The car ride home from a social event is always a debrief of who was there, who was wearing what, who said what, and so on and so forth. During one of these gossip sessions a little over a year ago, my mom brought up the change in appearance of one of our family friends, saying, “He looks so good!” I knew what she meant by “good” – he had lost weight. I love good gossip, but these conversations always seem to take a turn that I do not find amusing: who has gained and who has lost weight. My mom continued, listing the many methods our family friends have employed, “Is he doing keto? Is he intermittent fasting? Is he going to Life Time?” My dad chimed in with a surprising answer: “No, he started taking Ozempic.”

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Initially, I was confused. I only knew Ozempic from its catchy advertising jingle and its presence in my diabetic grandmother’s refrigerator. I never knew it to be a get-skinny-quick potion. But quickly, my social media feed informed me that, indeed, it was. From the Real Housewives to Elon Musk, “everyone” is supposedly on Ozempic – it is all the rage in Hollywood. While you may have thought the days of #thinspo and pro-anorexia Kate Moss mantras were well behind us, think again. It suddenly seems like everyone has forgotten about the body positivity movement and is now openly endorsing skinniness.

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Ozempic is an antidiabetic injection medication produced by Novo Nordisk, designed to lower blood sugar. Approved by the Food and Drug Administration (FDA) in 2017, the injection is meant to be administered in the thigh, stomach, or arm of individuals with Type 2 diabetes. According to the FDA, the drug’s active ingredient, semaglutide, encourages insulin secretion and impacts areas of the brain involved with appetite regulation (O’Brien). Ozempic is one of many brand-name drugs classified as GLP-1-based because the semaglutide in these medications contains a synthetic version of Glucagon-like Peptide-1. GLP-1 is a human hormone secreted from the gut, stimulating the pancreas’ release of insulin and signaling satiety to the brain (Belluz). People on drugs like Ozempic experience fullness faster, reducing their food intake and resulting in significant weight loss. Wegovy, another GLP-1-based drug produced by Novo Nordisk, was authorized by the FDA in 2021 for weight loss for individuals experiencing obesity or weight-based conditions (O’Brien). However, as many people turn to GLP-1-based medications for casual weight loss, many ask should drugs like Ozempic be used for weight loss.

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Obesity is a severe issue in America. Per the Centers for Disease Control and Prevention (CDC), almost 80% of adults and a third of children are clinically overweight or obese (Hobbes). While the blame has typically fallen on the weakness of character, researchers are beginning to see obesity “as a condition that arises from complex interactions between our biology and our environments” deserving of medical treatment (Belluz). Research has demonstrated that since 1959, 95% to 98% of attempts to lose weight fail, and two-thirds of those that do not eventually boomerang, with individuals gaining back more weight than they had lost (Hobbes). Dr. Shamsah Amersi, a gynecologist from Los Angeles, sees medications like Ozempic as a suitable avenue for individuals who cannot biologically lose weight. This includes women whose hormonal issues may prevent weight loss (O’Brien). As opposed to operations like bariatric surgery, GLP-1-based drugs are a less invasive option for treatment (Belluz). This approach to weight loss also promotes a more neutral relationship with food. Nearly 50% of 2022 New Year’s Resolutions in the United States were based on fitness and 40% on weight loss. Every year, upwards of $30 billion is spent on diet products (Tagle and Schneider). Yoni Freedhoff, a Canada-based doctor who specializes in obesity, says, “There is tremendous mental health benefits to no longer stressing around food, to no longer feeling like you’re out of control around food, and to no longer feeling like there’s something broken and wrong with you that prevents you from making those healthy choices you’d like to make.” In the eyes of endocrinology clinician-researcher Tony Gladstone, the benefits of GLP-1-based drugs in this field are too good to forgo. He asks, “[Should we not] develop treatments for obesity, because there’s a risk that it might get abused by Hollywood celebrities who want to lose a little bit of weight? I mean, that isn’t how medicine works” (Belluz).

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Others, however, find the casual uses of these medications to be far more concerning. Within six months, Novo Nordisk was short in Wegovy supply, and now, along with Ozempic, it is on the FDA’s shortage list (O’Brien). Comedian Chelsea Handler discussed her weight loss experience with GLP-1-based drugs on a podcast, saying, “My doctor... just hands it out to anybody.” Dr. Jorge Rodriguez, a gastroenterologist, says that although prescribing Ozempic for unofficial use is legal, he will not prescribe it for weight loss, saying it “restricts and harms the people that really benefit from it, which are the diabetics” (Smith). Celebrities embracing the Ozempic craze turn thin bodies into trends and standards of health. The co-founder and CEO of Equip, a virtual eating disorder treatment program, Kristina Saffran, says, “While the existence of Ozempic and celebrity headlines won’t cause eating disorders on their own, the climate they create makes it more likely that those who are vulnerable will develop them” (Konstantinovsky). Weight is also not an accurate representation of health, as “studies have found that anywhere from one-third to three-quarters of people classified as obese are metabolically healthy” (Hobbes). Therefore, those who are obese and healthy do not need these drugs, as noted by Dr. Jason Brett, Novo Nordisk’s executive director of medical affairs, in his statement saying, “We’re not looking at weight loss for cosmetic purposes or episodic weight loss for people who don’t fit those criteria from the FDA-approved label indications” (O’Brien).

