ALL of this! And the relentless media coverage is messing with countless humans and their recovery and mending processes. Many of my clients who graduated and moved on are now reaching out because they feel the return of their disordered thoughts and behaviors. Those who were feeling stable before all of this hype are now struggling mightily with this renewed promise of losing weight again. Losing weight FEELS LIKE belonging, like redemption, like feeling safe. This does NOT reflect on my clients. This feeling pulled back by another promise reflects just how f*cked up our culture is. Media's loud noise about this new shiny promise is shaking the foundations for so many. Can we talk about that, please? Thank you for addressing this!!
Thanks for writing this. The New York magazine piece really upset me. For one thing, it dug its claws into parts of my mind I thought I had quieted, kicked up all sorts of anxieties. But the main thing that bugged me is that, except for the one quote from Aubrey Gordon, it felt as if someone had just ripped off a mask and said, "Ha, ha, we were just kidding about fat acceptance and coming to terms with the data that diets don't work and being cool about everyone's body, obviously if there was a 'magic' pill to end fatness, everyone would take it if they could get it." I'm just pissed, but I've decided to focus on "have to take it forever" and "explosive diarrhea."
Thank you for this. I have two friends on Ozempic or equivalent drugs and I have such ambivalent, complicated feelings about all of it. My friends are both categorized as ob*se but not diabetic, and were put on the medication by their doctors, specifically for weight management. They describe relief and respite. A break. One said it feels wonderfully quiet inside her head.
I'd be lying if I said I didn't feel jealous. I want a respite, too - from my own pesky thoughts about food, from having this annoying physical body with physical needs, from public judgment about how that body looks (lolol like there's any respite from THAT, no matter what my weight actually is). I want peace and quiet.
It's crazy that it seems easier to find a respite, to achieve peace with my appetite and quiet inside my own echo-chamber head each time I want a snack, by taking a medication that prevents my brain from signaling to me about my body's needs and even wants, than by changing anything substantial about our culture and its view on bodies and food. Just wild, how firmly entrenched we are in all of this, as a society.
Yes. It really struck me how the peace that folks describe around food in the NY mag piece is like… the inverse of the peace that is possible with eating disorder recovery. With the meds, folks feel better bc their appetite is less. With ED recovery, folks can feel better about letting their appetite be what it is. But the latter feels virtually impossible to so many people because our culture demonizes appetites and bodies so much.
It's not just lady mags, either--kook at the cover of this week's Economist.
As someone who takes Ozempic for T2DM, I am so very, very burnt out on all this. I'd like to point out that the coverage and the backlash can be very difficult for those of us who take the GLP-1s for diabetes. The discussion veers between being blasé (GLP-1s are a serious commitment and the prospect of a lifetime commitment to maintain weight loss isn't something that should be tossed off lightly) to, honestly, some stuff that makes me feel icky. Would it be worth putting up with this drug just to lose a modest amount of weight? No. But for people with diabetes, we're weighing up delayed gastric emptying with a really potentially significant reduction in our A1c.
Yes - that’s my whole point. the Economist, etc are doing lady mag-style pieces about this trend. (The lady mags barely exist anymore or are doing their usual coverage but not getting praised for it the way general interest outlets are.)
And yes - diabetics are 100% getting left out of the conversation.
It's not just diabetics who are being left out of the conversation. So much of the reporting fails to acknowledge that many people who are taking this drugs who are not diabetic are doing so in order to treat *other hormonal and metabolic conditions* like PCOS.
Most of these conditions have no other currently available treatments because medical science has either been unwilling to invest research into them (anything that predominantly affects women) or blinded by the typical anti-fat cliches that body size is merely a matter of willpower. You basically have three groups of people taking these medications: diabetics looking to control their a1c values, people with other conditions looking to treat those conditions, and people attempting to solely lose weight. Yet the discourse only seems to zero in on the third group, and especially the folks in that third group who are already at or close to a "normal" weight.
"These pieces take a maybe-it’s-a-thing diet culture moment—any odd and slightly-to-very dangerous new tactic, which only a handful of rich people are doing—and make it, undeniably A Thing That People Are Doing Now."
