Oprah's Special on Weight Loss Medications: Practical and Psychological Considerations

Some of you may already have watched Oprah’s recent airing of "An Oprah Special: Shame, Blame and the Weight Loss Revolution". At Health Psychology Partners (HPP), many of our clients struggle with eating and weight challenges – so we have some thoughts on this topic!

Firstly, we were impressed by the show’s comprehensive discussion about weight, including weight stigma. Oprah shared her own experience navigating internalized weight bias and self-blame over decades, setting the stage for show guests to recount their own struggles. We also heard from a 14-year old girl who was bullied at school for her weight from a very young age; her mother even notes being mistreated by other parents, who felt that she was "to blame" for her child’s weight. These stories highlight the sad misconception that weight and weight loss are purely a matter of willpower. Do lifestyle factors matter? Of course. But the same is true of all other chronic diseases. We don't hear people commenting about how someone with asthma needs more 'willpower'.

Which brings us to our second takeaway from the show: medical management of obesity through use of anti-obesity medications can be a game-changer…for those who can get them.

For example, weight loss trials testing the now widely-known drug tirzepitide (Mounjaro, Zepbound) show up to 20-25% weight reduction over the course of 17 months. But weight loss isn't the only outcome worth noting. In March of this year, the FDA cleared Wegovy (same compound as Ozempic) to reduce the risk of cardiovascular death, heart attack and stroke in adults with cardiovascular disease and either obesity or overweight. There are risks associated with their use and we, at HPP, believe that close monitoring by a well-trained obesity medicine specialist and behavioral health specialist is of paramount importance. This type of thoughtful monitoring is particularly important for anyone with a history of disordered eating, as there can be many triggers that come with weight loss from some of the available medications. And because these and similar drugs are expensive and too often not covered by insurance, and production issues have made access difficult, presenting both an ethical dilemma and ongoing challenges that must be worked out over time.

Finally, we at HPP appreciate Oprah’s closing message, that one’s approach to weight management – including whether to attempt weight loss at all – is deeply personal. As HPP therapist Kathleen Semansky, LPC said, “we can all choose whatever path fits us best…Oprah’s message seemed like a very polite way of telling people to mind their own business.” We couldn’t agree more. Our goal at HPP is to help clients cope with the many struggles life presents; while overweight and obesity can be a source of stress, with knowledge and the right type of support we hope it doesn’t have to be.

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