The opposite day in my main care apply, considered one of my sufferers requested me to prescribe Ozempic. She had lately given beginning, and her physique had modified.
“I would like my physique again,” she advised me.
Did her physique actually go away? I questioned, 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 strain was regular, her labs seemed good. The one challenge was that she had gained perhaps 25 kilos during the last 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 little bit further adipose tissue.
She had an extended historical past of shedding and regaining weight, and years of relations pressuring her to be skinnier.
“I am undecided Ozempic will convey you peace along with your physique,” I urged, gently. Medically, I advised her, I did not assume she wanted to shed pounds.
She was undeterred. “My garments do not match,” she complained.
Was {that a} purpose to begin a weight-loss treatment? More and more, my sufferers assume so.
My apply in New Jersey is stuffed with folks determined to shed pounds, sufferers who imagine their true selves are smaller than the our bodies they really inhabit.
I’ve written publicly about my size-inclusive strategy to drugs – 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, nevertheless 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, longing for 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 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 does 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 acquired 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 larger 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. Now we have a weight-reduction plan business value many billions of {dollars} a 12 months, 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 advised to work on ourselves, squeeze in a little bit self-care: a little bit Peloton right here, a little bit intermittent fasting there.
Ozempic suits in completely, a medical answer to all the issues which can be assumed to return with being fats. Somewhat than fixing discrimination in opposition to folks with greater our bodies, we inform sufferers to repair themselves.
The brand new weight-loss medicine have a veneer of respectability – docs prescribe them, in any case – 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 12 months, 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 assume Ozempic is a miracle drug.
Docs are maybe essentially the most responsible of perpetuating the parable that weight reduction solves all the pieces. My discipline’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?” docs ask, when sufferers complain of something from insomnia to scorching flashes to foot ache. In the meantime, my sufferers share tales of missed diagnoses from docs who deal with their weight and neglect that fats sufferers may need different illnesses. Fats phobia has turn out to be so ingrained within the tradition of drugs 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 joyful. However this business 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 everything 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 payment for weight-loss apps. And we docs go on prescribing Ozempic.
After I determined, at age 22, to turn out to be a doctor, I imagined long-term relationships with my sufferers, incomes their belief. I did not assume I might be complicit in fat-phobic tradition, peddling weight-reduction plan medicine and all of their false guarantees.
But the business is so highly effective, it feels onerous to flee. After I recommend to sufferers that Ozempic may not be medically essential, they shrug. They are saying, “Fantastic, I will 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 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 wish to shed pounds, since supporting their physique autonomy is my obligation as their physician.
However I would like them to know there’s so much these drugs do not do.
They do not undo the harms of weight-reduction plan 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 drugs do not assist us really feel grateful for our our bodies – our bodies that climb mountains, beginning 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 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 altered the best way the world handled them, however the true downside behind their struggling is not solely 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 instrument to deal with it – is an effective first step. What if as a substitute of making an attempt to shrink ourselves, we tried to vary 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 vary form and dimension over time. She met my eye, by 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.
