Affording GLP-1 without affording the support around it is not okay

Back from a full week of no work. It was highly needed and like most people I saw the GLP1/Serena Williams news. Before sharing running to break my disconnection and sharing more I took a step back.

While hiking in northern Italy and looking back at my year working in women’s health access in workplaces, I kept thinking about that news I read on Serena Williams and a message received from a PCOS whatsapp group

“Ladies I think GLP1 is the thing thank god she is opening iup and we can now openly talk about it”.

She raised the fear of the stigma and the joy coming from a relief : a celebrity who did it all and has it all and still did not manage to make it work when it came to weigh loss. I wondered if Serenea Williams was conscious of the scale of what she just contributed to ?

Let me start with us. In our own healthcare and wellness circles we can be quick to worship discipline and shame our bodies and metabolism. I’ve done it too. Then Serena Williams said out loud that she used a GLP-1, with Ro, and half the internet set itself on fire. If the most decorated tennis champion of our time says her body needed a GLP-1 after kids, that should be a relief: sometimes it’s not about willpower. It’s about metabolims, timing, and access to proper care. Her announcement also surfaced a hard truth I care about at ninti: if we can afford the injection but not the behavioral, nutritional, and mental-health scaffolding that makes it safe and sustainable, then we are not doing healthcare. We are doing transactions. Reuters confirmed the Ro partnership and disclosed that Alexis Ohanian is both an investor and a Ro board member. That context matters, and the nuance matters too. c

Image from Ro.

Where the science is today, not the fantasy

GLP-1 and GIP/GLP-1 medicines can deliver major weight loss for many people and, some benefits that go beyond the scale.

Efficacy

In the STEP program, semaglutide 2.4 mg led to large, durable weight loss when continued. Stopping tends to bring weight back. Tirzepatide shows similar or greater loss, and a randomized withdrawal trial showed substantial regain when it’s stopped. This is chronic-disease medicine, not a 12-week detox. New England Journal of MedicinePubMedJAMA Network

Beyond weight.

The SELECT trial showed semaglutide 2.4 mg reduced major cardiovascular events in adults with overweight or obesity and established cardiovascular disease. And Zepbound, the tirzepatide brand for obesity, is now the first FDA-approved medication for obstructive sleep apnea in adults with obesity. Those are real health outcomes: fewer heart events, better sleep and daytime function. New England Journal of Medicine+1U.S. Food and Drug Administration

PCOS

Early studies and recent meta-analyses suggest GLP-1s can improve weight, insulin resistance, and some hormonal parameters in PCOS, especially when combined with metformin. This is promising, not gospel. Most trials are short and small, and they do not answer fertility and long-term questions yet. PMCNatureFrontiers

The part TikTok gets half right and dangerously half wrong

I’ve been seeing the TikTok videos and comments wars and the PCOS patient groups I’m in. There is relief, there is stigma-smashing, and there is also shaky information about side effects, fertility, and how to combine meds with training and food. Analyses of GLP-1 content on social platforms show a lot of promotional tone, thin risk communication, and mixed accuracy. The algorythm was quick at amplifying the news with some seriously disturbing content. We should take that seriously because millions are getting their first education there. FDA Access Data+1

Side effects and signals you actually need to know

If we are going to make this a global conversation, then people deserve the right tools to understand risks and to walk into their doctor’s office prepared. I love Serena but I believe she underestimated the consequences of that part

Common: Nausea, vomiting, diarrhea, constipation. Usually transient but not trivial. Labels carry a boxed thyroid warning based on rodent data. Do not use in pregnancy. japha.orgReproductive Health Access Project

Gastrointestinal events: A large observational study comparing weight-loss users reported higher rates of gastroparesis, bowel obstruction, and pancreatitis versus another obesity medication. These are rare but they are the kinds of risks that should be discussed before starting. New England Journal of Medicine

Gallbladder and biliary disease: Multiple meta-analyses of randomized trials show an increased risk, especially at higher doses and with longer use. Rapid weight loss itself raises gallstone risk. This is not a reason to panic. It is a reason to plan and monitor. PMCJAMA Network

Muscle and bone: With semaglutide, a meaningful fraction of weight lost can be lean mass. The STEP body-composition substudy found lean mass decreased in absolute terms, even as the proportion of lean mass relative to body weight improved. That means resistance training and adequate protein are not optional. They are part of the prescription. PMCNew England Journal of Medicine

Stopping and rebound: Discontinuation is consistently followed by weight regain across GLP-1 and GIP/GLP-1 trials and meta-analyses. That argues for clear long-term plans, not “try a few pens and see.” PubMed+1BioMed Central

