When Medicine Becomes Cosmetic: A Line We Shouldn’t Cross

I’ve struggled with my weight my entire life, so I want to begin there—not as a disclaimer, but as context. I know the frustration. I know the quiet shame. I know what it’s like to do the right things, fall short, try again, and still feel like your body isn’t cooperating. This isn’t written from judgment. It’s written from lived experience and genuine concern.

The new weight-loss drugs are impressive. For people who are morbidly obese, whose weight has pushed them into immobility, isolation, or immediate medical danger, these medications can be life-saving. When someone can’t walk safely, can’t leave their home, can’t work, or is watching their heart, lungs, joints, or blood sugar fail under the strain of excess weight, the risk makes sense. In those cases, these drugs aren’t cosmetic—they’re medical intervention.

Where I struggle is how casually they are now being used outside of that context.

These medications work by slowing the digestive system and suppressing appetite signaling. That is not a minor adjustment. Digestion isn’t a side feature of the human body—it’s a core system tied to immunity, hormones, inflammation, and long-term health. When you intentionally slow gastric emptying and intestinal movement, food and waste remain in the body longer than normal.

That reality has consequences.

Many users experience persistent nausea, vomiting, bloating, abdominal pain, reflux, constipation, or diarrhea. For some, these symptoms don’t fade with time. Gallbladder issues, including gallstones and inflammation, occur more frequently during rapid weight loss. Pancreatitis has been reported and can be severe. Ongoing digestive distress can lead to dehydration, placing strain on the kidneys and, in some cases, causing real injury.

Rapid weight loss also changes what the body loses. It’s not just fat. Muscle mass often declines, reducing strength and stability. Bone density can suffer as well, particularly without careful nutrition and resistance training. Those trade-offs matter more with age, not less.

There’s also an intestinal health concern that deserves honest discussion. The colon is designed to move waste through efficiently. Slower transit means stool stays in contact with the intestinal lining longer. We already know—independent of any drug conversation—that chronic slow transit is associated with higher rates of diverticulosis and diverticulitis. Increased pressure, harder stool, and prolonged retention stress the intestinal walls.

Colon and intestinal cancers are influenced by chronic inflammation and prolonged exposure to metabolic waste byproducts. Faster, healthy transit reduces exposure time. Slower transit increases it. That principle underlies decades of advice around fiber, hydration, and movement. When a medication intentionally slows digestion for long periods—possibly years—it’s reasonable to ask what that altered environment does over time. We simply don’t have decades of human data yet.

There are also unresolved hormonal questions. These drugs alter gut-brain signaling and carry warnings related to thyroid effects based on animal data. Whether that translates into long-term human risk remains unanswered. Appetite is also deeply connected to mood and emotional regulation, and some users describe feeling emotionally flattened or disconnected from normal hunger cues in ways that don’t feel healthy.

Then there’s a truth that rarely makes it into the conversation: when the drug stops, the weight often returns unless permanent lifestyle changes are in place. That alone tells us these medications don’t solve the underlying issue—they override it.

What troubles me most, though, is the messaging.

Turn on the television and watch the ads. The people smiling, laughing, and strolling through parks aren’t immobile or medically fragile. They’re mildly overweight, stocky, thick-set, or simply carrying some extra pounds—the kind of bodies most of us have seen our entire lives. The message is subtle but powerful: this drug is for you. Not because your life is in danger, but because you don’t like how you look or feel.

That’s a dangerous shift.

When we market powerful metabolic drugs to people who are otherwise functional, we blur the line between medical necessity and convenience. We medicalize discomfort. We turn patience into pathology. And we normalize long-term pharmaceutical dependence for problems that still respond to nutrition, movement, time, and support.

There’s also a fairness issue we can’t ignore. People whose lives truly depend on these medications already face high costs, limited availability, and insurance hurdles. Watching scarce medical resources drift toward cosmetic use while severely obese patients struggle for access doesn’t sit right with me.

I believe these drugs should be reserved for situations where the risk of not treating is greater than the risk of treating—when obesity has crossed into immobility, organ strain, or imminent health collapse. In those cases, the unknowns are worth accepting because the alternative is far worse.

For everyone else, the focus should remain on sustainable habits, realistic expectations, patience, and compassion. Not because it’s easy—but because it respects the complexity of the human body.

I say all of this as someone who understands the struggle deeply. I’m not dismissing it. I’m respecting the power of these medications enough to say they deserve restraint.

Medicine should save lives, not smooth over discomfort. Remembering that distinction protects people—not just today, but decades from now.