This week, the UK government announced after a £279m ''investment'' from Lilly that they plan to offer all fat people on unemployment benefits GLP-1 drugs to 'help them back into work.' The sheer bare-faced prejudice, corruption, and lack of critical thinking is simultaneously staggering and unsurprising.
I cannot find an article that supports this assertion. I do see that the NHS is studying (as a part of a large comprehensive study) how glp use impacts employment, but that is substantively different than offering “all fat people on unemployment benefits” the medication.
I keep thinking of all the people who have probably experienced similar side effects that we'll never know about....
I appreciated this line: "These are, of course, not the only medications that can have rare but extremely severe, even fatal side effects, and it doesn’t meant that they aren’t solid Type 2 Diabetes medications."
In my experience, when I've raised concerns about these medications, the default response seems to be something along the lies of "ALL medications have risks and side effects," and it just shuts down the conversation. I really admire the way you can acknowledge objections and still invite scrutiny.
I've written about it in this comment section before, but I once went to a doctor for what would be diagnosed as gastroparesis. She recognized the symptoms and sent me to a GI to be formally diagnosed. At the follow-up for that appointment maybe a month later, she tried to sell me on Wegovy for weight loss.
She was explaining how it works to me (slowing gut motility) and I asked if that would be a problem because of the gastroparesis. She immediately did a 180 and told me I absolutely can't take it actually. I don't want to be too hard on her because she's the closest thing to a weight-neutral doctor I've had... It's just that you can see how easily these meds can be prescribed without any regard for the potential damage they'd do. There's really no way to argue that the GI effects aren't being downplayed when that kind of thing happens.
GI issues are like headaches in that they range in severity from nuisance to migraine. (I'm not sure what the GI equivalent of a migraine is but am fully convinced it exists.) I've wondered with GLP-1s if the more severe issues are being equated with nuisance, either sincerely or disingenuously. I can absolutely see some HCP brushing off the effects as just an upset stomach, especially if this is the medication that's supposedly going to "save" your patient from fatness. Underneath all of that I would imagine fatphobia and medical gaslighting play a part as well.
I don't have data on this, I would absolutely like to see some. Anecdotally, I have definitely heard from multiple patients who told their providers that the side effects were intolerable and were told that they should try harder to tolerate them.
This is a total non sequitur and not really relevant to what you are getting at in your comment. But there is an actual condition call “abdominal migraines”. They are related to actual migraines and not a digestive problem, one of my kids had them ever few weeks for 6 months and then they went away.
My PCP keeps pushing these medications on me and is absolutely downplaying the side effects. When I asked her about gastroparesis, she blew it off saying only people who were “at risk” for it got it. That doesn’t sound right to me. Either way, I’m finding a new PCP.
It’s striking how this hardly ever gets talked about in the media, but then when you look on the various GLP-1 subreddits there are always anecdotal accounts from people talking about how it took months and a lot of medication for their digestive systems to return to normal after coming off these medications. Although I do think that even if doctors were much clearer up front with patients on what using these medications could cost them—both financially and in terms of negative long term health outcomes—a lot of people would choose to do so regardless, because they truly feel that having to take a drug that makes them sick for the rest of their lives is still going to give them a better quality of life overall than continuing to exist in a fat body in this society. Which is not to say that that’s okay! And I think doctors are doing a disservice to their patients here, but as with other kinds of disordered eating, they often can’t meaningfully monitor anything until patients show noticeable signs that there’s something really wrong or end up in the ER in the maybe fifteen minutes that most clinicians get to spend on actual patient care per appointment (especially if the patient is determined to hide any issues they may be having because they’re desperate to maintain or keep losing weight)… and that’s HCPs who would actually care, not even getting into all the people just rubber stamping prescriptions via telemedicine.
This is a nice summary. Pardon my cynicism, but it is telling that Ms. Bjorklund is suing the companies and not her providers (or apparently not yet). The companies are big targets with deep pockets, and obviously the lawyers believe they have a compelling case and can likely obtain a big settlement. Meanwhile many providers are jumping on the bandwagon because there is a very big market with many people willing to pay out of pocket for a treatment that can work very well. Minimizing side effects is financially incentivized. Providers who are providing little or no discussion of risks and side effects should be avoided.
As an RN I have worked with T2D for decades. The oral med Metformin can cause similar side effects. Diabetics that I worked with promptly notified their provider asking for a different medication. After getting morphine post op, I vomited for hours. This med is now on my allergy/sensitive list. We should all be active partners in our health care. Why did this woman not advise her provider that her medication was making her ill and just stop the stuff! Forty years of nursing experience and intuition tells me that perhaps she liked losing the weight so continued the med. And now she wants to get paid. Anybody can file a lawsuit for ANYTHING!
