The American Medical Association officially recognized obesity as a disease in June 2013 after decades-long controversy.¹ Although lifestyle interventions are promoted as a first-line obesity treatment, the resultant short-term weight loss often fails to improve long-term outcomes.² In the search for other solutions, glucagon-like peptide-1 (GLP-1) receptor agonists such as tirzepatide (Mounjaro™) and semaglutide (Wegovy® or Ozempic®) have greatly increased in popularity throughout the past year.

However, the media frenzy surrounding tirzepatide and semaglutide has raised concerns about this latest obesity treatment. Originally developed for diabetes, tirzepatide and semaglutide faced widespread drug shortages as celebrities such as Elon Musk and Chelsea Handler accredited the drugs for their weight loss. Resultant backlash attributed the anti-obesity medication boom to fatphobia.³

Still, the myriad of obesity’s biological and psychosocial obstacles can feel insurmountable after lifelong efforts to lose weight. But are GLP-1 receptor agonists the right solution for patients struggling to climb uphill to a “healthy weight”? Or do these injectables amplify disordered eating, weight stigma, and reliance on expensive pharmaceuticals? 

Perhaps it depends on who you ask.

For an insider’s view on this timely topic, we spoke with board-certified bariatric physician Kevin Huffman, DO and leading psychiatrist Michael Olla, MD, both of whom have decades of experience treating obesity and navigating its social implications.

Can BMI Justify Anti-Obesity Injections?

Although obesity is associated with higher risks for type 2 diabetes, certain cancers, mobility issues, and heart disease,¹ some experts feel that anthropometric measures such as body mass index (BMI) fail to reflect true health status.

A veteran in his field, Dr. Huffman has treated more than 10,000 patients with obesity and trained and mentored hundreds of physicians and allied healthcare providers. He is also the CEO and founder of AmBari Nutrition and the founder and president of The American Bariatric Consultants. 

Dr. Huffman admits that BMI does not tell the whole story about whether anti-obesity medication makes sense for an individual patient.

“BMI, a useful initial screening tool, necessitates more nuanced considerations when prescribing injectable weight loss medications,” he explains. “We acknowledge the uniqueness of each patient; body composition, fat distribution, metabolic health, and underlying medical conditions significantly influence our decision-making process.” 

He continues, “For instance, certain patients may present with central obesity despite having a lower BMI — this suggests an escalated risk for obesity-related complications. Diabetes or hypertension, obesity-related health issues, may still qualify individuals for intervention despite a slightly lower BMI than the conventional threshold.”

Providing Quality Care in a “Fatphobic” Environment

Medical professionals are far from immune to stigmatizing patients with obesity. Research findings show that over 50% of healthcare professionals attribute obesity to a lack of willpower.⁴

In addition, more than half of adults with overweight in Western countries report experiencing weight stigma. As a result of this stigma, patients with obesity and overweight are more likely to avoid healthcare.²

According to Dr. Huffman, “Navigating through this deeply ingrained prejudice is crucial when prescribing injectable anti-obesity medications: potent tools in aiding patients on their weight loss journey. Unfortunately, many barriers arise due to the fear and stigma surrounding obesity — these factors tragically deter numerous individuals from pursuing these potentially life-altering treatments.”

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He urges prescribers to approach these conversations with empathy, understanding, and a non-judgmental attitude to foster support and empower patients to access necessary, deserved care for a better quality of life.

Dr. Olla is the medical director at Valley Spring Recovery Center. He is a leading authority figure in the field of psychiatric medicine who focuses on holistic healing, patient well-being, and evidence-based practices.

“Believe it or not, fatphobia or weight bias is a common issue in plenty of medical professionals,” Dr. Olla explains. “Heavier patients tend to encounter lots of medical professionals with weight stigma. In these cases, doctors tend to focus so much on their weight that they ignore other symptoms these patients primarily come in for. This doesn’t just affect patients but also doctors who mean well.”

To address these biases, Dr. Olla encourages medical professionals to have honest conversations with patients before prescribing anti-obesity medications. He suggests openly discussing fatphobia’s potential influence on the decision-making process and explaining the medication’s benefits and risks without pressuring patients to use medication unless medically justified.