This was a great article and thanks so much for sharing that article from The Cut. Because I have done searches on these drugs, EVERY TIME I open the Google app the suggested stories for me are about them with the most ridiculous headlines. Today's is "Weight Watchers Buying Telehealth Service Known for Ozempic Weight Loss Prescriptions." Which side note- does this mean WW is admitting that their diet doesn't really work? I don't trust them.
The top article is often about some celebrity taking this new "fad drug" but rarely about actual fat people taking this drug for their health. This media coverage has made it all the more confusing for me as I have been spending the last year looking into these drugs, talking to people about them, and ultimately meeting with my doctor to discuss it for myself. I have a box of Wegovy in my fridge right now that only cost $25 because I have the privilege of having great insurance and I am still very on the fence about taking this medication because I still have so many questions. Can I take it and still be considered "body-positive?" Should I wait til my health markers are worse? Experts are saying that it is a lifetime drug because going off of it result in re-gaining the weight- why do I feel differently about taking this forever vs. my anti-anxiety meds that you can pry from my cold dead hands? And probably the biggest thing I am struggling with is- who can I talk to about this? When I've been vocal about body- positivity and the marginalization of fat people, will I be judged by my friends and family? But what other people think shouldn't dictate how I manage my own health. I have shared with only two friends so far and I am someone that shares everything with my friends.
Please keeping writing about this stuff and all of the nuances surrounding it, because magazines and podcasts are not capturing the complexity of being a fat person in our current world.
I feel like I could have written your whole comment. I’m looking into a future filled with scary possibilities (stroke, diabetes, heart failure), only 18 years to go until the age my dad died, four years to go until the age my brother developed critical heart failure, a year or two past when my sister and brothers developed diabetes. And I’m weighing that against a medication that may actually delay or even prevent those outcomes, even if it’s lifelong, will it maybe mean a longer life?
The Cut article was especially disheartening, and I do appreciate it being called out. But it does feel like the public discussion is still lacking so much nuance. Maybe there’s no way to responsibly have a public discussion on what is ultimately a deeply personal decision about balancing physical and mental health concerns and the societal consequences and contributing factors.
I think you’re right that public discussions about personal medical decisions are just wildly fraught — especially when the media brings so much unexamined anti-fatness to the table.
I also want to be clear that Burnt Toast is never a place where anyone should feel judged for their individual medical decisions. We support your right to body autonomy and your knowledge of your own lived experience!
I think your last sentence is really the heart of it. And we live in a world that LOVES public discourse on this kind of thing, but it is so deeply personal and individual. I think about the years that I refused to take medication for my anxiety because I thought it was a lack of faith on my part (evangelical upbringing).
GLP1-receptor agonists absolutely reduce cardiovascular risk factors. I don’t want to argue about this here, but there are many published articles on this now, and they are frontline treatment for DM type 2 explicitly because of the reduction in CV risk along with improved HgA1C.
I completely understand a lot of the skepticism people have about these drugs, especially considering the tenor of much of the media coverage over the last 6-12 months. But, I find myself disheartened by the fact that so many people are unaware that these drugs do actually represent significant breakthroughs in the treatment of many conditions that, until now, have had either no available or no effective treatments.
The endocrinology field is excited about these medications (and the ones currently being researched) for very good reasons, and it's not all down to a desire to eliminate fat people from the world. (An incomplete list of conditions that are currently being researched for treatment by GLP-1 drugs: PCOS, insulin resistance, metabolic syndrome, non-alcoholic fatty liver disease, IBS, Crohn's disease, Ulcerative Colitis, MS, Parkinson's, Alzheimer's, Rheumatoid Arthritis, Psoriasis, ALS, non-Alzheimer's dementia, substance use disorder...)
I have gotten the same press release several times from a doc offering to talk to me about Ozempic and Ozempic face. Tell me you don't read my newsletter without etc etc etc.
I would love for my brain to not want food. Yes, I'm working with my therapist on this. Because "not wanting food" shouldn't be the goal but it's a hell of a lot easier-sounding than "unlearning the last 36 years of diet culture/eating disorders and learning how to think about food in a healthy way."
