Friday Q&A: On Ozempic; Alcohol; Hormones & Breast Cancer; & How to Ask for Help

You ask the best questions!

It’s Friday Q&A time! Click here to submit your questions for future posts!

The first question (about Ozempic) is free for everyone. The remaining questions (about the NYT article on alcohol; HRT; and mental health) are for paid subscribers.

Photo by Jon Flobrant on Unsplash

Let’s dive in.

QUESTION #1

What do you think about Ozempic? I’ve heard that it is very expensive and has bad side effects. I have 20-30 lbs I’d like to lose but having a really hard time doing that. I am 68 and in very good health and I get moderate exercise. - Debbie

Dear Debbie,

Ozempic has created quite a buzz. Naturally I’m getting lots of calls about it. I’m also seeing a worrisome amount of misinformation and inappropriate messaging about it.

Here’s how I think about Ozempic: It is a wonderful addition to the broad array of tools we employ to help people manage weight. But it’s not a panacea. Just like any medication, appropriate usage requires a firm understanding of the data and the patient themselves.

I have written extensively about weight and my strongly-held position that obesity is a symptom, not a diagnosis. Our weight is the integrated sum of the societal, genetic, hormonal, behavioral, nutritional, and psychological factors. Therefore, helping a patient lose weight (if they need to for medical reasons) requires a 360-degree understanding of the patient at hand. 

We treat the patient, not the number.

The idea that we can address extra weight with a single medication like Ozempic is to deprive patients of a nuanced understanding of the complex array of issues that inform the number of the scale. That said, in conjunction with other treatment modalities (from adjusting our physical activity and eating habits to cognitive behavioral therapy and mindfulness techniques), Ozempic can be an very effective tool for weight loss if needed.

I have many patients taking it. The Ozempic success stories are happening for my patients with appropriately managed expectations of what a pharmaceutical can and cannot do — and who have an arsenal of tools (not just prescription meds) to navigate the various “levers” that determine our weight.

But not every person who struggles with weight should be on it. Ozempic has risks and potential side effects including cost and gastrointestinal woes. What’s even more risky, in my humble opinion, is depriving people of a nuanced conversation about their health. To the extent Ozempic can help people in the appropriate context, I’m all for balancing risks, a patient-centered approach, and helping people get healthier, inside and out.

I hope that is helpful! My newsletter series about weight loss are linked in here, here and here.

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QUESTION #2

What are your thoughts on the recent NYT article suggesting that ANY amount of alcohol is unhealthy? Yikes! - Cailyn