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You're listening to LifeKit from

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NPR. Hey, everyone.

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I'm Stacey Vanek Smith, inframarial

0:22

saguera. O-zempic.

0:25

A few years ago, most of us had never even

0:27

heard of it. And today, it is

0:29

hard to avoid hearing about it.

0:31

The slimming side effects of diabetes

0:33

drugs, O-zempic and Manjaro, have made

0:35

them very popular for weight loss.

0:39

More than nine million people are now

0:41

taking the prescription weight loss drug, along

0:43

with similar drugs like Wagovie and Roe.

0:46

O-zempic has been showing up all

0:48

over social media and Hollywood and

0:50

award shows. Oprah reveals

0:52

she's on weight loss medication.

0:55

The celeb recently made headlines for her

0:57

body transformation after hitting the red carpet

0:59

for the color purple premiere, rocking a

1:01

stunning dress that showed off her slim

1:03

figure. But what about the rest

1:05

of us? Dr. Mara Gordon

1:07

is a family medicine practitioner in New

1:10

Jersey, and she considers herself to

1:12

be a size-inclusive doctor. So I

1:14

like weight inclusive. I like size

1:16

inclusive. I like weight neutral.

1:18

It's really medicine that tries to step

1:20

away from our obsession

1:23

with weight and body size in

1:25

medicine. Recently, many of Dr.

1:27

Gordon's own patients have been asking her

1:29

about O-zempic, telling her they're interested in

1:31

a prescription. They want to try this

1:34

magical weight loss drug. Dr.

1:36

Gordon says the results of this have

1:38

been surprising. Some good, some

1:40

bad, some totally unexpected. Medicine's complicated.

1:42

That's why I'm in this field,

1:45

because I like it and I like the messiness of it. Dr.

1:48

Gordon actually wrote an essay for NPR about

1:50

her experiences, and she's been on LifeGate a

1:52

few times as well. So we wanted to

1:54

bring her on to talk about some of

1:56

what she's been seeing. So if you're considering

1:58

taking a drug like those... or

2:00

if you're just curious about it, we have

2:02

got you covered. After the break,

2:05

the good, the bad, all

2:07

about Osempic. Apply

2:30

for Apple Card in the Wallet

2:32

app on iPhone. Subject to credit

2:34

approval, savings is available to Apple

2:36

Card owners subject to eligibility. Savings

2:38

accounts by Goldman Sachs Bank USA,

2:41

Member FDIC, terms apply. This

2:43

message comes from NPR sponsor,

2:45

Teladoc Health. There are

2:47

lots of reasons for wanting

2:50

to be healthy. Family,

2:52

work, living a fuller life.

2:54

Teladoc Health understands. Whether you

2:57

have diabetes, high blood

2:59

pressure, or just need to

3:01

manage your weight, Teladoc Health

3:04

can help. Visit teladochealth.com/whatsyourwhy

3:06

for more information. That's T-E-L-A-D-O-C

3:08

health slash whatsyourwhy. This

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3:28

Hi, it's Terry Gross, the host

3:30

of Fresh Air. We bring you

3:33

in-depth, long-form interviews with actors, directors,

3:35

musicians, authors, journalists, and more. Listen

3:38

to our Peabody Award winning Fresh

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Air podcast from WHYY and NPR.