It's terrifying if your brain is already functioning as it should be. We know, however, that this is not always the case (e.g. the extreme end of the spectrum for people with the rare disorder Prader-Willi syndrome). As with most medical things, it's complicated and supervision by an ethical and competent medical provider is necessary (but sadly unavailable to many people)!
Respectfully, I find this comment to be reductive and unhelpful. As I've told various mental health professionals at some point during treatment - my train of thought is consistently taken up by thoughts about 1) what I just ate 2) what I am eating or 3) what I will eat next. I have been on medication (not any of the new waves of weight loss meds, one that has been around for a while) for a brief period of time. I didn't actually lose a significant amount of weight, but it was like someone turned off the tape playing in the background. I did not know it was possible to live without that background noise about wanting food 24/7. I get emotional thinking about it - I just didn't know it was possible to live like that. Alas, I also wanted to have children and that particular med is not to be taken during childbearing years, so the tape went back on. I am not a fan of diet culture, and I think all the 'journalism' about the celebrities on Ozempic is terrible and harmful. But I wish on this side of fat acceptance we could have a genuine conversation about the complexities of the issue, rather than painting every med and everyone who may consider taking it as mistaken.
I appreciate you sharing this. I think what’s inherently disturbing about the drugs and what gets celebrated about them is that it makes it sound like tricking your brain into wanting food less is the only way to turn off that tape — when we have lots of good research about eating disorder treatment showing that giving ourselves permission to eat can result in a similar liberation. The latter just feels very hard/impossible to many folks because of our cultural narratives about food and fatness.
That said — yes we need much more discussion of the complexities here. There are clearly scenarios where the drugs are warranted and useful, as Hilary describes below. And we also need to let people be in charge of their own bodies and you’re right to name that the backlash against these drugs sometimes loses sight of that.
One of the things that I think is most fascinating about the GLP-1 family of drugs is that the mechanism of action of these drugs is not fully understood.
The hormones that these drugs target, especially the newer ones that affect two or three receptors (tirzepatide [sold as Mounjaro], and the still-being-researched mazdutide, retatrutide, LY3502970, and AMG-133) don't seem to just affect appetite signaling. They also affect function at the cellular level. (This is why we're seeing so many potential novel applications like in the autoimmune and neurodegenerative spaces.)
I think that what we will ultimately find is that there is a significant difference between _suppressing_ one's existing appetite (whether via drugs or intentional deprivation like with disordered eating) and altering the efficiency of the body's metabolic processes such that a person's appetite is naturally lower because the body is meeting its energy needs from a smaller quantity of food.
The drugs currently on the market, especially older ones like liraglutide and semaglutide clearly have both appetite suppression effects as well as effects on metabolic efficiency. This is why, by the way, it's so important to properly titrate on them and be supervised by a medical provider who knows what they're doing; and why situations like people getting shady compounded versions of these drugs at day spas are so concerning.
I am optimistic, though, that as research progresses in this field the needle will move more towards the metabolic efficiency side. Tweaking the ratio of the different peptides involved and whether they are agonists (stimulators) or antagonists (inhibitors) and moving to drugs that require only monthly or quarterly dosing will likely be a big part of this.
The size acceptance movement (fat rights) will survive this, just as it has all the previous miracle Hollywood diets, magic pills (remember phen-fen?), amphetamins (outlawed as a weight loss method decades ago), Dr. Oz and his "reduce your belly" nonsense, and weight-loss surgery. The diet industry and bariatric promoters are very concerned that more fat people are coming to accept themselves, and discovering clothes that they look nice in, romantic partners that they had thought could never exist, fat celebrities (Lizzo!) and fat patients who are getting uppity about doctors' offices that have no place to sit due to the sizes of the chairs in the waiting rooms. Many surgeons are upset that only about 1% of their target patients actually have weight loss surgery. They, and other bariatricians, are fighting back, by bludgeoning the AMA into having stated that being fat is a disease, in the hope they can convince insurance companies to cover expensive procedures and medications. As with so much else in our society, you can figure a lot of things out if you "follow the money."
Wegovy is just the new kid on the block. There are plenty of red flags that it will not be so great in the long run, and it may take a while before all of its problems are discovered.
But there will be plenty of casualties along the way, and the opportunistic WW and their ilk will remain profitable for a long time to come. The only cultural survivors of all this will be people who can think independently, and tune out most of the fatphobic messages in our culture.
