GLP-1 Medications, Weight Loss & Women’s Health: A Naturopathic Perspective
What Dr. Caitlin Really Thinks About Ozempic, Wegovy, HAES, and Whole-Person Care
Welcome to the September edition of What's the Tea with Dr. C! I hope you are cozying up into the longer nights, cooler temps and the more regular routines that come with the season.
Like many people, I have been thinking and talking a lot about weight loss lately. With the growing availability and access of GLP-1 meds (Ozempic/Wegovvy etc), it is a topic hard to ignore. And since I am a doctor specializing in women's health (women account for more than 80% of GLP-1 use for weight loss and 1/5 of women ages 50-64 have used these meds), I am having these conversations multiple times per day.
I am a HAES (Health At Every Size) aligned practitioner - you can learn more about HAES and what that means here. I am also a naturopathic doctor. These two lenses make my analysis of weight loss as a free standing goal, and the use of GLP-1 medication to achieve that goal, a bit complex.
(I am going to skip over the use of GLP-1 as management for diabetes since I think that topic is quite different).
Some might assume as a ND, I am against the use of pharmaceuticals - but those that know and work with me know that isn't the case. I think the judicious and informed use of pharmaceutical medications can be a great option in many circumstances.
As a HAES provider, I don't see weight as an independent marker of health - health comes in a variety of body types. And in fact, I would say many of the habits folks use to manage and maintain a lower body weight might not actually be healthy habits when taken in the context of the whole person. For me, weight loss for weight loss sake is often more of an issue of personal preference or aesthetics versus a health concern. And of course what we interpret as "preference" is often steeped in a deep cultural conditioning that is quite complicated to unpack.
However, part of HAES philosophy is bodily autonomy and compassionate care - this requires the doctor to consider patient preference, values and lived experience. Our Naturopathic principles encourage us to Treat the Whole Person. Our culture is very fat-phobic and even in the absence of health changes, folks can experience real benefits when they lose weight. They are likely to be treated better by health care providers, experience more comfort when traveling, have better job opportunities - while I would like the culture to change, we can't deny the reality folks in bigger bodies face.
Even people who are not considered overweight - either based on the flawed BMI or their clothing size - are enticed by the possibility of being smaller or getting to their "goal weight" - even if that is only 10-15 pounds. And how can we blame them? We are bombarded by messages that getting rid of "meno belly, "food noise" "baby weight" (all marketing terms by the way) will lead to more ease, confidence, happiness. Weight loss is almost always accompanied by praise and positive body commentary. It is almost always pinpointed as the desired outcome. And now we are bombarded by social media and marketing campaigns assuring us that this dream can easily come true. Even folks who had previously felt content in their bodies start to wonder if maybe they are missing out.
Weight loss without meds is certainly possible, but the data isn't great. Most folks will gain back whatever weight was lost and often more. The back and forth between loss and gain offers it's own health challenges. - both mental or physical. And often the close counting and monitoring of food choices can lead to stress and disordered eating.
Weight loss with meds is also complex - the data seems to point to the same issue, as soon as meds are stopped most weight is regained. There are also side effects to consider, as well as cost and lack of long term safety data - the longest study duration is 2 years - a far cry from the lifetime of use most folks will need to sign-up for to see sustained change.
So what's a ND with a dream of body liberation, embodiment and lifelong wellness to do?
I'm honestly not sure.
These conversations are messy and imperfect and I would never pretend they are not. I can't promise I always have the answers, but I can promise that I will always be reviewing the research, questioning my biases, meeting folks where they are and doing my best.
What that looks like now is having broad and deep convos about the pros/cons of weight loss in general - what is a patient hoping to achieve and why. A review of blood work to assess areas of concern and discuss how/if weight plays a role. Reviewing history of eating disorders/disordered patterns around food. Discussing types of movement/exercise. Considering macro intake. Inquiring into the stories we are telling ourselves about our bodies and the bodies of others. Encouraging curiosity. Reminding that bodies change. Every person is different, every path is different. That to me is the heart of naturopathic medicine.
Currently, these are the things that I think are important when using GLP - 1 meds: mental health, getting protein, maintaining muscle mass, maintaining cardiovascular health, monitoring GI symptoms and microbiome change, dosing conservatively, monitoring for nutrient deficiencies .
Conversations I've had in the past week: when to stop GLP-1 before trying to conceive (both men and women), how to wean or maintain overtime, how to manage/monitor nausea and food aversion, unexpected positive associations with medications (decrease chronic pain is one example). We are learning together in real time. As I gain more experience with patients, my knowledge base grows and evolves. This is a work in progress for every provider out there, as we are doing this experiment in real time - the use of GLP-1 for weight loss is at a scale way beyond how they have been used in the past for diabetes management. This is a new frontier.
As a reminder, I cannot prescribe GLP-1 meds in the state of Colorado so I am doing this as an advisor versus a prescriber.
And please be assured that I will always always always work with patients in bodies of all shapes and sizes to feel better and achieve their health goals in a weight neutral way - weight loss is never my focus and I will never dismiss health concerns as "you just need to lose weight." The popularity of weight loss and weight loss meds right now is truly a mental health minefield for folks who have been working towards body positivity/body neutrality - I am very much here for those conversation as well!
Am I getting this right all the time? I don't think so - I'm not even sure what "right" is. Do I worry about feeding into the weight loss industrial complex any time I support someone with a goal of weight loss - yep, I do. Do I think that I am better equipped than most to provide nuanced support that considers the whole person, yes to that as well.
What I hope to convey is that I am here for my patients, wherever they are and whatever their choices may be. There is always a place for naturopathic medicine - including when using medications of all kinds. I want people to know I offer a listening ear, an educated analysis and an individualized approach. As a doctor my goal is to offer the best of what we know now, to remain flexible as that data changes and to always consider whole patient health as the beacon.
One fun thing I did this summer: My park ranger dream came true :)
See the above pic! I took the first step towards my next career as a park ranger (it's my 10 year plan - so not retiring anytime soon) by joining the Grand Lake Wilderness Group backcountry volunteer ranger patrol. My duties included backpacking to Crater lake for the weekend, chatting with hikers and backpackers and using "the authority of the resource" to help folks make safe choices for themselves and the environment. It was my first solo backpacking trip and my longest trek to date - about 2,700 ft elevation gain over 8ish miles one way. My pack was way too heavy and I was nervous to be out alone - but it was such a fun and rewarding experience and I can't wait to go out again. I think of being a park ranger sort of like being an ND for the wilderness - I loved answering questions, providing guidance and being of service. Plus getting to wear the park ranger outfit was so cool!
What were your summer wins? Any adventures on the horizon? What goals can I help you achieve?
In Health,
Dr C.