Is Ozempic Making Fatphobia Worse?

Ozempic is a blockbuster drug, which millions of Americans are already taking or struggling to obtain for the sake of weight loss. Many more will undoubtedly be contemplating trying to get a prescription now, in the new year, with the familiar pressures to shrink ourselves bearing down on us. Novo Nordisk, the company behind Ozempic and its sister drug, Wegovy, has become a veritable pharmaceutical behemoth: the firm’s market value now exceeds the annual economic output of its home country, Denmark. It is now the largest public company in all of Europe.

The question is, should it be?

As a moral philosopher, I’m less troubled by individual decisions to take Ozempic in order to lose weight—though the shortages these patients are causing for others who are using it for its originally intended purpose, treating diabetes, do raise red flags. But these shortages are presumably temporary, and people should do what they may need to do in a world that is brutally fatphobic and penalizes people living in larger bodies in ways that are severe and systemic. At the same time, Ozempic understood as a cultural practice deserves moral criticism—in much the same way that we can condemn diet culture without impugning those who are, like I once was, perpetually on a diet.

The manufacturers of Ozempic are turning a staggering profit by exploiting our fears about fatness, not to put too fine a point on it. And these fears are, in the world as it is, understandable, even well-founded: Fat people face routine discrimination in education, employment, and health care, just for starters. But the right answer to bigotry, bullying, and marginalization is never to eliminate the type of people who are its targets; we must remake the world to accommodate a diverse range of people, including those who are disabled, neuro-divergent, and who live in larger bodies.

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Of course, you might object: what about the health benefits of taking Ozempic and typically losing weight in the process—around 15 percent of a person’s starting weight, on average, according to some studies. The objections to that argument are twofold. First, Ozempic and similar drugs (semaglutide, tirzepatide, and liraglutide, among others) come with significant costs, risks, and side effects of their own—from the mostly unpleasant (gastrointestinal distress) to the serious (gastroparesis, a paralysis of the digestive tract; a possibly increased risk of thyroid cancer) to the potentially life-threatening (bowel obstructions, pancreatitis, and, by some reports, increased suicidality). These are significant health issues to factor into the equation.

There’s also the crucial point that major long-term studies show that, when patients lost weight the old-fashioned way (that is, through diet and exercise), they did not reap the health benefits it was assumed would flow from weight loss. To the surprise of the researchers, this even held in populations with Type 2 diabetes.

To be sure, it’s possible Ozempic, Wegovy, and similar drugs have independent health benefits—beyond their important role in treating Type 2 diabetes—with one study recently suggesting a reduction in heart attack incidence (even before, and hence independently of, weight loss). To which the obvious response is, great, let’s continue to investigate those possibilities and live in the hope that they may be beneficial for people who run a higher risk of those problems, whatever the size of their bodies.

But the question remains: Why are we often so sure that health considerations mandate weight loss per se, whether by taking Ozempic or otherwise? While many people assume they need to lose weight in order to be healthier, the longitudinal studies above belie that assumption. And the best available data suggest that people classified as overweight actually have lower mortality risks, statistically speaking, than their so-called normal-weight counterparts. Meanwhile, even moderately obese people have no greater mortality risk than “normal”-weight people either.

True, very heavy people do have greater mortality risks, along with very thin ones. But correlation is not causation, and we shouldn’t assume that being very fat (or, again, thin) is the decisive cause of ill health here; oftentimes, the causality may be complex or run in the other direction. Moreover, we know that weight cycling—losing and gaining weight repeatedly—carries independent health risks. And this is what will happen to people who take Ozempic and then stop taking it at some point, as have and will the vast majority.

What’s more, and important to recognize, Ozempic is not going to make very fat people thin, even by the most optimistic estimates. Fifteen percent of a 300-pound person’s weight is 45 pounds. A significant loss, to be sure, but one that will likely leave them in the same (stigmatizing) “severely obese” category of the (deeply problematic) BMI charts. For women like me, who were once in this category, the chance of ever achieving a “normal” BMI is vanishingly small—around 0.15 percent per year. (It’s even rarer for our male counterparts.) Ozempic does not fundamentally change this. And the systemic anti-fatness that plagues us is unlikely to change much either. If anything, there’ll be a reinforcement of the existing false belief that fatness is something we can control and represents a failure—to access a supposed miracle drug, and suppress or deny our appetite.

In truth, a drug like Ozempic will inevitably be used partly as a way for the already thin to get thinner. And while the rich inevitably get richer, in our capitalist society, they will now be the ones reliably getting thinner too: Ozempic and similar drugs are typically not covered by health insurance, and cost well over $1,000 a month out of pocket currently. They will be simply out of reach for most of the millions of uninsured or underinsured Americans who continue to exist even in the post-ACA era. To say there will be disparate access to Ozempic is a massive understatement.

And such disparities will have serious repercussions, especially in view of the existing relationship between poverty and fatness they stand to exacerbate. Many are too quick to assume a straightforward relationship here—the data are, in reality, quite complex, with the correlation showing up in some racial and gender demographics but not others. Moreover, some have argued that it’s less that poverty causes fatness; rather, fatness may cause poverty, with huge pay disparities existing for, in particular, very fat versus very thin women (to the tune of over a $40,000 annual average wage gap). Still, overall, there is a relationship here that stands to be worsened: already poor and working-class non-white women are far less likely to have access to Ozempic, and thus will tend to remain fatter, which they disproportionately are already; meanwhile, their wealthier, white counterparts will have access to greater thinness and, with it, thin privilege, and the associated increased earning power. And one can never be too rich or too thin according to capitalism—and fatphobia, in its potent intersections with misogyny, ageism, ableism, and racism.

Fatness wasn’t always a marker of lowly social status—in fact, it was once a sign of wealth, luxury, and abundance. But today it certainly is, in ways that are well-documented, and Ozempic will only worsen this. Thinner bodies—presumptively if furtively sculpted by Ozempic—will in turn come to have ever-greater social cachet. Your slimmer body says to the world, hey, I can afford this drug, along with my Peloton bike and my overpriced salad delivery service.

If you’re determined to take Ozempic for the sake of weight loss anyway, I’m not here to condemn you. But I would just ask you to think critically about the social practice in which you’re contemplating participating. And, as with other social practices that similarly aim at bodily conformity—Botox and skin-lightening creams among them—there’s something at least admirable about those who resist them.

In being an Ozempic hold-out, you’d be refusing to help line the pockets of a massive pharmaceutical company that profits handsomely from fatphobia. You’d be resisting the shallow and, sometimes, fascist beauty norms that say we should all look one way rather than another: young, white, and as thin as possible. You’d be resisting using your financial privilege to mark your body as an elite one within a pernicious social hierarchy. You’d thereby be saying no to a troubling kind of bargain: effectively paying for a thinner body and, ultimately, social status.

Kate Manne is the author of Unshrinking: How to Face Fatphobia. She is an associate professor of philosophy at Cornell University, where she’s taught since 2013. Before that, she was a junior fellow at the Harvard Society of Fellows. Manne did her graduate work in philosophy at MIT and is the author of two previous books, Down Girl and Entitled.