My Weight Loss Injection Diary: Ethical Considerations

I have questions …

I started semaglutide weight loss injections at the end of December. Since then, I’ve been learning about the process and thinking about why it gets such a bad rap in the weight loss community. There’s a stigma around using injections to lose weight. It seems like more people are opening up about using medication for weight loss, but there’s still judgment around those disclosures.

The Ethics of Weight Loss Medication

I do have some questions about the ethics behind weight loss programs and prescriptions. It’s important to consider the diet culture that surrounds the process. Since I’m new to it all, I can share my own experience.

No Eating Disorder Screening

I wasn’t asked any eating disorder screening questions during my consultation. Not one. That leaves me with some concerns about the process. I feel like it would be easy for this medication to be misused by people with body image issues who aren’t actually overweight.

As a former therapist, I understand that weight loss medications can present danger for clients who have eating disorders — and can even be dangerous for people who don’t realize their diet tendencies are considered disordered eating. Without some type of screening tool, how can doctors possibly prescribe responsibly? There’s always the risk of a medication being abused, but it still seems like there should be some due diligence in the initial consultation process.

BMI as the Standard

The consultation took place over the phone, and while there were questions about my body weight and height, the BMI is known to be an outdated and ethnocentric standard of health. It simply doesn’t say anything about our overall health or level of activity, and it can influence healthcare provider perceptions about the root of our problems when bias is involved. For instance, a person who weighs more might have their health concerns dismissed as being weight-related rather than investigated for other causes.

Caloric Intake

Additionally, it was suggested that I eat only 1,000 calories per day. Yet, every scientific resource I found online suggested that adults need, on average, 2,000 calories a day for weight maintenance and 1,500 or less for weight loss. In fact, medical professionals suggest that eating 1,000 calories a day might work for a couple of weeks for weight loss, but it can have serious health risks and could even trigger weight gain. The suggestion of a 1,000-calorie diet strikes me as being results-oriented rather than health-oriented, which is a common criticism of these kinds of weight loss methods.

In case you’re wondering, I am not following that caloric suggestion. It doesn’t seem healthy to me — and my research into the issue agrees. Instead, I am making healthy choices for the calories I choose to consume. I tend to eat around 1,200–1,400 calories daily, depending on my level of activity.

Diabetic Shortages

Originally, semaglutide was used to treat diabetes. Weight loss was a side effect that became marketed as a benefit for people without diabetes. As it has grown in popularity, there have been many drug shortages for people who depend on it to manage their diabetes. While the parent company who manufactures and administers this medication is aware of the issue, that doesn’t stop people from requesting Ozempic (the semaglutide brand primarily used to treat diabetes) for weight loss. Shortages could continue as a result, putting the health of those with diabetes at risk.

It was one reason I was hesitant to utilize this medication for weight loss. As I’ve read more about the issue, I’ve discovered that there are efforts to increase production on the drug while also better training doctors on obesity and weight loss management to help them avoid prescribing this drug for those who don’t actually meet the qualifications for it. Still, it does present an ethical concern as many more users flood the market and put further demands on the supply.

Medical Bias

Another ethical consideration involves medical bias. There’s a strong stigma around weight loss medications — likely for many of the aforementioned reasons. At the same time, it’s also possible that medical bias against overweight individuals could be part of the problem. That bias can impact diagnoses, as mentioned earlier, but it can also go into the opinions we form around weight loss medications as a society.

If weight is a risk factor in many life-threatening illnesses, then a medication that can help with weight loss seems like a benefit rather than a problem. Used correctly, it could assist many people who might have challenges to weight loss that go well beyond lifestyle — like hormones and heredity. It’s possible that a medical community that often shames people for weight gain could also participate in shaming medical attempts at weight loss. It pays to consider how much of the stigma has been formed out of a bias that people who aren’t losing weight just aren’t trying hard enough.

The Importance of Critical Thinking

Even though I have had a primarily good experience so far on the medication, I continue to think critically about the process. I’m not a doctor, and I can’t offer medical advice, but I can ask questions about the ethics of diet culture and the process of prescribing a medication that can impact our health — for better or worse. I didn’t go into this blindly, and I won’t be sharing only the good parts while glossing over some of my concerns.

Weight loss medications aren’t for everyone. They aren’t always affordable or accessible, but even beyond that, there’s a stigma that we often have to get around to decide to try it out. I’m not going to say if you should or shouldn’t do it, but I would suggest consulting a healthcare provider you trust. Even then, it still pays to do your own research and review what the experts have to say about this weight loss option.