Dr. Sarah Stombaugh:
This is Dr. Sarah Stombaugh and you are listening to the Conquer Your Weight Podcast.

Announcer:
Welcome to the Conquer Your Weight Podcast, where you will learn to understand your mind and body so you can achieve long-term weight loss. Here’s your host, obesity medicine physician and life coach, Dr. Sarah Stombaugh.

Dr. Sarah Stombaugh:
Imagine this. You have spent months thinking about being on a GLP medication, you made and then waited for the appointment to see the physician. You maybe argued with your insurance to get the medication approved, and now you’ve got Zepbound, you’ve got Wegovy in your hand, you’re ready to give yourself your first injection and you’re like, “Oh my gosh, I am terrified to do this. What was I thinking? What am I doing? Am I actually going to move forward with this decision? Do I really actually want to do this?” And whether you’re truly at that stage of medication in hand, feeling afraid, or if you’re just at the earliest stages of exploring, okay, would a GLP medication be right for me and my health situation, I just want to normalize that it is okay to be afraid. It is important even to go into any sort of medical decision with caution and to make sure that you understand what is the medication, what are the potential risk of this medication, and what are the potential benefits that I can be experiencing?

Because starting a medication feels very different when it’s actually in your hand, you’re ready to give yourself your first injection rather than earlier on in the journey. A lot of times you might be having fears like, “What if I have terrible side effects? What if something bad happens to me long-term? Am I going to be dependent on the medication? What are other people going to think? What if I start it and it doesn’t even work? What if I lose weight and then gain all of the weight back?” And our brain sometimes can just really spiral. So I want to go through each of those fears and help you to address those to figure out, okay, what is it that you’re actually afraid of and how significant is that fear? How seriously do we need to take it? And what does it make sense to think about from a long-term perspective for that?

So it comes up very commonly that people are afraid of side effects. Now, whether we’re talking about short-term side effects or long-term consequences, it is very common to experience these side effects, certainly. So many of the common minor side effects, things like nausea, things like diarrhea, things like constipation, things like headaches, it is common that people will have these side effects. What is also true and what we’ve seen in the clinical trials is that these are side effects that are generally mild, generally tolerable, and generally diminished over time as a patient gets used to being on the medication. But a lot of times we hear about much more scary side effects. We hear about gallbladder problems and pancreatitis. There’s a lot of conversation right now about hair loss. And I’m not saying that that can’t happen, but people really catastrophizing what that looks like. Hearing about people who have severe gastroparesis, that means frozen stomach, people who’ve end up in the hospital or maybe even died.

And headlines and social media are a lot of times about these rare complications. And especially with the way our algorithms are set up, a lot of times if you go searching, or maybe you’re not even searching, you’re just looking at GLP content and someone starts talking about a side effect and you’re like, “Oh my gosh, this sounds really scary.” So you watch the video in its entirety. Maybe it’s a minute long, maybe it’s three minutes long, but you sit and you’re engaged with that entire video. The algorithm’s like, “Oh, they just watched that entire video. They must want more content about all of the different side effects that can come up from GLP medications.” And it is not uncommon in my practice that I will have patients start bringing me a long list of very obscure side effects and saying, “Oh, I watched this video and I heard about this thing and what do I need to know?” And it’s like, “Whoa, your algorithm has fed you all of this information.”

And I’m not saying that you shouldn’t be well-informed, but your algorithm is just shooting all of the scary stuff at you and you are going to be much full served to go look at content about refinishing furniture or room decor or how to fit car seats in your new car or some sort of parenting thing.” Whatever your other interests are, I need you to spend some time looking at that content on social media and redirect your algorithm because your algorithm is scary. A lot of times your algorithm can send you information that can be really, really concerning. And I want you to imagine if someone’s starting their GLP journey and they’ve decided to document that on social media, there might be someone, probably many, many someones out there who make a video like, “Hey, today I took my first injection of Wegovy, my first injection of Zepbound and I feel fine, maybe a little nauseated, but overall I feel okay.” They are not going to get a lot of engagement on that video.

