The opposite day in my main care follow, one in all 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 puzzled, privately. I’ve had numerous 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 appeared excellent. The one subject was that she had gained possibly 25 kilos over the past two years, most of which she had spent gestating and breastfeeding a brand new human life. It is a tremendous feat, and it is unsurprising that it required a bit of further adipose tissue.
She had an extended historical past of dropping and regaining weight, and years of relations pressuring her to be skinnier.
“I am unsure Ozempic will deliver you peace along with your physique,” I steered, 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} cause to start out a weight-loss remedy? More and more, my sufferers assume so.
My follow in New Jersey is full of individuals 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 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.
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, 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, 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 remedy in 2023. And she or he advised viewers in her prime-time particular that she’s “releasing the stigma and the disgrace and the judgment” that include residing in a much bigger physique – one thing she will presumably do now as a result of she’s skinny.
She would not cease to ask if possibly 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 increased shallowness, happier marriages, extra vitality, much less again ache. Folks appear satisfied this remedy 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 price many billions of {dollars} a yr, thriving on – and perpetuating – a pervasive sense that our our bodies are by no means adequate. When life will get robust 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. Fairly than fixing discrimination in opposition to individuals with larger our bodies, we inform sufferers to repair themselves.
The brand new weight-loss medication have a veneer of respectability – medical doctors prescribe them, in spite of everything – 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 yr, a real windfall for Novo Nordisk, the Danish pharmaceutical firm that developed the blockbuster medication. They’ve a advertising and marketing 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 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 implies that a lot of my colleagues zone in on weight reduction as a remedy 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 deal with their weight and neglect that fats sufferers might need different illnesses. Fats phobia has develop into so ingrained within the tradition of drugs that it is onerous to see, until you look intently.
The load-loss business tells us that if we simply lose a couple of kilos, we’ll lastly be comfortable. However this business 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 charge 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 assume I might be complicit in fat-phobic tradition, peddling weight-reduction plan medication and all of their false guarantees.
But the business is so highly effective, it feels onerous to flee. Once I recommend to sufferers that Ozempic may not be medically crucial, they shrug. They are saying, “Advantageous, 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 clear up 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 rather a lot these medicines 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 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 in opposition to us. These medicines 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 principally 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 mentioned individuals began treating her kids higher as soon as she misplaced weight.
Actually, GLP-1 medicines helped a few of Oprah’s friends with their diabetes and adjusted the way in which 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 handle it – is an efficient 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 measurement 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 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.
