A few weeks ago, I saw a photo of myself that made my heart sink. It was taken at a conference where I was moderating an onstage panel about women and media. That day, I’d put together what I considered a chic outfit: a printed Eckhaus Latta top and a pencil skirt. It was a bit tight, but I felt confident in it — until I saw what I looked like sitting down. The photo, posted by an audience member on Instagram, was devastatingly unflattering.
I took Mounjaro — one of the “miracle” weight-loss drugs intended initially for diabetes patients — for over a year. But I’d been off of the medication for five months and was anxious I was gaining back the weight I had lost. To my mind, this was proof that I was right to be worried. But that I was worried at all felt even worse. I knew better. As a feminist writer and committed proponent of body positivity, I’d spent years trying to love my body at any size. And yet, here I was, agonizing over this picture.
Over the past few months, some of the conversations surrounding drugs like Ozempic and Mounjaro have focused on the plus-size influencers who’ve elected to go on one of these drugs — and what they owe their followers when they decide to change their bodies. Model Gabriella Athena Halikas revealed to NBC News that when her doctor suggested she go on Ozempic to manage symptoms of PCOS, she was worried about disappointing her followers. In January, influencer Rosey Blair told her followers in an Instagram caption that she was “unashamed to say” she’d been on Mounjaro for a year after previously experiencing ire from “certain people in the Body Positive community,” as she wrote in another Instagram post back in August 2022, for “pursuing some weight loss.” Most recently, Oprah Winfrey came forward to say she was on a semaglutide and released two different televised specials — with one streaming special on the way — on how the medication is revolutionary.
It’s a debate I’d started thinking about in earnest last year when I shared that I had decided to go on Mounjaro, a choice I struggled with. I had told myself going on the medication was for my health. And it was, but I was also aware of, and not opposed to, the potential for weight loss. These drugs work by convincing your brain you are full sometimes before you are, so I physically couldn’t eat much, and if I did eat too much, I’d get nauseous. Once on the drug, I started to lose weight quickly. Then, after a year, the manufacturer’s coupon I’d been using expired. Because I am not diagnosed with diabetes, my insurance won’t cover the remaining cost of the drug, anywhere between $500 and $800 per month (that’s with some insurance coverage, for those without, the drugs run anywhere between $900 and $1,300). The side effects compounded with the cost were finally too much to bear.
In the months since I’ve come off the medication, I’ve been forced to reckon with how I feel about my own body and how even the most steadfast and committed proponents of size inclusivity are vulnerable to a culture of mandatory thinness. Why is “loving yourself” at any size such a tall order? Is it because, in the words of Real Housewives of Salt Lake City star Heather Gay, “Body positivity is all a big lie”? Because, as she continued in a Nightline interview about her decision to take Ozempic for weight loss, “It’s better not to be overweight”?
Today’s body positivity is an outgrowth of the 1960s fat-activism movement. Fat activism was radical; it aimed to decenter thinness and made the case that fat people deserved the same rights and treatment that their thin counterparts received. It identified the medical treatment of fat bodies as a site of oppression and pain and encouraged women to stop endless cycles of dieting.
In 1967, 500 people staged a “fat-in” in New York City’s Central Park, and they unapologetically ate in public, held signs, and burned diet books and images of the English model Twiggy. In a Saturday Evening Post op-ed that same year, titled “More People Should Be Fat!,” a writer named Lew Louderback — enraged by how he saw his fat wife treated — made the compelling case for fat people’s human rights, stating, “When people are persecuted because they are fat, not a word is spoken in their defense.”
“Body positivity” wasn’t introduced until a few decades later, in the early aughts, when fat activism largely moved online. As the phrase spread in popularity, it also broadened the idea of fat acceptance to include various body types, giving way to “healthy at any size.” More recently, body positivity has lived on through hashtags — such as #loveyourbody, #allbodiesarebeautiful, #effyourbeautystandards, #bopo, and #curvygirls — and body-positive influencers who have amassed large followings, taken on brand deals, and have seemingly disrupted everything from fashion to lingerie to swimwear, demanding that brands and runways be size inclusive. “For the first time ever, plus-size women had access to technology where they could be the authors of their own stories,” says Virgie Tovar, longtime fat activist and author of You Have the Right to Remain Fat. “They could tell a different story about fatness than it had ever been told by TV directors and producers. And that absolutely changed the culture.”
But while fat activism was a cultural movement, body positivity has become more of a cultural moment; it is more about making peace with our individual choices and individual bodies and advocating for acceptance, most often in popular culture and fashion, rather than advocating for change to systems in medicine, education, housing, and employment law to support the needs of fat citizens and end the discriminations they regularly face.
