I agree with you that the Oprah special felt like an infomercial, and left me wondering if Oprah is planning to launch some new business that will capitalize on these meds. However, I do feel like nuance is needed on both sides. I'm on one of these GLP-1s and they have been absolutely life-changing for me. Obesity may or may not be a disease, but I do think that there are enough shared metabolic issues among a significant number of people with obesity that there must be some underlying biology/genetic link to it.
I've had high cholesterol since I was 19. Elevated blood pressure since I was in my early twenties. Elevated glucose levels since my teen years. Over the last five or six years, my weight had ballooned to the point where where basic movement (tying my shoes, bending down to pick things up, gardening) had become really difficult and uncomfortable. I was losing functionality and felt awful. I've been on these meds for 18 months now, and I will tell you that it's easier to move through the world as a smaller person, not only because of the way society looks at me, but because I have less pain and discomfort, and I can move my body more easily. I'm not out of breath going up the stairs, and I'm not drenched in sweat after a five minute walk. Although I am still obese, my life is so, so much better than it was 18 months ago. For the first time in my life, I have normal glucose, cholesterol and blood pressure numbers. I have less pain. I feel more in control of my body and my mind.
GLPs turned off my constant food noise. This is a concept hard to explain to those who haven't experienced it. But it's constant chatter and obsession about food that takes over your life. I can actually exercise and make healthy food choices without a constant internal battle on these meds. My brain has room for thoughts and ideas not centered on food. I tried therapy, journaling, self-help books, dieticians, medical health programs, health coaching...you name it...my GLP1 completely resolved my life-long food issues within an hour of my first shot. I read another one of your pieces about food noise, and while I appreciate what you are trying to do, I do wonder if you have an understanding of what food noise is, and how devastating it can be to a person's mental health.
I think of my life now as pre and post GLP1s. I have a lot more mental clarity. My moods are more stable. I don't have insulin-related crashes. I take joy in exercises and good foods. I'm less flaky with my commitments because I feel better. I have an easier time following through with tasks and completing my work on time. I believe all these mental health aspects were somehow linked to whatever underlying metabolic issues I was born with that eventually lead me to become morbidly obese.
Of course there are people who are going to be healthy at any weight. But I think there is a correlation between between disease and weight, especially for those of us at the highest and lowest percentiles. Yes, being underweight is a problem, but I think underweight-related conditions/diseases aren't highlighted as much because less than 2% of Americans are underweight and close to 20% of Americans are severely obese. At this moment, our country is seeing more problems related to severely obese individuals than severely underweight individuals.
I think it's far to be cynical about the drug companies' motives. Do I think they are driven by altruism? No. Of course they are driven by profits, and it's fair to question the safety of these medications and the ulterior motives of the pharmaceuticals. Of course I think the focus should be on creating an environment for health in our country where healthy foods are affordable and highly processed foods have warnings, and cities and neighborhoods are more walkable, and we have better social connections with our neighbors and supports, and everyone has health care and access to safe and enjoyable movement, etc. But from my own experience -- and the experience of friends and colleagues also taking these meds -- GLP1s have improved the lives of millions of people, and I don't think they should necessarily be villainized, or dismissed solely because some CEOs are making millions.
As a general rule, I try to avoid feeling sad for billionaires but, damn, Oprah makes me feel sad for her. She is so smart and talented and she has spent to much of her life/time/money on trying to fight her body. I really wonder if she's ever had a day where she wasn't thinking about her weight and was just content to live in the body she has? What a terrible waste of emotional energy.