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Those who fall within the obese range meet the FDA’s criteria and are eligible to benefit from these types of medications. According to the CDC, “weight that is higher than what is considered healthy for a given height is described as overweight or obesity.” The Body Mass Index (BMI), a person’s weight in kilograms divided by the square of height in meters, is widely used for measuring overweight and obesity. A calculated BMI between 25.0 to less than 30 is classified as overweight, and a BMI of 30.0 or higher is considered in the obesity range (CDC). Keep in mind: this is 80% of adults (Hobbes). In the judgment of the American Medical Association (AMA), individuals in the obese range are recognized as being in a “disease state with multiple pathophysiological aspects requiring a range of interventions to advance obesity treatment and prevention,” per Resolution 420 (Brown). 

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However, this decision has been subject to criticism for its flawed basis. When the classification of obesity as a disease became a question, the AMA had its Committee on Science and Public Health do its own investigation. The committee concluded by opposing the label of disease in a five-page document. In their opinion, obesity does not accurately embody the classification of a medical disease because it lacks symptoms and is not always harmful. In fact, in some circumstances, obesity may actually provide protection rather than harm. Also, a disease is characterized by the body not functioning normally, which is not always the case with obesity. Despite the committee’s recommendation, in 2013, hundreds of doctors at the AMA’s annual meeting voted Resolution 420 into motion (Brown). It is important to acknowledge that doctors have something to gain from this resolution. Doctors will be paid for providing their patients with weight-loss treatments and have an opportunity to upcharge them. In the case that companies like Medicare designate obesity as a disease, if a doctor so much as mentions weight to their patients, they could charge more for the same visit than if they did not mention it (Brown). While the AMA’s Resolution 420 may seem to have been made in the public’s best interest, it is crucial to consider the potential persuasion of financial interests in the decision-making process. Given this questionable foundation for the AMA’s decision, we must reassess our approach to addressing obesity. While promoting a more accepting and empathetic discourse on weight in medicine is essential, classifying all cases of obesity as a disease can be detrimental to certain people. When we accept obesity as a disease, we label all individuals who fall in the range of obesity as sick and in need of medical attention. In doing so, we will push unnecessary treatment onto people who may not need it. 

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Placing excessive emphasis on treatment for obesity may perpetuate the stigma surrounding it while reinforcing the problematic diet culture agenda. A pre-existing stigma around obesity can be labeled as a “fear of fat.” This phenomenon can be expressed through sentiments such as “One of the worst things that could happen to me would be if I gained 25 pounds,” “I worry about becoming fat,” and “I feel disgusted with myself when I gain weight” (Wellman et al. 3). Obesity and being fat have grown to be a source of shame and self-loathing. These feelings can incite disordered eating behaviors such as anorexia and bulimia (2). A study published in the American Psychological Association examined the link between weight stigma, fear of fat, and disordered eating. The study revealed that weight stigma correlates positively with fear of fat, which is also positively linked to rigid restraint and emotional eating (4). This research highlights the concept that by reinforcing the pathologization of obesity and contributing to the “fear of fat” stigma, we amplify negative self-perceptions and exacerbate the consequences of disordered eating behaviors. 

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Similarly, the medicalization of obesity triggers a “fear of sickness” in individuals, which perpetuates the same drive for weight loss as the fear of fat, but masquerades as a pursuit of health. If we subscribe to the idea that being obese is unhealthy, we simultaneously subscribe to the idea that attempts at losing weight are healthy. To rid yourself of weight becomes a way of distancing yourself from disease. Therefore, extreme ways of weight loss, such as administering GLP-1-based medication, are, in a sense, justified and become an avenue of “disease prevention.” As a by-product, weight loss grows into something positive and worth celebrating, creating an idealized standard. When these standards are internalized, and people see a gap between their actual body and the standard, they may experience body dissatisfaction. Across the majority of conceptual frameworks around eating disorders, including the Diagnostic and Statistical Manual of Mental Disorders, the discussion of body dissatisfaction is prominent, with several of these perspectives attributing it to a considerable causal role (Polivy 198). Having an idealized standard based on obesity being a disease thus breeds a climate in which eating disorders are far more prevalent. 

