Hello - I know I am a bit late, but I am the person who asked the question in the December AMA about the usage of GLP-1 medicines while continuing habitual alcohol use. At one point, I believe it was Dr. Baraki who made a comment along the lines of “I wish I could have more context to this question”, and while I am not sure this is the best place to do it, I figured I’d give it a go in hopes that it would help someone else learn/change their thinking or help give a more direct answer.
In general, I’d like to think I am very pro-GLP-1 usage. I think it is great and the “area under the curve” line of thinking when it comes to obesity really struck a chord with me, particularly as someone who was over weight for the first 25+ years of my life then lost a lot of weight. I consistently wax poetic to friends and family about the benefits of these medications. That said, up until recently, I never had a friend or family member on them.
Over the last year or so, we have become good friends with some neighbors. One of them is an NP at a weight loss clinic who is naturally very pro-GLP-1, and they have been seeing friends as patients and writing scripts for them. This feels legally gray to me, though I am not a lawyer. They are also a brand rep on the side for a pharma company who makes these medicines, and while I assume they do not get a kick back of any sort, they do get paid to travel around to other clinics and give presentations on these medicines. This, too, feels like a gray area in that there is no direct compensation to writing scripts (e.g. commission), but there seems to be indirect incentive at play.
More specific to my AMA question now, I did ask the question before the December roundtable GLP-1 update podcast with Dr. Nadolsky. That episode actually helped clarify a bit more the benefits of the medications and all the nuance with them. In fact, I was pleasantly surprised to hear there is some evidence they can help with other addictive behaviors like excessive drinking. I think that is really cool to see other benefits! Further, the roundtable helped distinguish that different things like obesity and alcoholism can and should be treated separately, since are not one in the same disease. Had I listened to that episode first, I may not have even asked my AMA question.
With all that context, here is my mea culpa of sorts, as I have thought a lot about your answer to my AMA question. It seems I have had a blind spot in my viewpoints that I think stems back to my own personal weight loss journey roughly 8 years ago before these medicines went mainstream. I did it “the old fashioned way”, obsessively tracking every calorie ingested and every amount of exercise completed. I completely quit drinking for 5-6 months to help the cause. I dialed in my sleep. I optimized everything I could. The mental toll was a lot. Luckily it was during a slow year for my career and I had a fiance who dealt with my neuroticism. But I succeeded and have kept 80% of the weight loss off to this day.
What I think triggered this was seeing someone in my personal circle use a GLP-1 medicine. Before that, it was easy to think “these medicines are great for the population and they should stick around”, but seeing someone succeed so easily with them after I grinded for so long… subconsciously I think I was making a sort of moral judgement even if I was trying not to. I am bummed I let that happen, but I am glad to have your answer bring it to the forefront of my mind. I still struggle with the dissonance of my NP friend giving scripts without seemingly working on any sort of behavior change. Excessive alcohol use aside, as more and more friends start on these medicines, I try to get curious about how they use them in conjunction with improving nutrition and what they eat day to day and how they change their exercise habits. It doesn’t appear much behavior change in those regards occurs either, however, I am now open to the fact that maybe using a GLP-1 medicine will lead to weight loss and therefore they may see that success and change other behaviors. That is my hope for them at least, since grinding like I did to lose weight forced me to change my habits for the better and keep the more permanent in my life.
If you’ve made it this far, I really appreciate it. It has been somewhat cathartic to grapple with the AMA answer and think this all through. It has given me an appreciation for old folks like my grandparents who bash new technologies compared to their old ways, like using a typewriting vs handwriting everything by hand, etc.
If I had to rephrase my question in the AMA, I’d phrase it like this… As a general normie, how can I be better at withholding judgement against folks using these medicines and get excited for them after having gone through the grinding myself? That is maybe a loaded question, more along the lines of general human psychology than fitness, nutrition, and medicine, but if you have the time and would like to give some thoughts, I’d appreciate it. If not, I totally understand since you are both very busy people! Thanks for everything you do, Barbell Medicine helped change my life 8 years ago when I lost weight, and I love seeing how it has evolved over time.