PCOS in the Ozempic Era

Spring is springing! The transition from winter to spring is a time of transformation, both in the natural world and within ourselves, and it is a time of possibility, challenging us to remain open to change and to embrace our potential for renewal. Now is the time that the seeds we planted before winter begin to sprout, for abundance, new beginnings, and setting intentions for growth.

I've been enjoying the new tapestry of colors and flavors at the farmers market, and have enjoyed playing around in the kitchen with the bright greens and root vegetables of spring. See below for a PCOS-friendly zingy Spring Pesto pasta in honor of the season.

But not everything about Spring is so great. Along with the arrival of seasonal allergies it's also the season of bombardment with the "get your summer body" messaging and advertising in the media. This can bring up shame among those who suffer from PCOS, because the conventional "eat less, exercise more" advice doesn't work for PCOS physiology. Many of us have tried every diet out there, without losing weight, and we end up gaining frustration, feelings of failure, and mistrust in our own bodies.

As if to kick off the body shame season, on the Spring Solstice Oprah's premiered her controversial special Shame, Blame, and the Weightloss Revolution. There were times I felt angry and frustrated at the one-sided nature of her special, and wanted to share some of the science behind Ozempic, Wegovy, and other GLP-1 medications so that you might make the most informed decision if you're considering going on these medications.

I want to be clear that I'm in full support of people taking medications to manage their health, including GLP-1 medications, and there is no shame in wanting to lose weight. How could we not want to lose weight when society puts so much pressure on women to be thin? I'm not against weight loss or wanting to lose weight, but I am against the extreme measures often marketed to us that harm our physical health as well as our emotional health and well-being.

To this end, I felt there were many aspects of GLP-1 medications that Oprah either glossed over or did not discuss at all, and I believe you deserve to know the full picture before choosing to take a medication that you'll need to take for life.

Here are a few points:

Side Effects from GLP-1 Medications are common and serious ones, though uncommon are possible:

These more mild side effects often include nausea, diarrhea, vomiting, and other GI issues. Serious, but rare side effects include pancreatitis and increased suicide risk. Not fun. In one study done on Wegovy, 17% of participants in the study had to stop taking the medication and drop out because the side effects were so intolerable. 17% is a lot. I was saddened that Oprah didn't take the side effects of the medication seriously. She only briefly gave the floor to one audience member who had side effects severe enough to land her in the hospital, and after sharing her story Oprah invalidated her by asking her if she'd consider trying another brand of the medication!

The only medical professionals featured on the special worked for the pharmaceutical companies who make the medication:

The focus of the special was on people who had lost weight on the medication, and those people were glorified and applauded. While there were several doctors interviewed, they both worked for pharmaceutical companies who make the medication. I was disappointed to see that there was not a single unbiased medical professional included in the special (and not a single dietitian!)

"Food noise" is actually "diet noise"

I was disappointed in the way Oprah demonized our normal hunger cues as "food noise." It's normal to think about food, especially when we are hungry and need to eat. We see in the research that when people obsess about food to an unhealthy degree, it often means they aren't eating enough or they are trapped in a restrictive diet culture mindset and have an unhealthy relationship with food. With PCOS, insulin resistance can cause us to experience food noise in the form of intense cravings, especially for carbohydrates. Yet these cravings can be managed without medication, with gentle nutrition strategies to manage insulin resistance and learning to heal our relationship with food. Drug-induced appetite suppression isn't a path to healing our relationship with food.

GLP-1 medications are extremely expensive for most people

Not all GLP-1s have been approved for weight loss in the absence of type 2 diabetes, and since celebrities are clamoring for these medications they're in limited supply. Many people have to pay upwards of $1000 a month for these medications, and when they need to be taken for life this really adds up. Framing these drugs as a "revolution" can put a lot of shame on those that can't afford this medication, and creates an even bigger divide in the social status of the "haves" and "have nots."

Not everyone loses weight on GLP-1s, and weight loss plateaus around 15% as metabolism slows

The focus of Oprah's special was huge success stories on the medication, but not everyone experiences such dramatic weight loss. Studies show that some people don't lose weight on GLP-1s, but the average amount of weight lost is 13 pounds over 56 weeks. After that point, weight loss tends to stop. After the initial high of weight loss wears off, it might be frustrating to continue taking an expensive medicine forever

To sum it up, I was saddened to think about the additional shame and blame some might feel after watching this special, especially those who can't tolerate or afford the medication, or for whom it didn't work.

The good news is, you can manage your PCOS symptoms without going on these medications and without needing to lose weight, especially through drastic measures that could further harm your physical and emotional health. The research shows us time and time again that putting weight loss on the back-burner and instead focusing on targeted strategies for gentle nutrition for PCOS, moving our bodies, managing our stress, and getting enough sleep can lead to symptom reduction and even elimination in PCOS. And once the underlying metabolic and hormonal issues are addressed, your weight will fall at the right weight for your body and genetics.

xoxo,

Vanessa