In that context, the ubiquity of these “miracle” drugs shouldn’t pose a threat to any movement for size inclusivity — we should, after all, accept each other in whatever we decide to do with our bodies. As model and size-inclusion activist Lauren Chan told me, “The incredible progress and effects of body positivity and neutrality in our culture are not invalidated and erased by individual decisions … people are a symptom of the systemic issue.” But given how intensely fatphobic our society is, Tovar says, body-positive influencers “play a very important emotional-support role as you’re making this unpopular decision” not to lose weight at any cost. So, when our fat role models choose a different narrative, those decisions affect how we feel about ourselves — and we often project those feelings onto them, shaming them for making their own choices.
The influencer Blair wrote on Instagram in March that she had been terrified to come forward about wanting to lose weight because of the blowback from her community. “The corner of body positivity that I was affiliated with was against intentional weight loss of any kind,” she wrote. “People said that sharing my desire to celebrate the mobility I gained was ableist and fatphobic.”
That some see these drugs as “an existential threat to the still-new body-positivity movement or a shortcut primarily for the rich and already thin,” Dr. Rachael Bedard wrote in this magazine, has caused us to “miss the chance to recognize its true significance.” Indeed, the concrete value of these prescriptions should not be downplayed: They do not just reduce blood sugar for diabetics; they lower the risk of heart attack and stroke. There is also evidence that Ozempic has helped people cut other addictions like smoking, drinking alcohol, and online shopping.
But that’s not why the drugs have caught our eye. We are talking about these drugs because they help people (celebrities, especially) lose weight. We are much more enthusiastic about how they could potentially “solve” fatness than we are that they could make substantial progress on health inequities (something, it turns out, they are doing the opposite of).
In a recent ABC prime-time special — Shame, Blame, and the Weight Loss Revolution — Oprah tells the audience through tears that, with the use of drugs like Ozempic, we can learn “to stop shaming other people for being overweight or how they choose to lose or not lose weight and, more importantly, to stop shaming ourselves.” She goes on to share stories of people whose lives were measurably better through weight loss. The stories are compelling and heartbreaking and make one crucial intervention: The size of our bodies is not about willpower. Our brains are just wired differently.
Still, this enthusiasm around the loss of weight alone reinforces the idea that it is the one and only goal, irrelevant to our health. (Which, considering how Oprah’s weight has been the subject of so much excruciating public scrutiny, may just be true for her.) As Tovar puts it, these drugs do not exist in a neutral landscape — they exist in a context where no matter your health issues your doctor will likely just tell you to lose weight, as will everyone else around you. After fighting to establish better standards around how we judge the relationship between weight and health, we are fusing those together again. Gay’s Nightline comments aren’t meant to stir a movement, but they are radical in their honesty. Despite lip service to embracing our bodies as they are, it is still far, far easier to be thin in this society … and we still judge fat people for what they do with their bodies.
There is no question that this class of drugs is a game-changing health intervention. Whether I end up back on it one day or not — a decision my doctor is currently helping me parse — Mounjaro has already changed my life. I started fitting into my clothes better and felt more confident in my body. I started walking without knee and ankle pain; I had more energy and was sleeping better, too. Whether it was physical, psychological, spiritual, or just that I had so deeply internalized shame around my body, these are questions that are impossible to detangle. I lost weight, and I felt better. And despite gaining back a few pounds, I continue to take better care of myself than I did prior to going on the medication.
But it’s a slippery slope between taking care of our health and aligning our sense of health with the size of our bodies. If we are to actually shift from a society that discriminates against fat people to one that understands, embraces, and accommodates all bodies, then we must see fat people as more than just fat people but as people with the same needs, desires, wants, and concerns as thin-bodied people. And that includes making choices about my body freely and without fear that others in our community will see it as a pointed betrayal. Body positivity fails if we use it as an excuse for conjuring up more tools to judge ourselves and hold each other to another set of untenable standards. And we fail body positivity if we don’t reckon with this new context it sits in.
In theory, these drugs level the playing field between different body types and health concerns, allowing us to embrace our bodies as they are and helping us “solve” how society discriminates against fat people. In reality, we’ve seen how the emergence of a “weight-loss miracle” destabilizes progress toward the more inclusive, less fatphobic society we imagined.
And while we’ve interrogated how these medications hurt all the progress we’ve made toward a culture of inclusivity, we’re standing at the precipice of a new shift: What happens when we come off the medication? Research suggests most people don’t stay on these drugs for more than a year — usually due to side effects and costs. As it turns out, this “solution” for fatness is neither equalizing nor sustainable.
I will continue to work on accepting myself as I am while trying to take care of myself, but I worry sometimes that I’m back to where I started — struggling to live a fully mobile, happy, and healthy life. And it is likely more than a medical intervention that can solve that. We can only really choose to go on medication if we can choose, without fear, to also stay off of it.
Related
- Mounjaro and Me
- Life After Food?
Samhita Mukhopadhyay , 2024-05-08 14:00:15
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