Unfortunately we don't live in a bubble and we have to live in this fat fobic culture. At 224 I was deemed too fat to live by a kidney transplant program. Two of the three programs in my state would not even do an evaluation! Since I was "morbidly obese" I was in the same category as someone 1200 pounds. Even though all studies show overweight people on dialysis live significantly longer than "normal" and underweight people. True science is irrelevant. Fat people aren't worthy of transplants. Luckily one program in my state was willing to give me a chance. I had to get and stay under 200. I was also ordered to get stronger. No marker for that though. I passed the heart stress test and an idiotic walking test for lung capacity with flying colors. The administrator of the walking test kept shaking her head at my speed. They told her I was obese and frail and would surely fail. I told her no, I'm just fat. Losing weight as a post menopausal, genetically fat woman on insulin is near impossible. No amount of exercise can make you lose. My Drs said I needed to get below 800 calories a day. My 20 years of T2 was always in control with oral meds, but all oral meds are contraindicated with kidney disease. They made me go on insulin, which is a strong weight gainer. My kidney disease is from 30+ years of dehydration caused from losing my colon at 30. Which is also why vegetables are a no go for me. I tapered up from the starting dose of ozempic to the full Wegovy dose. Over 2 years I went from 224 to 190 to 211. It wasn't working anymore. So I switched to Mounjaro and it took 6 months to get to the full dose. I didn't start losing until I hit the top dose and was able to stop the insulin. I'm still fat and malnourished, but at 178 I'm "doing great" and need to "keep up the great work" so that by the time my 6 year wait on the transplant list comes up I can be "worthy." My life is now consumed by the scale and the pursuit to prove I'm worthy. I go to the YMCA 5 nights a week, not because it helps me lose weight, it doesn't, but to prove "compliance." I eat once a day. I struggle to stay under the 800 calorie recommendation. Luckily I only have mild side effects from MJ, it truly is a miracle T2 drug. My A1C is in the normal range. Every day I fear my pharmacy benefit manager will declare me cured and deny the meds. They are doing that these days, the drug works, so you don't need it anymore crap. PBM don't stop chemo because it's working do they? I was fine at 224. My lowest adult weight was 175 in highschool. I can't imagine ever being smaller. Even lying in a hospital bed, malnourished and on TPN I didn't lose weight! But at 61 I'm not ready to go yet. So I have to jump through all the hoops to prove I'm worthy of a kidney. Luckily there is one transplant program in my state willing to take me, with conditions. Mayo clinic and the university of Minnesota still wouldn't consider me worthy of life at 178 lbs. I'd have to get under their magic bmi bullshit.
This is a great essay. And having worked in biotech for decades, I second the idea that pharma turns differences into illnesses and then blows up its profits. For example, back in the day, Genentech had to pay huge fines after starting a fake parents’ group to pressure doctors to prescribe genetically engineered Human Growth Hormone off label to short children (the med was only approved for dwarfism). MDs can prescribe off-label, but a fake parents’ group was too much.
Such a good assessment. The thing that gets me about these drugs is that it will really increase the perception that being fat is within someone’s control. More and more comments of “oh, you should be on the GLP drugs”, etc.
This moment feels so dangerous. It is now literally a choice to stay fat, since is is now so “easy” to lose weight with these “miracle drugs.” It seems likely that this will unleash an increase in explicit anti-fat behavior in both the medical community and society at large. Be skinny or die trying.
Thank you for this! Opeah may have divested of her WW holdings but I found myself imagining it impossible that her substantial investments avoid all pharmaceutical companies. The CEO's were given mere moments and no challenging questions. Most disappointing was the absence of any discussion that people who need these medicines for diabetes are having trouble accessing them. The show will only contribute to that problem becoming more difficult. I appreciate your deconstruction and all the facts you shared. Thank you!
Thank you, Kate! The moment I began watching Oprah’s show last night, I thought , “Can’t wait to read what Kate has to say on this!” Oprah tried to cover a vast topic in far too little time.
I wouldn’t want to be in Oprah’s shoes. I think being in control has become the constant in navigating her life. The one thing she’s always wanted: a slim body, has eluded her. In celebrity land & many cultures besides the American culture , looking beautiful has always been associated with thinness. It’s tough to have a love/ hate relationship with your genetic body type. Coming to terms with it (your genetic body type) can be one of life’s biggest challenges .
I’m so tired of pharma deluding people with their fabrications of the truth in the name of more & more profits. They’ve become the legalized “ pusher man” !
Thank you for this! I really appreciate your writing, and as someone who weight cycled most my life, and has been recently diagnosed diabetic I also really appreciate the care with which you discuss diabetes.
Oprah's infomercial... Kate Manne was quoted in a recent NY Times piece earlier this week. I agree with her very perceptive conclusions in her column here.
This is one of the rare times that I actually agree with the insurance industry's refusal to pay for what they say are "cosmetic" drugs. It is sad to see how desperately the doctors and the drug companies are scrambling to force insurance (including medicare and medicaid) to pay to make them rich. I don't feel very good about agreeing with the insurance industry about anything, but here I am.
Some doctors want people to take these meds for health reasons. But the overwhelming majority of fat patients (and some not-so-fat) want to take them for other reasons with which we are all too familiar--the nightmare of living in a society that hates the size and shape of your body, and wants you to hate it, too.
