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:
It’s not uncommon that I hear people say things like, “I wish I had never started this GLP medication.” And I want you to know that if you’re feeling that way, it’s okay, but we need to talk about that because sometimes the regret is about the medication itself. But a lot of times when we dig a little bit deeper, it might be regret about how we started the medication, maybe where we got it, the expectations we had about our journey, the support we did or maybe didn’t receive, or what happened if we stopped the medication. So I want you to know that if you’re experiencing regret and you’ve taken a GLP medication, that that is a legitimate reaction to any situation in your life, but certainly to a major medical decision like using a GLP medication. And the goal is not for me to say, “Hey, just forget about it and move on,” but for us to really take a look at, well, what is it that you regret?

And then most importantly, how do we shape that for moving forward so you could really take the best care of yourself in a long-term way, whether that means continuing, resuming, or staying off of a GLP medication? I want you to know that if you’re feeling regret today, it doesn’t mean that your original decision is wrong. There’s that very common saying that hindsight is twenty twenty, and this is always true. When we look back on an experience, it changes the way we evaluate those past decisions. But a lot of times at the time of making the decision, you are making the best decision that you could with the information that you had available to you at the time. So my goal is not that everybody in the world should be on GLP medications or that they shouldn’t. My goal is that you come out of this episode understanding what is best for my body if the first time around or what I’m doing right now isn’t working or hasn’t been working for me, is there an opportunity for me to change directions and make things look a little bit different?

So I want to start out by talking, what is it specifically that you regret? Because that will help to determine what the next steps are. There’s a lot of difference between I regret ever taking this medication, I regret the way I took this medication, I regret that I stopped the medication and what happened. I regret that I didn’t understand what I was signing up for. So let’s talk about one of the most common things that I hear. And I had a patient say to me in practice just the other day, she said, “I went to my primary care physician and she said, Oh, why are you seeing that weight loss doctor? I could just take over that GLP prescription for you.” And my patient was like, “Are you kidding me? The support that I have gotten from Dr. Stombaugh, I cannot imagine doing this experience without that level of support.” And in our practice, that’s what we’re doing.

We’re seeing patients incredibly frequently, at least monthly at the beginning of their journey in order to make sure that they get the support they need as they are starting and escalating these medications. But that is not the experience for everybody, whether you’re getting this prescription from your primary care physician, which I’m not saying that that’s a bad decision, that might be a perfectly appropriate decision, but maybe you’re getting it from them and they’re not used to prescribing these medications or don’t have other suggestions for support around side effects or how to support you in that journey. Maybe you got the medications from an online program. Maybe there was minimal medical evaluation required, you filled out a form and a box arrived on your doorstep and you felt like you were really alone in the journey. Maybe you were getting it from a medical spa in town and you were going in weekly and getting shots or maybe picked up the vials and were doing it on your own, but really felt like that, felt like I am on my own in this journey.

It is a very different experience to have a level of support in your weight loss journey versus feeling alone, feeling really isolated, which can lead to a lot of confusion and certainly can be a reason that people regret taking the GLP medications. So the regret isn’t, okay, I regret I took a GLP medication. It’s, I wish I had been better cared for when I took a GLP. And that can come from a lot of different people that might be seeing an obesity medicine physician like myself. It might be getting the prescription from your primary care physician, but you’re also working alongside with a nutritionist, with a health psychologist, with other people who are helping support you in your journey. But most importantly, that when you have questions, when you have issues, that you know, I have people that I can turn to to help address these questions for me and that you don’t feel like you’re floundering and that you’re alone.

So if that’s coming up, definitely there are opportunities for us to do that differently. Maybe it means restarting the medication or just continuing with where you’re at on the journey, but shifting things in a different direction with a different care team. So that might look very different. Now, one thing, especially over the last three or so years that has been coming up is the role of compounded medications in the GLP space. And so there’s people who have some regret of, okay, I had maybe a questionable counterfeit or a poorly sourced medication or they were taking a compounded medication. They’re like, it did nothing for me. I think one of the biggest challenges is that the compounded medications, I mean, we could talk about this honestly for hours upon hours, but what is true is that there are two main medications, two main GLP medications that are available on the market right now.

There are the semaglutide medications that is brand name Ozempic and brand name Wegovy. Then there are the tirzepatide medications that is brand named Zepbound, brand name Mounjaro. A few years ago, there was increased popularity of these medications and supply could not keep up with the demand for the medications. So we ran into really significant shortages across any and all of these brand name medications, which opened up the realization that there is an FDA loophole that says even though all of these medications are branded, they’re on patent, so Ozempic, Wegovy, Zepbound, Mounjaro, that legally you can have these medications made in a compounded way in order to meet that supply because the demand is so high and the branded medications were not able to keep up with supply. What is true is that that just got wildly out of control and the compounding medication space is everything from very well recognized, well ethical providers who are sourcing medication, testing their medication regularly.