I do want to clarify that while Oral Metformin shares some side effects with GLP-1s, it's not all side effects and not at the same intensity because Metformin does not specifically interfere with digestion as part of its mechanism of action, whereas GLP-1 drugs do exactly that - slowing gut motility, reducing stomach acid etc. producing more, and more intense gastrointestinal side effects, (including serious and life-threatening side effects like ileus) than oral Metformin.
While I'm not aware of a study on this, there are anecdotal reports from higher-weight people who are being pressured by healthcare providers to tolerate side effects that the patients are preventing as intolerable and we don't know if that was the case for this patient. These drugs are expected to produce significant gastrointestinal side effects and she may have told her healthcare provider and been told that it was normal and would pass if she just kept taking the drugs.
Second, as an RN you have access to information and privilege that a patient who is not a licensed healthcare provider may not. I'm very glad that you feel empowered to be an active partner in your healthcare and I wish that everyone did/was but many people have been raised/conditioned/scolded by their healthcare providers to believe that they are the patient and that the provider is the expert and that it is not for them to question that expert advice. I have certainly experienced this first hand as a patient even though I am hired to teach healthcare providers about the research around these drugs. And that's before we consider the impact that having marginalized identities/multiple marginalized identities can have in interactions with healthcare providers.
Finally, this case is about the claim that these drug manufacturers have not been forthcoming about side effect likelihood/intensity and if that is the case (and it has certainly been an issue with previous weight loss drugs,) then a lawsuit like this may be the only way that a patient can push to get more clear information. If it turns out that they haven't been forthcoming, then neither the patient nor the provider would have the opportunity for true informed consent.
We don't know all the facts - that's the point of the lawsuit. In the meantime I think it's important to avoid jumping to victim blaming based on intuition and assumptions about a patient who was and is severely harmed.
This week, the UK government announced after a £279m ''investment'' from Lilly that they plan to offer all fat people on unemployment benefits GLP-1 drugs to 'help them back into work.' The sheer bare-faced prejudice, corruption, and lack of critical thinking is simultaneously staggering and unsurprising.
So are they admitting that weight discrimination in employment is the primary factor in unemployment?
I’m surprised, as my T2D friend over there can’t get them even though Metformin isn’t working for her.
It's almost like they care more about people not being fat than they do about chronically ill people...
I don't "like" the situation but "simultaneously staggering and unsurprising" 💯
I cannot find an article that supports this assertion. I do see that the NHS is studying (as a part of a large comprehensive study) how glp use impacts employment, but that is substantively different than offering “all fat people on unemployment benefits” the medication.
This is the article I read https://www.theguardian.com/society/2024/oct/14/unemployed-could-be-given-weight-loss-jabs-to-get-back-to-work-says-wes-streeting
I keep thinking of all the people who have probably experienced similar side effects that we'll never know about....
I appreciated this line: "These are, of course, not the only medications that can have rare but extremely severe, even fatal side effects, and it doesn’t meant that they aren’t solid Type 2 Diabetes medications."
In my experience, when I've raised concerns about these medications, the default response seems to be something along the lies of "ALL medications have risks and side effects," and it just shuts down the conversation. I really admire the way you can acknowledge objections and still invite scrutiny.
Thanks for the kind words. The "all medications have side effects" blow off drives me up the wall. I wrote about it as it pertains to these drugs here if it's helpful: https://weightandhealthcare.substack.com/p/reader-question-wegovys-side-effects
I've written about it in this comment section before, but I once went to a doctor for what would be diagnosed as gastroparesis. She recognized the symptoms and sent me to a GI to be formally diagnosed. At the follow-up for that appointment maybe a month later, she tried to sell me on Wegovy for weight loss.
She was explaining how it works to me (slowing gut motility) and I asked if that would be a problem because of the gastroparesis. She immediately did a 180 and told me I absolutely can't take it actually. I don't want to be too hard on her because she's the closest thing to a weight-neutral doctor I've had... It's just that you can see how easily these meds can be prescribed without any regard for the potential damage they'd do. There's really no way to argue that the GI effects aren't being downplayed when that kind of thing happens.
GI issues are like headaches in that they range in severity from nuisance to migraine. (I'm not sure what the GI equivalent of a migraine is but am fully convinced it exists.) I've wondered with GLP-1s if the more severe issues are being equated with nuisance, either sincerely or disingenuously. I can absolutely see some HCP brushing off the effects as just an upset stomach, especially if this is the medication that's supposedly going to "save" your patient from fatness. Underneath all of that I would imagine fatphobia and medical gaslighting play a part as well.