3:44

Before we dive into how Dr. Mara

3:46

Gordon thinks about Osempic and what she's

3:48

noticed with her own patients, it's

3:50

important to understand how she thinks about

3:52

weight and health. Because it has been

3:54

a journey for her. I would say

3:56

it started as a resident and I

3:58

started slowly realizing. that what

4:02

I had thought was helpful, which was,

4:04

you know, suggesting that

4:06

my patients try to hop

4:08

on the treadmill more or, oh, have

4:11

you thought about losing a few pounds? It might

4:13

help your knee pain. Not only

4:15

was it not seeming to work, it

4:17

was not effective at, you know,

4:19

stopping their knee pain and not to mention

4:21

not effective at helping them lose weight. It

4:24

was, seems to be causing a lot of

4:26

harm. And I noticed sort

4:29

of just a look that would come across

4:31

people's faces when I would

4:33

bring up their weight. Just a

4:35

sort of disengagement, a sense of

4:37

distrust. Really kind of

4:39

seemed like betrayal a lot of the time

4:41

that I was sort of turning the conversation

4:43

to something that they weren't

4:45

always there to talk about and

4:47

they had definitely already

4:49

thought about themselves because everything in

4:52

our culture was telling them to. And it

4:54

sort of set me, set me

4:56

up not

4:59

as their ally but as an

5:01

antagonist. And I

5:04

noticed this over and over again. Just that,

5:06

you know, it wasn't helping and it

5:09

was actually causing harm. And so I decided

5:11

to do a little bit of

5:13

a literature review on it and I looked up some

5:15

of the medical literature on primary

5:17

care weight counseling. So, you

5:20

know, that's like I said a primary care doctor

5:22

like me saying, hey, why don't you why don't you lose

5:24

a few pounds? And

5:26

it has so little research to

5:28

back it up. There's basically

5:31

no evidence that it's effective at helping

5:33

people lose weight. There's

5:35

a ton of research on this

5:37

that shows that, you know, when

5:39

patients feel stigmatized by their doctors

5:41

around obesity, they just stop

5:44

coming, right? They don't

5:46

engage in care. They don't get

5:49

recommended screening tests. They don't

5:51

come to recommended preventative visits.

5:54

They avoid the doctor at all costs.

5:56

It's really, really harmful and this is

5:58

really well documented. in pretty big

6:00

sample sizes that this kind

6:03

of stigmatizing behavior on the part of doctors

6:06

has real health harms for our patients. I

6:09

mean, I imagine some skeptics might push

6:11

back a little on your practice and

6:13

say, you know, maybe you're doing your

6:15

patients a disservice. Like maybe they don't

6:17

love hearing about weight, but if

6:20

it's having a real impact on their

6:22

health or if losing weight could help

6:24

them with joint pain, with blood sugar,

6:26

with high blood pressure, shouldn't

6:29

you bring it up? Well, so

6:31

the approach that I like to take

6:33

is just really focusing on the medical

6:35

issue. So my approach

6:38

is that I try to

6:40

tackle whatever individual, you know,

6:43

ailment my patient is facing,

6:45

right? So if it's diabetes,

6:47

we treat diabetes. Part

6:49

of the treatment for diabetes is

6:52

exercise, eating lots of fruits and

6:54

veggies. Those things are great.

6:56

I think exercise is absolutely one of the

6:58

best medical treatments that we have. I

7:01

want to support my patients in finding ways to move

7:03

their body that feel good for them. But

7:06

I just think we have so much

7:08

stigma and so much shame

7:10

around body size in our culture that

7:12

really sort of pinning their success

7:14

or failure to a number

7:16

on the scale causes so much more

7:18

harm than good. Yeah.

7:21

Yeah. I remember once, this

7:23

was years ago, but I quit smoking

7:26

and I gained like... Congratulations. Thank you.

7:29

Thank you. I gained like 30 or 35 pounds. I

7:31

gained quite a bit of weight because I would just eat a

7:33

lot of sugar to make up for... Like

7:36

that's how I would deal with cravings. And

7:38

I went to a doctor and I didn't tell

7:40

him that I had smoked and he gave me

7:42

this huge lecture on how I needed to lose

7:44

weight. It was so traumatizing to

7:46

me at the time. And I

7:49

do remember that I just... Like

7:51

I completely... I didn't want to tell

7:53

him anything. I didn't tell him anything.

7:55

Yeah. And thank you so much for sharing that.

7:57

I mean, your story is not so far away.

8:00

of obesity stigma that I've heard in

8:02

medical settings and it is absolutely not

8:05

going to be the last. And, you

8:07

know, I appreciate you sort

8:09

of being brave and vulnerable to share

8:11

that because this stuff can be really hard to talk

8:13

about. Yeah, so maybe this is something

8:15

for our listeners to keep in mind that you should

8:17

find a doctor who makes you

8:19

feel comfortable and open. And if finding

8:22

a weight inclusive doctor sounds appealing, know

8:24

that they exist. You can seek them

8:27

out, even if you have no interest

8:29

in ozempic at all. So

8:32

I feel like that's a good moment

8:34

to kind of turn to the topic

8:36

at hand, ozempic, because that I think

8:38

certainly has just changed the conversation around

8:40

weight that we're having in this country.

