I'm a long time follower and I'm a psychiatrist. You did a fine job with this. Bravo for sharing your own struggles. You do a lot of good with your channel; sharing this all makes is even better.
People ask how I lost 50lbs and I said “I was walking 5 miles most days every week, had a personal trainer, ate lean home cooked meals, joined programs, had one alcoholic drink a month, counted calories, saw a therapist, saw a nutritionist, and I was barely able to maintain. These new meds made that work pay off. Nothing else did.
This. As other comments have said, loosing and maintaining weight loss is a 2nd (or 3rd) job for some of us. A drug that gave me back 16-24 hours of my week would be a dramatic quality of life improvement.
@@tlouie3181 I've been on a GLP-1 for more than a year and lost ~120 punds. I'm still doing all the work. Tracking everything I eat for over 400 days, excerising 5-7 days a week, some of that with a personal trainer. As the OP said, the meds make that work consistently effective for the first time in my long strugle with obesity.
As a fellow doctor who has been on a SSRI and just started a GLP-1 inhibitor, thank you for speaking about this topic. Goes to show we all have similar stories and challenges and we should all speak openly and honestly about them. It can only do good :)
So true, I take antidepressants Amitriptyline and Duloxetine for fibromyalgia. I was talking to another guy with fibro who refused to try the medications for it because "he wasn't depressed." I tried explaining to him that while they are anti-depressants, they are also used to treat chronic pain. All medications have side-effects, not all of those side effects are bad. The side effect for reducing pain when taking Amitriptyline was so effective, they don't even really use it to treat depression anymore! I had two patients in my office gossiping about a friend who takes anti-depressants and how she "relied on them" and how "unhealthy" that was. I rely on my glasses as much as I rely on my anti-depressants, but no one gives me lip for wearing glasses.
I get annoyed when people say medication is a "crutch" as if that's a bad thing. WHAT DOES A CRUTCH DO?! It helps you walk when an injured or malfunctioning leg would otherwise make it difficult, painful, or impossible. So if you're using medication as a CRUTCH... what do you think it's doing?! Imagine having a broken leg and someone tells you "you're just using that crutch as a crutch" YES THAT'S LITERALLY WHAT IT'S MADE FOR. I also hate the whole "you're not doing the work" criticism. If you need to get a job done, and there's an easy solution, and there's a difficult solution, are you doing the difficult solution on purpose just because you love to work more? wtf? Imagine you have to fill a big hole with dirt. Are you still gonna use your hands if someone gives you a shovel? Are you still gonna use the shovel if someone gives you a bulldozer? If there's some kind of work that absolutely needs to get done for your health to get better, medication isn't going to mask that. That work will have to get done one way or another. But if medication makes it easier to do that work, then why not take it? Why not make life easier? Why would I do more work when I don't have to?
The answer to this rhetorical question, of course, is that people treat it as a moral issue. They think you need to put in work because the sacrifice is what makes a person morally deserving of the benefits. Which you can then clearly see is a self-congratulating pat-on-the-back for people who've succeeded the hard way and want to feel superior to others, and ignoring that in reality people's bodies and situations are different. An acceptable sacrifice and work for one person may not be acceptable or workable for another. But that false sense of moral sacrifice and reward is why, as the video mentioned, the stigma causes some people to feel like using drugs is "cheating".
I *seriously* appreciate both the fact that this episode exists and you sharing your personal story. I’ve had many of the same struggles with my weight and mental health, and I only recently (within the last few years) became willing to use medication to help. It’s been *so much better* on my medications that I can’t even describe the difference in words. Thank you for your vulnerability in this video. I truly hope it helps shift the narrative on these conditions.
This was so raw and honest it caught me by surprise and I really appreciated it. There are things you discussed that I'm not brave enough to disclose publicly but have absolutely changed my life for the better. Thank you for this.
I just started taking anxiety meds last week, and have been having a hard time believing that they don't represent a failure on my part. This video has really helped me contextualize everything; thank you.
Wow, I just realized this this channel has been around for over 10 years now. I was never much interested in the subjects talked about here until you I found the channel from John Green, and it's still my #1 for health related news and discussions. Thank you Healthcare Triage for all your years of great content, I owe a lot of my knowledge and enthusiasm for health to you!
It's videos like this that make me feel so good about supporting Healthcare Triage on Patreon. Glad you're seeing QOL improvements on multiple fronts, Aaron!
Wow! One of my favorite episodes so far! (and I've been an avid watcher for so many years!) Thank you so much for being so vulnerable about your own struggles Dr. Carroll! That means the world to so many 🤗
Usually when talking about topics about healthcare, including those of mental health and obesity, there's a certain tendency of sticking to concrete facts. Sometimes you will get nonchalance, which is helpful to normalize taking the medication doctor Carroll talked about, but doesn't really help the ease the internal doubts or shame one might have. Honestly, this kind of honest, open and proactive acceptance makes me emotional. I feel seen, like I can feel good, from an emotional and visceral place, about the health decisions I logically know are good for me.
Thank you for your vulnerability on this subject! It is so important to have these discutions! Your point that suffering from depression or an eating disorder isn't a moral or motivational failure is so important! It reminds me of my own struggles with ADHD and how it specifically affects women, I would be so interested in an episode on the subject!
Thank you for sharing your story. I’m also on a GLP-1 agonist. It’s been life changing. I haven’t been this healthy since my early twenties. I’m an anaesthesiologist. We don’t 100% understand how every anaesthetic agent works, not down to the molecular level. We just know that they work, and they’re safe, and we use them. Sure, there are certain contraindications for certain conditions and you always have to weigh the risks and benefits. But there’s never a stigma associated with needing them. Nobody ever says “If you tried hard enough, maybe you could fall asleep deeply enough to withstand getting cut open”.
Wow. You and I had a very similar story. I was reluctant to go on anxiety medication because I too thought they were an admission of failure, or a crutch. Then I also had a panic attack and passed out on a work site, and was put on sertraline. Panic attacks are extremely rare now and I feel much better. Thanks for sharing your story! Makes others feel less alone in their struggles.
This must have been scary to share and I'm glad to be validated for what I've thought was true for so long. I weight lift, run and Pilates eat sub 1400 kcal and still am obese. I've been so discouraged because every doctor and OB (I gained a scary about of weight during pregnancy) just assumes I'm lying or offered no help or steps forward. And that's been my whole life even when I cycled 16 miles a day with extreme elevation changes in highschool I never could get below 210 as a 5'7"person but doctors assumed it was hormones or I was sneaking junk food😭
I'm sorry, but that's not scientifically possible. You are simply eating more than you need. There's a reason why every doctor and OB tell you the same thing. I understand it's harder for you than most other people, but you can't improve yourself if you are refusing to admit.
@@LZKS It is possible. Depends on metabolism, which can be way too low due to thyroid problems. It's not just about how much you eat, it's about how your body processes it. I have a friend who was called a liar by every doctor until one of them actually ran the right tests and discovered they had the slowest metabolism that doctor had ever seen.
A relative of mine had the same problem - she worked out every day - running, yoga, martial arts, at least an hour, sometimes two every day, and almost every professional told her "do more exercise!" She got lucky: one doctor believed her when she said things had changed. It turned out she had developed a "benign" growth on her pituitary. Brain surgery is really dangerous, so she keeps it under control with drugs, but she still does all the sports and is still "pudgy".
@@annelliott1384 Slow metabolism only measures your rate when resting. This DOES vary from individuals. It does NOT measure how much calorie you burn when you exercise. You burn how ever much calorie you need to burn to do certain amount of work. This is the immutable law of thermodynamics. So while having a slow resting metabolic rate makes it more difficult for you, it does NOT make it impossible.