They are guaranteeing the purity and the potency of their medication to people buying very wild peptides online and mixing it up in their own house and everything in between. And it can be a very scary space. And one thing that I’m running into a lot, especially in my practice now, is that someone will say to me, “Oh yeah, I took semaglutide for a while or I took tirzepatide from a while and I got it from this online pharmacy or I got it from this med spa or I got it from wherever. It’s not Zepbound, it’s not Mounjaro, it’s not Ozempic, it’s not Wegovy. It was one of these compounded medications and it just didn’t work for me.” And so the question that we’re asking then is, well, were you actually even taking what you thought you were taking? Were you taking what was a 100% chemical copy of the brand name medication?

And what’s wild is a lot of times the answer to that question is no. And it is not uncommon in my practice that I will encounter patients who say, “Yeah, I did that and it just didn’t work for me.” And I’m like, “Hey, let’s start again on one of these brand name medications. Are you open to trying again?” And if they are, we restart their journey with a brand name medication and their experience is entirely different. And so a lot of times there may be regret because you might be thinking, oh my gosh, this whole time I was paying a lot of money and was I even getting a legitimate product? And I don’t know the answer to that, but it can create a real sense of vulnerability, maybe a sense of shame. I was injecting something into my body and now I’m not even completely confident about what that was.

And so if that’s the type of regret that you have coming up, if you’re not sure, if you had that experience of using a semaglutide, using a tirzepatide, one of these compounded medications and maybe having a side effect or not having effectiveness from it or just not having a good experience with that medication, it may be worth considering would this journey look different given a second time around with a brand name medication? And so that can be a really important conversation to have with your physician. I think another really common regret that comes up is that starting the weight loss journey, we maybe have an idea of the number on the scale. We’d like to lose 20 pounds, 50 pounds, 100 pounds, whatever that looks like. And patients lose weight, but there are consequences of what that does to their body. And it might look like realizing, oh my gosh, my face looks thinner and people are saying I look older.

People are asking me, oh my gosh, are you okay? Do you have cancer? You look really bad. Or, hey, I’ve lost muscle. I’m noticing hair shedding. I feel weak. I don’t feel good in my journey. And I want to talk through that because having chronic excess weight on your body and then having weight loss will change the way your body looks. Now, a lot of times we blame the GLP medication for this, but the reality is it is not really the GLP medication that’s the problem. It is the rapid weight loss that is creating these problems. And so whether you’re talking about bariatric surgery, whether you’re talking about another non – GLP medication, maybe you’re talking about a intensive dietary regimen, for example, someone who has extreme and rapid weight loss is likely to see other effects of that in their body and not always really positive effects.

And so it can come up where people have hair shedding or loose skin or feeling like they’re weaker and it can be really hard to reconcile, okay, now I’m seeing a number that’s lower on the scale, but wow, I’ve got this really loose skin on my abdomen or on my legs that I am embarrassed by or I don’t like, or wow, all my hair feels like it shedded during this weight loss journey. What I want to offer to you is that your human body is absolutely amazing. Your body is always shifting, always evolving, and sometimes there are scars from things that we have been through in life. Sometimes there are physical scars, sometimes there are mental scars of having dealt with chronic obesity for a long time in our life. And if we’ve lost really significant weight, it is incredibly common that you will have loose skin.

And in this world where a lot of people are losing weight and a lot of people are being very open about their journey, what we’re seeing is that there are amazing ways that we can. Jeans that cinch up really high, swimsuits that cinch in the back, as well as learning to embrace, learn, and love our bodies for the way that they have served us. There are also things like plastic surgery for skin removal surgery, especially if it’s really distressing to you or if it’s creating other issues. Sometimes patients will have loose skin that creates a flap on their abdomen and they might deal with issues like getting skin infections and that can be really bothersome to deal with. So it absolutely may be appropriate for any reason, even if you just want to, to consider, does it make sense for me to have plastic surgery?

If you’re looking at though on the other side of things like hair loss, things like feeling weak, the good news is that your body is ever evolving and ever changing. Let’s say that you did not emphasize protein during your weight loss journey. Let’s say that you did not do any activity, you were not doing exercise, you were not doing any sort of resistance training like weightlifting, and you did get weaker during your weight loss journey. I’m here to tell you that that is okay and we can meet you where you are at right now and help you to rebuild that. Your muscle can rebuild, your muscle can grow, and you have not ruined your body. Your body is ever evolving and ever changing. And my goal for someone in this situation who’s like, “Yikes, I did this med and now I’m having these problems,” is how do I meet you where you are and then help to strengthen your body, energize your body, whatever it is that we need to do to nourish and support your body, we can move your body back in the direction of a way that it feels good, it feels energized, it feels nourished.

