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The opposite day in my main care apply, one in all my sufferers requested me to prescribe Ozempic. She had just lately given start, and her physique had modified.
“I need my physique again,” she advised me.
Did her physique actually go away? I puzzled, privately. I’ve had lots of conversations like this just lately, 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 appeared good. The one challenge 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 an incredible feat, and it is unsurprising that it required a bit of additional adipose tissue.
She had a protracted historical past of shedding and regaining weight, and years of relations pressuring her to be skinnier.
“I am unsure Ozempic will deliver you peace together with your physique,” I steered, gently. Medically, I advised her, I did not suppose she wanted to shed some pounds.
She was undeterred. “My garments do not match,” she complained.
Was {that a} motive to begin a weight-loss medicine? More and more, my sufferers suppose so.
My apply in New Jersey is stuffed with folks determined to shed some 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 dimension.
However for each affected person who seeks out my weight-neutral strategy, I’ve ten who’ve been offered the lie that dropping 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 exhibiting up at my door, looking forward to 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 he or she advised viewers in her prime-time particular that she’s “releasing the stigma and the disgrace and the judgment” that include residing 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 possibly 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 shallowness, happier marriages, extra power, much less again ache. Individuals 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’ve got a weight loss plan business price many billions of {dollars} a 12 months, thriving on – and perpetuating – a pervasive sense that our our bodies are by no means ok. 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 suits in completely, a medical resolution to all the issues which are assumed to return with being fats. Fairly 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 – 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 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 marvel 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 area’s obsession with physique mass index signifies that lots of my colleagues zone in on weight reduction as a treatment 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 give attention to their weight and neglect that fats sufferers may need different illnesses. Fats phobia has develop into so ingrained within the tradition of drugs that it is laborious 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 blissful. 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 maintain shopping for dietary supplements, maintain paying the month-to-month charge for weight-loss apps. And we docs 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 plan medicine and all of their false guarantees.
But the business is so highly effective, it feels laborious to flee. Once I counsel to sufferers that Ozempic may not be medically mandatory, they shrug. They are saying, “Fantastic, 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 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 some pounds, since supporting their physique autonomy is my obligation as their physician.
However I need them to know there’s lots these drugs do not do.
They do not undo the harms of weight loss 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 towards us. These drugs do not assist us really feel grateful for our our bodies – our bodies that climb mountains, start 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 go away the home due to their physique dimension, together with one Chicago-area mother who mentioned folks began treating her youngsters higher as soon as she misplaced weight.
Definitely, GLP-1 drugs helped a few of Oprah’s visitors with their diabetes and altered the way in which the world handled them, however the true drawback behind their struggling is not fully 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 efficient 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 various our bodies are appreciated, not medicated to take up much less area?
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 dimension 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 wouldn’t it 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.