navigating obesity against all odds and barriers to lasting change: 'you're never done'
9 minute read
brenda rogers has changed her life through referral to a weight management clinic and injections of the weight loss and type 2 diabetes drug mounjaro (tirzepatide), and her own tireless perseverance to be healthy.
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“obesity is a chronic relapsing disease. you’re never done. that’s a bit of a hard pill to swallow, and yet that is also freeing because once the doctor gives you a diagnosis, guess what happens after? there’s a treatment plan.”
this is a message of “liberation” from brenda rogers of vancouver. she has lived with obesity for as long as she can remember, and now she’s speaking out at conferences and community events to share her story of vulnerability and shame over not being able to lose weight and keep it off—and the long-internalized self-blame that’s so hard to let go of.
she’s talking to audiences that include insurance companies and health benefits managers so they can put a human face to the numbers and data on prescription drugs when they’re determining available coverage for their employees.
because now is the time to step forward and speak up, she says.
“until just recently, i absorbed all of these external messages, as many of us did, to eat less, move more, try harder and have willpower,” rogers says of the diet culture that has failed her throughout her life.
“you take that into every diet, and the promise was always if you just follow this closely enough, this time it will be different. and then it isn’t. and you don’t question the advice or the structure or the diet. you don’t question that. i’m questioning myself like, oh, i failed again. i’m the failure. it’s me. but it’s not.”
new era of glp-1s offers hope, uncertainty
the new era of glucagon-like peptide-1 (glp-1) medications as a treatment for weight loss has brought a lot of hope and uncertainty that needs to be addressed. now there’s the promise of generic versions of semaglutide, a type of glp-1, formulated as injections that are approved in canada and in pill form available in the u.s. the only semaglutide pill currently approved in canada is rybelsus, a once-daily glp-1 medication for adults with type 2 diabetes who also have cardiovascular disease or are at high risk for heart disease.
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generic versions of semaglutide will be less expensive and more accessible, but do they work as well?
novo nordisk canada, manufacturer of ozempic, is offering the glp-1 ozempic to canadian patients at a price aligned with generic alternatives. the drug is approved by health canada for the treatment of type 2 diabetes.
rogers, now in her early 50s, has changed her life through referral to a weight management clinic and injections of the weight loss and type 2 diabetes drug mounjaro (tirzepatide), and her own tireless perseverance to be healthy. she’s launched her own consulting firm to support business owners with operations and problem-solving, and is also focusing on advocacy to break down barriers to access glp-1s, like more education for health-care professionals and people living with obesity, and the issue of affordability for people like herself.
she’s a proud community member of obesity matters, the national patient advocacy group for people living with overweight and obesity.
the weight of self-blame
she explains that people with obesity are usually coming from a place of vulnerability and shame. they’re living in a larger body and perhaps dealing with additional health outcomes related to excess weight, and they’re carrying this extra emotional and mental weight of self-blame.
“it’s very internalized. and in almost all areas of my life, and i can see this in other people too, we are successful. we’re driven, we’re disciplined, we’re determined. we are having success in so many places. and yet, there’s this one area we can’t seem to get it together. and that’s what i carried. and without really knowing that it was this thing called shame. as time goes on, there’s a lot of energy that is soaked up feeding into that belief.”
in 2000, rogers was diagnosed with type 2 diabetes, which is increasingly common among people living with obesity. her family doctor later suggested she try a medical weight management clinic for help with her weight. that first pivotal appointment came in january 2023 for her assessment and blood tests that also led to a diagnosis of further conditions related to her weight, including high cholesterol, fatty liver and sleep apnea.
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“this was a low point in my life. this is not a highlight. i did not feel good about going to this clinic,” she says. “i’m sitting there at my highest weight, the lowest self-confidence, the most shame ever sitting there. i’m crying in the appointment. i don’t want to be there because i’m still thinking, ‘why do i need help? why can’t i get it together? i’m smart enough. i know everything about food there is.’ actually, a lot of us carrying a lot of weight know more about nutrition and movement than the average person.”
she began the trial and error of finding the medication that worked best for her, mounjaro. the drug is a dual gip/glp-1 receptor agonist, meaning it activates glp-1 receptors but also targets gip (glucose-dependent insulinotropic polypeptide) receptors for improved insulin release, which differentiates mounjaro from a traditional glp-1 drug.
everyone responds differently and it’s often a process to find the best medication fit. the additional hurdle for rogers was navigating the red tape of extended health insurance. mounjaro was covered for her type 2 diabetes. so, the prescribing doctor had to provide her elevated blood sugar numbers from diabetes to qualify for her insurance coverage.
“so you have to really be in the ditch to be able to get this coverage to pay for a medication that my body is really needing,” rogers says. the good news is, the medication not only stabilized her blood sugar, but it also quieted the relentless food noise she’s faced all her life.
glp-1 drugs open mental capacity for lifestyle change
“that medication is a tool to give me some space in my mental capacity, so that i can now do the things that i need to do. i need to make sure i’m sleeping well, managing my stress well, drinking a lot of water, nourishing my body. now i can go on walks, movement becomes easier. and you have the mental capacity to think more about work, your relationships, your future. so, it opens up this whole new world because you no longer have constant thoughts about food all the time.”