However, my biggest concern is not for the adults, who at least in theory, have free choice in the matter. Instead, it is about the children, who may be put on Wegovy or prescribed weight loss surgery, before they are old enough to give their informed consent, by some pediatricians who are acting on new advice from their professional society, the AAP, written by people who have some serious conflicts of interest in the matter, as does the AAP itself.
My own late daughter was harmed by her pediatrician, who complained to her about her slightly chubby legs at the age of 7, which triggered an eating disorder lasting 20 years. Her mother and I did not know about it, because we were not in the room at the time. We blamed ourselves for not firing that doctor. And that was decades before the AAP guidelines came out--it was probably caused by the personal fatphobia of the doctor himself.
My thanks to Virginia for providing one of the important platforms to discuss these things!
Oh god, your lede here is giving me extremely unpleasant flashbacks.
Thanks for this. I heard from a ladymag editor a few months ago asking me to write an Ozempic story (with a cursory "Don't worry, it's not just another Ozempic piece!" but it still gave me the icks). Given all the pieces that have come out since then I've been more and more relieved to have declined the assignment.
Ugggghhhh that Elna Baker episode of This American Life. It made me so angry. Thank you for validating my feelings and pointing me to that excellent essay critiquing it.
This is basically a side note but the article got me thinking about “lady mags” as you call them something I rarely do! I started subscribing to Glamour as a teenager and enjoyed it because it was mostly fun fashion and makeup. Weird and aspirational but it didn’t seem insulting to me. And some interesting sex info I filled away mentally for later. As a later teen, I started subscribing to Shape and it made me feel horrible about myself. I’ve been fat since I was 5. So it wasn’t like there was a difference in timing between the two subscriptions. I remember reading a statistic about how reading women’s magazines made a staggering percentage of women and girls feel worse about themselves for a certain period of time after reading. So I tested it out with my magazines and confirmed Shape was definitely a problem for me but Glamour was still fun. I canceled Shape after that.
A little over a year ago I got a Gift subscription to Real Simple. The last couple issues have had some major anti-fatness so I’m glad I won’t be continuing with it. I was surprised as I don’t even understand what that’s doing in a magazine about organization!
That is SO random about Real Simple. Just why?! And yes - I could go deep into the many nuances of which women’s mags caused the most harm and why and how that balanced the ratio of their potential for good. The fitness category was particularly toxic.
Thank you for covering this. I have strong feelings about these drugs because of my clientele (mostly people with disordered eating and eating disorders). I have seen firsthand the harmful side effects that everyone seems to be dismissing or glossing over as “not that bad”. To be clear, I do believe that GLP-1s have legitimate uses, especially for the treatment of diabetes and possibly other chronic health conditions, though we definitely need more research before making definitive claims. But I don’t think there is enough informed consent around the need to continue taking these medications indefinitely or about the potential risks/side effects, which can be significant. And based on the reported experiences of my clients who are taking them, doctors seem to be laser-focused on the potential for weight loss and then almost as an afterthought mention that they might also help manage their PCOS, insulin resistance, fertility, etc. In the aftermath of the AAP Guidelines, I’m most terrified for the children who could be prescribed these drugs.
The All Fired Up podcast did a great 2-part series on the history of weight loss drugs (CW: in-depth discussion of weight loss, repeated mention of “o-words”). And the Fen-Phen episode of Maintenance Phase is a fabulous deep dive into a past weight loss drug craze and serves as a cautionary tale.
ALL of this! And the relentless media coverage is messing with countless humans and their recovery and mending processes. Many of my clients who graduated and moved on are now reaching out because they feel the return of their disordered thoughts and behaviors. Those who were feeling stable before all of this hype are now struggling mightily with this renewed promise of losing weight again. Losing weight FEELS LIKE belonging, like redemption, like feeling safe. This does NOT reflect on my clients. This feeling pulled back by another promise reflects just how f*cked up our culture is. Media's loud noise about this new shiny promise is shaking the foundations for so many. Can we talk about that, please? Thank you for addressing this!!
