At just over 5 foot, 5 inches, Christie Woodard weighs a lean 125 pounds. She's also open about relying on a low-dose GLP-1 to keep her weight there. She says sometimes people question why she's on the drug, "because they look at me and think I'm at healthy weight, or maybe they even think I'm thin."
What people don't see is Woodard's previous struggles with obesity, which began in her 30s, and landed her at 260 pounds. She took up running half-marathons, but at that weight, it was painful.
"I was not fast," she says. "I had massive issues; I was in physical therapy constantly. I tore my meniscus."
Woodard, now 53 and living in Easton, Md., got gastric bypass surgery four years ago and cut her weight in half. Elated, she set a goal of completing half-marathons in all 50 states.
Her weight remained stable until last year, when pounds began creeping back, despite adhering to a strict diet and lots of exercise.
"I feel it in my knees, and mainly I feel it in my soul," she says. "I feel it in my confidence. It's messing with my head in a big way. I was terrified that I was going to go back to what I was."
So her bariatric surgeon, Dr. Betsy Dovec, prescribed a low dose of the drug Zepbound, even though Woodard's body mass index didn't technically classify her as overweight.
Dovec says Woodard isn't her only normal-weight patient on GLP-1s. "I prescribe medications for all types of people," she says. Though, she clarifies, she does not give the drugs to people for purely aesthetic reasons, like someone trying to shed a few pounds before an event, for example.
GLP-1 drugs are meant to treat metabolic diseases like diabetes and obesity. But as they become more available, some people who don't have excess weight seek them, sometimes just to slim down. The drugs — while still costly — are getting cheaper, and are available in pill form. There are also plenty of online sellers offering GLP-1s and compounded versions of them, making it relatively simple to get a prescription for people for whom they're not medically indicated.
That's controversial, as with many issues concerning weight and weight management.
But Dovec says classifying the use of these obesity medicines for people who are with normal or mildly excess weight as purely "cosmetic" misunderstands the various circumstances patients face. The drugs treat far more than weight, she says: They address metabolic diseases like diabetes or high blood pressure. Some doctors prescribe them off-label to manage alcohol use disorder, which the drugs appear to help for some people.
And obesity is a chronic disease, she says, so some patients like Woodard may need multiple strategies to help manage their condition — including surgery, diet, exercise and GLP-1s. Dovec says these are not drugs to be used for, say, kick-starting a diet. She says she's not had patients pursue them for those reasons, or misuse them to the point where their body mass index falls to below normal. "I've never seen that in my career," she says.
But Dr. Jennifer Manne-Goehler — an obesity specialist with Mass General Brigham and consultant to the World Health Organization — is concerned that people will access them and medicate themselves to meet a thinner ideal.
And that comes with some risks. In particular, she notes people using GLP-1s tend to lose muscle first, but regain fat when they stop using the drug. Periodic use, therefore, creates potential for yo-yo dieting effects known to be harmful to the body.
"I think the problem with giving this medication to people who really don't have an indication for it is they assume all the risks of it, plus the risk of weight regain, which may be adverse for their health," she says.
There are also risks to taking the drugs for people with disordered eating, especially since patients are not evaluated for these disorders when prescribed GLP-1 drugs.
Christie Woodard is no stranger to these controversies — and the judgment around weight and weight management. Initially, she felt ashamed to admit she needed GLP-1s, especially having already undergone bariatric surgery. "I didn't tell anybody at first. I felt like I'd failed," she says.
But she came to understand that surgery alone did not eliminate the disease of obesity, which in her case also means hunger hormones conspire against her maintaining her healthier weight. "We don't judge people for being on statins for cholesterol," she says. "Why should GLP-1s be different?"
Woodard, who is head of human resources for a large company, says her new perspective helped her successfully advocate to include coverage of GLP-1s in her employer's health insurance plan, which she says is not the norm.
In making the case with her boss and the insurer, she cited herself as an example: By taking the medicines, she now needs far fewer doctor's appointments, physical therapy and medications to manage various ailments associated with obesity. "The company I work for no longer pays any of that," she says.
Plus, says Woodard, feeling in control of her weight makes her much happier — and more effective at everything she does.
"I can wear what I want and the confidence is there," she says. "That shows up in everything I do, whether I am negotiating rates with our health insurance company or whether I am talking to an employee about a delicate situation or whether I'm negotiating something with my boss."
To date, Woodard has now run 34 half-marathons in as many states — and is confident she can complete the rest.
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