The opposite day in my major 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 need my physique again,” she informed me.
Did her physique actually go away? I puzzled, privately. I’ve had quite a 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 seemed good. The one problem 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 bit of 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 undecided Ozempic will deliver you peace together with your physique,” I advised, gently. Medically, I informed her, I did not assume 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 assume so.
My follow 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 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 dropping pounds will repair each drawback of their life. That delusion is nothing new, but it surely’s been newly medicalized within the period of Ozempic and Wegovy, a category of medicines often called 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 he or 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 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 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 greater vanity, happier marriages, extra power, much less again ache. Folks 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 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 adequate. When life will get powerful or the information will get insufferable, we’re informed to work on ourselves, squeeze in a bit of self-care: a bit of Peloton right here, a bit of intermittent fasting there.
Ozempic suits in completely, a medical answer to all the issues which are assumed to return with being fats. Fairly than fixing discrimination in opposition to folks with larger our bodies, we inform sufferers to repair themselves.
The brand 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. 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 medication. They’ve a advertising 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.
Medical doctors are maybe essentially the most responsible of perpetuating the parable that weight reduction solves all the pieces. My area’s obsession with physique mass index signifies that a lot 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 sizzling 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 might need different illnesses. Fats phobia has develop into so ingrained within the tradition of medication that it is exhausting to see, except you look carefully.
The burden-loss trade tells us that if we simply lose just a few kilos, we’ll lastly be completely satisfied. However 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 everything of our lives. If we do not keep vigilant, the kilos may come again. So we hold shopping for dietary supplements, hold paying the month-to-month payment for weight-loss apps. And we docs go on prescribing Ozempic.
After 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 would be complicit in fat-phobic tradition, peddling eating regimen medication and all of their false guarantees.
But the trade is so highly effective, it feels exhausting to flee. After I counsel to sufferers that Ozempic may not be medically mandatory, they shrug. They are saying, “Effective, 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 drugs 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 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 largely felt unhappiness. 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.
Actually, GLP-1 drugs helped a few of Oprah’s friends with their diabetes and altered the best way the world handled them, however the actual drawback behind their struggling is not completely medical. The issue is fats phobia.
This stigma is difficult to cope with, however recognizing it – and understanding that Ozempic is a woefully insufficient device to handle it – is an effective 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 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, via 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.