Thanks for writing this. The New York magazine piece really upset me. For one thing, it dug its claws into parts of my mind I thought I had quieted, kicked up all sorts of anxieties. But the main thing that bugged me is that, except for the one quote from Aubrey Gordon, it felt as if someone had just ripped off a mask and said, "Ha, ha, we were just kidding about fat acceptance and coming to terms with the data that diets don't work and being cool about everyone's body, obviously if there was a 'magic' pill to end fatness, everyone would take it if they could get it." I'm just pissed, but I've decided to focus on "have to take it forever" and "explosive diarrhea."
The thought of middle-schoolers enduring the side effect of "explosive diarrhea"--the accidents and humiliation--I shudder.
Thank you for this. I have two friends on Ozempic or equivalent drugs and I have such ambivalent, complicated feelings about all of it. My friends are both categorized as ob*se but not diabetic, and were put on the medication by their doctors, specifically for weight management. They describe relief and respite. A break. One said it feels wonderfully quiet inside her head.
I'd be lying if I said I didn't feel jealous. I want a respite, too - from my own pesky thoughts about food, from having this annoying physical body with physical needs, from public judgment about how that body looks (lolol like there's any respite from THAT, no matter what my weight actually is). I want peace and quiet.
It's crazy that it seems easier to find a respite, to achieve peace with my appetite and quiet inside my own echo-chamber head each time I want a snack, by taking a medication that prevents my brain from signaling to me about my body's needs and even wants, than by changing anything substantial about our culture and its view on bodies and food. Just wild, how firmly entrenched we are in all of this, as a society.
Yes. It really struck me how the peace that folks describe around food in the NY mag piece is like… the inverse of the peace that is possible with eating disorder recovery. With the meds, folks feel better bc their appetite is less. With ED recovery, folks can feel better about letting their appetite be what it is. But the latter feels virtually impossible to so many people because our culture demonizes appetites and bodies so much.
It's not just lady mags, either--kook at the cover of this week's Economist.
As someone who takes Ozempic for T2DM, I am so very, very burnt out on all this. I'd like to point out that the coverage and the backlash can be very difficult for those of us who take the GLP-1s for diabetes. The discussion veers between being blasé (GLP-1s are a serious commitment and the prospect of a lifetime commitment to maintain weight loss isn't something that should be tossed off lightly) to, honestly, some stuff that makes me feel icky. Would it be worth putting up with this drug just to lose a modest amount of weight? No. But for people with diabetes, we're weighing up delayed gastric emptying with a really potentially significant reduction in our A1c.
Yes - that’s my whole point. the Economist, etc are doing lady mag-style pieces about this trend. (The lady mags barely exist anymore or are doing their usual coverage but not getting praised for it the way general interest outlets are.)
And yes - diabetics are 100% getting left out of the conversation.
It's not just diabetics who are being left out of the conversation. So much of the reporting fails to acknowledge that many people who are taking this drugs who are not diabetic are doing so in order to treat *other hormonal and metabolic conditions* like PCOS.
Most of these conditions have no other currently available treatments because medical science has either been unwilling to invest research into them (anything that predominantly affects women) or blinded by the typical anti-fat cliches that body size is merely a matter of willpower. You basically have three groups of people taking these medications: diabetics looking to control their a1c values, people with other conditions looking to treat those conditions, and people attempting to solely lose weight. Yet the discourse only seems to zero in on the third group, and especially the folks in that third group who are already at or close to a "normal" weight.
Ah - the first thing that came to mind for me was The Cut and of course "regular" outlets.
The Economist stood out because while NYT et al regularly run lifestyle pieces, that's not usually their deal.
Oh yes, very true. They pretend to rise above the fray AND YET.
"These pieces take a maybe-it’s-a-thing diet culture moment—any odd and slightly-to-very dangerous new tactic, which only a handful of rich people are doing—and make it, undeniably A Thing That People Are Doing Now."
YUP.
and, as Virginia pointed out, A Thing That Maybe You Should Do (Or At Least Want To Do) Too
hi, it me. ugh.
Don't beat yourself up. It's really hard to fight cultural pressure and messaging!