@@LZKS having an abnormally slow metabolism doesn’t mean someone should just eat less and less, ignore their hunger signals, and be shamed and called a liar by doctors. It means there is something actually wrong. Like maybe a thyroid tumor. Doctors who aren’t even specialists in the topic telling people that their own reports and records of how much they are eating are lies because it’s outside of what the doctors expect leads to serious problems being undiagnosed. Someone who’s over 6 feet tall and 300 lbs and eating 1600 calories a day and gaining weight needs medical treatment because there’s a problem. They don’t need to be insulted and dismissed by every doctor they go to for help. “Just starve yourself” isn’t good medical advice, it’s setting people up for an eating disorder that could lead to malnutrition.
Thank you so much! Sharing science and researched based information is so important, but sometimes it's the personal experiences are what really break through to people. I've spent my whole life being just a little over weight. When I actively counted calories and tried to lose weight, it took me a year of restricting myself to 1500 cal per day to lose, like, 12 pounds. That is a lot of effort and I didn't even change clothing sizes. Tracking everything I ate for a year, not counting any exercise towards my calorie allowance, and it barely did a thing. Obesity is so little understood. Why does one person eat anything they want and never gain weight and another person live on a very disciplined diet and still struggle to get to a healthy weight? I don't know. What I do know, is that being heavy isn't a moral failing. Being depressed isn't a moral failing.
One does not eat anything they can and never gain weight. Unless you're God, you can't see what that person is doing on a daily basis down to the details. There are some factors that make it difficult to maintain healthy weight. But these are exceptions, NOT the rule. Every other person complaining they are the exception doesn't help epidemiologists determine root cause of obesity epidemic.
Thanks for this video! It's so important to normalize both of these things. I had similar fears about going on an SSRI and only did so when in crisis, and I cannot be more grateful for how much better it has made my life. I immediately wished I had started it years earlier.
Thank you for this episide. I think this episode is a good one for me to hear because I can deeply relate to the self-inflicted shame with these stigmas you talk about, and I need to hear more about taking care of myself. I can also relate to wanting there to be solid foundation of knowledge, but I'm glad that we can at least observationally determine better outcomes with these and other treatments. These videos have been immensely helpful to me for the last 10 years, and I'm glad you're taking steps to be around to help us navigate tough topics for many years.
Thank you for being so vulnerable and sharing your experience with us, Dr. Carroll. I’m glad you were able to improve your quantity of life. I think it’s interesting how certain medications can be used to treat a variety of conditions. When my middle child was a toddler, he used to take an allergy medication (cyproheptadine) to prevent his migraine attacks, and it worked AMAZINGLY. Last time I looked it up, researchers weren’t exactly sure how an antihistamine helped prevent migraines, but for my child it was super effective.
I have wanted you to address mental health medication for years… I was confident that my depression was under control it was not until my doctor wanted to use a anti-depressant off label to treat my quality of sleep that I learned that I was always tired because I was depressed. I’m uncertain whether my doctor was treating my pride or if he really thought it had some off label benefit but coupled with blood pressure medication I have felt better than I have in years… My doctor wants me to exercise more (walk 20 minutes every day) to help my cholesterol but even with my new found energy… all I want to do is sleep… Having had many bad experiences with under-qualified therapists I have strongly considered trying again in hope that it will give my subconscious a will to live…
The myths about mental heath are devastating. My dad is very much against therapy and mental health drugs and I think this stopped my mom from seeking the help she needed and that if she had she might still be here today. I am on an SSRI and in therapy and it has charged my life for the better. I am also struggling with my weight and wish that weight-loss drugs would be proscribed as a preventive rather then just to people who are already sick. Another thing to remember about these drugs is that modern medicine and neurology are really new if you look at the span of human history so it is not surprising that we don't understand how things work.
I really appreciate you sharing this! It took me years to not see my ADHD as a personal failing and get treatment for it. I am doing so so much better now and can’t believe I spend so much time trying to fight against myself. The stigma is real, and seems to be especially strong when directed towards ourselves.
OMG. You fell down a mountain! I had no idea. I've been watching you for years. I had no clue. Glad you're doing self-care that works. Your channel has succinctly explained things to me.... Let's go to the research! Thank you for being here.
Damn this hits close to home. I take pride in not taking drugs for anything not acutely debilitating. As I get older, I’ll need to reconsider my position.
Family NP here, I too am overjoyed that we have this added tool to our arsenal. It is expensive now, but I am hopeful that as the patents run out 10-20 years from now, that more patients will benefit and maybe Medicaid will start paying sooner. But I caution us all that we still need to focus on preventing weight gain in our patients, and on public health to help people prevent the need for this medication in the first place, cheaper produce, sin taxes on high calorie, hyper palatable foods, more walking and biking paths. We shoukd imbrace these medications, but also do the other work. They would not be necessary if our lifestyles were not so obesegenic. This is a societal and governmental failing, not a personal one.
I have had depression since high school. I would go on meds, go off meds, & not let anyone know. About 10 years back a psychiatrist sat me down & told me I would need meds for the rest of my life. It’s been a journey trying to finds drugs that work for me. I’m doing pretty good now. Side note: I have depression. I don’t suffer from depression. You wouldn’t say someone suffers from diabetes. They have diabetes.
Thank you for this! Your vulnerability and honesty on your own treatment is so refreshing. Acknowledging the stigmas that have affected your ability to seek the help you need is such a good way to let people in to see their own biases. Truly, thank you so much!
I take Bupropion for depression and I've been trying to get bariatric surgery for years because I've struggled with the same exact issues. My self image is absolutely devastated, always has been, and while my fight for surgery is still ongoing, I think part of the reason why I've not tried to receive any weight loss drug is because I have a feeling in the back of my head that I need to suffer in some way in order to lose weight.
This is great! Thanks for sharing your story. This how we can destigmatize these issues. I’m very open w people I know about how therapy AND medication have been critical for my anxiety and depression. AND that I see no need to eventually get off the medications since they WORK.
I’ve always known this and I come from the other end of the spectrum. I eat as much as I want and never give food a second thought and never waver from a BMI of around 20. Meanwhile I’ve watched my best friend get outrageously serious about diet and exercise and still struggle.
Aaron thank you so much for this video. I’m a healthcare provider and have benefitted a lot early on from these videos and podcasts on technical aspects; this topic is much more personal and really helpful perspective- additional approaches I can work in to talk about this with my patients. I love what yall do over here
So many things can lead to weight gain it's a wonder we even manage to survive this long. I have ADHD but was never told until I got a diagnosis myself as an adult. I was raised to always be myself and do what worked for me. It didn't matter if other people did things differently, all that matters is how I do things and what works for me. This helped in some ways, but honestly it did lots of harm and wish I was just made aware sooner so I could decide my own treatment plan. After starting medication I no longer had binge eating issues and also had more skills in dealing with my health. I've spent the last 4 years out of various medical offices trying to undo all the damage I've done to myself. All of this could have been avoided had my parents and society not tried to hide my ADHD and pretend that would make it go away.
One of your best videos. Thank you addressing these two chronic diseases. Traumas in childhood easily trigger these disorders as people seek to cope with very intense stress when they have little understanding of the world. Drugs that help manage these diseases are really godsend.
This episode felt very personal, for both of us. I have family on SSRI and even though it didn't work for me, it's a literal "chill pill" for them and we noticed a distinct difference when they miss a dose or two. Anyway, I just want to say Thank You for making this video and appreciate your perspective and insight. It's a good reminder to all of us how complex and diverse each human's biology can be.
