The opposite day in my main care apply, one in all my sufferers requested me to prescribe Ozempic. She had lately given delivery, and her physique had modified.
“I would like my physique again,” she advised me.
Did her physique actually go away? I puzzled, privately. I’ve had lots of conversations like this lately, 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 stress was regular, her labs seemed excellent. The one problem 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 an incredible feat, and it is unsurprising that it required a bit of additional adipose tissue.
She had a protracted historical past of dropping and regaining weight, and years of members of the family pressuring her to be skinnier.
“I am unsure Ozempic will carry you peace along with your physique,” I prompt, gently. Medically, I advised her, I did not suppose she wanted to shed pounds.
She was undeterred. “My garments do not match,” she complained.
Was {that a} motive to start out a weight-loss treatment? More and more, my sufferers suppose so.
My apply in New Jersey is crammed with folks determined to shed 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 measurement.
However for each affected person who seeks out my weight-neutral strategy, I’ve ten who’ve been bought the lie that shedding pounds will repair each drawback of their life. That fable 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 displaying up at my door, longing for 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 he or she advised 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 after 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 vanity, happier marriages, extra power, 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 now have a weight loss program trade price many billions of {dollars} a yr, 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 advised to work on ourselves, squeeze in a bit of self-care: a bit of Peloton right here, a bit of intermittent fasting there.
Ozempic matches in completely, a medical answer to all the issues which might be assumed to come back with being fats. Somewhat than fixing discrimination towards folks with greater our bodies, we inform sufferers to repair themselves.
The brand new weight-loss medicine have a veneer of respectability – medical doctors prescribe them, in any case – that makes them appear totally 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 medicine. They’ve a advertising and marketing funds 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 essentially the most responsible of perpetuating the parable that weight reduction solves all the things. My subject’s obsession with physique mass index signifies that a lot of my colleagues zone in on weight reduction as a treatment for each ailment.
“Have you considered shedding pounds?” medical doctors 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 medical doctors who concentrate on their weight and overlook that fats sufferers may need different ailments. Fats phobia has develop into so ingrained within the tradition of medication that it is exhausting to see, except you look intently.
The load-loss trade tells us that if we simply lose a number of kilos, we’ll lastly be completely satisfied. However this trade has created an issue solely extra weight-reduction plan – or extra medicine – can repair. It tells us that the physique is one thing to be tamed for the whole lot of our lives. If we do not keep vigilant, the kilos may come again. So we maintain shopping for dietary supplements, maintain paying the month-to-month payment for weight-loss apps. And we medical doctors go on prescribing Ozempic.
Once I determined, at age 22, to develop into a doctor, I imagined long-term relationships with my sufferers, incomes their belief. I did not suppose I might be complicit in fat-phobic tradition, peddling weight loss program medicine and all of their false guarantees.
But the trade is so highly effective, it feels exhausting to flee. Once I recommend to sufferers that Ozempic won’t be medically essential, they shrug. They are saying, “High-quality, I am going to 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 am 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 am grateful to the researchers who developed them. And I even prescribe them for individuals who merely need to shed pounds, since supporting their physique autonomy is my obligation as their physician.
However I would like them to know there’s quite a bit these medicines do not do.
They do not undo the harms of weight loss program 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 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 go away the home due to their physique measurement, together with one Chicago-area mother who stated folks began treating her kids higher as soon as she misplaced weight.
Actually, GLP-1 medicines helped a few of Oprah’s company with their diabetes and altered the way in which the world handled them, however the true drawback behind their struggling is not completely 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 handle it – is an efficient first step. What if as an alternative of attempting to shrink ourselves, we tried to alter our biases? What if we constructed a world the place numerous our bodies are appreciated, not medicated to take up much less house?
For my affected person who requested for Ozempic the opposite day, I advised her that it is regular for our bodies to alter form and measurement over time. She met my eye, by means 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 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.