I don't have data on this, I would absolutely like to see some. Anecdotally, I have definitely heard from multiple patients who told their providers that the side effects were intolerable and were told that they should try harder to tolerate them.
This is a total non sequitur and not really relevant to what you are getting at in your comment. But there is an actual condition call “abdominal migraines”. They are related to actual migraines and not a digestive problem, one of my kids had them ever few weeks for 6 months and then they went away.
My PCP keeps pushing these medications on me and is absolutely downplaying the side effects. When I asked her about gastroparesis, she blew it off saying only people who were “at risk” for it got it. That doesn’t sound right to me. Either way, I’m finding a new PCP.
And who is “at risk?!”
It’s striking how this hardly ever gets talked about in the media, but then when you look on the various GLP-1 subreddits there are always anecdotal accounts from people talking about how it took months and a lot of medication for their digestive systems to return to normal after coming off these medications. Although I do think that even if doctors were much clearer up front with patients on what using these medications could cost them—both financially and in terms of negative long term health outcomes—a lot of people would choose to do so regardless, because they truly feel that having to take a drug that makes them sick for the rest of their lives is still going to give them a better quality of life overall than continuing to exist in a fat body in this society. Which is not to say that that’s okay! And I think doctors are doing a disservice to their patients here, but as with other kinds of disordered eating, they often can’t meaningfully monitor anything until patients show noticeable signs that there’s something really wrong or end up in the ER in the maybe fifteen minutes that most clinicians get to spend on actual patient care per appointment (especially if the patient is determined to hide any issues they may be having because they’re desperate to maintain or keep losing weight)… and that’s HCPs who would actually care, not even getting into all the people just rubber stamping prescriptions via telemedicine.
This is a nice summary. Pardon my cynicism, but it is telling that Ms. Bjorklund is suing the companies and not her providers (or apparently not yet). The companies are big targets with deep pockets, and obviously the lawyers believe they have a compelling case and can likely obtain a big settlement. Meanwhile many providers are jumping on the bandwagon because there is a very big market with many people willing to pay out of pocket for a treatment that can work very well. Minimizing side effects is financially incentivized. Providers who are providing little or no discussion of risks and side effects should be avoided.
As an RN I have worked with T2D for decades. The oral med Metformin can cause similar side effects. Diabetics that I worked with promptly notified their provider asking for a different medication. After getting morphine post op, I vomited for hours. This med is now on my allergy/sensitive list. We should all be active partners in our health care. Why did this woman not advise her provider that her medication was making her ill and just stop the stuff! Forty years of nursing experience and intuition tells me that perhaps she liked losing the weight so continued the med. And now she wants to get paid. Anybody can file a lawsuit for ANYTHING!
There are a number of things to think about here.
I do want to clarify that while Oral Metformin shares some side effects with GLP-1s, it's not all side effects and not at the same intensity because Metformin does not specifically interfere with digestion as part of its mechanism of action, whereas GLP-1 drugs do exactly that - slowing gut motility, reducing stomach acid etc. producing more, and more intense gastrointestinal side effects, (including serious and life-threatening side effects like ileus) than oral Metformin.
While I'm not aware of a study on this, there are anecdotal reports from higher-weight people who are being pressured by healthcare providers to tolerate side effects that the patients are preventing as intolerable and we don't know if that was the case for this patient. These drugs are expected to produce significant gastrointestinal side effects and she may have told her healthcare provider and been told that it was normal and would pass if she just kept taking the drugs.
Second, as an RN you have access to information and privilege that a patient who is not a licensed healthcare provider may not. I'm very glad that you feel empowered to be an active partner in your healthcare and I wish that everyone did/was but many people have been raised/conditioned/scolded by their healthcare providers to believe that they are the patient and that the provider is the expert and that it is not for them to question that expert advice. I have certainly experienced this first hand as a patient even though I am hired to teach healthcare providers about the research around these drugs. And that's before we consider the impact that having marginalized identities/multiple marginalized identities can have in interactions with healthcare providers.
Finally, this case is about the claim that these drug manufacturers have not been forthcoming about side effect likelihood/intensity and if that is the case (and it has certainly been an issue with previous weight loss drugs,) then a lawsuit like this may be the only way that a patient can push to get more clear information. If it turns out that they haven't been forthcoming, then neither the patient nor the provider would have the opportunity for true informed consent.
We don't know all the facts - that's the point of the lawsuit. In the meantime I think it's important to avoid jumping to victim blaming based on intuition and assumptions about a patient who was and is severely harmed.
I wondered that, too.