This was a great article and thanks so much for sharing that article from The Cut. Because I have done searches on these drugs, EVERY TIME I open the Google app the suggested stories for me are about them with the most ridiculous headlines. Today's is "Weight Watchers Buying Telehealth Service Known for Ozempic Weight Loss Prescriptions." Which side note- does this mean WW is admitting that their diet doesn't really work? I don't trust them.
The top article is often about some celebrity taking this new "fad drug" but rarely about actual fat people taking this drug for their health. This media coverage has made it all the more confusing for me as I have been spending the last year looking into these drugs, talking to people about them, and ultimately meeting with my doctor to discuss it for myself. I have a box of Wegovy in my fridge right now that only cost $25 because I have the privilege of having great insurance and I am still very on the fence about taking this medication because I still have so many questions. Can I take it and still be considered "body-positive?" Should I wait til my health markers are worse? Experts are saying that it is a lifetime drug because going off of it result in re-gaining the weight- why do I feel differently about taking this forever vs. my anti-anxiety meds that you can pry from my cold dead hands? And probably the biggest thing I am struggling with is- who can I talk to about this? When I've been vocal about body- positivity and the marginalization of fat people, will I be judged by my friends and family? But what other people think shouldn't dictate how I manage my own health. I have shared with only two friends so far and I am someone that shares everything with my friends.
Please keeping writing about this stuff and all of the nuances surrounding it, because magazines and podcasts are not capturing the complexity of being a fat person in our current world.
I feel like I could have written your whole comment. I’m looking into a future filled with scary possibilities (stroke, diabetes, heart failure), only 18 years to go until the age my dad died, four years to go until the age my brother developed critical heart failure, a year or two past when my sister and brothers developed diabetes. And I’m weighing that against a medication that may actually delay or even prevent those outcomes, even if it’s lifelong, will it maybe mean a longer life?
The Cut article was especially disheartening, and I do appreciate it being called out. But it does feel like the public discussion is still lacking so much nuance. Maybe there’s no way to responsibly have a public discussion on what is ultimately a deeply personal decision about balancing physical and mental health concerns and the societal consequences and contributing factors.
I think you’re right that public discussions about personal medical decisions are just wildly fraught — especially when the media brings so much unexamined anti-fatness to the table.
I also want to be clear that Burnt Toast is never a place where anyone should feel judged for their individual medical decisions. We support your right to body autonomy and your knowledge of your own lived experience!
I think your last sentence is really the heart of it. And we live in a world that LOVES public discourse on this kind of thing, but it is so deeply personal and individual. I think about the years that I refused to take medication for my anxiety because I thought it was a lack of faith on my part (evangelical upbringing).
there is no evidence these drugs prevent stroke, heart failure etc!!!
GLP1-receptor agonists absolutely reduce cardiovascular risk factors. I don’t want to argue about this here, but there are many published articles on this now, and they are frontline treatment for DM type 2 explicitly because of the reduction in CV risk along with improved HgA1C.
And cholesterol and triglycerides!
I completely understand a lot of the skepticism people have about these drugs, especially considering the tenor of much of the media coverage over the last 6-12 months. But, I find myself disheartened by the fact that so many people are unaware that these drugs do actually represent significant breakthroughs in the treatment of many conditions that, until now, have had either no available or no effective treatments.
The endocrinology field is excited about these medications (and the ones currently being researched) for very good reasons, and it's not all down to a desire to eliminate fat people from the world. (An incomplete list of conditions that are currently being researched for treatment by GLP-1 drugs: PCOS, insulin resistance, metabolic syndrome, non-alcoholic fatty liver disease, IBS, Crohn's disease, Ulcerative Colitis, MS, Parkinson's, Alzheimer's, Rheumatoid Arthritis, Psoriasis, ALS, non-Alzheimer's dementia, substance use disorder...)
I have gotten the same press release several times from a doc offering to talk to me about Ozempic and Ozempic face. Tell me you don't read my newsletter without etc etc etc.
SAME
Is there anything more terrifying than a drug that makes your brain not want food?! Death drive 101...
It’s so heartbreaking how not scary that sounds to so many people.
I would love for my brain to not want food. Yes, I'm working with my therapist on this. Because "not wanting food" shouldn't be the goal but it's a hell of a lot easier-sounding than "unlearning the last 36 years of diet culture/eating disorders and learning how to think about food in a healthy way."