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Ironically, these very standards of health that are encouraged as beneficial create an unhealthy climate. The National Association of Anorexia Nervosa and Associated Disorders reports that eating disorders are among the deadliest mental illnesses and that 10,200 deaths each year directly result from an eating disorder. One death every 52 minutes is undoubtedly not a sign of health (ANAD). While we think we are promoting the pursuit of health, we are instead promoting an ascertainable sickness. This sickness is not only exacerbated by the disease association of obesity but by Ozempic directly. Of individuals with disordered eating attitudes, “16% of them present overeating, 20% purged by vomiting, and 61% food restraining” (Aparicio-Martinez). The way in which GLP-1-based drugs operate is similar to that of the 61% of individuals who engage in dietary restraint. This similarity highlights the way that GLP-1-based drugs essentially produce disordered eating. In our attempts to address obesity, we may inadvertently exacerbate the problem by promoting a more concrete and pathological illness. 

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To have a more productive discussion about the Ozempic controversy, it is important to address the fragmented and isolated parts of the debate related to weight loss and obesity. This debate is entrenched in weight loss and obesity. Failing to understand obesity and its implications could result in harm to a large population of people. In accepting the medicalization of obesity without further investigating it, we risk forcing treatment onto those who do not need it. We risk furthering the stigma around obesity. We risk creating a world in which eating disorders are acceptable. 

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It is crucial to recognize that the negative impact of our culture’s emphasis on weight loss and the fear of fat extends beyond those who are obese. The pervasive stigma affects everyone, regardless of their weight, and acknowledging this can foster empathy and more thoughtful conversations about obesity. By understanding the nuances of obesity and its underlying implications, we can reframe the dialogue and the basis on which medications like Ozempic exist, potentially improving the lives of those struggling with obesity. Having a more comprehensive and compassionate understanding of weight-related issues can help us approach conversations about obesity more thoughtfully and ultimately improve the lives of those affected.

 

Works Cited

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Aparicio-Martinez, Pilar et al. “Social Media, Thin-Ideal, Body Dissatisfaction and Disordered Eating Attitudes: An Exploratory Analysis.” International journal of environmental research and public health vol. 16,21 4177. 29 Oct. 2019, doi: 10.3390/ijerph16214177

 

Belluz, Julia. “Obesity in the Age of Ozempic.” Vox, Vox, 7 Feb. 2023, https://www.vox.com/science-and-health/23584679/ozempic-wegovy-semaglutide-weight-loss-obesity.

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Brown, Harriet. “How Obesity Became a Disease.” The Atlantic, Atlantic Media Company, 24 Mar. 2015, https://www.theatlantic.com/health/archive/2015/03/how-obesity-became-a-disease/388300/.

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“Defining Adult Overweight & Obesity.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 3 June 2022, https://www.cdc.gov/obesity/basics/adult-defining.html#print.  

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“Eating Disorder Statistics: General & Diversity Stats: Anad.” ANAD National Association of Anorexia Nervosa and Associated Disorders, 3 May 2023, https://anad.org/eating-disorders-statistics/. 

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Hobbes, Michael. “Everything You Know about Obesity Is Wrong.” The Huffington Post, TheHuffingtonPost.com, 19 Sept. 2018, https://highline.huffingtonpost.com/articles/en/everything-you-know-about-obesity-is-wrong/. 

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Konstantinovsky, Michelle. “Weight-Loss Drugs, Thin Worship, and Crash Diets: The Unwelcome Return of Eating Disorder Culture.” Glamour, 2 Mar. 2023, https://www.glamour.com/story/weight-loss-drugs-thin-worship-return-of-eating-disorder-culture 

   

O'Brien, Sarah Ashley. “How a Diabetes Drug Became the Talk of Hollywood, Tech and the Hamptons.” The Wall Street Journal, Dow Jones & Company, 18 Feb. 2023, https://www.wsj.com/articles/ozempic-weight-loss-diabetes-drug-11665520937?st=rvb7t9fz1odyu4l&reflink=desktopwebshare_permalink.   

 

Polivy, Janet, and C. Peter Herman. "Causes of eating disorders." Annual review of psychology 53.1 (2002): 187-213 https://www.annualreviews.org/doi/abs/10.1146/annurev.psych.53.100901.135103. 

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Smith, Stacey Vanek. “'You Forget to Eat': How Ozempic Went from Diabetes Medicine to Blockbuster Diet Drug.” NPR, NPR, 1 Apr. 2023, https://www.npr.org/2023/04/01/1166781510/ozempic-weight-loss-drug-big-business.

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Tagle, Andee, and Clare Marie Schneider. “Diet Culture Is Everywhere. Here's How to Fight It.” NPR, NPR, 4 Jan. 2022, https://www.npr.org/2021/12/23/1067210075/what-if-the-best-diet-is-to-reject-diet-culture. 

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Wellman, J. D., Araiza, A. M., Newell, E. E., & McCoy, S. K. (2018). Weight stigma facilitates unhealthy eating and weight gain via fear of fat. Stigma and Health, 3(3), 186–194. https://doi.org/10.1037/sah0000088