8:43

How have you noticed it? Like, what

8:45

have you heard from your patients? When

8:47

did you start hearing about this, I

8:49

guess, from your patients? So

8:51

I had heard about the

8:53

medicine ozempic for

8:56

many years. Since I've

8:58

been in practice in medicine, I've been using it

9:01

for years to treat diabetes. It

9:03

was developed as a diabetes drug. And

9:06

it is great. It can help protect your

9:08

heart. It can help lower your blood sugar.

9:11

It can help protect your kidneys. It

9:13

really, really has a lot of benefits for

9:15

patients who have

9:18

diabetes or people who are really at high

9:20

risk of cardiovascular disease. And in

9:23

2021, there was a big practice changing

9:25

article that came out in the New England Journal

9:27

of Medicine that was a trial

9:30

that looked at the use

9:32

of ozempic in patients who did not have diabetes.

9:34

So it was basically patients who had higher BMIs

9:37

who did not have diabetes. If you gave

9:39

them ozempic, would they lose weight? And the

9:41

answer was yes. And I remember

9:43

seeing it in the New England Journal

9:45

of Medicine and just saying, oh my

9:47

God, somebody is going to get really,

9:49

really rich off of this. It is,

9:51

I sort of

9:53

sensed and I was right That it

9:56

was going to become a huge commercial

9:58

phenomenon because diet culture is so. Ingrained

10:00

in I would highly is enormous

10:02

right? Like only and billions of

10:04

dollars total And so now doctors

10:06

to get in on the accent

10:09

on ends. Ah. Yeah. So

10:11

so that was sort of. My

10:13

first sense of let them pick

10:15

would be com and now it's

10:18

It's pretty widely available. Ah

10:20

with some important caveats which is

10:22

in New Jersey where I practice

10:24

Ah, medicaid will not cover it

10:27

for non diabetics isn't so much.

10:29

Practice is on. I. Would

10:31

say vast majority publicly and hurts on.

10:33

and so basically even if my non

10:36

diabetic seasons one it ah they can't

10:38

get at so whether or not you

10:40

think goes i'm back ah for weight

10:42

loss. Is. Good. Bad:

10:45

Neutral Complicated I'm I'm undergo

10:47

a complicated I It's still

10:49

not available. At low income folks

10:51

in most of the United States. So

10:53

there's that which is just an important.

10:56

Points make. And

10:58

I mean immediately people started asking for

11:01

it on so I do prescribe of

11:03

them back. Of

11:05

a couple decency who. Really?

11:07

Are happy with it. Yeah. I'm

11:09

have lost weight so really got on

11:11

it. Some who are sort of the

11:13

welder by it and how the world

11:16

to some really differently now that they've

11:18

lost lot away on a couple of

11:20

the has. Been. Diagnosed with depression

11:22

sense that starting in the Us

11:24

I'm back so complicated on have

11:26

a couple decency stop that because

11:29

the. Stomach upset was just

11:31

really, really intolerable for. Them that they

11:33

really when it's her into I see

11:35

that food as one of. Life's great

11:37

pleasure that so called for all

11:40

and ah. No family

11:42

oriented when food is just part of so many

11:44

things in our culture. And to feel like. They.

11:46

Never when it's it was very. Upset

11:49

aims I'm I'm save a couple of years since

11:51

he decided. To stop at everybody's

11:53

different. Mean. Their ads all over

11:56

the subway system in New York from.

11:58

a row i think But I mean, the

12:00

ads are everywhere. You can't really escape it.