I'm a DO in Oklahoma. Every year when I renew my medical license I have to answer a question right smack in the middle of the questions about criminal history, law suits, etc about whether or not I've ever taken an antidepressant. Likewise, the health system I work for stripped away coverage for GLP-1 agonists for weight loss. The stigma for both of these issues is very real.
Me, watching this in a psych ward mess hall. I've been on one SSRI or another since I was 13, pretty sure I've been through them all by now. Had bariatric (vertical sleeve) surgery in July 2019, and I've been on Ozempic for probably a year and a half, if not two years by now. The beat way to deal with stigma is being unapologetically open about our struggles. I'm never not going to have mental illness, and I'll never not struggle with obesity. These meds help. That's all I care about, and that's all anyone should care about.
This was a thoughtful video. Thank you for sharing your own experiences to help underscore just how difficult these mental blocks are, even for the professionals!
I honestly can't imagine not thinking about food all the time. I was able to lose weight calorie counting, but then I gained it back when I stopped. I started counting again, but it's hard. My mouth/brain just constantly want me to eat even if I don't need to.
Commendable sincerity! As for the unknown causes of obesity, I was surprised some time ago to learn that infections with a type of adenovirus (Ad-36) cause obesity. It may be that some of the small infections we have throughout our lives have a similar effect, but they have not yet been studied.
I wasted 10 years of my life trying to lose weight by going to the gym, counting calories, and having a personal trainer and nutritionist. These things are good and it will help many people lose weight, but it did not work for me as it made me develop multiple eating disorders, and I failed with calories every time because the hunger was insane. After using Ozempic, I lose 200 pounds in 2 years and it changed my life. And all my eating disorders are gone! I still go to the gym and eat healthy
Thank you for sharing! I’m reluctant to use weightloss meds because they are so new and also concerned about the rate of weight loss. Is it safe to lose weight so quickly? I’d love to see you do a follow up further along as more research comes out. Thank you!
It depends. Don't want to say there aren't doctors who do this, but some symptoms are similar to other symptoms, and can sometimes be hard and complicated to diagnosis.
Problem is being fat does indeed cause a multitude of symptoms that are similar to other things that have nothing to do with weight. And out of all the possibilities, weight is usually the easiest to treat. For the doctor at least, not so much for the patient that actually has to do it.
The issue is when doctors are more focused on patients’ weight than the actual issue. People have talked about having an ear infection or broken bone, and the doctor is more focused on their weight.
The hardest thing for us to admit I think is that our culture/society/lifestyle is so much to blame. I don't blame most overweight people for being overweight TODAY because so much of today's life is harmful in a huge variety of ways. Sedentary work requirements, polluted air, microplastics and VOCs at home - modern life is killing us. I mean a LOT of people literally do not have the means of accessing a nice forest for a jog and fresh veggies for lunch. Best they could do is run down a crowded sidewalk next to the smog of cars and stop at a Subway for a chicken sandwich. Tim Robbinson was right: "What the hell have they do to us? WHAT DID THEY DO TO US?"
I love your message about not blaming people for medical conditions. I despise what comes across as a promotional message to go get an off-label prescription for a drug that many diabetics need for their condition. I know people who have to run around my state trying to find the stuff because other people are using it for weight loss. This is a real issue for diabetics for whom this is the only med that has controlled their A1C.
Obese people also need this medication, too, both as a treatment and as a preventative. The issue here is the pharmaceutical companies not increasing supply fast enough when they knew it was becoming more popular, and even limiting it intentionally to keep prices artificially high. Don’t blame the doctors trying to support their patients, or people looking for a cure to a difficult, chronic condition. There is a reason he didn’t mention a specific brand, and pointed out his personal privilege. This wasn’t an advertisement, it was education.
My doctor took me off the ssri that I felt was making my life bearable because it had made me gain weight. In fact she has blamed every single problem I have had on my weight. It doesn’t matter what it is she blames in on my weight and won’t even try to help my symptoms and just tells me to loose weight. I am currently pregnant so loosing weight isn’t a healthy option for me or baby. I am afraid to go to my doctor because I know she will just throw up her hands and say live with it till you lose weight. It is so discouraging.
Doctors are like any other profession. Some of them are good at their jobs, some are not. It sounds like maybe you need to find a doctor who's better at their job.
Any chance of getting a new doctor? That's so awful. I've had cyclical periods of major depression most of my life, and the way it saps your energy and leaves you with almost nothing is unreal. How can a depressed person find the energy to exercise and eat healthy? My psychiatrist told me if I struggled with my weight on a medication, we would simply try another one. It's pretty bad that your doctor didn't do the same.
I did get a more supportive OB to see me through this pregnancy. She felt my mental health was more important than my weight and immediately put me back on a safe antidepressant for my pregnancy. I am trying to get into a new primary care provider but most in the area are booking months out, right about when I will be having a baby.
I finally took serotonin for depression and it worked great. Only problem was it gave me chronic diarrhea. I was switched to another type of drug and that worked fine too. I don't know why I waited so long to try these medications. I think I was afraid they would change my personality and I wouldn't be me. I haven't needed those drugs for years now, but when I did I was glad they were there.
My conundrum with weight loss and mental health is how linked they are for me. Not because of stress eating, but because food is a reliable source of dopamine. When I'm with my girlfriend in Brazil, I simply don't get the munchies because I'm all up on dopamine from all the new stuff I try to learn and it satiates me completely. But when I get back to the Netherlands, I suspect that food will become the main dopamine driver again, which is both expensive and unsustainable. So appetite suppressants would really help me keep focus better than something like ritalin would.
About 95% of the body's serotonin is found in the gastrointestinal tract, specifically in the enterochromaffin cells lining the digestive tract. Only a small portion, around 5%, is located in the brain and central nervous system. The roles of serotonin differ depending on its location. In the gut, it primarily regulates digestive functions like motility (gut movement), fluid secretion, and pain perception. In the brain, it acts as a neurotransmitter, influencing mood, appetite, sleep, and learning. The relationship between gut serotonin receptors and depression is complex and not fully understood. The brain and gut communicate through the gut-brain axis, and disturbances in this communication have been linked to mood disorders, including depression. Disruptions in serotonin levels or signaling in either the gut or brain can contribute to various conditions like irritable bowel syndrome, depression, and anxiety. Research is ongoing to explore the role of gut serotonin in mental health, and some studies suggest a potential link between alterations in gut serotonin levels and mood disorders.
Scary insight. You'd agree it's so sweet when you finally get to lose that unwanted weight. I lost 109 pounds (half the weight of a refrigerator) in less than 4 months and have kept it off since then. Just like every woman struggling with weight loss now, I yoyoed for years - staying on track for a month or 2, losing a few lbs in the process before falling off. And each time I fell off, I just gained the weight back plus more. In July 2021, I was at my heaviest - 255 lbs... See full story on my channel.
Great episoide! Can you do an episoide about how an indiviual should approach new medication? Something like how long you should try it and when you should stop? My struggle isn't an unwillingness to try something new (maybe a little), it is an inability to tell if something will work.
We actually do know how and why SSRIs work. We know that SSRIs don't work better than placebo in mild to moderate depression and that in severe depression they don't work better than any other stimulant. So it's the placebo effect for most people and a stimulant effect for some. It's weird that a lot of doctors still haven't gotten that memo.
Yep, meds help. And it doesn’t have to be just one or the other with meds vs lifestyle. ADHD meds would help me focus enough to stick to a meditation practice.
