. Perfect. That country needs those higher skilled doctors to stay there to help the local population, not just through direct treatment but through indirect influence on the medical community there. Medical tourism gives those doctors more reasons to stay there. Second, let’s give incentive for the extremely overpriced medical system in the US to change by patients not consuming it and instead patronizing poorer countries’ much cheaper services. There needs to a healthcare system revolution in the US, and Obamacare fell far short from delivering such a revolution. Third, medical tourism is a way for money to come from wealthy countries to poorer countries. It helps their economies. Fourth, the patients themselves while from wealthy countries are often not wealthy themselves. Medical tourism helps middle and lower middle classes in the US.
On Big Pharma, let’s go Teddy Roosevelt on these guys. Bust some trusts.
Late last fall, I dragged my perimenopausal self in for my annual physical, dreading everything that was coming. I have struggled with pre-diabetes for about 3 years after working really hard to keep it at bay after gestational diabetes X 3 pregnancies starting 16 years ago. But my odds of out-“running” that were low to begin with. Sure enough, my A1C had crossed into diabetic territory despite maxing out on metformin. My provider began the talk we’ve had every 6 months about diet and exercise and I just stopped her. I explained that strategy doesn’t work with my life right now. I can give diet and exercise their due in 10 years or so, when both my parents are dead and all my kids need is money. I have teens and a tween whose problems are harder and bigger than when they were toddlers. Both my parents are losing their minds, and my mom is terminal.
My provider totally got it. She offered up semaglutide (the active ingredient in Ozempic and Wegovy) as a possibility to reverse my metabolic disease. My insurance does not cover it because I am not insulin-dependent, nor do I ever want to be. I get the drug from a compounding pharmacy near my house for about $50 a month. It doesn’t have the proprietary ingredients that Ozempic or Wegovy have, but it’s 80% of the effectiveness for 5% of the cost. I have reliably lost about 1 pound per week. But the effect on my blood sugar has been miraculous. It’s really, really good at what it does.
Regarding on-label vs. off-label use, semaglutide is approved by the FDA for weight loss (as Wegovy) in adults and teens, but the high cost means most insurances won’t pay. Ozempic is the same drug but has an FDA label for diabetes.
I have a lot of complicated feelings around the “morality” of health. Good health is absolutely a privilege, and not everyone is positioned to have it (due to genetics or socioeconomic factors). The individuals I know who have cured or halted metabolic disease have not done so by eating healthy and going for a walk after dinner. It requires significant dietary restrictions (keto, intermittent fasting, etc.) and/or hours of exercise every day. Which begs the question of morality. When one has to decide between exercising 2-3 hours per day, giving my mom a shower, and driving Kid #3 to therapy (choose 1), is exercise even on the table? What about cooking two dinners, one keto for me and one for the other family members, or helping my dad pay the bills, or helping Kid 1 prep for career day (again, choose 1)? I work full time to provide food and health insurance for my family and modest college funds for my kids. I make choices every day that result in me being a crap daughter, or a crap mother, or just fat.
I have to chuckle at the advice to not buy unhealthy foods. Bless those sweet, sweet hearts. My self-control is rock solid (thank you, Mormon church). I use measuring cups and food scales—I don’t need to go to yet another dietician to see plastic food representing appropriate serving sizes. At my request, my provider also prescribed me a continuous glucose monitor (again, not paid for by insurance), and it has absolutely blown my mind. I can have a bowl of sugar-sweetened yogurt and granola and fruit and my sugar will not budge, but the same number of carbs in a bowl of “healthy” cereal with milk will send it sky high. A serving of potatoes is fine for me. A serving of rice is not. All supposedly “fast” carbs, all carefully measured, totally different result. We think we know, but we don’t know anything on an individual level. What I do know is that when I’m taking semaglutide, I’m not thinking about food. I’m not craving anything. I’m not watching the clock counting down to when I can eat again. I can use that headspace now for one of the other hundred things I need to do today. Or, you know, comment on W&T.
I have no objection to Ozempic or other medical weight loss strategies, provided they are sought under the care of competent providers, and not a solution of first resort. And if used, should also be in conjunction with diet and exercise, not a substitute for it, though individual needs and circumstances vary. I exercise and generally try to eat healthy, but now that I’m in my 40s I find it more difficult to maintain a healthy weight now than it was in my 20s and 30s. I may be in need of such meds eventually. And I’m not looking for a shredded physique, but just trying to get ahead of the diabetes and heart disease that runs in my family.
