Over the course of the pandemic, I gained a tremendous amount of weight.
This is the story of the experience of the medical treatment that helped me, and how I think about the risks of obesity now.
That photos is from last week. I am 43 years old.
I started life as more slight of build person than most.
I started, in my 20s, at 127 lbs at 5’8” tall. After years of antipsychotic medicines for bipolar disorder, I looked like this, at age 37, and 186 lbs.:
The pandemic changed my metabolic health for the worse.
There are reasons. I moved around less. I gave myself permission to drink a Coca-Cola more regularly than I had ever before, because you know, it's a pandemic. I had more symptoms of psoriasis.
I developed obstructive sleep apnea.
I also blah blah blah.
I ended up having one blood test with hemoglobin A1c of 7.4. I had developed diabetes. Here's what that looks like:
I'm being embarrassed and trying not to post pictures that make me look bad. Everyone does that, so I'm making a point. Buckle up:
This is 2 years ago:
And this just about 1 year ago:
It’s visually not good right?
People spend a lot of time worrying about what they look like, but one of the things we don't talk as much about is how people with metabolic syndrome feel.
I am here to report: it feels like being sick. It is unwellness. It’s slow, painful, inflamed, tired, broken.
I rather abruptly developed diabetes. I was, at that point, promptly started on semglutide (ozempic) when I saw an expert.
It went down…
And down. My last HbA1c was 5.2.
My weight went went down, which matters. But I got much less sick, which really matters. Obstructive Sleep Apnea resolved. My fatigue improved. My blood pressure returned to normal. I do look different, but I have never been particularly attractive, and I don't know how much people notice. Maybe they are being polite?
Here is what my body habitus looked like last week on vacation with my family:
The shorts are falling off now. They are then same ones as the above photo.
I am still not fashionable. I am, even to untrained eyes, less sick. I understand, as a physician, there is no risk-free intervention. There are significant risks with this new generation of GLP-1 drugs. There are side effects. They are serious, for many.
In our hurry to condemn the risks of an intervention? We can miss the risk assessment of inaction. And for me, that risk was was being sick, and obese, and diabetic, and I would have died years earlier. I may still. Obesity and metabolic syndrome isn’t just about vanity.
We would do well to remember risks of commission and risks of omission are different risks in the minds of doctors and industry. To patients, however, our physicians’ biases have serious risk as well.
Understanding the suffering we allow to take its course with the same seriousness with which we fret about side effects is my call to action. Other physicians like
have important things to say on the topic of the expense of these treatments.Being obese and diabetic? It sucked. This return to physical form isn’t easy, but understanding the choice, I am glad my doctor took the risk.
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https://open.substack.com/pub/williamhbestermannjrmd/p/new-weight-loss-drugs-can-cost-15000?r=1ct8f&utm_medium=ios&utm_campaign=post
Is crucial commentary on the costs.
I am happy to see such progress. I would have never imagined.