I really hate how people speak of crutches/canes as a negative thing! Some of us use them long term, and they radically improve health and safety. I don't understand why people have such a hard time understanding that literal crutches are for more than temporarily broken bones! They improve physical stability and make it possible to get around not only more but also in terrains that otherwise would be off limits because of the risks! It's not either you walk by your own power or you're in a wheelchair, there's a range inbetween there!
I actually think it's really hilarious that there is a stigma against someone with type 2 diabetes taking a medication for weight loss, But there is not a stigma against someone with type 2 diabetes taking insulin. If the source of that stigma really was the societal belief that that person is not trying hard enough on their own to control the disease, Then you would think type tube diabetes and insulin would receive the same treatment.
People with type 2 diabetes don't even take the medication for weight loss. The medication makes the pancreas excrete more insulin. The weight loss is only a side effect in this case.
My issue with antidepressants is the problems with libido. Suddenly it gets so hard relieve myself when the call comes and it infuriates me. It feels like being blue balled and that really upsets me so i dont feel like taking it.
Man, I can relate so much on the weight loss front. I'm 1.73m, used to weigh 120kg at heaviest but got to 75kg at the peak of my keto diet journey. I still hated my body because I was basically skinny fat. I've since gotten off keto, started lifting weights and tried to gain a bit of muscle. Currently around 85kg but mostly weight gain and not muscle gain (well, some, but it plateaued after a certain point). It's so frustrating that the results haven't been commensurable to the amount of effort that I'm putting in, but ranting about it just seems like I'm not working hard enough or I'm not doing it right. Is there a professional that I can consult about this?
I agree with much of the thrust of this video. However, I disagree some of the implied framing that weight loss isn't a matter of caloric reduction. The reasons someone can't consistently keep their consumption of calories below their TDEE are of course multifactorial, and often does involve some kind of willpower at some steps. The issue is we shouldn't moralize that a person is unable to overcome the roadblocks and/or if they use medication such as Ozempic to assist with it, in the same way we shouldn't moralize people using SSRIs or therapy to manage depression.
Well if you’ve ever taken art history you would know that ‘normal weight’ as we see it today wasn’t always so. There have always been smaller and bigger people. More fit or less fit. Although I do agree with the fact that obesity has definitely been on the rise. Probably because 90% of the food in grocery stores isn’t food and everything we eat, drink and breath is full of chemicals that fuck with our epigenetics and hormones 🤷♀️
If we decided we shouldn't use drugs when we don't understand their mechanisms, we'd have to give up on general anesthetic. Probably for the best that we accept that a drug works and can be beneficial without needing to know how or why it works.
My daughters prescriber told us that sertraline could effect memory in my daughters later years, so she needs to get off it ASAP. Which hasn’t been doable yet. Is there any truth to that?
But wait, how CAN you afford it out of pocket? I'm a data scientist and we earn s good wage but my insurance just cut my wegovy and the only thing i can think to do is get a compounded version. Otherwise it's $900/month and only Elon Musk can afford that.. What are you buying out of pocket? Also I've heard of people buying and compounding THEIR OWN semaglutide from China which is epically dangerous, just because it's cheap!
Hi Dr Aaron, I've been a viewer since the beginning of this channel and I'm incredibly grateful for your videos. Please take the following criticism as my attempt to be helpful, and remember that the positives massively outweigh the benefits. However, I feel like you need to work on your understanding of weight and fatness. Growing up when we makes this tough, it took me a long time to get past my own biases. I feel like you need to go back to square one, try to unlearn what you've learnt, and work your way back up. I can guarantee that you will not end up in the same place as you started. I'm not particularly fat, but I'm general interested in anything where culture, medicine, commerce, and the actual evidence intertwine. What got me interested in this particular area was when I learned a couple of fat people I knew (through some deep late-night discussion) would actively choose not to seek medical care from me, despite the fact that I believed I was 'evidence-based' and sympathetic. Hearing you talk about weight in this video feels like I'm listening to a recording of myself back then. The greatest of intentions, but misguided. If you want to make a positive change for you and your patients, a first step might be to never use BMI again, except where you are forced to through insurance/laws. Maybe also think about the fact that you tried everything you could to lose weight, but couldn't. What does that mean to you?
I love Healthcare Triage because of "To the Research" and "Anecdote does not equal data". I'm happy that you're doing well! However, this is not the rigoruos standards I have come to expect. "I fell like", "I have..", "It can't be because I have...", etc. are not what you usually take for good arguments when you eveluate topics. This gives me the same feeling as someone advocating for acupuncture or homeopathy.
Anecdotes are only a problem when they are refuted by evidence, or when they are used to obfuscate evidence. Most humans value and remember stories more than numbers, so anecdotes can be a critical tool in getting people on board with the evidence. A doctor should provide both: here is the evidence and here is a personal example, if they want to be most effective. Homeopathy and acupuncture aren’t bad because of the existence of anecdotes, they are bad because of the lack of evidence. This medication isn’t pseudoscience.
Obesity and mental health issues are not the sufferer's fault. Point taken. Absolutely. Well and needfully done. But speaking strictly about obesity... Yet another expensive drug you have to be on for the rest of your life with unpredictable side effects and unsure effectiveness? No thanks. I lost over 110lbs by water fasting and moderate exercise when NOTHING else worked. It was difficult, but it cost me nothing. And I can keep doing it whenever the weight begins creeping back on. I've kept it off for seven years now. Some of these drugs cost THOUSANDS of dollars a month, and are a lifetime commitment. Not possible for most people who need them.
So what medications was it? You didn't say what it which ones have worked for you. I understand we are all made differently, cellularly - probably why you refrained from discussing the actual drug you are on.
BMI isn’t a perfect measure for individuals, but it has been shown to be quite reliable across large populations, including in studies that went in attempting to show the opposite. If you have conditions often caused by or affected by weight and you also are overweight, a doctor should take that into account until there is substantial evidence suggesting otherwise. All differential diagnosis is taking test results, making the most likely guess, and then treating accordingly. If it doesn’t work, you take more tests and guess again.
I'm a long time follower and I'm a psychiatrist. You did a fine job with this. Bravo for sharing your own struggles. You do a lot of good with your channel; sharing this all makes is even better.
People ask how I lost 50lbs and I said “I was walking 5 miles most days every week, had a personal trainer, ate lean home cooked meals, joined programs, had one alcoholic drink a month, counted calories, saw a therapist, saw a nutritionist, and I was barely able to maintain. These new meds made that work pay off. Nothing else did.
Keeping weight off can be a second full time job for a lot of people
This. As other comments have said, loosing and maintaining weight loss is a 2nd (or 3rd) job for some of us. A drug that gave me back 16-24 hours of my week would be a dramatic quality of life improvement.
@@tlouie3181 I've been on a GLP-1 for more than a year and lost ~120 punds. I'm still doing all the work. Tracking everything I eat for over 400 days, excerising 5-7 days a week, some of that with a personal trainer. As the OP said, the meds make that work consistently effective for the first time in my long strugle with obesity.
As a fellow doctor who has been on a SSRI and just started a GLP-1 inhibitor, thank you for speaking about this topic. Goes to show we all have similar stories and challenges and we should all speak openly and honestly about them. It can only do good :)
So true, I take antidepressants Amitriptyline and Duloxetine for fibromyalgia. I was talking to another guy with fibro who refused to try the medications for it because "he wasn't depressed." I tried explaining to him that while they are anti-depressants, they are also used to treat chronic pain. All medications have side-effects, not all of those side effects are bad. The side effect for reducing pain when taking Amitriptyline was so effective, they don't even really use it to treat depression anymore!