I also don’t object to medical tourism for reasons mentioned above by John W; it’s another way for patients to “vote with their feet” when the American healthcare system falls short. Interestingly, we in the U.S. are in a new era of “medical tourism” without even leaving the country–in which certain essential medical care is freely available in some states but illegal in others. That’s how screwed up our system is.
Re: medical tourism
I think I need to get more educated on medical tourism in general, but here are some off the cuff comments.
I’m opposed to banning medical tourism where people actually go somewhere to be treated. Is anyone actually pushing for that? It is a person’s own choice where they go and what risks they take. But I have been in hospitals in both Spain and Italy, both of which are first world countries, and I gotta say I would be a thousand times more comfortable with treatment in the States. I’m not going for treatment in any other country unless I absolutely have to. Not for surgery, not for an MRI, nothing.
Prescription drugs are more complicated. Presumably they are the same wherever you buy them, so why not go somewhere else? But they if they find their r&d through the sales in the States then everyone buying them overseas could cause a real problem. And they may be better controlled here. I don’t know. But I’m not going looking for other sources anytime soon; luckily the stuff I need is cheap and readily available.
Many of you may be too young to remember the “revolutionary” weight loss drugs phen-fen from the early 90’s. People were getting on it right and left and losing substantial amounts of weight. Problem was it was eventually shown to cause pulmonary hypertension and heart valve problems. The drug wasn’t actually pulled off the market until 1997. I have a family member who still deals with heart problems to this day. The company ended up with legal damages of over $13 billion. Not knowing how much research has been done into the side effects of this drug for weight loss, I personally would be very wary about taking it for weight loss only for at least a couple more years until more research has been done, although it sounds like some people on here have had good results. If it turns out to be a good, safe alternative long term then I have no problem with people using it.
I also wish our country would work harder at helping us have better food options. We have chemicals and substances in our food here that are outlawed in the EU. I can’t help but wonder how that affects our obesity and especially our health.
I second the books Laura mentioned, Intuitive Eating and Health at Every Size. My last thought was if this drug does turn out to work well, then it’s possible the size of our population could go down dramatically. What will happen to the people who cannot or do not want to take this drug? Will overweight/obese people become even more marginalized and discriminated against?
“…for thy merchants were great men of the earth; for by thy [pharmakeia] were all nations deceived.” The Revelation 18:24
Unless morbidly obese, relying on Big Pharma for quick fix—particularly for weight loss—is a farce. Anyone remember the quick-fix weight loss drug called Phentermine (Phen-fen, Fin-Fin)? How did that go?
How about the truth claims of the Covid Vaccine? We are now learning of long-term health problems associated with the CDC and FDA recommendations…
Every healthy person I know avoids processed foods and Big Pharma. Every unhealthy person I know relies on processed foods and Big Pharma. As for the morality of it—lifestyle, appetite, and habits, shape our mind and body: health is the consequence of moral choices.
“…for thy merchants were great men of the earth; for by thy [pharmakeia] were all nations deceived.” The Revelation 18:24
Unless morbidly obese, relying on Big Pharma for quick fix—particularly for weight loss—is a farce. Anyone remember the quick-fix weight loss drug called Phentermine (Phen-fen, Fin-Fin)? How did that go?
How about the truth claims of the Covid Vaccine? That it was not properly tested, that data was manipulated, that the vaccine is more risky than the virus itself (except in cases with medical preconditions), that the vaccine is more contagious (shedding) than the virus itself. We are now learning of long-term health problems associated with the CDC and FDA recommendations…
Every healthy person I know avoids processed foods and Big Pharma. Every unhealthy person I know relies on processed foods and Big Pharma. As for the morality of it—lifestyle, appetite, and habits, shape our mind and body: health is the consequence of moral choices.
Our food supply in the USA is toxic.
@lois is correct, we need exercise and best diet choices. However, we do not have the best diet choices available in the USA.
Everytime I travel out of the country I loose weight, Just with a better choice of foods and higher quality foods ,not available here.
We should change the allowed standards, then charge these companies with white collar crimes, if not improve, for deceiving the public. The foods we purchase are not what they appear to be. I am not for excessive government oversight typically, but this would be an area for some teeth in changing the available options. If people want to Drink sodas, eat bon bons and daily dairy queen hamburgers, let them.
