Semaglutide is helping dispel the myth that weight loss is about willpower, patients say.
People taking the drug say it validated their experience that dieting didn't work, reducing stigma.
Critics say the drug is co-opting activist language, and worry about potential long-term risks.
For most of her adult life, Cora Moyer struggled to lose weight. She tried nearly every diet she could find, from keto and intermittent fasting to calorie counting and Weight Watchers.
In the short term, she could manage to shift the scale by watching what she ate. But nothing seemed to stick.
Then, 18 months ago, Moyer tried a prescription medication called semaglutide. Touted as a "game changer" in the weight-loss world, the injectable drug works by increasing the production of insulin, a hormone that helps manage blood sugar.
Immediately, Moyer's relationship to food changed. Previously insurmountable cravings dissipated, and "it was the first time in my life I felt like I was neutral toward food," she told Insider.
But it wasn't just the hunger that resolved. Moyer said the medication also helped her come to terms with decades of guilt and shame about her eating habits and weight.
"For almost 40 years, I felt, and was made to feel, like I was lazy and had no willpower where food was concerned," she said. "It wasn't until I took medication that changed my chemistry that I realized that the 'food chatter' in my brain wasn't my fault."
In conversations with Insider, semaglutide patients reported strikingly similar experiences with the drug — namely, a sudden end to cravings and an abrupt quieting of obsessive thoughts around food.
After years or decades of self-doubt, shame, and stigma, they say the drug feels like validation: their inability to lose weight long-term was never a matter of self-control. They're relieved that they can stop enduring the deprivation of yo-yo dieting and frustrated weight loss efforts.
Semaglutide can change people's relationship to hunger
Initially developed to treat diabetes, semaglutide was FDA-approved for weight loss in June 2021. It's the first medication to receive that authorization since 2014.
Typically dosed via weekly injections, the drug acts on the brain's reward center, curbing hunger and dampening other appetites, including alcohol cravings. (Its mechanism can also cause some gastrointestinal side effects, such as nausea and diarrhea.)
Research published in early 2021 found that people taking the drug lost 15% to 20% of their body weight over 68 weeks, compared with 2.4% for people taking a placebo. It also found people need to continue taking the drug to maintain weight loss.
The drug has drawn praise from medical experts, as well as high-profile public figures like venture capitalist Marc Andreesen, who called it a "silver bullet" for weight loss. In late 2021, just months after its approval, demand for the medication had already overwhelmed supply, prompting shortages that are still ongoing, per the FDA.
Patients told Insider that semaglutide dramatically changed their experience of hunger and satiety.
For Stacey McGrath, a 50-year-old construction worker from Washington, semaglutide was a revelation. Nearly 110 pounds overweight, McGrath had suffered from joint pain at her job. Since starting the drug in June, she's lost a total of about 40 pounds, without the persistent feelings of hunger and yo-yo dieting that plagued her previous efforts.
"I could lose five pounds and gain back six," she said. "Before, I would eat until my stomach hurt. Now, between one bite and the next, my brain will say 'You're done.'"
For many patients, taking the drug opened their eyes to how little their willpower mattered
Like other semaglutide patients, McGrath had tried a number of diets and strategies to lose weight, without success.
Over the years, she said, comments from strangers, acquaintances and even family members made her feel she should be ashamed of her size. At one point, her father told her that she needed to lose some weight and "have some pride" in her appearance, which she said still stings to this day.
McGrath said that semaglutide has given her a sense of relief: it's clear evidence that despite all her discipline, physiology was an irrefutable factor in her weight.
"It's hugely validating, because that's all you hear, that people are overweight because they have no willpower," she said.
Taking a drug like semaglutide can help kickstart the process of separating weight and willpower to relieve internalized stigma, said psychologist J. Ryan Fuller, who works with weight loss patients, including those on medications.
"It's not about trying to white-knuckle through weight loss, thinking you aren't as strong as everyone else," he told Insider. "I think it can be very validating for clients to see that when they take the medication, it's a lot easier."
52-year-old Tina Baylocq, a California-based communications consultant, has lost 70 pounds on semaglutide. She told Insider that the drug curtailed cravings for bacon and sugar, and helped put the brakes on her urge for second helpings at most meals.
Prior to the medication, Baylocq said she consistently felt scrutinized for her appearance, her food choices, and her exercise habits. She said everyone from strangers to intimate partners seemed to feel entitled to comment.
"I was judged very harshly," she said. "At dinner, people would say 'I'm just going to have a salad' and the implication was clear that I should be following their example."
When Baylocq was in college, she said her mother once bought a new outfit for her sister, and made it clear Baylocq would get one too, if only she lost some weight.
"Every boyfriend I ever had would make comments about how I used to be cute before I gained a few pounds," Baylocq said. "If you're heavier, people's impression of you is that you're lazy, you just need to have some willpower, stop eating so much and go to the gym."
