Episode #153: Taking a GLP Isn't Cheating

In this episode, Dr. Sarah breaks down one of the most common emotional struggles people face when considering GLP-1 medications like Wegovy, Ozempic, and Zepbound: the belief that taking medication is “cheating.” 

If you’ve ever felt guilty for needing medical help to lose weight—or worried that others will judge you—you’re not alone. Cultural messages about willpower, discipline, and doing things “the hard way” have shaped the way many of us think about weight loss. But obesity is a medical condition, and using an evidence-based treatment is not only appropriate—it’s empowering. Today’s conversation will help you understand the science behind GLP-1s, reframe unhelpful beliefs, and step into your journey with confidence, clarity, and compassion.

You’ll learn:

• Why many people feel shame or guilt when considering weight-loss medication
• How internalized obesity bias and cultural pressure shape beliefs about “willpower”
• The physiology of hunger, satiety, metabolism, and set point regulation
•  What GLP-1 medications actually do in the body
• Why using medication is not a shortcut or moral failure
• The difference between physiologic support and “cheating”
• How medication creates the stability needed to build sustainable habits
• Why the real work still happens off the medication—through skills, routines, and mindset
• Practical reframes to help you embrace your treatment plan without guilt

Ready to get started on your weight loss journey? We’re now enrolling patients for in-person visits in Charlottesville, Virginia and for telemedicine throughout the states of Illinois, Tennessee, and Virginia. Learn more and get started today at https://www.sarahstombaughmd.com

Transcript

Dr. Sarah Stombaugh:
This is Dr. Sarah Stombaugh, and you are listening to the Conquer Your Weight Podcast.

Announcer:
Welcome to the Conquer Your Weight Podcast, where you will learn to understand your mind and body so you can achieve long-term weight loss. Here's your host, obesity medicine physician, and life coach, Dr. Sarah Stombaugh.

Dr. Sarah Stombaugh:
If over the last couple of years you've seen the popularization of these GLP medications like Ozempic, Wegovy, Zepbound, and Mounjaro, everybody's talking about them. You see the med spa on the corner selling semaglutide and tirzepatide, and you've been thinking, like, maybe I should take those medications, but like I just can't. Like, all I need to do is I need to work harder, I need to try harder, I need to stick with my diet for longer, and like I don't need to use these medications. And I'm not saying that medications like the GLPs are going to be the right fit for everybody. But what is absolutely true is that every single day I encounter people who would actually be really great candidates for these medications. When we look at their health history, we look at their weight history, we look at their metabolic health, we see things like elevated blood sugar, ever elevated liver enzymes, cholesterol, blood pressure, increased waist circumference, we see signs of obesity as metabolic disease. And I think about hey, this is really someone who's a good candidate for these medications.

Yet, as individual patients, a lot of times we're very reluctant to take the medications. Now, I believe very strongly, you as the patient, you are the boss of your body. So you could decide if you're going to take something, if you're not going to take something. Let's say you've even started on your journey, you've been taking a medication for a period of time, and you just decide, hey, I'm done, I will totally support that as well. So you are the boss of your body, and I want you to have the information that you need to make the decision that will best support you in your health goals. I think one of our biggest challenges is that we as a society have this really significant obesity bias. We do not understand obesity as the chronic disease that it is. A lot of times we think of it as a lack of willpower. It's like, okay, if I could just try harder, if I could just exercise more, if I could just eat fewer calories, if I could just resist those desserts at my office, if I could just do these things, then I would see the weight. All I need to do is try harder. And while on the surface, sometimes I think that feels very true. We look back a lot of times over a history of many years or many decades of failed diet attempts, and we're wondering, okay, am I the problem here? And sure, it may be easy to believe that, but a lot of times we're looking at people who are incredibly hardworking, people who are incredibly successful in their professional lives, in their personal lives, people who have their act together yet are struggling with their weight. Even physicians, even obesity medicine physicians who understand at its core the physiology of why we gain weight sometimes struggle with their weight. And it's because obesity is about so much more than willpower.

