In It Together: Doctor and Patient on GLP-1s

“My weight has always been kind of an issue,” said Gerald Fernandez, a 33-year-old mortgage broker in Naples, Florida. Over the years, he has sought advice from his physicians but felt unsatisfied with the guidance he has received: “They never gave me a solution, besides ‘Work out more, eat less.'”

Earlier this year, Fernandez found a new clinician who suggested he take a glucagon-like peptide 1 (GLP-1) receptor agonist for weight loss. He said he has lost about 20 lb in the 3 months he has been taking compounded semaglutide. But the medication is not the only difference-maker this time.

When Fernandez’s doctor, Yanet Diaz-Martell, MD, an internist and hospitalist at Physicians Regional Healthcare System in Naples, Florida, discussed his eligibility for the medication, she said she was taking it, too. “She told me what to expect based on her education and on her own experience,” Fernandez said. She told him in detail about the side effects she experienced, letting him know he may not have the same experience.

Diaz-Martell lost about 32 lb in an 8-month period last year, she said, and now takes semaglutide for maintenance. When she tells patients who can benefit from the medication that she is on it, the reaction is positive. “They feel, ‘Ok, if my doctor did it, it should be OK.’ It gives them a kind of confidence,” she said.

But she stresses medication is just one aspect of her approach. “I tell my patients that it’s not magic,” she said. She puts patients on a program to increase their physical activity and reduce their calorie intake. Fernandez got a “wellness blueprint” that spells out the regimen. “I’ve been following it like the Bible,” he said.

Two in five adults in the United States have obesity, and many more have a body mass index of 27 with comorbidities, qualifying them for GLP-1 therapy, so it’s not surprising that a physician and patient would both be taking the drugs at the same time.

Not all physicians disclose that fact, but those who do say the decision can be good for both provider and patient. However, other physicians cite some potential hazards to what might become “over-sharing,” such as clinicians losing objectivity and thinking the medication that worked for them is the solution for all.

Escaping the Obesity Judgement

Physicians who share that they are on a GLP-1 for weight loss find that as word gets around, patients seek them out because of their transparency. “I had a patient who said her primary care doctor didn’t believe in the medication,” Diaz-Martell said, “so she came to me.”

Catherine Toomer, MD, a family medicine physician and weight care specialist in South Carolina, said most of her patients know her backstory before they call for an appointment.

“I do videos, I talk about it a lot,” she said. Toomer said she has lost more than 100 lb — 60 of that before going on the medications, then another 45+ after she started taking a GLP-1. With her patients, she focuses on managing expectations, such as fast weight loss, driven by what people may see on social media.

When patients come to her, she said, “they know they aren’t going to be shamed” that they are taking a GLP-1. They appreciate being taken care of psychologically, she said. Toomer has encountered this kind of shaming herself, she said, after her weight gain: “A colleague said, ‘I can’t believe you let yourself get this way.'”

Sharing the Journey

Toomer counts many physicians as patients, including Tawanna Gilliard, MD, of Summerville South Carolina, a regional medical director for a nationwide insurance company, who has been in Toomer’s care for 2.5 years. When she learned about Toomer’s personal story, “what it showed me is, she knows the struggle.”

Gilliard, who has coexisting medical issues, said her weight loss “has been like a tortoise.” She has lost 70 lb, but slowly. “I can get stagnant, and she’s very encouraging,” she said.

When John Mulligan, MD, MBA, chief clinical officer of Options Medical Weight Loss, in Chicago, tells patients he has reached his goal weight by taking a GLP-1, “they generally support me and are surprised.”

Mulligan said he took a GLP-1 for 8 months, reached his target, and stopped taking the drug about 3 months ago. The results have been encouraging. He has reduced the number of blood pressure medications he takes from three to one, sleeps better, and no longer has aspiration or gastroesophageal reflux disease, he said.

A common response from his patients to his story: “No one has ever explained this to me so well.” They appreciate the real-life application he provides for their own treatment plan, he said.