And so successful obesity treatment should be about improving not just the scale being as low as possible, but how do we improve both your health and your function and help your body feel really good. Another regret that I see coming up is that people stop the medication and they regain maybe all of the weight and they wish that they had never started it in the first place. And I think this is one of the most emotionally complicated forms of regret. They lose weight, 60 pounds, 70 pounds, 100 pounds, whatever it looks like. They’re feeling better, their clothes are fitting differently, their food noise decrease, their health markers are improving. So maybe they don’t have prediabetes or high blood pressure or whatever it looked like beforehand, and then they stop their GLP medication and it just all comes rushing back. All of the other things that they were dealing with, they feel hungry all the time, their blood sugars start going up, their weight starts increasing, and it’s like, “Why did I even do this in the first place?

I feel like I’m right back where I started and somehow it feels worse knowing that I feel like I’m going backwards from where I was.” And this weight regain in this way can feel incredibly painful after having a significant weight loss. Maybe you’ve been getting comments from people in your life where they’re like, “Oh my gosh, you’ve lost so much weight.” And now they’re like, “Oh my gosh, did she gain weight?” You’re worried that people are noticing and maybe they are, maybe they’re not, but it can be almost embarrassing and like, “Okay, I failed. I didn’t lack the willpower. Maybe I ruined my metabolism with the medication. I should have never taken it in the first place.” And what I want to offer to you is that this medication is generally designed as a long-term medication, but you as the patient, you are the boss of your own body, so you get to decide what does it look like to take the medication or to not take the medication.

If you experience weight regain, it may be a sign to you, okay, obesity is a chronic disease and I need to continue to treat it chronically with medications as well as those other lifestyle interventions to continue to support my long-term weight and health goals. And it might make sense in the situation that you’re sitting down to work with an obesity medicine physician. I think very commonly I encounter patients who are like, “Okay, I lost the weight and then my doctor started weaning me off of it,” and that’s okay. If you are losing more weight than you need to, maybe the patient is really saying, “Hey, I want to try to get off this medication and we’re going to attempt to wean.” I am all for supporting a patient in that, but the goal should not be to stop the medication, especially when that’s driven from someone else.

So if you are feeling pressure from your physician or whoever your prescriber is to stop the medication now that you’re in goal weight, I worry that you’re not getting the support that you need and working with someone who understands obesity as a chronic disease, something that requires long-term management is going to be life-changing for you. Another regret that people realize is that they started out and they didn’t realize it was going to be long-term. So this is something sort of tailing off the previous one, you already stopped the medication, but sometimes people are starting it and they’re like, “Whoa, this cost a lot of money. I didn’t realize what this commitment would be.” And they’re not sure if they can continue to take this long-term. And so there can be this regret coming up even in the middle of their journey of like, “Whoa, what have I decided to do?” And it doesn’t mean that everyone who starts a GLP has to remain on the exact same medication or the exact same dose forever, but I do think it’s important when you’re starting out that you realize, “Hey, this could be a long-term medication.

This is designed as a long-term medication,” and that you have a team of people who can help you in supporting you, not just on day one or month six or month 12, but what does it look like two years from now, five years from now, and do you have that team who continues to support you in a long-term way? So if you are having any of these regrets or even any others, I want you to think about what can we do next? First, I want you to get really clear on what it is that you regret about the journey. Maybe it’s one of the five things that we talked about, or maybe you’re having another regret that I didn’t even talk about here. Feel free to shoot us a message or leave us a comment about some of those other regrets that have come up.

And I want you to be really clear about what specifically is it that you regret and then ask what specifically do I wish I would have done differently? Sometimes, like I said, hindsight’s twenty twenty and we made the best decision that we could at the time that we made the decision. And so you do not need to beat yourself up endlessly about the decisions that past you made, but the question becomes, okay, with where I am at right now, what is it that I can do moving forward? And I think in this episode, more than any other one, I have said work with an obesity medicine physician. And previously too, I have so much respect for the primary care physicians and the OB-GYNs and the sleep medicine physicians and the cardiologists and the liver doctors and everybody else who is prescribing these medications and changing people’s lives.

And there are patients who may need more support and that is okay. If you feel like you do not have the support that you need from your current prescriber, I want to encourage you to get the support that you need. I would love to see you as a patient in my own clinic. I see patients in person in Charlottesville, Virginia and throughout the states of Illinois, Tennessee, and Virginia by telemedicine. You can learn more at www.sarahstombaughmd.com. If you are not in one of those states though and you’re like, “Oh shoot, I wish I could work with a doctor like you,” I do have a great online program called the GLP Guide, which is a great online resource that has videos addressing all of these frequently asked questions. So when you are in your journey and you feel like you’re floundering, you’re looking for more support, that is a great tool to feel empowered in this journey.

You can also go to the ABOM, the American Board of Obesity Medicine, and look for a physician. Someone who is certified in obesity medicine near you can be a helpful tool as well. Thank you for joining us for this week’s episode. Make sure to like and subscribe, share this with those in your life, and I’ll see you all next week.