Maybe if they had some sort of huge following otherwise, they’d get a little bit of engagement, but that is really boring type of content. Now, if someone shows you them feeling very sick, there’s a B-roll video of them vomiting or in a hospital gown and they’re like, “I experience this rare side effect from a GLP medication. Make sure you watch this video so that you can protect yourself in your GLP journey.” All of a sudden you’re like, “Oh, well that sounds like something I should pay attention to.” And so you watch that, other people watch it, they like it, they comment, “Oh my gosh, are you okay?” And there’s a lot of engagement. And so that type of video might have tens of thousands, hundreds of thousands or more types of views and it gets pushed further up in the algorithm. So again, not that you should bury your head under the sand and not be aware of the side effects, but this is where having a really good conversation with your physician of what are the most common side effects?

Here are some of the rare side effects I’ve heard of. Can you help me to understand these? And if I’m at increased risk of them, having that conversation with your personal physician is going to be one of, if not the best tool for understanding it because you are very, very, very unlikely to experience some of those more severe side effects, but that is a conversation that you deserve to have one-on-one with your doctor and not fed to you based on any sort of sensational social media or other media post. There’s also a lot of fear about long-term effects from it, and that is an entire topic for a different day. But again, bring that up with your one-on-one physician. Do not get that information from social media. I think another fear that comes up very commonly is, oh my gosh, what if I become dependent on this medication?

And when we use that language, I really want to point out that that sounds like drug abuse type language or any sort of substance abuse type language where we’re actually talking more about addiction and dependence, and that does not apply in the setting of a chronic disease treatment. When someone is talking about their asthma, for example, they don’t say, oh, I’m dependent on my albuterol rescue inhaler, I’m dependent on my daily steroid inhaler. They just say, I have severe asthma. I use this daily steroid inhaler and I use my albuterol when needed and it saves my life. When someone has hypertension, they don’t say, oh, I’m dependent on my high blood pressure medications. They just treat their high blood pressure and they say, oh, I have high blood pressure, but I take these medications and that helps keep it in control. So this dependent word is even problematic, and I’m using this word because a lot of times that’s the word that I see.

And so I just want to shift that that is probably not the best question to be asking, but you might be asking, okay, what if my body needs this medication? And to that, I will say, so what if it does? I do want you to be aware that generally we think about GLP medications in a long-term fashion. Obesity is a chronic disease process and using medication to chronically treat a chronic disease makes a lot of sense. Now, what I want my patients to be aware of is that you don’t have to commit to taking this medication for the rest of your life, but I want you to at least be open to the idea of it. One of the things that I see very commonly in my practice is that people who have this hesitation of like, oh my gosh, do I have to take this thing forever?

They start the medication and they’re like, oh my gosh, can I take this thing forever? I never want to stop taking this medication because I feel so much differently, so much better in my body. I do not want to lose that tool. So I want you to be open-minded to it at least and understand what does it look like and having that conversation with your care team, with your prescriber of what will this look like for me and for my own health journey? Another very common question that comes up is what are other people going to think? We know that weight and obesity and weight loss is tied to a lot of judgment, and you’ve heard me talk about it before, but weight is such a challenging condition because we wear it on the outside of our body, unlike almost any other health condition that people are facing.

And so when you lose weight, people in your life may notice and they may comment. What I want to offer to you though, and I’ve said it before and I’ll say it again, you are not obligated to disclose your medical treatment to everyone who asks about your weight. Your weight and how you are treating it is nobody else’s business. So you can share that with people in your life if you want to, but you do not have to. What I will often offer to patients is if you think about any other health condition, if you had high blood pressure, if you had depression, who are the people in your life that know that you’re taking a high blood pressure medication? Who are the people that know you’re taking an antidepressant medication? Those are the people that you may want to consider, you trust them enough that you’re sharing this other health information with them.

You may want to consider sharing that you’re on a GLP or you’re on a weight loss medication. You may want to consider sharing it with those people as sort of a general rule, but you do not owe anyone an explanation and you can redirect that conversation. So when we think about judgment, my best advice to you is do not disclose it to the people in your life who you know are going to judge you. I think another fear that comes up very commonly is what if this doesn’t work? I think especially at this point, there’s so much evidence for GLP medications. We’ve both research-based evidence, but then also just the social proof of you know probably a lot of people in your own life who’ve taken a GLP medication and if they’ve had positive effects, if they’ve lost weight, it’s been life changing for them, you might be afraid like what if that’s not my experience and what if I fail this as well?