So we're going to talk about some of these things, but before we do, I want to think about obesity as a chronic disease. And I think this is one of the most powerful ways that really over the last couple of years, we've started to understand that obesity is not just willpower. Well, I shouldn't say that. Over the last couple of years, we have really accepted that. We, I think, as a medical community of people who have studied this for a very long time, have realized that. And we've been trying to convince everybody else, hey, this is the case. But it's only been over the last couple of years that we've started to see that uptake a lot more significantly. We've seen things like the WHO, the World Health Organization, declare obesity as a chronic disease, as an epidemic. And that helps give us some insight as okay, well, why is it a disease? You know, what are the things that contribute to that? And a lot of times we think about the simplicity of calories in versus calories out. And you still hear variations of that today of okay, if you want to lose weight, all you have to do is eat less and move more. But the reality is there's a lot of other factors at play that may be beyond our individual control. When we think about the factors that affect uh obesity, one of the things that's really interesting is that a huge proportion of obesity is determined by our genetics. It's estimated that 40 to 70% of obesity or body weight is determined by our genetics, and that can be really challenging when you're trying to fight genes. Additionally, we know that epigenetics can play a really significant role. Epigenetics are how our genes interact with our environment. So this can be everything from when you were a fetus inside of your mother and growing the environment there to, as an adult, the environment that you live in. This can be everything from endocrine disruptors, like microplastics and other chemicals. 

The biggest challenge that we have right now as of 2025 is that this is an area that we're still really exploring and really understanding. So you hear a lot of things out there, and while some of them may very well prove to be true, it's a big challenge because we have to live and exist in this world. And we don't want to live and exist in a world that we fear, just, you know, constantly in fear of living here, existing here, eating here, moving here. So all that to say, though, the environment that we live in not just affects the choices that we make, but affects our genetics, which is completely wild. And we know that it can affect even multiple generations. You know, we think about a pregnant woman, for example, the environment that she lives in is also going to create an environment for her growing baby. And that growing baby, if it's a female, actually has eggs inside of it that will be the future generation. So a woman may be impacting herself, her daughter, and her potential grandchildren as well, which is just absolutely wild for us to think about. So, all that to say, we have factors going back all the way to our genes and to our epigenetics. Then we look at systems factors. We look at things like what is the food environment that we live in? What are foods that are readily available to us? How is food made and produced today in 2025? It was different than the way it was made and produced decades ago or centuries ago. Food looks very different.

Now, some of this has been for the good. It's eliminated in developed countries at least. It's eliminated a lot of food scarcity, it's made foods that can be shelf stable, and there's really amazing things that have come from that. But are there downsides to some of these practices as well? Possibly. We know that a lot of food is very highly processed, for example. We know that foods that are lasting on the shelves for many, many months are often broken down nutritionally in a way that our body can absorb them rapidly. And they don't do the same things for us in terms of the way our body feels natural fullness or satiety. So if you think about eating an apple, for example, you think about crunching on that apple, even if you haven't partnered it with anything else, you've got a lot of fiber, you've got, you know, this whole package of food that helps to digest the fruit sugar a little bit more slowly. And so that energy sticks with you for a little bit of time. When you compare that to then a very processed version of that, for example, like apple juice, we've taken an apple, and a lot of times we've actually taken many apples, like three to four apples, typically it will take to make a full cup of apple juice. We've taken that, we've processed it, and now we just have the sugar without any of the fiber. That's the part that we're discarding and throwing away. So, even in an example as simple as that, we take what is very healthy, a piece of fruit, we deconstruct it in a way that our body gets the sugar from it very quickly. It doesn't have this lasting absorption. And all of those things make a really big difference, especially when we think about sort of time over time. This isn't just a single cup of apple juice that we're talking about. It's our granola bars, it's fast food, it's breads, it's so many things that we consume have either added ingredients to enhance flavor, they have broken down ingredients to make them easier to digest. And all of these things make it really hard to be in line with our body's natural hunger and fullness signals. So we've got this environment that we're living in, which can be really challenging, especially depending on the type of work that you're in, maybe the people that you surround yourself with.