Contraception and pregnancy: Tirzepatide can reduce exposure to oral contraceptives because it slows gastric emptying. Labels advise backup contraception around initiation and dose escalations. None of these drugs should be used while trying to conceive or during pregnancy. GOV.UKjapha.org

Quality and supply: As demand surged, counterfeit and compounded products flooded markets. The FDA has logged dosing errors and quality concerns with compounded semaglutide and recently said the semaglutide shortage is resolved, with plans to clamp down on compounding exceptions. This is exactly where a clinician and a legitimate pharmacy matter. U.S. Food and Drug Administration+2U.S. Food and Drug Administration+2

Access and affordability are the real fault line

Serena’s story breaks stigma. But if you can afford a GLP-1 pen and not the clinical wraparound — dietetic care, resistance training plan, mental-health support, time for follow-up — then you are buying probability without safety rails. In the US, list prices around a thousand dollars a month are common for branded GLP-1s. In France, Wegovy was authorized and then slated to be reimbursed only under tight criteria, with the government repeatedly signaling concern over costs and supply; in parallel, a limited patient-access program launched while formal reimbursement decisions evolved. None of this creates predictable access to the full bundle of care. PubMedClinicalTrials

A conversation we need to have, out loud

Me: These drugs can change lives beyond weight, including energy, cognition by way of sleep and cardiometabolic relief.
Colleague: Yes, and they can also erode muscle and unsettle the gut if you do not pair them with training and nutrition.
Me: So the real intervention is the drug plus behavior plus monitoring, over years.
Colleague: Which is exactly what most people cannot afford or schedule.
Me: Then democratization cannot just be cheaper pens. It has to be coverage for the care around the pen.

On TikTok the line between medicine and lifestyle gets blurry. A weekly shot becomes a vibe check. That is where we — employers, payers, platforms, clinicians, founders — have to be adults in the room.

On Serena x Ro, with fairness and context

Critics argue she is “promoting a weight-loss agenda.” I think that is too easy. She is also saying out loud that disciplined people sometimes need medical help, and that metabolism after pregnancy can defy perfect behavior. That is destigmatizing. At the same time, commercial context matters. Ro benefits from her influence, and her husband sits on Ro’s board. Disclose it, scrutinize claims, and still allow women to seek care without moral tests. You can celebrate the messenger and still interrogate the system. Reuters For a snapshot of the media reaction and why people felt torn, this roundup is useful.

What women actually need to take into the clinic

If the internet is going to debate GLP-1s at scale, the minimum we owe people is a checklist that makes the doctor’s visit safer. As a PCOS patient and someone who have been under metformin for an IVF protocole that was stopped as it was skyrocketting my prolactin levels, I know first hand how being prepared can change our decision making process in the better. It does not guarantee everything but it help us in having a better understanding of how to interact with these.
I come here with my patient voice, and patient background, and if there is one thing that we need to do more of is equip us with the right tools because the reality check is that once we are out of that doctor’s office we are on our own.

Ask these, in plain language.

• Am I a candidate based on my BMI, comorbidities, and meds I already take
• What baseline labs and conditions do you need to rule out first pancreatitis history, gallbladder disease, thyroid cancer history including MEN2
• Which drug and dose, and what is the slowest titration that still works for me
• What is the plan to protect muscle and bone specific protein target, resistance training minimums, vitamin D and calcium if needed
• How will we monitor side effects and what are the red flags that mean stop now
• How do these meds interact with my contraception, IVF IUI plan, and future pregnancy plans what backup do I need and when
• What is the plan and budget for behavioral support dietitian, strength coach, therapist If I cannot afford these, what is the bare-minimum safe plan
• If I ever stop, what is our maintenance plan to minimize rebound and how often will we follow up
• What pharmacy will dispense this how will we verify it is an approved product and not compounded without medical necessity
• Realistic outcomes for me beyond weight sleep, blood pressure, A1c, joint load What will success look like at 3, 6, and 12 months

Care should be affordable. Not the pen by itself. The care. If we normalize GLP-1s but do not normalize coverage for the nutrition, resistance training, mental health, contraception counseling, and regular follow-up that make them responsible, then we have learned nothing from the last decade of healthcare and wellness culture.

I am grateful Serena Williams said the quiet part. I also want clearer, braver commitments from payers, oublic health systems and employers. Fund the wraparound. Require programs that package GLP-1s with behavioral support as the default, not the upsell. Platforms should label content about side effects with the same energy they label supplements. Telehealth companies should publish outcomes by cohort and disclose conflicts consistently. That is how you turn a celebrity moment into a public-health win.

I would lovde to hear your thoughts on this one and let me know what you’d like to read more of from my substack.

I am back here after a deserved week of a break and I can’t wait to share all the things I have planned for you.

With Care,
Fatoumata