In Enough, Jastreboff describes Todd as a patient, but it is unclear if he was associated with Y-Weight or another clinic. Jastreboff uses his story to illustrate how patients can experience uncomfortable side effects from using obesity medications and the importance of being consistent and taking them as prescribed. 

At 38 years old, Todd had obesity and also suffered from gout. Jastreboff describes how he began using obesity medications and, after suffering from some nausea, worked with his physician to stay at the lowest possible dose. This strategy was successful at first: Todd lost 34 pounds over several months and felt less pain due to his gout. However, Todd’s progress was stunted when he chose to leave his medications at home to go on an all-inclusive Caribbean vacation. The author explains, “He would eat, drink, be merry, and get his money’s worth at the same time. He planned to resume the medication after returning home” (216). 

Upon returning home and neglecting his medications again, Todd’s intense cravings returned. After overeating and regaining some of the weight he had lost, Todd decided to return to the medication, but this abrupt transition from nothing to a high dosage reignited the uncomfortable side effects he had experienced before. Jastreboff uses Todd’s example as a cautionary tale. His decision to neglect his medication and then try to keep the weight off on his own resulted in an unnecessary “yo-yo” experience as well as dangerous side effects. 

She explains the lesson of Todd’s story: “All this reminded him that he had obesity, a chronic disease that must be treated chronically, and so he needed the medication to maintain his weight and health goals” (219). In claiming that Todd “needed the medication,” Jastreboff presents GLP-1s as essential for achieving a healthy weight and avoids addressing both the serious potential side effects and the various reasons why such medications might not be necessary for all patients.

Quisha is a patient who lost weight using obesity medications. Jastreboff describes Quisha’s weight loss plan as ambitious, as she paired the medications with intense exercise and a healthy eating plan. As a result, she lost weight rapidly, shedding two pounds a week. However, after losing 50 pounds over six months, Quisha began to feel tired, was unable to digest fatty foods, and had some abdominal pain. After going to the hospital, she learned that she had gallstones and needed to have her gallbladder removed. 

The author points to Quisha as an example of more extreme side effects of obesity medications, explaining that because they encourage rapid weight loss, they can result in inflammation of the gallbladder. She writes, “I include the side effect of gallstones because, although it is rare, it does happen. Gallstones and inflammation of the gallbladder (cholecystitis) can occur with any form of rapid weight loss—bariatric surgery, caloric restriction, and effective medications” (220). However, in claiming that this serious side effect can occur “with any form of rapid weight loss,” Jastreboff does not offer further commentary on whether or not this side effect is more likely with some forms of weight-loss treatment than others. This is an especially salient factor considering that gallbladder issues are acknowledged as a serious potential side effect of GLP-1s specifically. 

Jastreboff also uses Quisha’s example to communicate that, more often than not, losing weight slowly and steadily is better than rapid changes. She reports that after Quisha’s gallbladder surgery, she and her physician approached her weight loss more cautiously, helping her lose half a pound per week. Jastreboff presents this moderate approach as a healthy and sustainable one that is less likely to result in serious side effects.