After I guested on Oprah's show in the 1970's in Chicago, before it became nationally syndicated, she treated me well (as well as the other guest who was a larger woman who was an officer of the local NAAFA chapter in Chicago), although the notion of accepting one's larger size was obviously foreign to her. In the intervening years, Oprah has several times said that "Any woman who has a weight problem but says she is happy at her size, is lying" or words to that affect. She still believes that.
Amen! Thanks for this summary of why this kind of BS is so damaging. AND! Even the premise "You’re not to blame for your weight." is based on the assumption that if you aren't in a specific size window, there must BE someone/thing to *blame* for your weight. Which is false and is the rhetoric of healthism/sizism (I just wrote a post on healthism so this is top of mind!). So frustrating that this is the message that is put in our collective consciousness.
I'd be interested in hearing what others thought of Tessie McMillian Cottom's opinion piece today on the Oprah special in the NYT's. She's a smart sociologist but seemed to play it NYTimes-safe by focusing only on the cost of and differential access to the new weight loss meds. She only grazed over the side effects and just lightly alluded to the larger issue of social sanctioning of body size. Although also interesting--even poignant--to read that she's had a life long psychosocial relationship with Oprah's fight with her body. That says something.
I agree with you that the Oprah special felt like an infomercial, and left me wondering if Oprah is planning to launch some new business that will capitalize on these meds. However, I do feel like nuance is needed on both sides. I'm on one of these GLP-1s and they have been absolutely life-changing for me. Obesity may or may not be a disease, but I do think that there are enough shared metabolic issues among a significant number of people with obesity that there must be some underlying biology/genetic link to it.
I've had high cholesterol since I was 19. Elevated blood pressure since I was in my early twenties. Elevated glucose levels since my teen years. Over the last five or six years, my weight had ballooned to the point where where basic movement (tying my shoes, bending down to pick things up, gardening) had become really difficult and uncomfortable. I was losing functionality and felt awful. I've been on these meds for 18 months now, and I will tell you that it's easier to move through the world as a smaller person, not only because of the way society looks at me, but because I have less pain and discomfort, and I can move my body more easily. I'm not out of breath going up the stairs, and I'm not drenched in sweat after a five minute walk. Although I am still obese, my life is so, so much better than it was 18 months ago. For the first time in my life, I have normal glucose, cholesterol and blood pressure numbers. I have less pain. I feel more in control of my body and my mind.
GLPs turned off my constant food noise. This is a concept hard to explain to those who haven't experienced it. But it's constant chatter and obsession about food that takes over your life. I can actually exercise and make healthy food choices without a constant internal battle on these meds. My brain has room for thoughts and ideas not centered on food. I tried therapy, journaling, self-help books, dieticians, medical health programs, health coaching...you name it...my GLP1 completely resolved my life-long food issues within an hour of my first shot. I read another one of your pieces about food noise, and while I appreciate what you are trying to do, I do wonder if you have an understanding of what food noise is, and how devastating it can be to a person's mental health.
I think of my life now as pre and post GLP1s. I have a lot more mental clarity. My moods are more stable. I don't have insulin-related crashes. I take joy in exercises and good foods. I'm less flaky with my commitments because I feel better. I have an easier time following through with tasks and completing my work on time. I believe all these mental health aspects were somehow linked to whatever underlying metabolic issues I was born with that eventually lead me to become morbidly obese.
Of course there are people who are going to be healthy at any weight. But I think there is a correlation between between disease and weight, especially for those of us at the highest and lowest percentiles. Yes, being underweight is a problem, but I think underweight-related conditions/diseases aren't highlighted as much because less than 2% of Americans are underweight and close to 20% of Americans are severely obese. At this moment, our country is seeing more problems related to severely obese individuals than severely underweight individuals.
I think it's far to be cynical about the drug companies' motives. Do I think they are driven by altruism? No. Of course they are driven by profits, and it's fair to question the safety of these medications and the ulterior motives of the pharmaceuticals. Of course I think the focus should be on creating an environment for health in our country where healthy foods are affordable and highly processed foods have warnings, and cities and neighborhoods are more walkable, and we have better social connections with our neighbors and supports, and everyone has health care and access to safe and enjoyable movement, etc. But from my own experience -- and the experience of friends and colleagues also taking these meds -- GLP1s have improved the lives of millions of people, and I don't think they should necessarily be villainized, or dismissed solely because some CEOs are making millions.
