Norway's surge in obesity medication prescriptions leaves patients without crucial lifestyle support. Christian Saarheim began injections in January 2023 after significant weight gain. Over subsequent months, his hunger diminished as his dosage increased. His doctor monitored side effects but offered little guidance on changing habits. "There was little or no focus on lifestyle change from the GP's side," Saarheim said. He understands the principles of healthy eating but finds execution difficult. With reduced appetite from the drugs, he thought he could eat whatever he wanted if calories stayed low—a mindset he admits persists today.
A Widespread Systemic Failure
Mari-Mette Graff of the National Association for the Overweight says many share this experience. "The sad thing is that people are often sent home without help," Graff stated. She reports patients receive no support from GPs or pharmacies, with some referred to Facebook groups for advice. Graff shared a desperate message from someone who lost only one kilogram after six months on medication, having been advised to "eat as usual." She calls this approach directly unethical. Continuing to eat calorie-dense, nutrient-poor food like ready-made pizza or burgers and chips can lead to deficiencies in protein and vitamins. "In the worst case, it could also be irresponsible," Graff added.
A Divide in Medical Follow-Up
Graff notes a clear disparity in care. Patients receiving obesity medicine in hospitals often get good follow-up. The systemic problem lies with those prescribed the drugs by their general practitioner. "Many prescribe it on the wrong premise. In the sense that they do not follow up the patient afterwards," she explained. Torgeir Hoff Skavøy, head of the Norwegian Association for General Medicine, acknowledges this is not how it should be. He states GPs fundamentally possess the knowledge and tools for adequate follow-up. "You might meet a GP who has fantastic expertise and interest in the field. And then you will have other GPs who, unfortunately, find it less interesting and do a more minimum follow-up," said Skavøy, a GP in Bergen for nearly 20 years.
The Rapid Rise of Weight-Loss Drugs
Since 2020, sales of medications aiding weight loss have skyrocketed. This trend began with the off-label prescribing of the diabetes drug Ozempic for slimming. The first highly effective obesity medicine was approved in Norway in 2023, fueling further demand. This rapid adoption has exposed gaps in the standard care framework. The medical focus on pharmaceutical intervention has, in many cases, overshadowed the essential behavioral component of sustainable weight management. The system currently allows for a scenario where a patient receives a powerful biological tool but no instruction manual for the lifestyle changes required for long-term success.
The Ethical Dilemma of Prescription
Graff's criticism points to a significant ethical dilemma within primary care. Prescribing a chronic medication for a complex condition like obesity without providing parallel support for dietary and behavioral change raises questions about duty of care. It creates a scenario where patient outcomes are jeopardized not by the drug's failure, but by the system's failure to treat the whole person. The referral to informal online forums for professional advice underscores a breakdown in the clinical pathway, placing the burden of complex medical navigation on the patient.
The Patient's Persistent Struggle
Christian Saarheim's experience illustrates the personal consequence of this systemic gap. His acknowledgment that he still holds the belief he can eat anything if calories are low reveals how the medication alone does not reset deep-seated relationships with food. The injection addresses the physiological driver of hunger but not the psychological, environmental, and habitual drivers of weight gain. Without professional guidance to build new skills and knowledge, patients are set up to rely indefinitely on the medication, unsure of how to maintain their health if they ever stop. This dependency cycle is a direct result of the incomplete treatment model.
A Call for Structured Support
The solution, as voiced by advocates like Graff, is not to restrict access to effective medicines but to mandate integrated support. A proper treatment protocol for obesity medication should mirror that of other chronic conditions: medication management coupled with ongoing patient education and lifestyle coaching. This requires systemic change, potentially including updated guidelines for GPs, dedicated referral pathways to dietitians or behavioral therapists, and clear standards for follow-up frequency and content. Skavøy's acknowledgment of varying GP interest highlights that relying on individual clinician enthusiasm is insufficient, structured support must be embedded in the care model.
The Looming Question of Long-Term Results
The conversation inevitably turns to what happens when patients stop the medication. Emerging data shows many regain weight after cessation, a outcome almost guaranteed if no lasting lifestyle changes were made during treatment. This potential for rebound weight gain makes the lack of concurrent lifestyle intervention not just an oversight but a critical flaw that could harm patient health and wellbeing in the long run. It transforms a potential tool for lasting health improvement into a short-term fix with a high probability of reversal, wasting healthcare resources and eroding patient trust.
Who Bears Responsibility?
The central, unresolved question is one of responsibility. Is it the prescribing doctor's duty to ensure holistic care? Should the healthcare system provide accessible, funded lifestyle programs automatically linked to such prescriptions? Or does the onus fall on the patient to seek out this support independently? The current fractured approach, where a hospital patient might receive comprehensive care while a GP patient receives only a prescription, creates a two-tiered system of treatment outcomes. Until this is resolved, Norway's use of powerful obesity medications will remain a story of medical advancement undermined by a failure of holistic care. The drugs work, but the system surrounding them is broken, leaving patients like Christian Saarheim navigating the complex journey of weight management largely alone.