If at work there's always these types of treats available in the break room, if you live in a family where other people are consuming those types of foods, it can be really challenging to break apart from what is just around you and what is also the habit of that thing. So the food in our environment makes a really significant difference. We also think about the culture that we live in and this like go, go, go energy that we have. That impacts us both in terms of what of our stress levels, how is our body feeling and processing emotions throughout the day, as well as how are we sleeping at night? And I find that both of these two things, both stress management as well as emphasizing good quantity and good quality of sleep, are really important for helping our bodies to maintain ideal metabolic health. But this like go go go culture that we have really makes us feel stressed. I mean, if you felt the stress of just like getting your kids out the door, it's like, wow, I've really put my body into this state of like overdrive for what? Like I'm this is not a life-threatening situation. This is me just trying to get my kids out of the door. Similarly, because of our go-go-go, a lot of times people are limiting the amount of time that they sleep. And so people are sleeping less and less. And this can have really detrimental impacts on our health. We think about the movement and the environment that we live in.

We live in a fairly sedentary environment. We're not as active as we used to be. And that can be really challenging because our body needs to be moving, our body needs to be burning energy, and we think about that calories in versus calories out. While that is overly simplified, what's also true is that our body does, if we burn more energy, our body will ask for more calories. And so there's this natural if we're moving and we're burning more energy, our body's going to ask for more food, ask for more fuel. So there can be this balance where we're able to move our body to get the appropriate hunger signals to then our body then be asking for food and being able to adequately fuel and nourish our body with both the macronutrients, the fats, the carbohydrates, the proteins, as well as the micronutrients, all those vitamins and minerals that your body needs. So we've got all of these different factors at play. And what's true is that all of those things we want to be working on in the weight loss journey. And as we are accumulating fat, our body has a really difficult time releasing it. Our body stores fat for times where food is not going to be readily available for us. And this is amazing when you think about the survival mechanics of hey, is my body going to be able to appropriately store energy for times where there is food scarcity, for times where there is famine? It is amazing that that has happened. And if you live today, which all of you do because you're watching this video, you are the ancestors of people who have survived famines. You know, my Irish ancestor who survived the famine, they survived and passed on their genes. And so we know that there are these genetic and epigenetic components, and our bodies are designed to store fat.

Now, the challenge is we think about fat as this like blob that sits in our body, but it is not a blob, it is actually a very metabolically active blob. So, fat tissue, adipose tissue, is a structure, it is an organ on our body, and it is a metabolically active organ. When we have excess adipose tissue on our body, it affects our hormonal and cellular signaling in a really important way. And this is where GLP medications can be absolutely life-changing. We know that having excess fat mass on our body can contribute to things like insulin resistance. Insulin is our energy processing hormone. When we eat carbohydrates and when we eat proteins as well, our body releases insulin in order to take that energy and store it away for later. And what happens when we release that insulin is that our body is going to take the energy, it's going to use the insulin as a cellular signaling to look at all the different cells in the body and say, hey, do you need energy available? I have this glucose that we've broken down from food. Would you like it in your cell? And if the cells need energy, then great, the insulin helps support shuttling that energy into the cell. The problem is that when we've stored up excess energy, our cells may not need that energy. 