I had two patients in my office gossiping about a friend who takes anti-depressants and how she "relied on them" and how "unhealthy" that was. I rely on my glasses as much as I rely on my anti-depressants, but no one gives me lip for wearing glasses.
I get annoyed when people say medication is a "crutch" as if that's a bad thing. WHAT DOES A CRUTCH DO?! It helps you walk when an injured or malfunctioning leg would otherwise make it difficult, painful, or impossible. So if you're using medication as a CRUTCH... what do you think it's doing?! Imagine having a broken leg and someone tells you "you're just using that crutch as a crutch" YES THAT'S LITERALLY WHAT IT'S MADE FOR.
I also hate the whole "you're not doing the work" criticism. If you need to get a job done, and there's an easy solution, and there's a difficult solution, are you doing the difficult solution on purpose just because you love to work more? wtf? Imagine you have to fill a big hole with dirt. Are you still gonna use your hands if someone gives you a shovel? Are you still gonna use the shovel if someone gives you a bulldozer? If there's some kind of work that absolutely needs to get done for your health to get better, medication isn't going to mask that. That work will have to get done one way or another. But if medication makes it easier to do that work, then why not take it? Why not make life easier? Why would I do more work when I don't have to?
The answer to this rhetorical question, of course, is that people treat it as a moral issue. They think you need to put in work because the sacrifice is what makes a person morally deserving of the benefits. Which you can then clearly see is a self-congratulating pat-on-the-back for people who've succeeded the hard way and want to feel superior to others, and ignoring that in reality people's bodies and situations are different. An acceptable sacrifice and work for one person may not be acceptable or workable for another. But that false sense of moral sacrifice and reward is why, as the video mentioned, the stigma causes some people to feel like using drugs is "cheating".
This impacts 1000x more with your personal story.
I *seriously* appreciate both the fact that this episode exists and you sharing your personal story. I’ve had many of the same struggles with my weight and mental health, and I only recently (within the last few years) became willing to use medication to help. It’s been *so much better* on my medications that I can’t even describe the difference in words.
Thank you for your vulnerability in this video. I truly hope it helps shift the narrative on these conditions.
This was so raw and honest it caught me by surprise and I really appreciated it. There are things you discussed that I'm not brave enough to disclose publicly but have absolutely changed my life for the better. Thank you for this.
I just started taking anxiety meds last week, and have been having a hard time believing that they don't represent a failure on my part. This video has really helped me contextualize everything; thank you.
Wow, I just realized this this channel has been around for over 10 years now. I was never much interested in the subjects talked about here until you I found the channel from John Green, and it's still my #1 for health related news and discussions. Thank you Healthcare Triage for all your years of great content, I owe a lot of my knowledge and enthusiasm for health to you!
This made our day! Thank you! :) -Tiffany
It's videos like this that make me feel so good about supporting Healthcare Triage on Patreon. Glad you're seeing QOL improvements on multiple fronts, Aaron!
Thank you! Your support means the world to us!!
Wow! One of my favorite episodes so far! (and I've been an avid watcher for so many years!) Thank you so much for being so vulnerable about your own struggles Dr. Carroll! That means the world to so many 🤗
Thank YOU! We wouldn't be here without people like you 💛
I'm so happy for you. Glad it is helping and you're willing to share your experience
Usually when talking about topics about healthcare, including those of mental health and obesity, there's a certain tendency of sticking to concrete facts. Sometimes you will get nonchalance, which is helpful to normalize taking the medication doctor Carroll talked about, but doesn't really help the ease the internal doubts or shame one might have. Honestly, this kind of honest, open and proactive acceptance makes me emotional. I feel seen, like I can feel good, from an emotional and visceral place, about the health decisions I logically know are good for me.
Thank you for your vulnerability on this subject! It is so important to have these discutions!
Your point that suffering from depression or an eating disorder isn't a moral or motivational failure is so important! It reminds me of my own struggles with ADHD and how it specifically affects women, I would be so interested in an episode on the subject!
Thank you for sharing your story.
I’m also on a GLP-1 agonist. It’s been life changing. I haven’t been this healthy since my early twenties.
I’m an anaesthesiologist. We don’t 100% understand how every anaesthetic agent works, not down to the molecular level. We just know that they work, and they’re safe, and we use them. Sure, there are certain contraindications for certain conditions and you always have to weigh the risks and benefits. But there’s never a stigma associated with needing them. Nobody ever says “If you tried hard enough, maybe you could fall asleep deeply enough to withstand getting cut open”.
Wow. You and I had a very similar story. I was reluctant to go on anxiety medication because I too thought they were an admission of failure, or a crutch. Then I also had a panic attack and passed out on a work site, and was put on sertraline. Panic attacks are extremely rare now and I feel much better. Thanks for sharing your story! Makes others feel less alone in their struggles.
This must have been scary to share and I'm glad to be validated for what I've thought was true for so long. I weight lift, run and Pilates eat sub 1400 kcal and still am obese. I've been so discouraged because every doctor and OB (I gained a scary about of weight during pregnancy) just assumes I'm lying or offered no help or steps forward. And that's been my whole life even when I cycled 16 miles a day with extreme elevation changes in highschool I never could get below 210 as a 5'7"person but doctors assumed it was hormones or I was sneaking junk food😭
I'm sorry, but that's not scientifically possible. You are simply eating more than you need. There's a reason why every doctor and OB tell you the same thing. I understand it's harder for you than most other people, but you can't improve yourself if you are refusing to admit.
@@LZKS It is possible. Depends on metabolism, which can be way too low due to thyroid problems. It's not just about how much you eat, it's about how your body processes it. I have a friend who was called a liar by every doctor until one of them actually ran the right tests and discovered they had the slowest metabolism that doctor had ever seen.
A relative of mine had the same problem - she worked out every day - running, yoga, martial arts, at least an hour, sometimes two every day, and almost every professional told her "do more exercise!" She got lucky: one doctor believed her when she said things had changed. It turned out she had developed a "benign" growth on her pituitary. Brain surgery is really dangerous, so she keeps it under control with drugs, but she still does all the sports and is still "pudgy".
@@annelliott1384 Slow metabolism only measures your rate when resting. This DOES vary from individuals. It does NOT measure how much calorie you burn when you exercise. You burn how ever much calorie you need to burn to do certain amount of work. This is the immutable law of thermodynamics. So while having a slow resting metabolic rate makes it more difficult for you, it does NOT make it impossible.
@@LZKS having an abnormally slow metabolism doesn’t mean someone should just eat less and less, ignore their hunger signals, and be shamed and called a liar by doctors. It means there is something actually wrong. Like maybe a thyroid tumor. Doctors who aren’t even specialists in the topic telling people that their own reports and records of how much they are eating are lies because it’s outside of what the doctors expect leads to serious problems being undiagnosed. Someone who’s over 6 feet tall and 300 lbs and eating 1600 calories a day and gaining weight needs medical treatment because there’s a problem. They don’t need to be insulted and dismissed by every doctor they go to for help. “Just starve yourself” isn’t good medical advice, it’s setting people up for an eating disorder that could lead to malnutrition.
Thank you so much Aaron, for an amazingly personal video. I've fallen off of HCT for a while, and I'm really glad I came back to this.
Thank you so much! Sharing science and researched based information is so important, but sometimes it's the personal experiences are what really break through to people.
I've spent my whole life being just a little over weight. When I actively counted calories and tried to lose weight, it took me a year of restricting myself to 1500 cal per day to lose, like, 12 pounds. That is a lot of effort and I didn't even change clothing sizes. Tracking everything I ate for a year, not counting any exercise towards my calorie allowance, and it barely did a thing.
