Using GLP-1s at a normal BMI? There are benefits and risks : NPR

After deciding to try running a half marathon in all 50 states, Christie Woodard completed one in Las Cruces, New Mexico, in 2023. She strives to stay fit and strong since undergoing bariatric surgery for obesity and taking GLP-1 medication to maintain a healthy weight.

Christie Woodard

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Christie Woodard

At just over 5 feet 5 inches tall, Christie Woodard weighs 125 pounds. She is also open to the idea of ​​using low-dose GLP-1 to maintain her weight. She says sometimes people wonder why she takes this medication, “because they look at me and think I’m a healthy weight, or maybe they even think I’m thin.”

What people don’t see are Woodard’s past struggles with obesity, which began in his 30s and left him weighing 260 pounds. She started running half marathons, but at that weight it was painful.

“I wasn’t fast,” she said. “I was having huge problems; I was in physical therapy all the time. I tore my meniscus.”

Woodard, now 53 and living in Easton, Md., had gastric bypass surgery four years ago and cut her weight in half. Delighted, she set a goal of completing half marathons in all 50 states.

Her weight remained stable until last year, when the pounds began to fall off, despite following a strict diet and lots of exercise.

“I feel it in my knees, and especially in my soul,” she says. “I feel it in my confidence. It bothers me a lot. I was terrified of going back to the way I was.”

So her bariatric surgeon, Dr. Betsy Dovec, prescribed her a low dose of the drug Zepbound, even though Woodard’s body mass index didn’t technically classify her as overweight.

Dovec says Woodard isn’t his only normal-weight patient on GLP-1. “I prescribe medications to all types of people,” she says. However, she points out, she doesn’t give drugs to people for purely cosmetic reasons, such as someone trying to lose a few pounds before an event.

GLP-1 drugs are intended to treat metabolic diseases like diabetes and obesity. But as they become more available, some people who aren’t overweight are seeking them out, sometimes just to lose weight. Medicines – although still expensive – are becoming cheaper and available in pill form. There are also many online sellers offering GLP-1 and compounded versions of it, making it relatively simple to obtain a prescription for people for whom they are not medically indicated.

It’s controversial, as are many issues surrounding weight and weight management.

But Dovec says that characterizing the use of these obesity drugs for people who are normal weight or slightly overweight as purely “cosmetic” ignores the various circumstances patients face. The drugs treat more than weight, she says: They address metabolic diseases like diabetes or high blood pressure. Some doctors prescribe them off-label to manage alcohol use disorder, which these medications appear to help in some people.

And obesity is a chronic disease, she says, so some patients like Woodard may need multiple strategies to help manage their condition, including surgery, diet, exercise and GLP-1. Dovec says these are not medications intended, for example, to start a diet. She says she hasn’t had patients sue them for these reasons, or abuse them to the point that their body mass index falls below normal. “I’ve never seen that in my career,” she says.

But Dr. Jennifer Manne-Goehler — an obesity specialist at Mass General Brigham and consultant to the World Health Organization – worries that people will access it and treat yourself to achieve a slimmer ideal.

And that carries some risks. In particular, she notes that people using GLP-1 tend to lose muscle first, but regain fat when they stop taking the drug. Periodic use therefore creates the potential for yo-yo dieting effects known to be harmful to the body.

“I think the problem with giving this drug to people who really have no indication is that they assume all the risks,” more the risk of gaining weight again, which can be harmful to their health,” she explains.

There are also risks to taking these medications for people with eating disorders, especially since patients are not evaluated for these disorders when they are prescribed GLP-1 medications.

Christie Woodard is no stranger to these controversies — and the judgment around weight and weight management. At first, she was ashamed to admit that she needed GLP-1, especially since she had already undergone weight loss surgery. “At first I didn’t tell anyone. I felt like I had failed,” she says.

But she eventually realized that surgery alone did not eliminate the disease of obesity, which in her case also meant that hunger hormones were conspiring to prevent her from maintaining a healthy weight. “We don’t judge people who take statins for cholesterol,” she says. “Why should GLP-1 be any different?” »

Woodard, who runs human resources for a large company, says her new perspective helped her successfully advocate for including GLP-1 coverage in her employer’s health insurance plan, which she says is not the norm.

In pleading her case to her boss and the insurer, she used herself as an example: thanks to taking medication, she now requires far fewer doctor’s appointments, physiotherapy and medications to manage various obesity-related illnesses. “The company I work for doesn’t pay any of that anymore,” she says.

Plus, Woodard says, feeling in control of her weight makes her much happier and more successful in everything she does.

“I can wear whatever I want and the confidence is there,” she says. “It shows in everything I do, whether I’m negotiating rates with our health insurance company, talking to an employee about a delicate situation, or negotiating something with my boss.”

To date, Woodard has run 34 half marathons in as many states – and is confident she can finish the rest.