December 9, 2023

Recently, two of my good friends (neither of whom is obese) have joined the masses taking semaglutide for weight loss. Because the three of us live in different parts of the country, our friendship is maintained by annual visits and frequent texts. Lately in our text thread, all they can do is rave about how these drugs have been “life-changing” in helping them drop the stubborn 20 pounds they’ve been wanting to lose since hitting their 40s. I’m conflicted about the safety and popularity of these drugs for weight loss, and so I’ve remained silent whenever this topic comes up. Our annual trip is coming up, and I fear I’ll be forced to offer my opinion about their weight loss, especially since the trip involves time at the pool. Should I compliment them to keep the peace? Or is there a tactful way to make my differing opinion about these drugs known? — Name Withheld

From the Ethicist:

It’s not the job of friends to play doctor. People who have been prescribed semaglutide will have received medical advice about possible side effects. More than a few will have experienced them. You imply there’s a moral problem about taking the drug, but you don’t say what it is.

Maybe your concern is that your friends have been prescribed a semaglutide medication for an “off label” use, one that hasn’t been authorized by the F.D.A. But physicians use off-label therapies all the time (including for serious conditions like macular degeneration, with backing from E.U. and U.K. authorities). You’d want to be specific about why this off-​label use is objectionable.

Or maybe you’re worried that they’ve been using a drug that has been in short supply, posing difficulties for those with diabetes who need it. That was a real issue — though, as manufacturing has ramped up, a temporary one. You might still feel they had been selfish to make even a minuscule contribution to that shortage. (There are millions of semaglutide prescriptions in the United States alone.) If so, you might invite a broader discussion with your friends about the problems to which your own various habits of consumption are making similar contributions. Not knowing what your specific concerns are, I can’t tell you how to broach them. But if what’s really bothering you is the thought that your friends are taking the easy way out, well, I doubt that’s a cogent position. In any case, the evidence is clear: Moralizing weight issues doesn’t help solve them.

I’m 82, and my mother died when I was 8. I always thought she was buried in our family plot near the city where we lived at the time, but when I became interested in genealogy, I discovered her grave was actually in another state. Curious about the choice, I wrote to that cemetery’s office last year and asked if nearby gravestones bore any of my mother’s family names. They told me they would answer my question after I paid for the upkeep on my mother’s grave, which had been accruing for over a century. They enclosed a bill.

I’ve been a widow for almost 20 years, and my husband spent his final years in a nursing home, which drained our savings. It would be a serious hardship for me to pay this bill. But we’re talking about my mother’s grave — universally regarded as almost sacred. I loved my mother dearly, and part of me feels as if I’m abandoning her if I don’t pay up. But I don’t believe we stay in our graves, and another part of me thinks she would understand. I keep wondering where I stand, morally. The cemetery, meanwhile, has sent me another bill, this one larger than the last. — Name Withheld

From the Ethicist:

I see why you’re drawn to do something. My sisters and I were horrified when our parents’ joint burial plot in Ghana was set upon by grave robbers, and, at some expense, we put it back in order. However secular-minded you and I may be, the burial grounds of our parents feel somehow special. Still, you don’t owe this cemetery anything: It wasn’t you who decided where your mother would be buried. You shouldn’t be on the hook for money a cemetery chose to spend on the grave’s maintenance. Your mother died long ago, when things were different, but nowadays there’s an arrangement called an “endowment care,” in which people can set up a special trust fund that secures a grave’s future maintenance. Most cemeteries are also required to put some of their revenue into a “perpetual care fund.”

What do you owe your mother? Probably the love and gratitude you already feel. You aren’t letting her down by not paying this bill. In fact, you might be letting her down if you did: If your mother was anything like mine, she would have been horrified by the thought of your impoverishing yourself in your 80s for this reason.

The previous column’s question was from a reader who, concerned about a friend’s obesity, wondered whether she should intervene. Regarding her friend, she wrote: “Food is her drug. It is clear she lives for it as an addict would. She steadfastly refuses to talk to me or her family about it. … What, if anything, can I do to help her?”

In his response, the Ethicist noted: “Unlike her primary-care provider, you have no special knowledge of complex conditions. (One such complexity: the vicious cycle that can arise between depression and obesity.) You may not be the right person to make a difference here. She has explicitly asked you not to raise the issue with her. As someone who cares about her, you obviously have reason to want her to get healthier. But you can’t insist on it. If the time comes when she cracks the door open to a conversation about her health, there’s plenty of good advice out there (including from the federal site about how to get into it — keeping your focus on her well-being, not her eating habits; avoiding fault finding, judgment and shame; talking with her, not at her.” (Reread the full question and answer here.)

I can imagine everyone in this person’s life, with the best of intentions, is telling her that she should change. A more compassionate approach could be to offer loving presence; invite her to share what she is experiencing and feeling in her life, without judgment masked as instruction. In that safe space of acceptance, she may find an inner motivation for real change. Matt

One of my dearest friends has been quite overweight all her life. It is not for lack of knowledge, motivation, or effort. I know it is a hardship for her. I intentionally do not bring it up. As in any deep friendship, we need to know that we love each other, regardless of our physiques. Linda

The Ethicist missed an important part of the situation — whatever life pain or challenge is driving the friend to self medicate with food in the first place. The letter writer can be a good friend by offering curiosity and support about these different areas of her life, all without needing to mention the friend’s eating habits or body. Amy

Your friend has made it very clear that she doesn’t want you to talk to her about this. It’s not as though you’re telling her something she doesn’t already know. Instead all you are doing is creating an environment of distrust between you. You may not think you are being judgmental, but I would find it surprising that your friend does not feel judgment coming from you. Respect her wishes. Elayne

As someone who participates in a 12-step recovery program, I know the pain of watching loved ones struggle with addiction and difficult life choices. But I now also know the freedom of accepting my powerlessness in trying to change others and their choices. Your friend has shown you her boundaries. Now it’s time for you to take care of yourself and manage your own feelings around her choices. In finding ways to meet her where she’s at, you might actually be able to enjoy your friendship with her again. Luca


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