Drugs like Ozempic aren't changing negative narratives around diet and weight

Irish Times

5 days ago

Friends keep asking me what I think about
Ozempic
. I know they're asking because I've written about food history, gender and eating disorders, but until recently I wasn't sure what I thought, wasn't sure that someone who has never had metabolic disease or lived in a body that attracted comment had any business having opinions about the drugs called GLP1 agonists.
I support any development that undermines the idea that bodyweight has a moral aspect, or that individuals control the size of their bodies. We are shaped in every way by environment, society and genetics far more than by the small scope of personal choice within those determinants. Health is mostly determined by heredity and wealth. So if the new drugs stop people insisting that self-discipline and self-starvation are the answer to fatness, all to the good.
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But I'm not sure they're generally helping us live better lives. I gather GLP1 agonists are good as diabetes medication – not an area in which I am qualified to opine. Their rising use for other purposes seems to be correlated to increasing media excitement about extreme thinness, particularly in women, which is demoralising to those of us who grew up with heroin chic and the worship of emaciation and have lived in the shadow of those ideals ever since.
If the drugs are changing narratives about diet and weight, I'm not seeing it. There's no decline in mindless writing about and advertising of 'guilt-free' foods and 'guilty pleasures'. (What you put in your mouth has no bearing on your moral worth. The only sinful foods are those harmfully produced.)
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I understand that these medications work by depriving people of pleasure in eating. I'd argue that pleasure is politically and ideologically important as well as nice, that without pleasure we fall prey to the idea that life is nothing but scarcity and survival, which leads quickly to the idea that life is a competition and weakness is failure, at which point you're well down the road to dark places we don't need to go.
Taking expensive drugs to make daily life less fun so you take up less space doesn't sound to me like the kind of choice made by happy people in a functional society, though you could argue that unhappy people in a dysfunctional society – for example, fat people hoping to be paid, promoted and desired as much as their thinner colleagues in Europe today – might perfectly sensibly make such decisions. Getting thin to succeed in a fat-phobic society is still an understandable individual solution to a structural problem.
And it seems to me that the big structural problem here is not that people are fat but that we have created and continue to promote a food system that makes most consumers unwell, and are now creating and promoting a regime of medication that, at great financial and personal cost, claims to counteract the effects of that food system. We're all being sold ultra-processed, intensively farmed food that makes us and our planet sick, and then being sold drugs that moderate the effect of that food on individual bodies but compound the harm to the environment. I am certain that the same shareholders profit from the manufacture and sale of the food that causes the problem and the drugs that treat it.
Ozempic's popularity is a symptom and driver of social and economic injustice, and I wish we could spend some of its cost on systemic change instead
None of which means that I blame any individual for making whatever decisions seem necessary to cope. I only note that the troubles that show up in our bodies rarely began there, and therefore the sustainable solutions won't begin with injections.
There are countries that have been able to reduce the proportions of intensively produced and processed foods consumed by their populations, especially by children. There are examples of local, regional and national governments creating and sometimes imposing healthier and more sustainable environments, but it can't happen without at least some popular demand, and the established interests and beneficiaries of harmful systems will never want such change.
So what I think about Ozempic is that its popularity is a symptom and driver of social and economic injustice, and I wish we could spend some of its cost on systemic change instead. We could subsidise the production and transport of a lot of fresh local produce and build a lot of playgrounds, sports facilities and bike lanes for what we lose paying pharmaceutical companies to heal us from their absence. And it would be much more fun.