Obesity is so little understood. Why does one person eat anything they want and never gain weight and another person live on a very disciplined diet and still struggle to get to a healthy weight? I don't know. What I do know, is that being heavy isn't a moral failing. Being depressed isn't a moral failing.
One does not eat anything they can and never gain weight. Unless you're God, you can't see what that person is doing on a daily basis down to the details. There are some factors that make it difficult to maintain healthy weight. But these are exceptions, NOT the rule. Every other person complaining they are the exception doesn't help epidemiologists determine root cause of obesity epidemic.
Thanks for this video! It's so important to normalize both of these things. I had similar fears about going on an SSRI and only did so when in crisis, and I cannot be more grateful for how much better it has made my life. I immediately wished I had started it years earlier.
Thank you for this episide. I think this episode is a good one for me to hear because I can deeply relate to the self-inflicted shame with these stigmas you talk about, and I need to hear more about taking care of myself. I can also relate to wanting there to be solid foundation of knowledge, but I'm glad that we can at least observationally determine better outcomes with these and other treatments.
These videos have been immensely helpful to me for the last 10 years, and I'm glad you're taking steps to be around to help us navigate tough topics for many years.
Thank you for your support, it is truly rewarding to know we've been helpful to people! :) -Tiffany
Thank you for being so vulnerable and sharing your experience with us, Dr. Carroll. I’m glad you were able to improve your quantity of life.
I think it’s interesting how certain medications can be used to treat a variety of conditions. When my middle child was a toddler, he used to take an allergy medication (cyproheptadine) to prevent his migraine attacks, and it worked AMAZINGLY. Last time I looked it up, researchers weren’t exactly sure how an antihistamine helped prevent migraines, but for my child it was super effective.
I have wanted you to address mental health medication for years… I was confident that my depression was under control it was not until my doctor wanted to use a anti-depressant off label to treat my quality of sleep that I learned that I was always tired because I was depressed. I’m uncertain whether my doctor was treating my pride or if he really thought it had some off label benefit but coupled with blood pressure medication I have felt better than I have in years… My doctor wants me to exercise more (walk 20 minutes every day) to help my cholesterol but even with my new found energy… all I want to do is sleep… Having had many bad experiences with under-qualified therapists I have strongly considered trying again in hope that it will give my subconscious a will to live…
The myths about mental heath are devastating. My dad is very much against therapy and mental health drugs and I think this stopped my mom from seeking the help she needed and that if she had she might still be here today. I am on an SSRI and in therapy and it has charged my life for the better. I am also struggling with my weight and wish that weight-loss drugs would be proscribed as a preventive rather then just to people who are already sick. Another thing to remember about these drugs is that modern medicine and neurology are really new if you look at the span of human history so it is not surprising that we don't understand how things work.
I really appreciate you sharing this! It took me years to not see my ADHD as a personal failing and get treatment for it. I am doing so so much better now and can’t believe I spend so much time trying to fight against myself. The stigma is real, and seems to be especially strong when directed towards ourselves.
OMG. You fell down a mountain! I had no idea. I've been watching you for years. I had no clue. Glad you're doing self-care that works. Your channel has succinctly explained things to me.... Let's go to the research! Thank you for being here.
Sincerest thanks to you, too 😊
Damn this hits close to home. I take pride in not taking drugs for anything not acutely debilitating. As I get older, I’ll need to reconsider my position.
Family NP here, I too am overjoyed that we have this added tool to our arsenal. It is expensive now, but I am hopeful that as the patents run out 10-20 years from now, that more patients will benefit and maybe Medicaid will start paying sooner. But I caution us all that we still need to focus on preventing weight gain in our patients, and on public health to help people prevent the need for this medication in the first place, cheaper produce, sin taxes on high calorie, hyper palatable foods, more walking and biking paths. We shoukd imbrace these medications, but also do the other work. They would not be necessary if our lifestyles were not so obesegenic. This is a societal and governmental failing, not a personal one.
I have had depression since high school. I would go on meds, go off meds, & not let anyone know. About 10 years back a psychiatrist sat me down & told me I would need meds for the rest of my life. It’s been a journey trying to finds drugs that work for me. I’m doing pretty good now.
Side note: I have depression. I don’t suffer from depression. You wouldn’t say someone suffers from diabetes. They have diabetes.
Thank you for this! Your vulnerability and honesty on your own treatment is so refreshing. Acknowledging the stigmas that have affected your ability to seek the help you need is such a good way to let people in to see their own biases. Truly, thank you so much!
I take Bupropion for depression and I've been trying to get bariatric surgery for years because I've struggled with the same exact issues. My self image is absolutely devastated, always has been, and while my fight for surgery is still ongoing, I think part of the reason why I've not tried to receive any weight loss drug is because I have a feeling in the back of my head that I need to suffer in some way in order to lose weight.
This is great! Thanks for sharing your story. This how we can destigmatize these issues. I’m very open w people I know about how therapy AND medication have been critical for my anxiety and depression. AND that I see no need to eventually get off the medications since they WORK.
I’ve always known this and I come from the other end of the spectrum. I eat as much as I want and never give food a second thought and never waver from a BMI of around 20. Meanwhile I’ve watched my best friend get outrageously serious about diet and exercise and still struggle.
Aaron thank you so much for this video. I’m a healthcare provider and have benefitted a lot early on from these videos and podcasts on technical aspects; this topic is much more personal and really helpful perspective- additional approaches I can work in to talk about this with my patients. I love what yall do over here
So many things can lead to weight gain it's a wonder we even manage to survive this long. I have ADHD but was never told until I got a diagnosis myself as an adult. I was raised to always be myself and do what worked for me. It didn't matter if other people did things differently, all that matters is how I do things and what works for me. This helped in some ways, but honestly it did lots of harm and wish I was just made aware sooner so I could decide my own treatment plan. After starting medication I no longer had binge eating issues and also had more skills in dealing with my health. I've spent the last 4 years out of various medical offices trying to undo all the damage I've done to myself. All of this could have been avoided had my parents and society not tried to hide my ADHD and pretend that would make it go away.
Thanks for sharing your story on this and of course the science! Well...what little science we have.
One of your best videos. Thank you addressing these two chronic diseases. Traumas in childhood easily trigger these disorders as people seek to cope with very intense stress when they have little understanding of the world. Drugs that help manage these diseases are really godsend.
Light and love to you Dr.
Thank you for this video 😌
This episode felt very personal, for both of us.
I have family on SSRI and even though it didn't work for me, it's a literal "chill pill" for them and we noticed a distinct difference when they miss a dose or two. Anyway, I just want to say Thank You for making this video and appreciate your perspective and insight. It's a good reminder to all of us how complex and diverse each human's biology can be.
Having had multiple physicians blame the symptoms of my diagnosed Ehlers-Danlos Syndrome on obesity was so harmful to my health.
I'm a DO in Oklahoma. Every year when I renew my medical license I have to answer a question right smack in the middle of the questions about criminal history, law suits, etc about whether or not I've ever taken an antidepressant. Likewise, the health system I work for stripped away coverage for GLP-1 agonists for weight loss. The stigma for both of these issues is very real.
Wow! The personal nature of this was both a surprising and powerful. Thank you
Me, watching this in a psych ward mess hall.
I've been on one SSRI or another since I was 13, pretty sure I've been through them all by now. Had bariatric (vertical sleeve) surgery in July 2019, and I've been on Ozempic for probably a year and a half, if not two years by now.
The beat way to deal with stigma is being unapologetically open about our struggles. I'm never not going to have mental illness, and I'll never not struggle with obesity. These meds help. That's all I care about, and that's all anyone should care about.