But for those of us who want a healthier food supply, we can not find it. Even when you spend more money in buying higher quality food, avoiding processed foods, organic fruits, vegetables, etc…..it still has problems with chemicals and other deceitful practices. Much of the food at whole foods, is still not whole. This is even present in the ” healthy” pet foods. Blue Buffalo claims to have the healthiest food, but it still has issues. Ideally growing our own food, would be best, but that is completly unrealistic in 2023.
Why is it that many food preservatives that are banned in Europe, are allowed in the USA?
This is a short list of some examples
https://www.chicagotribune.com/dining/table-talkers/sns-stacker-us-foods-banned-other-countries-20211103-gxobzgtxvnf6pnt26ugjstmxka-photogallery.html
Even our organic fresh fruit/vegetables have chemicals.
If the LDS church wants to take the lead on moral issues, this would be an opportunity. However they are making too much money, including its’ food stocks, for the rainy day, while the public consumes the toxins.
The definition of fresh, organic, healthy are debatable and ever changing…..just like the LDS lexicon of translate, and Mormon.
Something I discovered when hiking long distances (more than a thousand miles in a year) is that all the men lost weight from the 15-20 mile days.
But.
Many women did not lose weight and they tended to eat a third less than a guy hiking the same distance.
I don’t see any moral virtue in being able to lose weight through exercise. Or any moral failing in using other methods.
I do see the issue when off label uses deprive sick people of their medication.
But I also think we spend too much time and effort assigning moral weight to genetics that result in some being fat and some thin.
Middle,
I found your comment stuck in the filter and got it out but what I really wanted is for someone to give you a hug.
I’ve no advice, just sympathy and admiration.
Rockwell, I think that medical tourism is predominantly to private clinics. I lived in Egypt and was impressed with many private medical facilities. I knew an American couple there who had a baby while in Egypt. They raved of the quality of the clinic that helped them deliver the baby. And then there were public facilities. Pretty stark difference.
I am an emergency physician and I see all the problems that arise from medical tourism. Post procedure infections, drains that cannot be removed, complications due to poor technique are just a few examples. These problems show up after the patient has left the country where the procedure was performed. They come to the ER in the USA looking for help but no doctor in the US wants to take on another doctor’s mistake or complication. These patients get lost in a quagmire of doctor hand offs while their infections worsen, drains scar over and their beautiful tummy tucks and butt lifts eventually go back to the operating room for debridement or revision in an attempt to save their life. If you cannot follow up with the doctor that did the procedure, and it is an elective procedure, DO NOT have it done. Not to mention any savings had by getting a procedure in a foreign country will evaporate if you have to deal with a complication in the US.
Middle Radish makes some excellent points about the socioeconomic factors impacting diet and exercise. Thanks for the comment and I’m also glad Stephen pointed out it came out if the comment filter or I wouldn’t have seen it.
I recall when I began cycling to seminary and Sixth form college (17-18) I was hopeful I might lose weight, (not that I was overweight at that age). The exercise gained me 1/2 stone. Muscle presumably. On the other hand I did lose weight my first year at university, in a self catering hall of residence, my room on the 5th floor, and the kitchen on the 3rd floor, no lift… I probably burnt off half the calories running upstairs to the room and 5th floor fridge for things I’d forgotten to bring down. But that didn’t last when I was living in a 5th floor flat for two further years with a longer walk to and from university..for the next two years. I’ve never been sporty.
These days I feel as though I am fighting my genes, it’s as though my body is programmed to try and store something of what I eat. I don’t drive, so walk and cycle for most things during the week. Taking a bus for longer journeys. I am not slim, and at the moment I am reducing carbs to the minimum, because otherwise weight just keeps creeping up. It’s alarming. I hate going to the GP and having them tell me I weigh more than I did the previous year.. it could be worse..
Oddly enough I lost weight the week we were locked down with covid Christmas 2021. Didn’t go anywhere. Just rested, read books and ate.. including all the treats I’d been storing up festivities. Is my problem exercise?!?
