The opposite day in my major care observe, one among my sufferers requested me to prescribe Ozempic. She had not too long ago given delivery, and her physique had modified.
“I need my physique again,” she instructed me.
Did her physique actually go away? I questioned, privately. I’ve had lots 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 seemed good. The one 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 is an incredible feat, and it is unsurprising that it required just a little further adipose tissue.
She had an extended historical past of dropping and regaining weight, and years of members of the family pressuring her to be skinnier.
“I am unsure Ozempic will convey you peace along with your physique,” I prompt, gently. Medically, I instructed her, I did not suppose she wanted to drop pounds.
She was undeterred. “My garments do not match,” she complained.
Was {that a} cause to begin a weight-loss medicine? More and more, my sufferers suppose so.
My observe in New Jersey is full of individuals determined to drop 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 bought the lie that dropping pounds will repair each drawback of their life. That fantasy is nothing new, but it surely’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, anticipating 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 medicine in 2023. And she or he instructed viewers in her prime-time particular that she’s “releasing the stigma and the disgrace and the judgment” that include dwelling in a much bigger physique – one thing she will 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 individuals.
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 a substitute 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 shallowness, happier marriages, extra vitality, much less again ache. Folks appear satisfied this medicine 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 have now a eating regimen trade 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 instructed 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 answer to all the issues which are assumed to return with being fats. Slightly than fixing discrimination in opposition to individuals 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 spite of everything – 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 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 suppose Ozempic is a miracle drug.
Docs are maybe essentially the most responsible of perpetuating the parable that weight reduction solves every thing. 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 dropping 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 give attention to their weight and overlook that fats sufferers may need different ailments. 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 trade tells us that if we simply lose just a few kilos, we’ll lastly be blissful. 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 would possibly come again. So we maintain shopping for dietary supplements, maintain paying the month-to-month price for weight-loss apps. And we medical doctors 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 suppose I would be complicit in fat-phobic tradition, peddling eating regimen medicine and all of their false guarantees.
But the trade is so highly effective, it feels onerous to flee. After I recommend to sufferers that Ozempic won’t be medically vital, they shrug. They are saying, “Advantageous, 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 resolve 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 pounds, since supporting their physique autonomy is my obligation as their physician.
However I need them to know there’s so much these drugs 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 drugs 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 principally felt unhappiness. She shared wrenching testimonials from individuals who felt ashamed to go away the home due to their physique dimension, together with one Chicago-area mother who mentioned individuals began treating her kids higher as soon as she misplaced weight.
Actually, GLP-1 drugs helped a few of Oprah’s visitors with their diabetes and adjusted the best way the world handled them, however the actual drawback behind their struggling is not solely medical. The issue is fats phobia.
This stigma is difficult to cope with, 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 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 instructed her that it is regular for our bodies to alter form and dimension 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 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.