I really appreciate your perspective and insights. This is why I've been tuning in since day one and don't plan to stop!
We are grateful, as always, for your support! :) -Tiffany
This was a thoughtful video. Thank you for sharing your own experiences to help underscore just how difficult these mental blocks are, even for the professionals!
Thank you for sharing your personal story. It really helps and means a lot.
I used striction bp and showed a significant improvement, my doctor said I'm doing great, I'm really recommending this
I honestly can't imagine not thinking about food all the time. I was able to lose weight calorie counting, but then I gained it back when I stopped. I started counting again, but it's hard. My mouth/brain just constantly want me to eat even if I don't need to.
Holy crap this was impressive to watch. Respect sir. You are the kind of doctor I am working to become.
This is a truly excellent video. Thank you.
Commendable sincerity! As for the unknown causes of obesity, I was surprised some time ago to learn that infections with a type of adenovirus (Ad-36) cause obesity. It may be that some of the small infections we have throughout our lives have a similar effect, but they have not yet been studied.
Thank you for this episode!
I wasted 10 years of my life trying to lose weight by going to the gym, counting calories, and having a personal trainer and nutritionist. These things are good and it will help many people lose weight, but it did not work for me as it made me develop multiple eating disorders, and I failed with calories every time because the hunger was insane. After using Ozempic, I lose 200 pounds in 2 years and it changed my life. And all my eating disorders are gone! I still go to the gym and eat healthy
Thank you for sharing this! 🎉 I think it's so brave and sorely needed!
really beautiful video! and what a nice window into Dr. Carroll's experience. powerful testimony!
Thank you for this, especially sharing your own experiences.
Thank you for making this video
Thank you for sharing! I’m reluctant to use weightloss meds because they are so new and also concerned about the rate of weight loss. Is it safe to lose weight so quickly? I’d love to see you do a follow up further along as more research comes out. Thank you!
We will absolutely keep up with and share the data on this! :) -Tiffany
So glad you did this video
The "Related HCT episodes" just links to itself.
Doctors also want to blame being fat for everything and ignore symptoms of other things that may have nothing to do with their weight.
It depends. Don't want to say there aren't doctors who do this, but some symptoms are similar to other symptoms, and can sometimes be hard and complicated to diagnosis.
Oh my goodness… There is no scenario in which being overweight is a benign thing. It leads to dysfunction in every body system.
Problem is being fat does indeed cause a multitude of symptoms that are similar to other things that have nothing to do with weight. And out of all the possibilities, weight is usually the easiest to treat. For the doctor at least, not so much for the patient that actually has to do it.
@@MisterCynic18thats a very convenient excuse for dismissing the complaints and needs of overweight patients.
The issue is when doctors are more focused on patients’ weight than the actual issue. People have talked about having an ear infection or broken bone, and the doctor is more focused on their weight.
you *fell down a mountain*? @_@ holy crap, I'm so glad you're here to make this video!
The hardest thing for us to admit I think is that our culture/society/lifestyle is so much to blame. I don't blame most overweight people for being overweight TODAY because so much of today's life is harmful in a huge variety of ways. Sedentary work requirements, polluted air, microplastics and VOCs at home - modern life is killing us. I mean a LOT of people literally do not have the means of accessing a nice forest for a jog and fresh veggies for lunch. Best they could do is run down a crowded sidewalk next to the smog of cars and stop at a Subway for a chicken sandwich. Tim Robbinson was right: "What the hell have they do to us? WHAT DID THEY DO TO US?"
I love your message about not blaming people for medical conditions. I despise what comes across as a promotional message to go get an off-label prescription for a drug that many diabetics need for their condition. I know people who have to run around my state trying to find the stuff because other people are using it for weight loss. This is a real issue for diabetics for whom this is the only med that has controlled their A1C.
Obese people also need this medication, too, both as a treatment and as a preventative. The issue here is the pharmaceutical companies not increasing supply fast enough when they knew it was becoming more popular, and even limiting it intentionally to keep prices artificially high. Don’t blame the doctors trying to support their patients, or people looking for a cure to a difficult, chronic condition. There is a reason he didn’t mention a specific brand, and pointed out his personal privilege. This wasn’t an advertisement, it was education.
My doctor took me off the ssri that I felt was making my life bearable because it had made me gain weight. In fact she has blamed every single problem I have had on my weight. It doesn’t matter what it is she blames in on my weight and won’t even try to help my symptoms and just tells me to loose weight. I am currently pregnant so loosing weight isn’t a healthy option for me or baby. I am afraid to go to my doctor because I know she will just throw up her hands and say live with it till you lose weight. It is so discouraging.
Doctors are like any other profession. Some of them are good at their jobs, some are not. It sounds like maybe you need to find a doctor who's better at their job.
Any chance of getting a new doctor? That's so awful. I've had cyclical periods of major depression most of my life, and the way it saps your energy and leaves you with almost nothing is unreal. How can a depressed person find the energy to exercise and eat healthy? My psychiatrist told me if I struggled with my weight on a medication, we would simply try another one. It's pretty bad that your doctor didn't do the same.
I did get a more supportive OB to see me through this pregnancy. She felt my mental health was more important than my weight and immediately put me back on a safe antidepressant for my pregnancy. I am trying to get into a new primary care provider but most in the area are booking months out, right about when I will be having a baby.
I finally took serotonin for depression and it worked great. Only problem was it gave me chronic diarrhea. I was switched to another type of drug and that worked fine too. I don't know why I waited so long to try these medications. I think I was afraid they would change my personality and I wouldn't be me. I haven't needed those drugs for years now, but when I did I was glad they were there.
My conundrum with weight loss and mental health is how linked they are for me. Not because of stress eating, but because food is a reliable source of dopamine. When I'm with my girlfriend in Brazil, I simply don't get the munchies because I'm all up on dopamine from all the new stuff I try to learn and it satiates me completely. But when I get back to the Netherlands, I suspect that food will become the main dopamine driver again, which is both expensive and unsustainable.
So appetite suppressants would really help me keep focus better than something like ritalin would.
To the Anecdotes! ☝️
About 95% of the body's serotonin is found in the gastrointestinal tract, specifically in the enterochromaffin cells lining the digestive tract. Only a small portion, around 5%, is located in the brain and central nervous system. The roles of serotonin differ depending on its location. In the gut, it primarily regulates digestive functions like motility (gut movement), fluid secretion, and pain perception. In the brain, it acts as a neurotransmitter, influencing mood, appetite, sleep, and learning. The relationship between gut serotonin receptors and depression is complex and not fully understood. The brain and gut communicate through the gut-brain axis, and disturbances in this communication have been linked to mood disorders, including depression. Disruptions in serotonin levels or signaling in either the gut or brain can contribute to various conditions like irritable bowel syndrome, depression, and anxiety. Research is ongoing to explore the role of gut serotonin in mental health, and some studies suggest a potential link between alterations in gut serotonin levels and mood disorders.
Scary insight. You'd agree it's so sweet when you finally get to lose that unwanted weight. I lost 109 pounds (half the weight of a refrigerator) in less than 4 months and have kept it off since then. Just like every woman struggling with weight loss now, I yoyoed for years - staying on track for a month or 2, losing a few lbs in the process before falling off. And each time I fell off, I just gained the weight back plus more. In July 2021, I was at my heaviest - 255 lbs... See full story on my channel.
Great episoide! Can you do an episoide about how an indiviual should approach new medication? Something like how long you should try it and when you should stop? My struggle isn't an unwillingness to try something new (maybe a little), it is an inability to tell if something will work.