12:03

And the ads are primarily targeted

12:05

towards using it for weight loss. Yeah,

12:08

and I mean, my question is, who's making money off

12:10

of it, right? Who's benefiting? And

12:14

some people might argue that patients are benefiting,

12:16

and I think some do. But

12:20

I think it's always, whenever a patient comes

12:22

to me and they say that they want to lose weight, my

12:25

first question is always, why? What's

12:29

your goal? What are you trying to achieve? I

12:32

get really, really interesting answers. And it's

12:34

not clear that weight loss is

12:36

always the solution. So a lot of the time it

12:38

has to do with feeling tired, feeling

12:42

slow, feeling fatigued, a little depressed.

12:45

And patients get

12:47

so upset. But I mean, really, the answer

12:49

is exercise. And I struggle

12:51

with exercise, too. It's hard to make time

12:53

for it in our daily lives. I mean,

12:56

it's just really an uphill battle. Our culture

12:58

is not favorable to exercise. But if

13:00

you want to feel like you can chase your kids

13:02

at the playground or play soccer with them, you've

13:05

got to get moving. And

13:08

I try really, really hard to disentangle our

13:13

talk about exercise from our talk

13:15

about weight loss. And they're so

13:19

bound up together in our society because of

13:21

diet culture, because there's a lot of people

13:23

making a lot of money off of trying

13:26

to get you to lose weight. So I

13:28

think exercise is for everybody, fat, thin, old,

13:30

young. You just have to find something

13:32

that feels good for you. And it can take

13:34

so many different forms. It doesn't need to be

13:37

running a marathon at all. Gardening counts, walking

13:39

counts, swimming counts. I mean, there's so much

13:42

you can do to just move your body.

13:44

So that's what I work really hard with my

13:47

patients to do is try to think

13:49

about how they can move in ways

13:51

that feel good and help them achieve their

13:53

goals. Yeah, I actually think that's

13:55

a useful takeaway for our listeners, too. I

13:58

mean, we've all spent our lives swimming. messages

14:00

about weight and body image and all

14:02

the rest of it. Now all this

14:04

messaging about ozmpic. And you know,

14:06

maybe something that's useful to do when we

14:08

are feeling like maybe we want to lose

14:10

some weight or change our bodies in some

14:12

way is to think about what else might

14:14

be going on and ask ourselves maybe why

14:17

we want to lose this weight and what

14:19

we think would change in our lives if

14:21

we did lose this weight. I

14:23

mean, this drug, I think it's easy to lose sight of the

14:25

fact. It's pretty new. And I think

14:29

it wasn't necessarily

14:31

developed for

14:33

weight loss necessarily. And a lot of times

14:36

when drugs become this popular, like

14:38

side effects will start to emerge or

14:40

because, you know, there are so many

14:43

different individual bodies that have different reactions

14:45

to the drug. I'm wondering like what

14:47

are maybe some of the open questions

14:49

or the medical questions

14:51

or concerns that you

14:53

have or that are kind of floating around

14:55

about ozmpic? So as a

14:58

doctor, my

15:00

rule is start low and

15:02

go slow. Only start a med

15:04

if you really need it. Try

15:06

to use a minimum dose. Don't

15:08

escalate it unless there's like a

15:10

clear indication just that less

15:12

is more in medicine. And

15:15

that's kind of an unpopular perspective.

15:17

Even though it's what we learn in med

15:19

school, we quickly unlearn it because we realized

15:21

that, you know, our whole corporate healthcare system

15:23

is predicated on more and more and more and more

15:26

more. But as a, you know, working

15:28

in my little corner of primary care, that's sort

15:31

of the mantra that I try to adhere to.