And so you've got this insulin going around saying, Hey, do you need this energy in your cell? And the cells say, Hey, actually, nope, I don't. I'm perfectly adequately energized right now. I do not need that energy right now. I do not need that glucose. And so the body's like, okay, I guess I'll store this away as fat for later. Or the body can create a situation where it increases the insulin levels of like, hey, I have a lot of fat stores. I may not need these. I'm gonna store it away as later. And it kind of like shoves the glucose into the cells. And so this happens. And then eventually we start to see a situation where the body is not able to store away that energy and we start to see the glucose levels rise. So the blood sugar levels are going up over time. And this is the situation that contributes to things like prediabetes or ultimately type 2 diabetes. But the earliest sign of that can be dysregulated and increased fat storage. And it feels like your body is storing fat all the time and not able to release weight. And it's absolutely true because when your body is signaling insulin like that, it's sending the message that right now we are in energy storage mode. So your body cannot be storing energy and burning energy at the same time. So if you are in storage mode, your body is going to have a really difficult time releasing excess weight, burning those fat stores because you have this insulin resistance, your body is stuck in storage mode. Additionally, having excess fat cells will contribute to leptin resistance. Leptin is a satiety hormone. So when we eat a meal, when we feel fullness, it's leptin signaling to say, hey, I've had enough food, I'm done right now.

The challenge is that when we have leptin resistance, our body ignores that signal. And that happens because of dysregulated signaling with adipose tissue. That when we're eating, our body doesn't feel full as quickly. So we find ourselves in the situation where our body is feeling hungry more often because of insulin resistance, it's storing energy more often and stuck in that storage mode. And when we're eating, we're also eating more. It takes more food for us to feel satisfied because of this dysregulated signaling. And because of those things, even when we're eating well and we're exercising and we're sleeping and we're managing our stress, it can be really, really difficult for our body to release weight because we're fighting against the cellular signaling that we have very little, if any, control over. And that's where medications like the GLPs, Ozempic, Wegovy, Zepbound, Mounjaro, semaglutide, tirzepatide, liraglutide, Saxenda, there's so many out there. They can be absolutely life-changing for people because they are working on the underlying hormonal issues that are driving obesity. And we have no issues when we look at other health conditions, a lot of times about thinking about taking medications. 

Now, I think I hesitated in saying that because absolutely I encounter patients who are like, Dr. Stombaugh, I do not want to take a blood pressure medication, I don't want to take a cholesterol medication, I don't want to be taking these medications, and I get that as well. So that absolutely comes up, and that's another conversation for another day. But what's really interesting is that a lot of times we have absolutely no qualms about sure, I would take a medication for my blood pressure, I would take a medication for my cholesterol, I would take an inhaler if I had asthma, I would take chemotherapy if I had cancer. We have no issue with using these medications because we see the very important role that they are playing. And it doesn't mean that we ignore all of the other stuff. The magic happens when we combine medication with the lifestyle. Anybody who is using medications and still eating poor food and not exercising and not working on the stuff, okay, maybe that is cheating. But the patients that I encounter, that is not the case. They have been working their darndest for a very long period of time to eat in line with their goals, to increase their movement, to be working on getting good sleep, to be managing their other health conditions, to be managing their stress, to be managing their relationship with food. They've been trying and in a lot of cases, pretty well succeeding to do all of these things, yet it's not taking effect in the way that they expect it to. And that's where the GLP medications become this really amazing tool in the toolbox. They become the tool that allows all of the other things to finally like click in this way that, like, oh my gosh, is this what it's supposed to feel like? And that is one of my favorite comments that people make is when they're like, oh, this wasn't that hard. This was easy and not like in a oh my gosh, I cheated and I skirted around it in a wow. 