I relate so much to Middle Radish’s comment. Until menopause, my BMI had never been over 25 (usually was 21-23), and all my blood panel results have always been so good they got double takes from the doctors. Some of those blood panel results are still top notch, but others (the bad cholesterol and the blood sugar) have gone into sudden decline since menopause with absolutely no change to diet on my part, and with me adding DAILY bike riding for the past 4 years. One doctor, 30-ish very fit guy, suggested I try exercising more and eating healthier, as if I was sitting on my couch consuming a bucket of chicken while watching hot dog eating contests on TV. When I explained that I already bike daily for 45 mins to an hour, his answer was that I should “go longer and increase the intensity.” Just how many hours a day am I supposed to devote to an activity that will not change my weight one iota, especially since half the year here it’s over 100 degrees? Stephen Marsh is totally correct. While my husband can still lose weight by dieting, although it’s getting harder with age, I just plateau. Menopause is nature’s way of signaling to the world that fertility has ended, so seek a mate elsewhere.
Fortunately, my female primary care doctor is not giving me this ridiculous inane pep talk as if I can just fight my way back to a pre-menopausal body. It’s just not happening! But she is the one who prescribed Ozempic, and I honestly felt great for those five weeks. She had done it herself, and said that lots of doctors had used it to lose weight. I’d love to do it one or two more months, with breaks in between to make sure I’m keeping the weight off. My energy was higher, and I felt full from a much smaller caloric intake. I know some feel nauseated with it, but I didn’t have side effects. I’m going to ask about semaglutide at my next appointment. I do remember the phen-phen scare of the 90s (and even the sacharrine scare of the late 70s!). This one feels different, but you never know.
The government response to the recent kidnapping (and murder since 2 died) of the American medical tourists from South Carolina is interesting. We puff out our chests and act tough, but we don’t acknowledge or address the underlying issue: that health care in the US is too damned expensive. I recognize that this particular tourist was seeking an elective procedure, but those are particularly expensive due to insurance (privatization) rather than having healthcare for all. I would be hesitant to have a procedure done in another country (maybe dental), but that’s due to the post-procedure question mentioned above which is a valid concern. I also know some who simply pay cash for all procedures (here in the US), and avoid insurance altogether. I am not a fan of that after my brain surgery experience where they wanted to charge me approximately $100K for a procedure that the poorest person in S. Korea gets for free (in the movie Parasite).
I have two extremely enterprising acquaintances who are very good at identifying trends and capitalizing on them financially. Sure enough, their latest business venture is weight loss…starring Ozempic, combined with aesthetic treatments, and geared toward people who have a high level of disposable income (in a community where being thin, young, and pretty is highly valued). I don’t think using weight-loss medications or having aesthetic treatments is inherently bad. But I do think marketing these things to people by playing on their insecurities and making enormous profits while pretending to care about their health is very, very problematic.
I’m a primary care doctor and whatever direct to consumer advertising ozempic is doing seems incredibly effective because I have patients requesting prescription for it daily. Semaglutide is a great drug for treating both diabetes and obesity. I’m very pleased there is an effective non-surgical treatment for obesity and I hope access improves. I personally would not recommend taking it for people (like Angela) who do not suffer from diabetes or obesity. All drugs have potential risks as well as potential benefits and the studies demonstrating health benefits for people who do not have these diseases have not been done. I imagine they will be done for people who are overweight but not obese given the enormous market. Healthy diet and exercise are necessary for good health but there is a huge amount of data showing they are not very effective at getting diabetes and obesity into remission alone. I don’t like the framing of either diet/exercise interventions or medication. Metabolic diseases have causes that are complex and multifactorial. They have little or nothing to do with moral failures. Given the stigma and judgment obese people get I can understand why movements like HAES happen but I don’t think it’s helpful to deny that obesity is a disease and that all sizes can be “healthy”.
I mean to say obesity is never “healthy”
E: I should clarify that I was in the pre-diabetic range (suddenly) and also creeping toward a 30 BMI (which is technically obese I believe), with the previous year’s weight gain being the most substantial. Part of my thought is that if insurance will only cover it when you have Type 2 diabetes, why not to prevent it? I also can’t take estrogen due to DVT history. I got rid of 13 pounds that stayed off for most of a year (now net ten pounds loss after the holidays.) Rest assured, I still look like a chubby middle aged woman, not a skinny celebrity.