15:33

So I think that I

15:36

think it's very good to be skeptical of

15:38

the social forces at work

15:40

that are making it so popular who

15:42

benefits from those social forces, who's losing

15:46

from those social forces. Yeah. So

15:49

I think it's good to have just a basic

15:51

degree of skepticism. There's a lot of

15:53

active research. I've sort of read these sort of

15:55

anecdotal accounts about ozmpic may

15:58

stop gambling. And that

16:00

has, my

16:02

understanding is very little data to back it

16:04

up. So I think it's an

16:06

active area of research. It's really interesting to

16:09

see how obsessive behaviors might be

16:11

related to gut hormones or who we

16:13

are. It's quite fascinating. Yeah. You

16:16

know, I'll eagerly be seeing what kind of research

16:18

comes out, but I think skepticism about that is

16:21

good. I wanted to ask

16:23

you like for anyone who's listening

16:25

to this, who maybe is considering

16:27

asking their doctor about Ozempic or

16:30

like when your patients come to you and they're

16:32

curious about it, thinking

16:34

about maybe using it, what do you

16:37

ask them? What do you tell them to think

16:39

about? What would you tell people to consider before

16:42

they would start using Ozempic

16:44

or Wogovee or a drug

16:47

like that? Yeah. So, I

16:50

mean, at first I'll say like, don't feel

16:52

shame. So self-compassion. And finding somebody that you

16:54

trust, a healthcare provider that you feel comfortable

16:56

with, that you can sort of talk through

16:58

those issues with, I think would be my

17:00

first step. Next step is trying

17:03

to unpack why you want to lose weight. So

17:07

is it just something that you've been told by

17:09

some nasty

17:11

doctor at some point when you quit

17:13

smoking 20 years ago? Is

17:17

it something that your grandma says that

17:19

you should do? Is it a comment

17:21

that you had at the Thanksgiving dinner

17:23

table that sent you spiraling? And

17:27

then three, just

17:29

sort of deciding what your personal

17:34

risk-benefit ratio is, I

17:36

think, around

17:40

using a medication like this, possibly

17:43

for life. There is some research that shows

17:45

that people tend to regain weight if they

17:47

stop it, right? So if

17:49

it's important to you to lose

17:52

weight using a medicine like Ozempic, if you've

17:54

discussed the risks and benefits with your doctor

17:57

and you feel like it's a good fit

17:59

for you. then yeah I

18:02

think trying to sort of

18:04

have a conversation with yourself is this something I'm okay with

18:06

being on for the rest of my life what

18:08

does that mean for the way that I

18:10

think about food and enjoy food what does

18:12

it mean culturally for me around my experiences

18:14

with food and deciding if yeah

18:16

if it's worth it and a good camera

18:19

care doctor that you feel

18:21

comfortable with exploring those issues

18:24

is just so important to

18:26

have along for the ride well

18:30

Mara Gordon thank you so much for talking with

18:32

us about Ozempic yeah thank you so much for

18:34

having me so just to

18:36

recap a few things to think about

18:39

if you are curious about Ozempic number

18:41

one find a doctor who is weight

18:43

inclusive this could be really helpful to

18:46

have productive conversations number two

18:48

think about your goal as it relates

18:50

to weight loss do you actually need

18:52

to lose weight what are you hoping

18:54

will happen if you do lose weight

18:56

is there another way to achieve that

18:58

goal or to help achieve that goal

19:00

in addition to losing the weight you're wanting to

19:02

lose number three drugs like

19:05

Ozempic they come with some

19:07

pretty serious side effects and trade-offs and

19:09

it's worth it to weigh those pros

19:11

and cons with a doctor you trust

19:14

for more life kit please check out our other

19:17

episodes we have in fact another episode with

19:19

dr. Mara Gordon all about how to find

19:21

a great primary care doctor you

19:23

can find that at NPR org slash life

19:26

kit and if you love life kit and

19:28

you want more subscribe to our newsletter that

19:30

is at NPR org slash life kit newsletter

19:33

also we would love to hear from

19:35

you if you have episode ideas or

19:37

feedback you want to share please email

19:39

us like it at NPR org this

19:42

episode of life kit was produced

19:44

by Sylvie Douglas our visuals editor

19:46

is back Harlan our digital editor

19:48

is Malika Garibh Megan Kane is

19:51

the supervising editor Beth Donovan is

19:53

the executive producer our production team

19:55

also includes Andy Tagle Audrey win

19:57

and Claire Marie Schneider engineering support

20:00

Patrick Murray and Thematic Smith and

20:02

remarry of the Giro. Thanks for

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about this too personal? Just tell me.

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Here's the question said: Behind the scenes

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