It's terrifying if your brain is already functioning as it should be. We know, however, that this is not always the case (e.g. the extreme end of the spectrum for people with the rare disorder Prader-Willi syndrome). As with most medical things, it's complicated and supervision by an ethical and competent medical provider is necessary (but sadly unavailable to many people)!
Respectfully, I find this comment to be reductive and unhelpful. As I've told various mental health professionals at some point during treatment - my train of thought is consistently taken up by thoughts about 1) what I just ate 2) what I am eating or 3) what I will eat next. I have been on medication (not any of the new waves of weight loss meds, one that has been around for a while) for a brief period of time. I didn't actually lose a significant amount of weight, but it was like someone turned off the tape playing in the background. I did not know it was possible to live without that background noise about wanting food 24/7. I get emotional thinking about it - I just didn't know it was possible to live like that. Alas, I also wanted to have children and that particular med is not to be taken during childbearing years, so the tape went back on. I am not a fan of diet culture, and I think all the 'journalism' about the celebrities on Ozempic is terrible and harmful. But I wish on this side of fat acceptance we could have a genuine conversation about the complexities of the issue, rather than painting every med and everyone who may consider taking it as mistaken.
I appreciate you sharing this. I think what’s inherently disturbing about the drugs and what gets celebrated about them is that it makes it sound like tricking your brain into wanting food less is the only way to turn off that tape — when we have lots of good research about eating disorder treatment showing that giving ourselves permission to eat can result in a similar liberation. The latter just feels very hard/impossible to many folks because of our cultural narratives about food and fatness.
That said — yes we need much more discussion of the complexities here. There are clearly scenarios where the drugs are warranted and useful, as Hilary describes below. And we also need to let people be in charge of their own bodies and you’re right to name that the backlash against these drugs sometimes loses sight of that.
One of the things that I think is most fascinating about the GLP-1 family of drugs is that the mechanism of action of these drugs is not fully understood.
The hormones that these drugs target, especially the newer ones that affect two or three receptors (tirzepatide [sold as Mounjaro], and the still-being-researched mazdutide, retatrutide, LY3502970, and AMG-133) don't seem to just affect appetite signaling. They also affect function at the cellular level. (This is why we're seeing so many potential novel applications like in the autoimmune and neurodegenerative spaces.)
I think that what we will ultimately find is that there is a significant difference between _suppressing_ one's existing appetite (whether via drugs or intentional deprivation like with disordered eating) and altering the efficiency of the body's metabolic processes such that a person's appetite is naturally lower because the body is meeting its energy needs from a smaller quantity of food.
The drugs currently on the market, especially older ones like liraglutide and semaglutide clearly have both appetite suppression effects as well as effects on metabolic efficiency. This is why, by the way, it's so important to properly titrate on them and be supervised by a medical provider who knows what they're doing; and why situations like people getting shady compounded versions of these drugs at day spas are so concerning.
I am optimistic, though, that as research progresses in this field the needle will move more towards the metabolic efficiency side. Tweaking the ratio of the different peptides involved and whether they are agonists (stimulators) or antagonists (inhibitors) and moving to drugs that require only monthly or quarterly dosing will likely be a big part of this.
The size acceptance movement (fat rights) will survive this, just as it has all the previous miracle Hollywood diets, magic pills (remember phen-fen?), amphetamins (outlawed as a weight loss method decades ago), Dr. Oz and his "reduce your belly" nonsense, and weight-loss surgery. The diet industry and bariatric promoters are very concerned that more fat people are coming to accept themselves, and discovering clothes that they look nice in, romantic partners that they had thought could never exist, fat celebrities (Lizzo!) and fat patients who are getting uppity about doctors' offices that have no place to sit due to the sizes of the chairs in the waiting rooms. Many surgeons are upset that only about 1% of their target patients actually have weight loss surgery. They, and other bariatricians, are fighting back, by bludgeoning the AMA into having stated that being fat is a disease, in the hope they can convince insurance companies to cover expensive procedures and medications. As with so much else in our society, you can figure a lot of things out if you "follow the money."
