A few years ago, if you’d asked me what I thought about GLP-1 medications, my answer would have been pretty clear.
I was sceptical. And I had real concerns.
Not because I lacked compassion for people living with obesity. Quite the opposite. My concern came from a much bigger question about the world we’ve created and how we respond to the health consequences that follow.
My instinctive reaction was this: why are we creating a pharmaceutical solution to a problem we helped create?
We live in a world where ultra-processed food is cheap, convenient, and everywhere. Many of us sit for most of the day. Stress is chronic. Sleep is poor. Movement has been engineered out of everyday life. In many ways, we’ve built an environment that often works against good health.
And then, when predictable health consequences show up, we prescribe medication?
At the time, that felt like a reasonable question. Why not focus harder on fixing the root cause?
But over time, and particularly through my own experience with perimenopause and more recently working with clients using GLP-1s, my thinking has changed significantly.
One of the biggest shifts in my thinking has been this: changing appetite is one thing. Changing habits is another.
That distinction matters.
My own hormone experience changed the conversation for me
Like many women in midlife, I’ve had my own experience of changing hormones, and like many women, I’ve made the decision to use hormone therapy.
I take a combination of hormones for perimenopause, potentially for the long term. Right now, I simply don’t know if I’ll ever come off it.
Not because I’m weak. Not because I failed to manage things naturally. Not because I lacked discipline.
Because hormones matter, not just for how we feel today, but for how our bodies age.
When hormone levels shift, the effects can be significant. Sleep disruption, brain fog, mood changes, reduced resilience, energy dips, changes in body composition, declining bone density. These are not trivial quality-of-life inconveniences. They can meaningfully affect health, wellbeing, and long-term outcomes.
Hormone therapy has helped me. But perhaps unexpectedly, it has also changed how I think about medication more broadly.
We don’t typically apply the same moral judgement to HRT. We don’t tend to frame it as weakness, or failure, or taking the easy way out. It is generally understood as a legitimate medical response to a physiological change.
That made me pause.
GLP-1 medications work through a hormonal pathway, which made me think differently about how we judge medication use.
These are not identical clinical situations, of course. But the broader principle is similar. Hormonal systems influence health in profound ways, and sometimes medication is an entirely appropriate part of managing that.
That shift in perspective changed how I viewed GLP-1s.
Obesity is more complex than the public conversation suggests
One of the biggest mistakes we make is treating obesity as though it is simply a behaviour problem.
Eat less. Move more. Show more discipline.
If that were enough, obesity rates would look very different.
Because while behaviour absolutely matters, obesity is now widely recognised as a chronic, relapsing disease influenced by far more than willpower alone.
Biology matters. Genetics matter. Hormones matter. Appetite regulation matters. Insulin resistance matters. Stress matters. Sleep matters. Environment matters. The systems we live in matter.
None of this removes the importance of daily habits. But it does challenge the simplistic idea that obesity is purely a personal failing.
And unfortunately, there is still enormous stigma attached to body weight.
People living with obesity are often judged as lazy, lacking discipline, or somehow taking shortcuts if they use medication. That stigma helps no one, and it gets in the way of more useful conversations about health, support, and evidence-based care.
This is bigger than individual body weight
Obesity is not a fringe issue.
In New Zealand, around one in three adults live with obesity. In Australia, around two in three adults live with overweight or obesity.
These are extraordinary numbers.
This is one of the defining public health challenges of our time, and the economic cost is significant, with obesity and related chronic disease creating billions in direct healthcare costs and lost productivity across both New Zealand and Australia.
And the consequences extend far beyond the individual.
Obesity increases the risk of type 2 diabetes, cardiovascular disease, fatty liver disease, sleep apnoea, osteoarthritis, certain cancers, and reduced quality of life.
But even if someone has never personally navigated obesity, they are still affected.
Because we all live inside the same obesogenic environment. We all know people navigating these health challenges. We all experience the downstream impact through stretched health systems, increased chronic disease burden, reduced workplace productivity, and rising healthcare costs.
This is not about blaming individuals.
It is about recognising that when a problem is this widespread, the explanation cannot simply be personal failure. And neither can the solution.
Medication helps. It does not replace healthy habits.
Changing my view on GLP-1s does not mean I think they are a magic fix.
Far from it.
If anything, my own experience with hormone therapy has reinforced the opposite.
Medication can support physiology, but it does not replace personal care.
I still need to eat well. I still need to sleep well. I still need to move my body. I still need to strength train. I still need to manage stress.
And I now think about GLP-1s in much the same way.
These medications may improve appetite regulation, metabolic health, and create physiological space for change. But they do not automatically build the habits needed for long-term health.
And this is where I think the public conversation often misses the point.
Because GLP-1s create practical challenges too.
Reduced appetite can mean people unintentionally eat far too little. Protein intake can drop. Muscle mass can be lost. Hydration can become an issue. Side effects can make food feel confusing, unappealing, or physically difficult. Poor habits can quietly undermine long-term health outcomes.
Interestingly, many of these concerns are not unfamiliar to women navigating perimenopause either.
Muscle preservation becomes more important. Protein matters more. Strength training matters more. Recovery changes. Energy can feel less reliable.
In both cases, physiology shifts.
And in both cases, lifestyle support still matters enormously.
We need to stop thinking in extremes
The public conversation around GLP-1s often feels frustratingly polarised.
On one side: These medications are cheating. Or: Why can’t people just eat less and move more?
On the other: These medications are the answer.
Neither position is useful.
The more honest truth is somewhere in the middle.
GLP-1s can be a legitimate medical tool. And they are not a substitute for practical health support.
Both things can be true.
I still believe we need to address the bigger root causes. Healthier food systems. Less normalisation of ultra-processed food. Better public health policy. More movement built into modern life. Less chronic stress. Better preventative health education. Less stigma.
But while we wait for systems to improve, real people are living in the current reality right now.
And they deserve support.
Where I’ve landed
So yes, I’ve changed my mind.
Not because I suddenly think medication is the answer to everything. And not because I no longer believe healthy habits matter.
Quite the opposite.
I believe healthy habits matter deeply.
But I also believe people living with obesity deserve the same nuance, compassion, and evidence-informed care we apply to other chronic health conditions.
I believe biology matters. I believe hormones matter. I believe medication can be appropriate. And I believe people deserve far better practical support than they are often given.
Which brings me to something I’ve become increasingly convinced of.
People using GLP-1s deserve far better practical support than they’re often given.
This is part of why I created Start Well.
Because for many people, the early weeks on GLP-1s are where the real questions begin.
What should I eat if I’m barely hungry? How do I protect muscle? What matters most when appetite changes? How do I avoid under-eating, fatigue, and poor habits that create bigger problems later?
Medication can change physiology.
But practical support is what helps people navigate real life.