We actually do know how and why SSRIs work. We know that SSRIs don't work better than placebo in mild to moderate depression and that in severe depression they don't work better than any other stimulant. So it's the placebo effect for most people and a stimulant effect for some. It's weird that a lot of doctors still haven't gotten that memo.
Yep, meds help. And it doesn’t have to be just one or the other with meds vs lifestyle. ADHD meds would help me focus enough to stick to a meditation practice.
That is my story word for word! I opted for Gastric Sleeve
I really hate how people speak of crutches/canes as a negative thing! Some of us use them long term, and they radically improve health and safety. I don't understand why people have such a hard time understanding that literal crutches are for more than temporarily broken bones! They improve physical stability and make it possible to get around not only more but also in terrains that otherwise would be off limits because of the risks! It's not either you walk by your own power or you're in a wheelchair, there's a range inbetween there!
Wish my emotions could agree with this. I am on mental health meds and obese. I feel the same as you though I know better.
Brilliant video -- I've had a similar experience with sertraline! :)
I actually think it's really hilarious that there is a stigma against someone with type 2 diabetes taking a medication for weight loss, But there is not a stigma against someone with type 2 diabetes taking insulin. If the source of that stigma really was the societal belief that that person is not trying hard enough on their own to control the disease, Then you would think type tube diabetes and insulin would receive the same treatment.
People with type 2 diabetes don't even take the medication for weight loss. The medication makes the pancreas excrete more insulin. The weight loss is only a side effect in this case.
"It felt like a crutch"
I guess in a way it is. Crutches are useful devices that are important in helping those with a disability.
My issue with antidepressants is the problems with libido. Suddenly it gets so hard relieve myself when the call comes and it infuriates me. It feels like being blue balled and that really upsets me so i dont feel like taking it.
Man, I can relate so much on the weight loss front. I'm 1.73m, used to weigh 120kg at heaviest but got to 75kg at the peak of my keto diet journey. I still hated my body because I was basically skinny fat. I've since gotten off keto, started lifting weights and tried to gain a bit of muscle.
Currently around 85kg but mostly weight gain and not muscle gain (well, some, but it plateaued after a certain point). It's so frustrating that the results haven't been commensurable to the amount of effort that I'm putting in, but ranting about it just seems like I'm not working hard enough or I'm not doing it right.
Is there a professional that I can consult about this?
I agree with much of the thrust of this video. However, I disagree some of the implied framing that weight loss isn't a matter of caloric reduction. The reasons someone can't consistently keep their consumption of calories below their TDEE are of course multifactorial, and often does involve some kind of willpower at some steps. The issue is we shouldn't moralize that a person is unable to overcome the roadblocks and/or if they use medication such as Ozempic to assist with it, in the same way we shouldn't moralize people using SSRIs or therapy to manage depression.
How did 99.9% of people before 1985 to the beginning of time maintain normal weight? I was born in '62 and still normal weight. I don't understand.
Well if you’ve ever taken art history you would know that ‘normal weight’ as we see it today wasn’t always so. There have always been smaller and bigger people. More fit or less fit.
Although I do agree with the fact that obesity has definitely been on the rise. Probably because 90% of the food in grocery stores isn’t food and everything we eat, drink and breath is full of chemicals that fuck with our epigenetics and hormones 🤷♀️
If we decided we shouldn't use drugs when we don't understand their mechanisms, we'd have to give up on general anesthetic. Probably for the best that we accept that a drug works and can be beneficial without needing to know how or why it works.
My daughters prescriber told us that sertraline could effect memory in my daughters later years, so she needs to get off it ASAP. Which hasn’t been doable yet. Is there any truth to that?
But wait, how CAN you afford it out of pocket? I'm a data scientist and we earn s good wage but my insurance just cut my wegovy and the only thing i can think to do is get a compounded version. Otherwise it's $900/month and only Elon Musk can afford that.. What are you buying out of pocket?
Also I've heard of people buying and compounding THEIR OWN semaglutide from China which is epically dangerous, just because it's cheap!
You look happier.
Hi Dr Aaron, I've been a viewer since the beginning of this channel and I'm incredibly grateful for your videos. Please take the following criticism as my attempt to be helpful, and remember that the positives massively outweigh the benefits.
However, I feel like you need to work on your understanding of weight and fatness. Growing up when we makes this tough, it took me a long time to get past my own biases. I feel like you need to go back to square one, try to unlearn what you've learnt, and work your way back up. I can guarantee that you will not end up in the same place as you started.
I'm not particularly fat, but I'm general interested in anything where culture, medicine, commerce, and the actual evidence intertwine. What got me interested in this particular area was when I learned a couple of fat people I knew (through some deep late-night discussion) would actively choose not to seek medical care from me, despite the fact that I believed I was 'evidence-based' and sympathetic. Hearing you talk about weight in this video feels like I'm listening to a recording of myself back then. The greatest of intentions, but misguided.
If you want to make a positive change for you and your patients, a first step might be to never use BMI again, except where you are forced to through insurance/laws. Maybe also think about the fact that you tried everything you could to lose weight, but couldn't. What does that mean to you?
Go get boosted it's only 5
Aron be like "i eat quite healthily"
Also Aron be like: i have depression, anxiety and obesity.
C'mon man.
I love Healthcare Triage because of "To the Research" and "Anecdote does not equal data".
I'm happy that you're doing well! However, this is not the rigoruos standards I have come to expect.
"I fell like", "I have..", "It can't be because I have...", etc. are not what you usually take for good arguments when you eveluate topics. This gives me the same feeling as someone advocating for acupuncture or homeopathy.
Anecdotes are only a problem when they are refuted by evidence, or when they are used to obfuscate evidence. Most humans value and remember stories more than numbers, so anecdotes can be a critical tool in getting people on board with the evidence. A doctor should provide both: here is the evidence and here is a personal example, if they want to be most effective. Homeopathy and acupuncture aren’t bad because of the existence of anecdotes, they are bad because of the lack of evidence. This medication isn’t pseudoscience.
7:10 “Medical treatments should not be dismissed just because we don’t fully grasp their mechanism”
We haven’t dismissed Tylenol yet
Obesity and mental health issues are not the sufferer's fault. Point taken. Absolutely. Well and needfully done. But speaking strictly about obesity...
Yet another expensive drug you have to be on for the rest of your life with unpredictable side effects and unsure effectiveness? No thanks. I lost over 110lbs by water fasting and moderate exercise when NOTHING else worked. It was difficult, but it cost me nothing. And I can keep doing it whenever the weight begins creeping back on. I've kept it off for seven years now.
Some of these drugs cost THOUSANDS of dollars a month, and are a lifetime commitment. Not possible for most people who need them.
Rigorous trials? Non biased?
So what medications was it? You didn't say what it which ones have worked for you. I understand we are all made differently, cellularly - probably why you refrained from discussing the actual drug you are on.
It's pretty well known how Semaglutid works. What are you on about?
Kind of disappointed to hear Dr. Carroll tout BMI as a reliable source of health information.
He is a Doctor and it is the one the Medical Profession uses. No, it's not perfect, but then nothing is.
BMI isn’t a perfect measure for individuals, but it has been shown to be quite reliable across large populations, including in studies that went in attempting to show the opposite. If you have conditions often caused by or affected by weight and you also are overweight, a doctor should take that into account until there is substantial evidence suggesting otherwise. All differential diagnosis is taking test results, making the most likely guess, and then treating accordingly. If it doesn’t work, you take more tests and guess again.
Yaass, Ozempiqueen!
Youve let that bias tant your older videos.