There are television moments from my childhood that I can still replay in my head in eerie detail: the moment the space shuttle Challenger exploded (something I watched alongside my grade-school class on a TV that had been wheeled into the room); the Tonya Harding–Nancy Kerrigan incident; the Baby Jessica rescue; Charles and Diana’s wedding; and the episode of The Oprah Winfrey Show in which she revealed her dramatic weight loss by wheeling out 60-plus pounds of animal fat in a Radio Flyer wagon wearing “skinny” Levi’s cinched tightly at the waist.
That was in 1988. Last week, Winfrey’s weight loss caused a stir again, this time because she revealed that the key to her current dramatic transformation (on display as she does promotion for The Color Purple) came thanks to medication. While Winfrey didn’t specify which drug, many have assumed she is using a semaglutide (a GLP-1 agonist) like the increasingly popular Ozempic. It was first approved back in 2017 for those with type 2 diabetes, and weight loss was a side effect—one that didn’t go unnoticed by manufacturers. In 2021, Wegovy became the first GLP-1 agonist approved for chronic weight management, though other semaglutides are now frequently being prescribed off-label (not an uncommon practice in medicine) for the same purpose. The drugs work by stimulating the production of insulin and stalling glucagon, which spikes blood sugar; the effect on the patient taking it is that they get a signal of satiety.
Fatima Stanford, MD, an obesity medicine physician at Mass General Hospital and associate professor at Harvard Medical School in Boston, is intentional about not calling the class of drugs weight-loss medications, but instead “anti-obesity medications,” underscoring the qualification by the CDC of obesity as a disease, unlike other chronic conditions such as diabetes or high blood pressure. Though, this is one, she adds, that you wear for the entire world to see. It’s something that can—even if you are an internationally beloved superstar like Winfrey—open you up to scrutiny. Stanford’s practice takes a holistic approach, employing a psychologist, a dietitian, and an exercise physiologist, so patients on semaglutides have a multi-pronged protocol.
Before prescribing, Lisa Erlanger, MD, a family physician in Seattle affiliated with UW Medicine who also points to the limited data around these drugs, recommends doctors lead with questions like: What are you hoping to achieve through weight loss? What will it be like to lose your appetite? Do you have a history of a difficult relationship with food? Are you having negative social, psychological, or symptomatic impacts? When thinking about how Ozempic and others are prescribed, it’s important to consider how doctors should be addressing weight more generally.
But can celebrities like Winfrey admitting that they are on these medications help to combat the stigma that comes around weight (both loss and gain) in any way? Do celebs owe us an admission? Though they are in the public eye, celebrities are—just like us—still entitled to medical privacy. Same goes for a celebrity’s decision to get cosmetic surgery; though we are collectively obsessed with mulling over the “did they or didn’t they” (just look at all the Instagram accounts devoted to just that), they are under no obligation to divulge that information. Winfrey is someone who has been historically transparent about her weight over the years, publicly chronicling various diet plans and fitness routines, and also, as an investor in Weight Watchers, profiting from it. But the goal by sharing her choice now likely comes from wanting to reduce bias around this choice of treatment more generally, Stanford suggests.
While Ozempic may now be a Bravo plot point and frequent comedic punch line, there is still plenty of judgment around the decision for real people. Rebecca Puhl, PhD, deputy director for the Rudd Center for Food Policy Obesity, thinks a celebrity disclosure can be helpful in some cases in helping to raise awareness, counter false beliefs, and generate support for others going through similar experiences. It’s the celebrities offering skewed information about how they lost weight (similar, say, to those who suggest olive oil is the secret to a lineless face) that can be the problem. “This can mislead people to develop disordered eating strategies and put them at risk of making inappropriate choices for themselves in trying to emulate their favorite celebrities,” she says. When people think that a celebrity’s shifting body shape came from exercising and dieting, it can result in compulsive behaviors and shame, adds Erlanger.
While any celebrity’s candor about taking these medications as a means of weight loss may go far in reducing the stigma around them, it would be really groundbreaking to see more speaking up to reduce the stigma around bigger bodies. “I believe that as long as we label body size as a disease and ask individuals to change their weight despite evidence that it won’t make them healthier long term, we are perpetuating the stigma of being in a bigger body,” says Erlanger. That the rise of these medications coincides with the body-positivity movement and the arrival (finally) of bodies of different shapes and sizes in mainstream media is a tough pill to swallow. The stigma we should be more focused on isn’t the one around taking medications to lose weight, but this phobia of bigger bodies that is a constant presence and injustice in our society, says Mara Gordon, MD, a primary physician in Camden, New Jersey. Because while people’s bodies may be becoming thinner, what isn’t disappearing is the phobia we have of the ones they are shedding.
Can you be in a bigger body and be healthy? Yes. But our culture has made it challenging for some to be in that bigger body and be happy. When we are laser focused on weight, when it becomes a metric or determinant for success, when it’s synonymous with self-worth, when someone like Winfrey, whose achievements are countless, is remembered in great part for her weight fluctuations, what does that say about all of us? In this #Ozempic age, changing a body you aren’t content in seems like more of a possibility than ever before (at least for those for whom these medications are safe and accessible). And, yes, these drugs can serve as a powerful tool in that transformation, but are they also perpetuating our fixation on thinness? They may be radically changing our bodies, but the real question is whether they can ever change our minds.
