Shame and stigma are among the most powerful obstacles to a healthy weight loss journey.

Shame and stigma can be present before, during, and after weight loss in different ways.

GLP-1 medicines improve weight loss but introduce new sources of shame and stigma.

Marcus had practiced his answer before anyone asked the question. By the time a colleague stopped him in the hallway after a staff meeting, "Man, you look different. What are you doing?" he had a smooth response ready: cleaner eating, better sleep, less drinking. All of it true. Just incomplete.

"I told myself it was private, which it is," Marcus says now, several months into tirzepatide (a GLP-1 medicine). "But there's a difference between keeping something private and hiding something because you're ashamed of it."

Marcus is one of two composite patients, drawn from years of clinical work with people using GLP-1 medicines, whose stories anchor this piece on shame and stigma during GLP-1 treatment. The second is Diane, a cardiac nurse who has spent her career telling patients that obesity is biological, not a character flaw, and who is still working out how to extend that same belief to herself.

Researchers distinguish between two forms of stigma.1 Enacted stigma arrives from outside: the raised eyebrow, the offhand comment, the relative who suggests you're taking the easy way out. Self-stigma is the critical inner voice that runs automatically even when no one else is around. Both forms are active throughout the GLP-1 journey. And they often show up more than once.

In clinical practice with GLP-1 medicines, four moments are influenced by stigma: (1) the decision to start treatment, (2) the social experience of using it, (3) the choice to continue long-term, and (least expected) (4) the moments when treatment is visibly succeeding.2 Marcus and Diane each lived through two of them.

1. The Gatekeeper: The Barrier to Starting

By the time Marcus seriously considered tirzepatide, he had already spent three months turning the decision over privately. He researched the way he........

© Psychology Today