According to Dr. Olla, reviewing other treatment options respects a patient’s autonomy and right to make their own treatment decisions.

“The key is to focus on how the drug can help reverse or at least slow down the effects of obesity on the body,” he explains. “This can help the patient understand that their doctor is concerned about their overall health, rather than their weight.”

Weighing the Costs and Benefits of Anti-Obesity Medications

Prescribing anti-obesity medications in today’s cultural climate is no simple task. Physicians must carefully weigh the pros and cons to lead patients to the most appropriate and beneficial treatment path.

“As a doctor myself, I am 50/50 on prescribing weight loss medications,” Dr. Olla shares. “Obviously, you wouldn’t want your patients to develop metabolic or cardiovascular diseases caused by excess weight. However, at the same time, I don’t want to encourage a medication that can only cause more health problems to the patient. In my opinion, there should be more research on how anti-psychotics and weight loss medications could go hand in hand without putting an individual in further danger.”

A multidisciplinary approach is the key to ensuring that patients receive not just comprehensive care, but also unwavering support throughout their weight loss efforts.

According to research findings published in Endocrine Practice, over 70% of healthcare providers believe that anti-obesity medicine as an adjunct to lifestyle counseling is an appropriate therapy that can kick-start weight loss and give patients a greater sense of control over their weight.⁵

However, clinicans remain hesitant to prescribe anti-obesity medications, with some seeing anti-obesity medication as a short-term solution and others being concerned about safety, efficacy, and cost of staying on these medications. These barriers lead to low prescribing rates, which perpetuates a cycle of low perceived demand and lack of coverage by insurance carriers.⁶

Dr. Olla also explains how psychiatric comorbidities can complicate obesity treatment. He notes that anti-psychotics and antidepressants can raise hunger levels and cause unwanted weight gain.

“Some patients press for medications that can counteract the side effects,” he says.

He feels that it is not safe to prescribe anti-obesity medication to those with psychiatric conditions, particularly eating disorders. Doing so may increase body weight focus, promote disordered eating habits, increase anorexia risk, and lead to a psychological dependency on weight loss medication.

Aside from psychiatric comorbidities, clinicians must also consider whether a patient has diabetes or other physical conditions. As a bariatric physician, Dr. Huffman explains the counseling differences between those prescribed injectables for weight loss vs type 2 diabetes.

“In managing type 2 diabetes, the counseling provides specific guidance such as carbohydrate counting instructions, recommendations for blood glucose monitoring methods, advice on medication adherence — emphasizing its critical role in the effective management of this condition — and underlining consistency as key when maintaining stable blood sugar levels.”

Dr. Huffman emphasizes that, before prescribing injectables, clinicians should (1) take a holistic approach, (2) assess a patient’s motivation to implement lifestyle changes, and (3) monitor patient adherence to anti-obesity medication regimens. According to him, motivational interviewing and a tailored approach empowers patients to make lasting change.

Leveraging Collaboration to Ensure the Best Treatment

According to Dr. Olla, clinians should remember that they do not need to navigate the complexities of obesity treatment alone. For instance, psychiatrists may work with endocrinologists before prescribing weight loss medications to patients with mental health conditions.

“The expertise of an endocrinologist is needed because anti-psychotic drugs can cause significant weight gain, and careful health monitoring is required,” Dr. Olla explains.

In Dr. Huffman’s practice, prescribing obesity medication is far from the final step in a comprehensive approach to weight management.

“Prescribing patients with injectable weight loss medications necessitates crucial care elements: ongoing support, referrals, and follow-ups,” Dr. Huffman says. “Primarily, I guarantee comprehensive counseling and educational resources for the patients.” 

Dr. Huffman encourages prescribers to refer to registered dietitians for individualized meal plans and exercise specialists or physical therapists for safe and effective exercise programs. Mental health providers, behavioral therapists, and support groups can also play a pivotal role in a patient’s success.

“A multidisciplinary approach is the key to ensuring that patients receive not just comprehensive care, but also unwavering support throughout their weight loss efforts,” he says.

It remains to be seen whether anti-obesity medications will help or hurt in the fight against obesity and weight stigma. However, clinicians can build an army of specialists to not only optimize patient care but also help share the responsibility of treating this weighty issue.