Wegovy is just the new kid on the block. There are plenty of red flags that it will not be so great in the long run, and it may take a while before all of its problems are discovered.
But there will be plenty of casualties along the way, and the opportunistic WW and their ilk will remain profitable for a long time to come. The only cultural survivors of all this will be people who can think independently, and tune out most of the fatphobic messages in our culture.
However, my biggest concern is not for the adults, who at least in theory, have free choice in the matter. Instead, it is about the children, who may be put on Wegovy or prescribed weight loss surgery, before they are old enough to give their informed consent, by some pediatricians who are acting on new advice from their professional society, the AAP, written by people who have some serious conflicts of interest in the matter, as does the AAP itself.
My own late daughter was harmed by her pediatrician, who complained to her about her slightly chubby legs at the age of 7, which triggered an eating disorder lasting 20 years. Her mother and I did not know about it, because we were not in the room at the time. We blamed ourselves for not firing that doctor. And that was decades before the AAP guidelines came out--it was probably caused by the personal fatphobia of the doctor himself.
My thanks to Virginia for providing one of the important platforms to discuss these things!
Oh god, your lede here is giving me extremely unpleasant flashbacks.
Thanks for this. I heard from a ladymag editor a few months ago asking me to write an Ozempic story (with a cursory "Don't worry, it's not just another Ozempic piece!" but it still gave me the icks). Given all the pieces that have come out since then I've been more and more relieved to have declined the assignment.
I apologize for the PSTD trigger, I know you were in the trenches with me. We got out though!!
Thank you SOOO much for this!!! Have I told you lately how grateful I am for you and for all you do? Can't wait until your book comes out.
Ah thank you Roxy!!
Ugggghhhh that Elna Baker episode of This American Life. It made me so angry. Thank you for validating my feelings and pointing me to that excellent essay critiquing it.
This is basically a side note but the article got me thinking about “lady mags” as you call them something I rarely do! I started subscribing to Glamour as a teenager and enjoyed it because it was mostly fun fashion and makeup. Weird and aspirational but it didn’t seem insulting to me. And some interesting sex info I filled away mentally for later. As a later teen, I started subscribing to Shape and it made me feel horrible about myself. I’ve been fat since I was 5. So it wasn’t like there was a difference in timing between the two subscriptions. I remember reading a statistic about how reading women’s magazines made a staggering percentage of women and girls feel worse about themselves for a certain period of time after reading. So I tested it out with my magazines and confirmed Shape was definitely a problem for me but Glamour was still fun. I canceled Shape after that.
A little over a year ago I got a Gift subscription to Real Simple. The last couple issues have had some major anti-fatness so I’m glad I won’t be continuing with it. I was surprised as I don’t even understand what that’s doing in a magazine about organization!
That is SO random about Real Simple. Just why?! And yes - I could go deep into the many nuances of which women’s mags caused the most harm and why and how that balanced the ratio of their potential for good. The fitness category was particularly toxic.
Yes! All the weight-loss drug coverage is so triggering! I feel like we've taken a step 10 (or 50) years backward in body acceptance.
So grateful for your clear writing and thinking. Thank you.
Thank you for covering this. I have strong feelings about these drugs because of my clientele (mostly people with disordered eating and eating disorders). I have seen firsthand the harmful side effects that everyone seems to be dismissing or glossing over as “not that bad”. To be clear, I do believe that GLP-1s have legitimate uses, especially for the treatment of diabetes and possibly other chronic health conditions, though we definitely need more research before making definitive claims. But I don’t think there is enough informed consent around the need to continue taking these medications indefinitely or about the potential risks/side effects, which can be significant. And based on the reported experiences of my clients who are taking them, doctors seem to be laser-focused on the potential for weight loss and then almost as an afterthought mention that they might also help manage their PCOS, insulin resistance, fertility, etc. In the aftermath of the AAP Guidelines, I’m most terrified for the children who could be prescribed these drugs.
The All Fired Up podcast did a great 2-part series on the history of weight loss drugs (CW: in-depth discussion of weight loss, repeated mention of “o-words”). And the Fen-Phen episode of Maintenance Phase is a fabulous deep dive into a past weight loss drug craze and serves as a cautionary tale.
Such valuable perspective, thank you Holly!