The different day in my main care follow, certainly one of my sufferers requested me to prescribe Ozempic. She had not too long ago given delivery, 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 a whole 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 phase she did this week.
My affected person’s blood strain was regular, her labs appeared good. The solely situation 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’s an incredible feat, and it is unsurprising that it required somewhat further adipose tissue.
She had an extended historical past of dropping and regaining weight, and years of relations pressuring her to be skinnier.
“I’m undecided Ozempic will deliver you peace together with your physique,” I advised, gently. Medically, I informed her, I did not suppose she wanted to drop a few pounds.
She was undeterred. “My garments do not match,” she complained.
Was {that a} purpose to begin a weight-loss treatment? Increasingly, my sufferers suppose so.
My follow in New Jersey is crammed with folks determined to drop a few pounds, sufferers who imagine their true selves are smaller than the our bodies they really inhabit.
I’ve written publicly about my size-inclusive method to medication – I do not direct my sufferers in the 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 measurement.
But for each affected person who seeks out my weight-neutral method, I’ve ten who’ve been bought the lie that dropping 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 referred to as GLP-1 agonists. And sufferers are displaying up at my door, anticipating the promised panacea.
Even Oprah, whose physique measurement 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 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 be able to 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. Instead 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 imagine Ozempic will give them greater shallowness, happier marriages, extra power, much less again ache. People appear satisfied this treatment can do all of it.
It’s actually no shock that my sufferers overestimate the therapeutic powers of this once-a-week injection. Our society is obsessive about thinness. We have a eating regimen trade price many billions of {dollars} a 12 months, thriving on – and perpetuating – a pervasive sense that our our bodies are by no means ok. When life will get powerful or the information will get insufferable, we’re informed to work on ourselves, squeeze in somewhat self-care: somewhat Peloton right here, somewhat intermittent fasting there.
Ozempic suits in completely, a medical answer to all the issues which might be assumed to come back with being fats. Rather than fixing discrimination in opposition to folks with larger our bodies, we inform sufferers to repair themselves.
The new weight-loss medication have a veneer of respectability – docs prescribe them, in any case – that makes them appear totally different from HerbaLIfe or Weight Watchers. But, 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 12 months, a real windfall for Novo Nordisk, the Danish pharmaceutical firm that developed the blockbuster medication. They have a advertising price range 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.
Doctors are maybe probably the most responsible of perpetuating the parable that weight reduction solves the whole lot. My area’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 dropping pounds?” docs ask, when sufferers complain of something from insomnia to scorching flashes to foot ache. Meanwhile, my sufferers share tales of missed diagnoses from docs who concentrate on their weight and overlook that fats sufferers might need different ailments. Fat phobia has change into so ingrained within the tradition of drugs that it is arduous to see, until you look intently.
The weight-loss trade tells us that if we simply lose a couple of kilos, we’ll lastly be glad. But this trade 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 the whole thing of our lives. If we do not keep vigilant, the kilos would possibly come again. So we preserve shopping for dietary supplements, preserve paying the month-to-month price for weight-loss apps. And we docs go on prescribing Ozempic.
When I made a decision, at age 22, to change into a doctor, I imagined long-term relationships with my sufferers, incomes their belief. I did not suppose I’d be complicit in fat-phobic tradition, peddling eating regimen medication and all of their false guarantees.
Yet the trade is so highly effective, it feels arduous to flee. When I counsel to sufferers that Ozempic may not be medically vital, they shrug. They say, “Fine, I’ll simply get it on-line,” at any variety of telehealth companies the place sufferers can self-report no matter weight will get them the prescription.
To be clear: I’m not anti-Ozempic. GLP-1 medicines can remedy sure issues. I fortunately prescribe them for a lot of of my sufferers with diabetes or coronary heart illness, and I’m grateful to the researchers who developed them. And I even prescribe them for individuals who merely need to drop a few pounds, since supporting their physique autonomy is my obligation as their physician.
But I would like them to know there’s quite a bit these medicines do not do.
They do not undo the harms of eating regimen tradition, distorted physique picture and pervasive weight stigma. They do not change the best way we have turned consuming right into a morality contest, the best way the pleasure and ritual of sharing meals with our family members has been weaponized in opposition to us. These medicines do not assist us really feel grateful for our our bodies – our bodies that climb mountains, delivery 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 largely felt disappointment. She shared wrenching testimonials from individuals who felt ashamed to depart the home due to their physique measurement, together with one Chicago-area mother who mentioned folks began treating her youngsters higher as soon as she misplaced weight.
Certainly, GLP-1 medicines helped a few of Oprah’s visitors with their diabetes and altered the best way the world handled them, however the true downside behind their struggling is not completely medical. The downside is fats phobia.
This stigma is difficult to take care of, however recognizing it – and understanding that Ozempic is a woefully insufficient instrument to deal with it – is an efficient first step. What if as a substitute of attempting 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 area?
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 measurement 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 would it not really feel like to like your physique the best way 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.