Since she lost weight, Baylocq said she's noticed people pay more attention to her and treat her with more respect.
"When I was heavy, I was invisible and now I'm not. This is fucked up in so many ways," she said. "I'm trying not to be angry about it."
Some activists are glad to see the 'willpower' myth die — but they don't think semaglutide is the answer
Underlying the use of semaglutide is the medical argument that obesity is a treatable disease, caused by genetic and environmental factors outside of patients' control.
The website for Wegovy, Novo Nordisk's semaglutide drug for weight loss, offers a section dedicated to the obesity-as-disease model, detailing the biological reasons why a person may not lose weight "despite their best efforts."
The approach can help reduce misconceptions about weight as well as help providers offer better care to patients, according to Dr. Jason Brett, executive director of medical affairs for Novo Nordisk.
"We should have a goal to reduce weight bias and stigma and make sure people understand obesity is indeed a disease that needs medical management and is not an issue of willpower," Brett told Insider. "But by doing that, it doesn't mean we say that any weight is healthy or it should be disregarded. We want to improve health."
Yet Wegovy's marketing plays both sides, said Ragen Chastain, an activist and writer specializing in a weight-neutral approach to health. Chastain said the drug's marketing aims to reduce stigma around weight by acknowledging that it's often out of a person's control, while still capitalizing on the societal pressure to lose weight for profit.
"People have been conditioned to believe that fat people's problem is that they eat too much, and anything that helps them stop doing that, no matter how painful or uncomfortable, is 'worth it,'" she said.
Chastain said that she supports personal autonomy and people choosing what's best for their lives. But she thinks people should think seriously about the potential risks of semaglutide, and discuss them with their doctor before taking the drug.
Wegovy currently carries a boxed warning (the most serious designation from the FDA) for pancreatitis, kidney injury, gallbladder disease, and depression/suicidal ideation, and for risks of thyroid tumors, based on animal studies.
Several patients who talked to Insider said they experienced mild side effects like nausea or adverse reactions to overeating from the medication, particularly when they first began taking it.
Those concerns warrant further study, said Dr. W. Scott Butsch, director of obesity medicine at the Cleveland Clinic. But he noted that many medications with boxed warnings are safely used by patients every day, including antidepressants, anti-inflammatory drugs, and antibiotics.
"There's enough evidence to make us feel comfortable that we're providing appropriate care to patients," Butsch said.
For one dietitian, medication brought balance without burnout
Sara Nejat-Bina, a critical-care registered dietitian in California, has been taking tirzepatide, a drug similar to semaglutide, since June.
Despite her own expertise in nutrition, Nejat-Bina, 46, had been unable to address her high blood pressure with a calorie-cutting diet. She was only able to lose weight through an exhausting three-hour daily workout routine: two spin classes and CrossFit.
"I do believe in health at every size, but I wasn't healthy anymore," she told Insider. "I knew if I didn't start controlling my weight, it wouldn't stop with hypertension."
Medication, she said, brought balance without burnout.
"I can eat like a normal person without feeling deprived, and I can exercise like a normal person," Nejat-Bina said. "I have more time to focus because I'm not constantly trying to control my appetite or judging myself about what decisions I'm making in the kitchen."
While Nejat-Bina shares Chastain's concerns about the marketing around medication, she's taken aback by the aggressive opposition from weight-neutral advocates and practitioners.
"I'm shocked," she said. "If you're denouncing medications that could help people, I think it's counterintuitive to what the movement says."
Nejat-Bina believes medication offers a much-needed alternative to some patients dealing with long-term health issues, stigma, and the harm of chronic dieting.
"I don't think it's for everyone — it's a personal choice and needs to be talked about with your doctor," Nejat-Bina said. "Taking long-term medication is always a concern, but I was more fearful of the effects of hypertension, stroke risk, and possible cancer."
Semaglutide has changed patients' understanding of themselves
Patients interviewed by Insider expressed gratitude for the way semaglutide helped them overcome internalized guilt and shame over their bodies. They said the medication kickstarted a process of making lifestyle changes and mental shifts they hope will persist, regardless of whether they stay on the drug.
"It allows you to change your relationship with food, but you have to put in the work," McGrath said.
To maintain the benefits of treatment over time, Fuller said, patients may still need to confront the root causes of issues like emotional eating, as well as social or environmental triggers of unhealthy habits.
"The drugs aren't going to teach people different coping mechanisms," he said. "They are going to have to find ways to feel connected, feel pleasure and manage negative emotions without it."
But patients and experts said semaglutide could have an impact that goes beyond individual patients' results: potentially moving the needle in how society thinks about weight and willpower.
Moyer said the drug opened her eyes to the reality of weight as a physiological fact, instead of a moral flaw. She hopes it will do the same for others.
"Obesity is the only condition that doctors tell patients to treat themselves," she said. "Having finally had measurable success with medical help, I will never look at obesity again as the result of a personal failure."
Read the original article on Insider