When I ask patients in my clinic if they are interested to consider weight management medication, the first response I get can be anywhere across the spectrum from ‘Yes please, how soon can I start!’ to, occassionally, a flat out ‘absolutely not’. What reasons may be behind some people with obesity not wanting weight management medication?
A survey study by Le Roux and colleagues was conducted in USA, UK, France, and Germany, exploring barriers to using weight management medication.
The top 3 reasons why people with obesity said they were not taking medication:
- 34% didn’t want to take medication
- 33% had side effect concerns
- 26% did not trust weight management medication
- (#4 on the list was cost)
For the 34% who did not want to take medication, reasons may overlap with others on this list, but there may be other things going on behind the scenes. When I explore reluctance to consider medication with my patients, some tell me that they feel it is their fault that they struggle with weight, and that they should be able to lose weight without the help of medication – this is called internalized weight bias. I spend time to help people understand the biology of weight, that it is not their fault that they struggle with weight, that losing weight defies normal human biology, and that ‘eat less move more’ therefore works for very few. There are some who tell me that they would feel ashamed to take weight loss medication. I have also had patients who are having success with weight management medication, but they are afraid to keep taking the treatment in case they ‘get caught’ by their family or friends.
The statistics tell us that a lot of people stop taking weight loss medication within a year after starting treatment. While some are due to cost, loss of insurance, shortages of medication, or wanting to ‘test the waters’ to see if they can keep weight off without medication, I think there are people out there who are not talking about the self blame, and both internal and external bias and shaming that they are experiencing because they are taking weight management medication.
It brings me great sadness that weight bias and stigma can present a barrier to people accepting treatment for elevated weight. Do people feel shame or feel shamed by others and thus say no to treatment when it comes to taking heart medication, arthritis medication, or chemotherapy? I would say that would be pretty rare to non existent.
BOTTOM LINE: If your patient says they don’t want weight management medication, ask permission to explore why – there may be more underlying that statement than you think. We need to continue to push back against the frigid glacier of weight bias by speaking out and educating about obesity, until it is completely melted away.
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