In the years before the Spain trip, Juneja, 32, a lawyer, had put on 50 pounds. She called it the “Fascist 50” — much of it gained during the Trump presidency, when her work dealt with the era’s democracy abuses.
Diagnosed with clinical obesity, she had come to embrace her larger body size. She’d been steeping herself in literature on fat acceptance and learning about the “Health at Every Size” movement, which seeks to demedicalize obesity and promote an understanding that body size is not necessarily correlated with health. On that beach day, she remembers wanting to document how far she’d come, “to celebrate this beautiful body.”
Then she learned that her cholesterol levels had soared to 10 times the normal range. It was the result of a genetic predisposition and had to be treated by cholesterol medication, her doctor told her, but weight loss could help, too. Juneja was also growing concerned about how her weight would heighten her risk of Type 2 diabetes, for which she has a strong family history, and potentially complicate a future pregnancy.
When her doctor broached medication to treat the obesity — such as semaglutide, currently sold by Novo Nordisk under the brand names Wegovy and Ozempic — Juneja refused. The fat acceptance literature she’d been studying opposed weight loss as a means to health. Using an obesity drug also felt like an admission that her body was something to be ashamed about at a moment when she’d come to embrace it.
The new class of obesity drugs — referred to as “GLP-1-based,” since they contain synthetic versions of the human hormone glucagon-like peptide-1 — are considered the most powerful ever marketed for weight loss. Since the US Food and Drug Administration approved Wegovy for patients with obesity in 2021, buzz on social media and in Hollywood’s gossip mills has erupted, helping drive a surge in popularity that’s contributed to ongoing supply shortages. While celebrities and billionaires such as Elon Musk and Michael Rubin praise the weight loss effects of these drugs, regular patients, including those with Type 2 diabetes, struggle with access, raising questions about who will really benefit from treatment.
But there’s another tension that’s emerged in the GLP-1 story: The medicines have become a lightning rod in an obesity conversation that is increasingly binary — swinging between fat acceptance and fatphobia.
“It feels like you have to be like, ‘I love being fat, this is my fat body,’ or, ‘Fat people are evil,’” Juneja told me.
While many clinicians and researchers hail GLP-1-based therapy as a “breakthrough,” and one deemed safe and effective by FDA, critics question its safety and usefulness. They argue the drugs unnecessarily medicalize obesity and dispute that it’s an illness in need of treatment at all. They also say the medicines perpetuate a dangerous diet culture that idealizes thinness and weight loss at all costs.
At the same time, many of the patients currently on treatment tell a story that seems to fall somewhere between “miracle” and “useless” diet drugs. Despite all the TikTok videos decrying obesity medication as the easy way out, progress is not always straightforward. Navigating side effects, dosing, weight plateaus, and access issues are frustrating features of many patients’ journeys. Patients also told me it’s hard to know if and when to come off the drugs, or that a healthy end goal has been reached. A minority don’t respond to the drugs at all.
One thing they had in common: wanting medical help to lose weight, despite the cultural conversation around fat acceptance. Even Juneja, who eventually started using the GLP-1-based drug tirzepatide, sold as Mounjaro by Eli Lilly, argues that the medicines are part of a more nuanced story, one society needs to internalize. Rather than viewing obesity as the result of personal failing or emotional issues, easily reversed with diet and exercise, patients like Juneja say they’re beginning to see it as medical researchers long have: as a condition that arises from complex interactions between our biology and our environments. Like other complex illnesses, such as diabetes, this means it can also benefit from medical treatment.
And some patients, including those who accept their larger bodies, may want to try obesity medication for help losing weight. “You can be healthy at every size,” Juneja summed up. But “I was not healthy at the size that I was.”
by Julia Belluz, Vox | Read more:
Image: Sargam Gupta for Vox
[ed. See also: The New Obesity Breakthrough Drugs (Ground Truths).]