I’ve failed this diet, this is just another thing. Is it just going to be another thing that doesn’t work for me? What if everybody else has this huge success on this medication and I am uniquely broken and I do not have the response to medication? Now what I want to say to that is we don’t know until we start and we can look at the clinical data. So we can look at the trials for Wegovy, we can look at the trials for Zepbound and we can say, okay, what happened for the average individual? Maybe they lost 15%, 20% of their starting body weight. Well, what does that look like for you? What would be a realistic estimate? And as you’re going in your weight loss journey, are you on that trajectory or not? There are people who are not responders to this medication and that is not a sign of personal failure.

That is a sign that this is not the right tool for them. What’s amazing is that the time of this recording is fall of 2026 and so much is changing in the world of obesity medicine. Within the next three years, we are going to have so many more medications beyond just the GLP receptors or the GLP – GIP receptors to help treat people with obesity. So let’s say you start it and it doesn’t work. Well, so what? Maybe we get to choose another medication or another intervention for you. So this is where having a care team that you’re checking in with regularly, having that comprehensive support where you’re working on nutrition, you’re working on exercise, you’re addressing other health issues that are coming up, like maybe there’s a sleep disorder to be treated, the psychological intervention and the day-to-day behavioral choices that you’re making, all of those things will be helpful in providing that comprehensive intervention and your response to the medication is not a direct reflection of you as a person, but rather your underlying physiology and do we have the right tools at this stage to meet that?

Generally, yes. And for some people, the answer to that at this time is no, but that is something that is ever evolving. I also get a lot of people who are afraid of what if I lose the weight and then I regain it? Now I do want to say, as we’ve talked about, this is generally considered a long-term medication. And so going into it, you are the boss of your body. You get to decide forever, am I taking or not taking a medication? But generally will want to be thinking about these medications in a long-term fashion and stopping the medication often will cause weight regain. What I want to offer to you though is that if you’ve struggled with your weight for any period of time, you have likely been through other dietary inventions, other weight loss attempts where even if you’ve lost weight and you’ve had weight regain, you are okay and we can help you through this next intervention.

This time can look different. You can look back and say, okay, what went well about that journey and what didn’t? What would I do differently? And this time around, I want you to feel confident that you have maybe both the medication, these GLPs have been life-changing for so many people, as well as the other support so that you’re going into it with the best plan possible. When a medication fails you, if you have weight regain, I want you to know that that is not a you problem. That is our failure to fully understand and treat the human physiology that you are dealing with. And sometimes I’m so humbled in medicine because we know a lot. We know so, so much. And it was only a hundred years ago that we did not yet understand insulin and type one diabetes was a deadly disease. 150 years ago, we were routinely bloodletting and didn’t yet fully understand germ theory and weren’t even washing our hands.

That is not that long ago in human history. It is amazing how much we do not yet know how much we are learning and five years from now, 10 years from now, 20 years from now, a hundred years from now, what we will know. And so if you are struggling, if the medications aren’t working, if you regain weight, is that a personal failure or is that a failure of our medical community to fully understand obesity as disease process? And if you are not working with physicians who think about it in that way and you’re feeling a lot of blame or you’re feeling a lot of shame, I want to invite you to get a care team who is going to partner with you, help you feel empowered and eliminate any of that shame or blame that you might be feeling. So you’ve got that medication in your hand, you’re ready to get started.

It is important that you are cautious. You should make an informed choice, but I do not want you to be afraid. If you are looking for someone who could help support you in your weight loss journey, that when you’re staring at that med, if you want to send a message to your doctor saying, “Oh my gosh, I’m afraid of this med. Should I start it? Can you remind me of the risk of X, Y, Z side effect?” I would so love to be that person in your life. My patients will tell you over and over again, “I have gotten these type of messages of Dr. Stombaugh, I’m holding it in my hand. I can’t do it. Will you remind me of the potential benefit of the medication?” And I would be so honored to walk alongside you in your weight loss journey. I see patients in person in Charlottesville, Virginia and by telemedicine throughout the states of Illinois, Tennessee and Virginia.

If you’re looking for more support, find my website at www.sarahstombaughmd.com. Thanks for joining me today. If you’re on YouTube, please like, subscribe, and share this video with those in your life. I so appreciate you being here. I’ll see you all in the next video.