When we as doctors think about risks of any medication, the first thing that comes to mind is the potential for side effects. But when I ask my patients what they perceive as potential risks of treatment, often the answer is something else entirely. In line with this, I really loved this recent paper published in Obesity Pillars that asked people living with obesity what they perceive as risks of weight management medication.

RISK#1: Not being ablet to get access to weight management medication in the first place.

Barriers to access noted include cost/lack of insurance coverage, long waiting lists to get in to see doctors, and being ‘shut down’ by health care providers when they ask for weight management medication. Some payors have strict weight loss requirements to continue to pay for medication – clearly they need to learn that weight management is about improving health and quality of life, and not numerical criteria on the scale. Some noted that if they have weight loss success and their BMI falls under the obesity medicine prescribing criteria, their insurance will cut them off, saying they no longer qualify.

RISK #2: That they would fail to meet treatment expectations.

People described a failure to meet their own expectations for weight goals as a risk of taking weight management medication, and how demoralizing that would feel. Others shared the emotional impact of risking watching others have success, but not having success themselves. Some described the risk of feeling demoralized by not meeting expectations that their health care team or even society has for them getting treatment. (Imagine now we were talking about rheumatoid arthritis, heart disease, or hypertension. I think it unlikely that anyone would judge a person, nor would most people feel like a failure, if treatment goals were not being met with medications to treat those conditions.) Remember: (drawing from the wise words of my colleague Dr Michael Vallis): People don’t fail treatments. Treatments fail people.

There is the expectation that ‘life is just going to get better’ with weight loss, and the risk that it won’t. Obesity is deeply interwoven with quality of life as a condition that affects so many aspects of health, well being, and can affect interpersonal relationships in both positive and negative ways. So there is no guarantee that life will get better with weight loss.

There is the expectation that ‘you will be fixed’ with results of weight loss medication, and then what happens if you’re not? The relationship between obesity and mental health is complex, and while medication can help to treat obesity, it doesn’t treat the underlying emotional contributors that may be contributing in the first place.

Expecting a cure, or people around you expecting that you will be ‘cured’ with weight loss medication, was described. Here is where we need to continue to educate that weight management strategies present a mode of control, not cure, of this chronic medical condition.

RISK #3: That treatment would be successful, but that they would lose their sense of self, their coping mechanims, and their identity, along with the loss of weight.

There was a fear of losing ‘the real me’, the fear of ‘the lonely me’, the loss of comfort of food. Where to reach for comfort, if not to food? It’s normal to take comfort in food – food releases endorphins in our brain, which essentially make us feel better. Here’s where people on a weight management journey need support and education to learn about finding comfort from sources other than food.

There was a concern that they would be treated differently, losing friends or relationships. And also a risk of the rather offensive experience of being treated better by society when they do lose weight, when they were (of course) the same person all along.

At the end of the day, most people returned to the point that treatment is still “definitely worth it”.

“It’s important to look at the other side of the risk, and that’s the risk of not taking action.”


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