Part 5 – It Comes Down to Why
As is commonly the case on this blog when it comes to multi-part posts, I never expected that to happen. My intention was to take one post to summarize a book club discussion … about a subject so complex and pervasive that we’ve now examined weight as a function of health, proper nutrition, parenting, sociology, psychology, business, brain chemistry, and equity, to name a few. (I really should have thought this through…) But I have gotten some very encouraging feedback along the way about the previous posts in this series, so if you haven’t read from the beginning, I suggest you do. [1]
For those of you who are still along for the ride, we will now wrap up our look at the benefits for people who truly need GLP-1 Agonist drugs (such as semaglutide) and conclude the subject (for now) by taking a look at who stands to win big or lose out as a result of this new trend.
Accessibility and Equity
Aside from the demonstrated reductions in certain health risks (e.g. diabetes and high blood pressure) and weight that friends of mine have already achieved since being on these drugs, I was also surprised to hear anecdotes about how weird it is to no longer be thinking about food all the time. I have had times in my life where I’ve been obsessed with calories consumed, calories burned, and the all-important number on the scale, but those phases have been periodic. I can’t begin to imagine what it would be like living with such a preoccupation for decades, especially if I may or may not not even be seeing results from that level of discipline.
I think the thing that has been the most surprising for me to hear is how much mental bandwidth is freed up once you don’t have to focus all of your attention on food – how it leaves the space to think about hobbies and things that bring joy or the ability to pursue other types of personal development and improvement. Even just having more energy and feeling less joint pain from carrying around less weight might be enough to make some deem the drugs worth it, if improved quality of life is now part of the equation.
Image credit: [2]
Of course, there’s an aspect of equity here. We know that there are socio-economic factors that play into obesity, and we can’t talk about semaglutide drugs without addressing their cost. Even if a healthcare provider deems them necessary for a patient, not all insurance plans may cover the cost without a diabetes diagnosis, and they are prohibitively expensive out-of-pocket (currently around $1,000 per month). But they are available for those who can afford them, from celebrities to soccer moms – all to drop vanity pounds. Unfortunately, it seems that there is already such increased demand for this fad drug from people who don’t need it that some people who do (such as diabetics) are having difficulty finding it in stock. [3]
Economic Ecosystems
Part of this situation may come from the fact that manufacturers may not have anticipated such a run on a diabetes drug, but they’ll be able to scale production of existing offerings, no doubt, and other alternatives will become available over time, too – one was just approved by the FDA last month. [4] So that’s good news for that sector of big pharma: semaglutide manufacturer Novo Nordisk is hoping to surpass $3.5 billion in sales just from their obesity drugs by 2025. [5] But their gain is somebody else’s loss, and many other business sectors have relied on the fact that we (as a society) generally consume a lot of food and hate ourselves for it.
Increased use of semaglutide drugs for weight loss will undoubtedly have an adverse impact on companies that push weight loss solutions. (As I noted in last week’s post, the diet industry represents $70B alone.) Business trends of note have unsurprisingly included fast food and snack food companies watching closely as people taking semaglutide drugs consume less of their products. [6] Interestingly, though, Walmart noted that while their customers on these drugs spent less on food, they spent more on lifestyle and fitness products, representing not necessarily a reduction in consumption but a shift (which tracks with the personal anecdotes I mentioned above).
Content and image credit: [7]
Some economists are actually anticipating benefits across various sectors, as healthier people will take fewer sick days and be more productive while at work. Meanwhile United Airlines estimated $80M in savings per year on jet fuel if their passengers weighed 10 pounds less on average. [8] Unexpectedly, some bariatric surgeons aren’t fazed, skeptical that the drugs will represent effective competition to their service. Some claim there will be an increase in bariatric surgery, possibly in conjunction with semaglutide prescriptions that are less effective than hoped. [9]
I personally was shocked about the prospect of multiple life-altering weight loss methods in conjunction, but that brings us back to the question of what is truly necessary vs. how much is too much? If semaglutide use becomes so prevalent that thinness is truly a function of wealth, we may see an arms race of weight loss; a situation in which the goal posts defining thin and fat shift downward to increasingly unhealthy levels. A thought-provoking piece on “The Cut” (linked from Sole-Smith’s blog!) examines these thoughts and more – it’s worth a read for more detail. [10]
What’s the Verdict?
But speaking of Sole-Smith, let’s summarize. Based on my reading of her book, I felt a lot of resistance to any attempts at weight loss, no matter the situation. I agree that our obsession with image is unhealthy and that punishing ourselves to try to achieve an unnecessary ideal is even unhealthier. It is true that we have a lot of fat phobia in our culture that bleeds into the medical field and affects patient care, prioritizing weight over health in some cases. Despite my own deeply ingrained anti-fat biases, I agree that every human is worthy of dignity and respect, regardless of size.
Image credit: [11]
However, I also know people who want to lose weight for reasons other than vanity; for whom weight gain and adverse health outcomes have been causative, not correlative; who are genuinely grateful for the opportunity to feel healthier and engage in healthier activities thanks to drugs that are also being abused by those who can afford to chase thinness (justifiably drawing Sole-Smith’s ire [12]). And I think it is in part because I have seen some of those exceptions in action that this book (which had some good points) ultimately rubbed me the wrong way. I felt that it seemed to discount the experiences and desires of real people who don’t want to look like a magazine cover but just want to be physically and mentally healthy. To me it felt like her message in Fat Talk [13] was that no fat person should be judged, but every attempt to lose weight should be. It felt very black-and-white, and you should know by now that I don’t do well in that world.
Of course there are overweight people who want to lose weight so they can feel better about themselves and enjoy their lives more, without getting into “never thin enough” territory. Maybe that represents a spot on the slippery slope away from the body positivity she’s pushing, or maybe it’s just an aspect of the fact that every body is different, every journey is different, and it ultimately comes down to why you’re trying to lose weight. I think that if some of the content of this book had simply been framed in a more nuanced way, it could have been a very beautiful call to love each other and to love ourselves – because ultimately that’s what it comes down to: without sounding too preachy, it’s about being comfortable enough in our own skin that we’re doing things to make ourselves healthy and happy, rather than trying to fulfill someone else’s standard.
~
And on that note, I’ll call it a wrap on this book and the related book club discussion. Please let me know what you think about this book, other books, or any of the relevant topics we’ve covered over the last five weeks.
As always, thank you for reading!
[1] https://radicalmoderate.online/fat-talk-part-1/
[2] https://tardis.fandom.com/wiki/Adipose
[3] https://www.thecut.com/article/weight-loss-ozempic.html
[5] https://www.thecut.com/article/weight-loss-ozempic.html
[6] https://www.cnn.com/2023/10/05/investing/ozempic-food-companies/index.html
[10] https://www.thecut.com/article/weight-loss-ozempic.html
[12] https://virginiasolesmith.substack.com/p/can-mainstream-media-stop-ozempic-pieces
[13] https://www.goodreads.com/en/book/show/61144950
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