The opposite day in my major care observe, certainly one of my sufferers requested me to prescribe Ozempic. She had not too long ago given start, and her physique had modified. “I would like my physique again,” she informed me. Did her physique actually go away? I questioned, privately. I’ve had quite a lot of conversations like this not too long ago, spurred by the onslaught of media protection of Ozempic and Oprah’s ecstatic endorsement of its advantages throughout a particular TV section she did this week. My affected person’s blood stress was regular, her labs regarded good. The one subject was that she had gained perhaps 25 kilos over the past two years, most of which she had spent gestating and breastfeeding a brand new human life. It is a tremendous feat, and it is unsurprising that it required just a little additional adipose tissue.
She had a protracted historical past of dropping and regaining weight, and years of relations pressuring her to be skinnier. “I am unsure Ozempic will convey you peace together with your physique,” I advised, gently. Medically, I informed her, I did not suppose she wanted to drop extra pounds. She was undeterred. “My garments do not match,” she complained. Was {that a} cause to start out a weight-loss treatment? More and more, my sufferers suppose so. My observe in New Jersey is full of folks determined to drop extra pounds, sufferers who consider their true selves are smaller than the our bodies they really inhabit. I’ve written publicly about my size-inclusive strategy to medication – I do not direct my sufferers in direction of weight reduction, and I’ve a loyal following of sufferers who come to me particularly as a result of I do not harass them about their physique dimension. However for each affected person who seeks out my weight-neutral strategy, I’ve ten who’ve been offered the lie that shedding pounds will repair each downside of their life. That delusion is nothing new, however it’s been newly medicalized within the period of Ozempic and Wegovy, a category of medicines generally known as GLP-1 agonists. And sufferers are exhibiting up at my door, looking forward to the promised panacea.
Even Oprah, whose physique dimension has been the topic of nationwide curiosity for many years, appears to purchase the hype. She publicly introduced she was utilizing a GLP-1 treatment in 2023. And she or he informed viewers in her prime-time particular that she’s “releasing the stigma and the disgrace and the judgment” that include dwelling in an even bigger physique – one thing she will presumably do now as a result of she’s skinny. She would not cease to ask if perhaps fats phobia is the issue, not fats folks. I’ve had sufferers cry tears of frustration once I level out that they’re a “wholesome” weight and their labs present no proof of diabetes. As an alternative of being thrilled they’ve obtained a clear invoice of well being, they’re upset their insurance coverage will not pay for GLP-1 agonists. I’ve had sufferers confess they consider Ozempic will give them increased shallowness, happier marriages, extra vitality, much less again ache. Individuals appear satisfied this treatment can do all of it. It is actually no shock that my sufferers overestimate the therapeutic powers of this once-a-week injection. Our society is obsessive about thinness. We’ve got a food plan business price many billions of {dollars} a yr, thriving on – and perpetuating – a pervasive sense that our our bodies are by no means adequate. When life will get powerful or the information will get insufferable, we’re informed to work on ourselves, squeeze in just a little self-care: just a little Peloton right here, just a little intermittent fasting there. Ozempic suits in completely, a medical resolution to all the issues which can be assumed to return with being fats. Somewhat than fixing discrimination towards folks with greater our bodies, we inform sufferers to repair themselves. The brand new weight-loss medication have a veneer of respectability – docs prescribe them, in spite of everything – that makes them appear completely different from HerbaLIfe or Weight Watchers. However, like all of the weight-loss guarantees that got here earlier than them, they’re being drastically oversold.
Ozempic and Wegovy gross sales are estimated at $13 billion a yr, a real windfall for Novo Nordisk, the Danish pharmaceutical firm that developed the blockbuster medication. They’ve a advertising and marketing finances to match: the corporate spent $491 million on promoting within the first half of 2023. With budgets like that, it is no surprise my sufferers appear to suppose Ozempic is a miracle drug. Docs are maybe probably the most responsible of perpetuating the parable that weight reduction solves the whole lot. My subject’s obsession with physique mass index implies that lots of my colleagues zone in on weight reduction as a remedy for each ailment. “Have you considered shedding pounds?” docs ask, when sufferers complain of something from insomnia to sizzling flashes to foot ache. In the meantime, my sufferers share tales of missed diagnoses from docs who concentrate on their weight and neglect that fats sufferers may need different ailments. Fats phobia has turn into so ingrained within the tradition of medication that it is onerous to see, until you look carefully. The burden-loss business tells us that if we simply lose a couple of kilos, we’ll lastly be completely satisfied. However this business has created an issue solely extra weight-reduction plan – or extra medication – can repair. It tells us that the physique is one thing to be tamed for everything of our lives. If we do not keep vigilant, the kilos would possibly come again. So we hold shopping for dietary supplements, hold paying the month-to-month payment for weight-loss apps. And we docs go on prescribing Ozempic. Once I determined, at age 22, to turn into a doctor, I imagined long-term relationships with my sufferers, incomes their belief. I did not suppose I would be complicit in fat-phobic tradition, peddling food plan medication and all of their false guarantees. But the business is so highly effective, it feels onerous to flee. Once I recommend to sufferers that Ozempic may not be medically crucial, they shrug. They are saying, “Advantageous, I am going to simply get it on-line,” at any variety of telehealth providers the place sufferers can self-report no matter weight will get them the prescription.
To be clear: I am not anti-Ozempic. GLP-1 drugs can clear up sure issues. I fortunately prescribe them for a lot of of my sufferers with diabetes or coronary heart illness, and I am grateful to the researchers who developed them. And I even prescribe them for individuals who merely need to drop extra pounds, since supporting their physique autonomy is my obligation as their physician. However I would like them to know there’s lots these drugs do not do. They do not undo the harms of food plan tradition, distorted physique picture and pervasive weight stigma. They do not change the way in which we have turned consuming right into a morality contest, the way in which the pleasure and ritual of sharing meals with our family members has been weaponized towards us. These drugs do not assist us really feel grateful for our our bodies – our bodies that climb mountains, start infants, hug grandparents. They do not repair the informal self-hatred that is been normalized in our fatphobic world. Watching Oprah’s weight reduction particular, I principally felt unhappiness. She shared wrenching testimonials from individuals who felt ashamed to depart the home due to their physique dimension, together with one Chicago-area mother who mentioned folks began treating her kids higher as soon as she misplaced weight. Actually, GLP-1 drugs helped a few of Oprah’s company with their diabetes and adjusted the way in which the world handled them, however the actual downside behind their struggling is not totally medical. The issue is fats phobia. This stigma is difficult to take care of, however recognizing it – and understanding that Ozempic is a woefully insufficient device to deal with it – is an effective first step. What if as a substitute of making an attempt to shrink ourselves, we tried to alter our biases? What if we constructed a world the place various our bodies are appreciated, not medicated to take up much less house? For my affected person who requested for Ozempic the opposite day, I informed her that it is regular for our bodies to alter form and dimension over time. She met my eye, by way of tears, and confessed that she felt like her genuine self – her skinny self – was simply ready to emerge.
“What wouldn’t it really feel like to like your physique the way in which it’s?” I requested. My affected person did not have a solution. Mara Gordon is a household doctor in Camden, N.J., and a contributor to NPR. She’s on Twitter as @MaraGordonMD.