When other people who have not struggled with chronic weight, with chronic obesity, when they're just like, oh, I just like, I just eat less for a little bit of time and I just like get a little bit more active and like the weight just flies off. When people are saying that, that's because that is true for some people. And for people who have never struggled with their weight, they do not understand. They will not understand unless they are you've studied in this area or experienced in this area. People who have never struggled with the weight, the people you hear on social media who are just like, okay, well, just eat less, just eat healthier, just exercise more. They're not wrong. Those things help. Those things are important. And those things may not be the entire picture. And the challenge is that we have this very mixed messaging from people from a society that has really significant obesity bias. And of course, we've internalized that. Of course, we believe that we just need to work harder. But what I will offer to you is that you're already working hard. You are already doing all the things or trying to do all of the things. You're trying to avoid the sweets, but you're finding having really intense cravings for those, that may be your hormone speaking, that may be insulin resistance screaming at you to have some sugar. That may not be a lack of willpower. That may be hormonal signaling. And if you have a hormonal problem, if you have this dysregulated signaling, doesn't it make sense for us to consider a medication? Now when we use a medication, it doesn't have to mean that you take a mega dose of a medication. It doesn't have to mean that you take it forever. Again, another conversation for another time. In general, these medications are designed for long term use. So if you're starting the medication, I want you to at least be open to the idea that you would consider taking it for. The rest of your life. 

But again, you are the boss of your body. If you do not want to take a medication long term, I am not going to force you to do that. No doctor is going to force you to do that because you could just stop. I will tell you, it is safe to stop the GLP medications cold turkey. There's a lot of conversation about weaning off of them. And again, there are people who do that, a different topic for a different day. We will absolutely create content on that for you. But you can stop a GLP medication cold turkey. It will be totally safe for you to do that. It may feel kind of miserable in your body depending on the situation, depending on the dose that you're on, but it is safe for you to do that. So you are the boss of your body. Only you get to decide if you take a medication, for how long you take the medication, and then what role that plays for you. It can be the lowest dose that helps to support you in making the food choices, making the movement choices, getting the sleep, doing all of the other pieces. It can be the tool that allows all of the other things to happen. And that is your choice and nobody else's. And one of the biggest challenges though is that we do wear our weight on the outside of our body. So when you lose weight, people will comment, but I will tell you in 2025, if you lose weight without a GLP, people are still assuming that you used GLP medications. So you might as well just do it if that's your reason for not taking the medication. And the reality is it's nobody else's darn business. If somebody asks you, oh my gosh, are you taking one of those medications? You do not have to answer that question. You do not have to comment when someone's like, oh my gosh, you've lost a lot of weight. What are you doing? You do not have to tell them. You can tell them, I've been taking care of my health. Thanks for noticing. You do not owe anybody an explanation. It is your private health history and you do not need to tell anybody what medications you're taking. You do not need to tell them what you're eating, how you're moving. It is nobody's business. They may ask, that is not going to stop them from asking, but you get to choose how you respond to that. And a lot of times I think about it similar to how I would think about a blood pressure medication or a depression medication. 

If you were taking a medication to support your mood, you've been struggling with chronic depression or anxiety, maybe you've been struggling with blood pressure, and you're taking a medication for that. Who in your life knows that you are taking those medications? It may be zero people, it may be one or two people, it may be 25 people. But that is a really good rule of thumb. If there are two people in your life that know you are taking medications to support depression, to support anxiety, those are the people with whom you may feel comfortable sharing that you are on a GLP journey. If you do not feel comfortable talking about your health history more broadly, you do not have to tell your next-door neighbor, your coworker, the mother that you see at PTA. You do not have to tell any of them, if you are taking a medication, which medication you're taking and how you're working on your weight loss goals. That is your own business because people will have their own biases. They will have opinions for you, they will be discouraging at times. They may be encouraging, but why take the risk with someone who is not that close to you? So the conversation is between you, it is between your physician. You may have another couple of close confidants in your life, but do not let other people's obesity bias impact you. You get to decide for me what makes the best, you know, what makes the most sense. What is the best decision for me for right now, for my health? And then with that information, you get to decide what you do in moving forward. 

If you are looking for support like this, I am so excited to support you in my brand new YouTube channel. If you're on my regular podcast, thank you so much for joining us here. You may be interested in following this on YouTube, so definitely check it out over there as well. We are going to have weekly content every Wednesday to help support you in your weight loss goals. Thank you for joining me today. I'm Dr. Sarah Stombaugh. See you all next time.