Stop your moralizing. I grow weary of your superior airs.
I am a 60-plus-year-old physician who has led a disciplined life. Despite going to the gym two to three times a week and with an acute awareness of my caloric intake, I had been overweight for many years. I, along with nearly three-quarters of Americans, have committed the sin of being heavy. Today I have a BMI slightly above 25 and proudly wear the scarlet letter O(zempic) on my chest.
When I started glucagon-like peptide-1 (GLP-1) injections nearly three years ago, I did so in secret from everyone but my wife. Out of embarrassment, I did not go to the doctor. Instead, after considerable research, I chose an online pharmacy that promised discretion. Like my first Playboy subscription when I was younger, my medication arrived wrapped in a plain brown wrapper.
I thought I had maybe 20 pounds to lose. But once I started losing weight, I realized I was heavier than I’d thought. Looking back over more than a decade of photos on my phone, I have to question what level of delusion led me to think I only had a couple of pounds to lose. When I started my journey, I weighed 248 pounds and had a BMI of 31. I was just at the beginning of “OBESE.” I now weigh 202 pounds and have a BMI of 25.2, just tipping the scales at overweight. Though the Navy Body Fat Calculator has me at 14 percent body fat, which lies well within the “Fit” range. BMI isn’t everything. Even in this defense of my current weight, you might detect a touch of residual sensitivity.
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Ordering medications online allowed me to keep my secret. Feeling better and in my new wardrobe, I recently came out, ready to face the damning looks and judgment of those who had never struggled with their weight. At my recent annual physical, I told my doctor that I was taking a GLP-1. He was a physician who, sadly, was constitutionally skinny and maybe ten years my junior. I saw scorn in his eyes as he began explaining portion size and food choice to me. I could tell he was put off by having to deal with yet another patient who could not control their intake. Feeling superior to others, even without justification, is one of life’s little joys. I smiled and nodded as he condescendingly explained nutrition to me.
Today’s rant is fueled by the fact that, as a health plan chief medical officer, I recently attended a national conference where speakers did not hesitate to address the “GLP-1 crisis.” From the stage, my ears were filled by thin people who never struggled with their weight, who delivered the message that GLP-1 agents will take down the U.S. economy, or at least the health insurance industry. So, in addition to feeling shame for taking my medication, I can now add guilt for bringing down the economy. Suffice it to say that the cost of a GLP-1, now that it’s available from numerous sources, is almost reasonable if you pay out of pocket. (The retail cost of Ozempic is $1,000 to $1,200 per month. Semaglutide is available online for $149 per month, or less.) The unreasonable and immoral cost of drugs in this country is worthy of many more articles.
One last misperception I would like to address. When my doctor started me on lisinopril, they did not tell me my blood pressure would improve in six months or that I would stop the drug once my blood pressure was under control. When they started me on my statin, they did not tell me my lipid problem was temporary. The obesity epidemic in this country has many causes beyond a lack of self-control, including genetics, ultra-processed foods, stress, and some of the medications we prescribe. Get over it. Obesity is a chronic condition. I am doctor enough to know that my best efforts left me 40 pounds overweight and that it was not going to be fixed by a short course of any medication. I understand that I am likely on this medication for a long time. The fact that this is, as yet, unacknowledged is part of the ongoing shaming of people who use these agents.
The GLP-1 I take has reduced my weight by 45 pounds, from a BMI of 31 to 25. It has lowered my risk of heart attack, stroke, Alzheimer’s, and bad knees. It is probably reducing my need for lisinopril and a statin as well. I read articles avidly that demonstrate the health effects of losing weight. Something none of us need to be told. I look and feel better. However, I am tired of the shaming looks and judgment from those who have never been the least bit overweight.
Save me from the abuse of those who have never struggled, and I will proudly wear the scarlet letter “O” upon my chest.
Robert Pretzlaff is chief medical officer of Chinese Hospital and its affiliated health plan, Chinese Community Health Plan, in San Francisco. A physician executive with more than two decades of leadership experience, he has served as senior vice president, chief medical officer, and chief clinical officer at Henry Mayo Newhall Hospital; chief medical officer at Lodi Memorial Hospital and at Lumeris; and regional chief medical officer, then chief physician executive and president of Dignity Health Medical Group in Nevada. Earlier, he was division chief of pediatric critical care at UC Davis Medical Center.
Board-certified in pediatrics and pediatric critical care, Dr. Pretzlaff has authored 28 peer-reviewed articles and six book chapters spanning clinical research, bioethics, law, and health care finance, with work appearing in Health Care Analysis and Physician Executive.
An experienced sailor, he also writes fiction as R.K. Preston, including the novel Sea Change.