“I can trust him in the journey because he’s doing it himself,” said one patient, Liz, who requested only her first name be used out of concerns about her privacy. While she began to take a GLP-1 agent in early June, “to have a medical professional going through the same steps you go through humanizes it — it’s an incredible relationship builder,” she said.

Elena Christofides, MD, an endocrinologist and researcher in Columbus, Ohio, applauded the growing use of medications for weight loss as a sign “providers are taking obesity more seriously and using the tools we have to manage it more effectively.” However, Christofides said she also sees some potential hazards when physicians — whether they disclose the fact — are on the same weight loss medications as their patients.

A clinician can lose objectivity, she said, depending on the success or failure of their own treatment. For instance, she said, “they had success on one drug and therefore never prescribe the other drug believing if one works, they all work. Alternately, let’s say that the doctor has a bad experience on one drug, they might be biased against ever prescribing that again, believing that if they couldn’t take it, no one should take it.”

A Physician for a Patient…a Lawyer for a Client?

What happens when physicians decide to prescribe weight loss medications for themselves? Data on the extent of the practice are not available, but in general, self-prescribing is discouraged by the American Medical Association Code of Ethics, except in emergency situations if no other qualified physician is available or for short-term problems. State laws on self-prescribing medications vary greatly, with some frowning on it and others not addressing the issue at all.

John Passantino, MD, an internist at OMNI Medical Group, in Tamarac, and a hospitalist for Sound Physicians at Holy Cross Health, in Ft. Lauderdale, Florida, said he supports the appropriate use of GLP-1s, but “I disagree with self-prescribing medications due to the compromised objectivity of the prescriber.”

“It’s never a good idea to access these medications without evaluation by a healthcare professional for obesity complications and related diseases, and with ongoing follow-up,” agreed W. Timothy Garvey, MD, professor of medicine and obesity expert at The University of Alabama at Birmingham.

Self-prescribing “is always a bad idea,” said Arthur Caplan, PhD, head of medical ethics at NYU Grossman School of Medicine, in New York City, and a frequent contributor to Medscape Medical News. Physicians may ignore underlying conditions, for example, or overlook their less-than-ideal lifestyle, depending just on the medication, he said. “Is it a major ethical flaw? No, but it’s a minor one.” Self-prescribing can lead to troubles, he said, such as missing other health conditions. “And losing weight [alone] doesn’t mean you are in shape.”

Self-prescribing inappropriately can also potentially reduce the already low stockpile of the injectables for those who truly need them, but that problem is expected to be short-lived, Caplan said, as companies report gearing up to manufacture more of the medications.

He does see the value of a physician telling a patient he or she is on the same medication. And patients are likely to talk more freely about their challenges with weight loss, he said: “I think that it makes it a better bond.”

SIDEBAR: Physician, Disclose Thyself

Do patients whose doctors share their own GLP-1 weight loss story have more success losing weight? That research is lacking, but studies on the value of physician self-disclosure in other medical areas has found it can help.

• Emergency department patients whose physicians self-disclosed their experience with a similar medical complaint, or gave other personal information, rated that physician more positively, with greater communication skills and rapport, and were more satisfied with the encounter.
• When faculty shared their own experiences with depression and mental health with internal medicine residents at Mayo Clinic in Rochester, Minnesota, the residents said the sharing helped destigmatize mental health issues and made them more likely to seek help when needed.
• In another study, patients saw physicians who self-disclosed as more empathic than those who did not. Patients were more likely to self-disclose their own information if their physician did, especially a female physician.

Diaz-Martell, Toomer, Passantino, and Mulligan reported no relevant financial conflicts of interest. Christofides is a speaker and consultant for Novo Nordisk and Lilly. Garvey is a consultant for Lilly, Novo Nordisk, and other companies. Caplan reported no relevant financial conflicts of interest.

Kathleen Doheny is a freelance journalist based in Los Angeles. Follow her on X: @DohenyKathleen.