I am in my late 40s and recently started to rapidly gain weight. Over the past two or three years, my BMI has increased from normal weight to obese. I have PCOS, and my blood pressure and cholesterol have started to increase. My doctors have brought up the possibility of weight-loss medication, but I am torn as to whether I should keep trying to lose weight on my own or start medication. I generally haven’t been very successful on my own, but I’m also worried about starting one of these medications. Is there data about whether weight loss is easier if you haven’t been very overweight for very long? About the impact of being overweight for a couple years vs. five years? Am I being logical in terms of wanting to see more about how these medicines develop before I start one, even if I could benefit from one now?
—Anonymous
I am very sorry you are dealing with this. You are not alone in your struggles or your reticence to take weight-loss medication. I see women like you in my office every day.
Our understanding of weight gain, weight loss, and obesity has changed in the past 10 years. I would argue we are only beginning to understand how much we don’t know about how body weight is regulated. What we do know is that the idea that weight is all about how much energy you put in your body in the form of food and the energy you expend in the form of activity is often not true.
Weight loss is not easy for most people, but we know that women with polycystic ovary syndrome (PCOS), like yourself, often struggle with weight gain. There is no good data to suggest that weight loss is easier for those who have been overweight or obese for a shorter period of time.
However, it is clear that metabolic diseases like high blood pressure, high cholesterol, and high blood sugar are progressive and that the biochemical changes that cause those diseases precede them, often by decades. Over those decades, many, many small changes occur until the body can no longer compensate and the disease becomes apparent.
So by the time you actually have high blood pressure or high cholesterol, you are not at the beginning of the disease but already in the middle of it. The damage they cause is cumulative. The sooner you address these changes, the better.
It is a common misconception that medications like Ozempic are new and that we don’t fully understand their effects on the body. The first medications in the class of GLP-1 agonists, to which Ozempic and Wegovy belong, were approved by the FDA in 2004. The first GLP-1 agonist was approved for weight loss in 2014. And Ozempic was approved in 2017. We have lots of good data on the safety of these medications. Not only do they lower blood sugar and assist with weight loss, they also reduce the risk of cardiovascular disease and prevent progression from prediabetes to Type 2 diabetes.
Another misconception about GLP-1 agonists is that they are a shortcut or cheating. They are not! While GLP-1 agonists are not for everyone, in patients with obesity and metabolic disease, they are a useful tool to help patients effectively lose weight and reverse the disease.
I cannot tell you whether a weight-loss medication like Wegovy is right for you, but they are safe and effective, and addressing health problems like high blood pressure and high cholesterol promptly is important for maintaining future health.
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