“We puff out our chests and act tough, but we don’t acknowledge or address the underlying issue: that health care in the US is too damned expensive”
Exactly. This post and the comments have alerted me to some of the risks associated with medical tourism. I don’t doubt that these exist. Do risks exist in the US healthcare system, however? Of course. I have heard horror story after horror story. I keep hearing about how the medical systems in other countries are just so bad. I don’t deny that there are bad hospitals, bad doctors, and bad treatment in other countries. But if we look at the overall stats, consider the fact that the US is not ranking no. 1 or even in the top ten for healthcare quality. There are plenty of countries ranking much higher than the US in Europe and Asia. And even in countries that rank lower than the US, there are private clinics and doctors that rank high and do quality work. The life expectancy in the US is lower than much of the developed world.
Bear in mind, there is a lot of bias towards one’s own culture and country when it comes to healthcare. I have friends from Brazil whose son had a mouth deformity that they said doctors in the US could not solve, but that those in Brazil did. I have a Russian sister-in-law who swears by Russian traditional homeopathy. I have Chinese friends who think that the US system is nonsense and far prefer a combination of Chinese traditional medical procedures with a mix of modern medicine. Most of my friends and acquaintances are Hispanic. Many of them prefer Mexico to the US because of cost and because it is a system that they know. And then there are other Hispanics who trust only the US and have sworn off the healthcare of Colombia, Argentina, or the other countries they come from. Anecdotally it all seems like a mixed bad. And statistically I don’t see an overall apocalyptic picture that many in the US sometimes paint of foreign healthcare.
Lastly, it should be noted that many of the doctors that people do end up seeing for medical tourism, at least stories I’ve heard from people going to India, Turkey, and Thailand for treatment, are trained in the US or Europe alongside other doctors of the first world. Their knowledge isn’t that much different from doctors in the US or Western Europe. But they’ve preferred to go back to their home countries because of a range of factors. Sometimes people just like being around the culture of their upbringing. They just feel more comfortable. And I commend these doctors. We need more high-quality professionals to stay in the less-developed world. They are among the ones who will bring those countries to a state of greater development.
I especially appreciate Travis’s comments here, and I encourage him to do even better on the conspiracy theories. Here you go: Covid is actually designed to improve your health, and all the talk of transmission and illness and death has been a liberal conspiracy. If we had only let it run with no attempts to slow it, it could have brought the world to total health by now! Instead, wicked and conspiring people have thrust an unholy vaccine upon us that’s really only a devious way to reduce our brainpower so that we can no longer resist the long arm of the government.
Believe it, Travis! You know you want to!
Angela that makes sense and I’m not criticizing. In fact there is another diabetes drug (metformin) that I have prescribed off label for years for people who are pre diabetic. It slows the progression (or may help prevent) to diabetes. It’s been around decades so there is a well established track record for safety and it is dirt cheap. It also tends to have a weight benefit although nowhere near semaglutide.
I am a Type 2 diabetic. 30 plus years and counting. I take Metformin and Jardiance daily. My A1C remains steady at about 6.4. I am checked twice a year with a diabetic doctor. Blood panel, kidneys, etc., all carefully monitored. However, those 20 extra pounds continue to plague me. “Chubby Post-menopausal woman” is a good description. I started Ozempic this very day and we will see where it leads. Hopefully a break in weather will also allow a bit of walking in the future.
I know very few people in life who can eat what they want and maintain a healthy body and physique. If you are one of them, good for you!
Also, today on my errand running, I saw quite a few joggers taking advantage of the gorgeous day here in Utah Valley. One guy was jogging barefoot! Apparently that’s a thing???
I went down the exercise road. Tried once unsuccessfully to get my doctor to prescribe metformin. No how much I exercise, my appetite keeps up with the calorie burn with *surprising* accuracy. My weight doesn’t budge unless I adjust my eating which is very difficult to do (I’ve done it a few times but it’s always a steep uphill battle and fails more often than not). That said, despite the extra twenty pounds that I carry, I am so happy that I went down the exercise road. It has enriched my life and preserves my wellbeing in ways I can’t describe. I will often exercise alone but enjoy finding exercise groups wherever possible, finding that the social benefits help me as much as the physiological benefits.
I really love the thoughts around obesity as a moral failing and LOVED middle radish’s comments.
I’m still unpacking the internalized shame I have regarding how clean my house is and how fit I am because both to me seem packaged as moral issues.