My husband, who has struggled with his weight for decades, has decided under the recommendation of his doctor to begin taking Zepbound, an injectable specifically for weight loss. When he starts to lose weight, we know he will be congratulated and questioned by friends, co-workers and associates, as he has before when he has had significant weight loss. Are we obliged to tell people how he is losing weight? Would it be OK to be dishonest? — Name Withheld
From the Ethicist:
Your husband, you indicate, has a sound medical reason for starting this treatment. It should make him healthier, and if it does, your friends ought to be happy for him. But you’re probably thinking that they’ll congratulate him on the assumption that he lost weight by sticking to a diet or an exercise regimen — by some newfound act of will — and would look askance if they knew he had done so through drugs.
That response would reflect a tendency to relate obesity to some deficiency of character. Moralizing about weight management in this way is misguided and unhelpful. Various studies have shown that such attitudes are not only demotivating but also associated with disgust toward and discrimination against people with obesity — and that the experience of weight stigma can be seriously disabling. When obesity is a threat to health, it’s better to think of it as a problem to be solved than a vice to be conquered.
The notion that people who are taking drugs like Zepbound — known as GLP-1 receptor agonists — are choosing the “easy way” may also reflect a misconception about how easy it is. Side effects of these drugs include nausea and vomiting, diarrhea, constipation, abdominal pain, indigestion and pancreatitis. (Surveys find that a high percentage of patients prescribed these drugs, including those taking them for diabetes, discontinue them owing to GI complaints.)
Is your husband obliged to disclose that he is on Zepbound? Of course not. His medical history is indeed his business. But if questions arise, I hope that your husband considers candor. To combat moralizing about obesity, it might help if those who have decided to lose weight were frank about the strategies that have worked for them.
Readers Respond
The previous question was from a reader who was concerned about a new swimmer at her pool. She wrote: “A friend and I take a daily early-morning swim, usually all by ourselves, in a pool that has no lifeguard. A woman arrived the other day and announced that she loves to swim but only does so when another person can be present, because she recently had an EEG that revealed some abnormalities. We, two ladies ‘of a certain age,’ are very uncomfortable with this situation and worried because we don’t think we could handle an emergency in the pool. … What are our responsibilities to her in case of a crisis? Do we suggest that she not swim with us because we would be incapable of helping if something happened to her?”
In his response, the Ethicist noted: “Don’t tell her she can’t swim with you. Just explain that you don’t think you would be able to perform lifeguard duties. … she may simply find it reassuring, psychologically, to know that you could use a phone and call for help if she were having distress. Whether she can safely swim is a question for her doctor; she may have been told that not swimming would be worse for her health.” (Reread the full question and answer here.)
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I found the Ethicist’s response to this letter both helpful and humane. Just a P.S.A.: Regardless of health condition, age or fitness level, no one should ever swim alone! — Megan
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In my opinion, people who frequent pools and beaches, no matter how old, have an ethical obligation to learn basic lifesaving skills, including calling 911 and water rescue. Learning CPR is a plus. Acquiring these skills doesn’t mean anyone has to accept responsibility for someone else on request. Lifesaving knowledge can help you understand and explain your limitations. — Arnold
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I would go further than the Ethicist in warning the woman that I cannot perform lifeguard duties. I’m actually a lifeguard, and I know that drownings can happen in seconds, and it’s not reasonable to expect that another swimmer would notice an emergency fast enough to prevent tragedy. I would advise the letter writer to caution the newcomer that not only is she not strong enough or trained enough to respond should something happen in the pool, she’s also not capable of watching intently enough if the other woman is truly depending on her to do so. If the woman chooses to swim anyway, she should do so understanding the difference between a bystander and a lifeguard. — Liz
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Friendly neighborhood neurologist here. Though we are not sure what EEG abnormalities this person has, it sounds as if her provider is concerned she may have a seizure tendency (epilepsy). When I and many of my colleagues counsel patients with seizures, we often discuss matters of safety including never swimming or bathing alone. I specifically tell patients that they must have one person watching them only at all times — a lifeguard or someone doing something else/watching multiple people is not enough. Otherwise, they may have a seizure and drown, without anyone noticing in time. With this background, I personally would not feel comfortable taking responsibility for this woman’s safety and well-being. She needs to have someone there specifically to monitor her or discuss whether this is a safe situation with her doctor, who is intimately familiar with her history. — Whitney
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A few years ago, when I lived alone, I was put on medication that would sometimes make me feel as if I could pass out at any moment. I would go on a walk outside, where neighbors could see me in case I fainted (as opposed to the alternative: fainting inside by myself). I felt safer knowing someone could call for help or be able to make sure I was OK. I never actually fainted, but maintaining this practice allowed me to live a more normal life despite my disability, while taking an otherwise very helpful medication. This woman is absolutely seeking psychological safety. My advice? Ask her what she needs you to do if she does have a medical event. She may give you a relative’s phone number to call if she is headed to the hospital. You don’t have to give CPR to be a good neighbor. — Cassidy