My patients think Ozempic is a wonder drug. But it can't fix fat phobia

The other day in my primary care practice, one of my patients asked me to prescribe Ozempic. She had recently given birth, and her body had changed.

"I want my body back," she told me.

Did her body really go away? I wondered, privately. I've had a lot of conversations like this recently, spurred by the onslaught of media coverage of Ozempic and Oprah's ecstatic endorsement of its benefits during a special TV segment she did this week.

My patient's blood pressure was normal, her labs looked perfect. The only issue was that she had gained maybe 25 pounds over the last two years, most of which she had spent gestating and breastfeeding a new human life. It's an amazing feat, and it's unsurprising that it required a little extra adipose tissue.

She had a long history of losing and regaining weight, and years of family members pressuring her to be skinnier.

"I'm not sure Ozempic will bring you peace with your body," I suggested, gently. Medically, I told her, I didn't think she needed to lose weight.

She was undeterred. "My clothes don't fit," she complained.

Was that a reason to start a weight-loss medication? Increasingly, my patients think so.

My practice in New Jersey is filled with people desperate to lose weight, patients who believe their true selves are smaller than the bodies they actually inhabit.

I've written publicly about my size-inclusive approach to medicine – I don't direct my patients towards weight loss, and I have a loyal following of patients who come to me specifically because I don't harass them about their body size.

But for every patient who seeks out my weight-neutral approach, I have ten who have been sold the lie that losing weight will fix every problem in their life. That myth is nothing new, but it's been newly medicalized in the era of Ozempic and Wegovy, a class of medications known as GLP-1 agonists. And patients are showing up at my door, eager for the promised panacea.

Even Oprah, whose body size has been the subject of national interest for decades, seems to buy the hype.

She publicly announced she was using a GLP-1 medication in 2023. And she told viewers in her prime-time special that she's "releasing the stigma and the shame and the judgment" that come with living in a bigger body – something she can presumably do now because she's thin.

She doesn't stop to ask if maybe fat phobia is the problem, not fat people.

I've had patients cry tears of frustration when I point out that they are a "healthy" weight and their labs show no evidence of diabetes. Instead of being thrilled they've received a clean bill of health, they're upset their insurance won't pay for GLP-1 agonists.

I've had patients confess they believe Ozempic will give them higher self-esteem, happier marriages, more energy, less back pain. People seem convinced this medication can do it all.

It's really no surprise that my patients overestimate the healing powers of this once-a-week injection. Our society is obsessed with thinness. We have a diet industry worth many billions of dollars a year, thriving on – and perpetuating – a pervasive sense that our bodies are never good enough. When life gets tough or the news gets unbearable, we're told to work on ourselves, squeeze in a little self-care: a little Peloton here, a little intermittent fasting there.

Ozempic fits in perfectly, a medical solution to all the problems that are assumed to come with being fat. Rather than fixing discrimination against people with bigger bodies, we tell patients to fix themselves.

The new weight-loss drugs have a veneer of respectability – doctors prescribe them, after all – that makes them seem different from HerbaLIfe or Weight Watchers. But, like all the weight-loss promises that came before them, they're being drastically oversold.

Ozempic and Wegovy sales are estimated at $13 billion a year, a true windfall for Novo Nordisk, the Danish pharmaceutical company that developed the blockbuster drugs. They have a marketing budget to match: the company spent $491 million on advertising in the first half of 2023. With budgets like that, it's no wonder my patients seem to think Ozempic is a miracle drug.

Doctors are perhaps the most guilty of perpetuating the myth that weight loss solves everything. My field's obsession with body mass index means that many of my colleagues zone in on weight loss as a cure for every ailment.

"Have you thought about losing weight?" doctors ask, when patients complain of anything from insomnia to hot flashes to foot pain. Meanwhile, my patients share stories of missed diagnoses from doctors who focus on their weight and forget that fat patients might have other diseases. Fat phobia has become so ingrained in the culture of medicine that it's hard to see, unless you look closely.

The weight-loss industry tells us that if we just lose a few pounds, we'll finally be happy. But this industry has created a problem only more dieting – or more drugs – can fix. It tells us that the body is something to be tamed for the entirety of our lives. If we don't stay vigilant, the pounds might come back. So we keep buying supplements, keep paying the monthly fee for weight-loss apps. And we doctors go on prescribing Ozempic.

When I decided, at age 22, to become a physician, I imagined long-term relationships with my patients, earning their trust. I didn't think I'd be complicit in fat-phobic culture, peddling diet drugs and all of their false promises.

Yet the industry is so powerful, it feels hard to escape. When I suggest to patients that Ozempic might not be medically necessary, they shrug. They say, "Fine, I'll just get it online," at any number of telehealth services where patients can self-report whatever weight will get them the prescription.

To be clear: I'm not anti-Ozempic. GLP-1 medications can solve certain problems. I happily prescribe them for many of my patients with diabetes or heart disease, and I'm grateful to the researchers who developed them. And I even prescribe them for people who simply want to lose weight, since supporting their body autonomy is my duty as their doctor.

But I want them to know there's a lot these medications don't do.

They don't undo the harms of diet culture, distorted body image and pervasive weight stigma. They don't change the way we've turned eating into a morality contest, the way the pleasure and ritual of sharing food with our loved ones has been weaponized against us. These medications don't help us feel grateful for our bodies – bodies that climb mountains, birth babies, hug grandparents. They don't fix the casual self-hatred that's been normalized in our fatphobic world.

Watching Oprah's weight loss special, I mostly felt sadness. She shared wrenching testimonials from people who felt ashamed to leave the house because of their body size, including one Chicago-area mom who said people started treating her children better once she lost weight.

Certainly, GLP-1 medications helped some of Oprah's guests with their diabetes and changed the way the world treated them, but the real problem behind their suffering isn't entirely medical. The problem is fat phobia.

This stigma is challenging to deal with, but recognizing it – and understanding that Ozempic is a woefully inadequate tool to address it – is a good first step. What if instead of trying to shrink ourselves, we tried to change our biases? What if we built a world where diverse bodies are appreciated, not medicated to take up less space?

For my patient who asked for Ozempic the other day, I told her that it's normal for bodies to change shape and size over time. She met my eye, through tears, and confessed that she felt like her authentic self – her thin self – was just waiting to emerge.

"What would it feel like to love your body the way it is?" I asked. My patient didn't have an answer.

Mara Gordon is a family physician in Camden, N.J., and a contributor to NPR. She's on Twitter as @MaraGordonMD. [Copyright 2024 NPR]