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the weight started to come off, and she felt better. but with restructuring at her former workplace, she lost her job and her benefits. she didn’t qualify for any provincial health coverage for the medication, so what next? her medication costs her about $550 a month out of pocket, she says.
the mental and emotional toll of navigating stigma, cost barriers and inconsistent access to medication all undermine well-being.
rogers found another job with extended health coverage and stayed for six months so that she could afford the medication, despite the job being “toxic” and unsuitable.
“i went up to a higher dose and it was working beautifully. my body really responded to it,” she says of the medication, adding that she started rationing what she had left to make it last longer. “it’s no wonder people give up. you’re having to navigate this system that is confusing, inconsistent and changing.”
starting her own business, she has the added stress of paying for her medication while advocating for affordability.
another point she circles back to in navigating obesity is education and awareness about the disease and its interventions. medical weight management clinics typically don’t just prescribe glp-1s but also provide ongoing education to support patient success. rogers learned more about the disease and about external and internal weight bias and how they shape people’s health.
the solution is not just about medication, but making lifestyle and behaviour changes that help people build self-confidence and healthy routines.
professional guidance on weight transformation
gina livy, a fitness and weight-management professional in newmarket, ont., discussed the foundation of 2022年世界杯名单猜测 for people with obesity at a recent obesity matters summit. she runs a virtual clinic, the livy method, that empowers people through professional guidance to start with food and then look at factors like movement, sleep and stress that all contribute to weight.
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“it’s not knowing what to do and then how to do it when life is hard, and doing it long enough and understanding it so it resonates with you,” she says of helping people find habits that are sustainable for them.
“my goal is to teach you, for example, when to eat. there is being hungry versus eating out of habit versus eating emotionally when you’re coping and stressed out, right? then there is what to eat,” she notes, outlining that she helps educate people about how the body processes food and the difference between carbohydrates to give you energy, protein that you need for muscle and fat for healthy function.
“it’s understanding how you feel after eating fish versus a steak or how you feel eating fruit versus chocolate. it’s about being connected to your body. we’ve become so disconnected, especially if you spend any time dieting, you can’t trust when to eat, what to eat and then how much to eat.”
livy has worked with people who’ve had gastric bypass surgery for obesity, which makes it easier for them to lose weight because they can’t eat certain foods and can only consume a limited amount of food. but the maintenance part of this transformation is difficult because they may not have prepared for the lifestyle change necessary, she explains, cautioning that the same can happen with glp-1 drugs.
‘massive disconnect’ from what your body needs to maintain weight loss
“there can be a massive disconnect. when you lose weight, there’s three reasons why you gain it back. one, you don’t give your body time to adjust to your new weight. you can’t just lose 20, 60, 80 pounds and not need your body to adjust. your hormones, your blood flow, metabolism, body temperature have to adjust to the weight that you’ve lost. not giving the body time means you go back into old habits. the second reason is situational change. so something happens in your life that is dramatic, someone dies, you lose your job, you move, you revert back into old habits. the third reason is not being mindful. and why? because you revert back into old habits.”
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while she’s hopeful that people benefit from glp-1 drugs, she’s learned at obesity conferences that many people are eating less of the same food. they’re not changing their behaviour. and if they stop the medication, they gain the weight back and add more pounds.
“even though you’re not hungry [on glp-1s], your body still needs food. so this is where people are seeing that muscle loss, which is just adding to the situation by slowing their metabolism even more. and with women in midlife, you need that. you need bone density. you need that strength. you’re going to fall and break a hip and not recover, so that’s a whole other thing.”
while food is foundational, lifestyle changes like exercise, mindfulness and sleep, for example, need to be part of treatment. she’s worked with clients who were using ozempic to manage their type 2 diabetes all along, which also requires lifestyle changes.
“you’re not going to address diabetes just taking a medication,” she emphasizes. “you are not going to address obesity as a disease just by taking medication. you have to also address the health issues. and no one is talking about that right now.”
for rogers, her doctor has confirmed that the medication she’s taking is the one that works for her, so switching to a less expensive generic glp-1 won’t deliver the same success, creating more complexity for physicians and patients.
“so these dear doctors are now not just having to care for people’s health and prescriptions and everything. now they have to calculate about dollars. ‘you stay on mounjaro, but we’ll reduce the dosage,’” she says of conversations with her doctor. “so now i’m not going to be shedding weight as effectively and successfully as i have in the past because i’m going on a smaller dose.” she decided that she’ll find the money for her full dose and keep going.
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“i have no intention of ever going off of this medication because my body needs this. obesity is a chronic, relapsing disease. that means it doesn’t go away.”
her message to others living with obesity is about advocacy, finding community and pursuing a treatment plan.
“you can’t do this alone. because we would have if we could have, right? and you deserve to have evidence-based care, compassion and support. just like anybody who’s broken their leg, had a heart attack, or has been diagnosed with another chronic disease. you deserve that.”
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