As a general rule, I try to avoid feeling sad for billionaires but, damn, Oprah makes me feel sad for her. She is so smart and talented and she has spent to much of her life/time/money on trying to fight her body. I really wonder if she's ever had a day where she wasn't thinking about her weight and was just content to live in the body she has? What a terrible waste of emotional energy.
All I can say is: thanks for watching so I didn't have to!
Unfortunately we don't live in a bubble and we have to live in this fat fobic culture. At 224 I was deemed too fat to live by a kidney transplant program. Two of the three programs in my state would not even do an evaluation! Since I was "morbidly obese" I was in the same category as someone 1200 pounds. Even though all studies show overweight people on dialysis live significantly longer than "normal" and underweight people. True science is irrelevant. Fat people aren't worthy of transplants. Luckily one program in my state was willing to give me a chance. I had to get and stay under 200. I was also ordered to get stronger. No marker for that though. I passed the heart stress test and an idiotic walking test for lung capacity with flying colors. The administrator of the walking test kept shaking her head at my speed. They told her I was obese and frail and would surely fail. I told her no, I'm just fat. Losing weight as a post menopausal, genetically fat woman on insulin is near impossible. No amount of exercise can make you lose. My Drs said I needed to get below 800 calories a day. My 20 years of T2 was always in control with oral meds, but all oral meds are contraindicated with kidney disease. They made me go on insulin, which is a strong weight gainer. My kidney disease is from 30+ years of dehydration caused from losing my colon at 30. Which is also why vegetables are a no go for me. I tapered up from the starting dose of ozempic to the full Wegovy dose. Over 2 years I went from 224 to 190 to 211. It wasn't working anymore. So I switched to Mounjaro and it took 6 months to get to the full dose. I didn't start losing until I hit the top dose and was able to stop the insulin. I'm still fat and malnourished, but at 178 I'm "doing great" and need to "keep up the great work" so that by the time my 6 year wait on the transplant list comes up I can be "worthy." My life is now consumed by the scale and the pursuit to prove I'm worthy. I go to the YMCA 5 nights a week, not because it helps me lose weight, it doesn't, but to prove "compliance." I eat once a day. I struggle to stay under the 800 calorie recommendation. Luckily I only have mild side effects from MJ, it truly is a miracle T2 drug. My A1C is in the normal range. Every day I fear my pharmacy benefit manager will declare me cured and deny the meds. They are doing that these days, the drug works, so you don't need it anymore crap. PBM don't stop chemo because it's working do they? I was fine at 224. My lowest adult weight was 175 in highschool. I can't imagine ever being smaller. Even lying in a hospital bed, malnourished and on TPN I didn't lose weight! But at 61 I'm not ready to go yet. So I have to jump through all the hoops to prove I'm worthy of a kidney. Luckily there is one transplant program in my state willing to take me, with conditions. Mayo clinic and the university of Minnesota still wouldn't consider me worthy of life at 178 lbs. I'd have to get under their magic bmi bullshit.
This is a great essay. And having worked in biotech for decades, I second the idea that pharma turns differences into illnesses and then blows up its profits. For example, back in the day, Genentech had to pay huge fines after starting a fake parents’ group to pressure doctors to prescribe genetically engineered Human Growth Hormone off label to short children (the med was only approved for dwarfism). MDs can prescribe off-label, but a fake parents’ group was too much.
Such a good assessment. The thing that gets me about these drugs is that it will really increase the perception that being fat is within someone’s control. More and more comments of “oh, you should be on the GLP drugs”, etc.
This moment feels so dangerous. It is now literally a choice to stay fat, since is is now so “easy” to lose weight with these “miracle drugs.” It seems likely that this will unleash an increase in explicit anti-fat behavior in both the medical community and society at large. Be skinny or die trying.
Thank you for this! Opeah may have divested of her WW holdings but I found myself imagining it impossible that her substantial investments avoid all pharmaceutical companies. The CEO's were given mere moments and no challenging questions. Most disappointing was the absence of any discussion that people who need these medicines for diabetes are having trouble accessing them. The show will only contribute to that problem becoming more difficult. I appreciate your deconstruction and all the facts you shared. Thank you!
Boy, it sure sounds like the pharma companies won't be happy until all of us are on daily drugs. Thanks for the summary.
I want to say I feel sorry for Oprah, but I kind of don't. It's pretty clear she doesn't have the public's best interest in mind.
Thank you, Kate! The moment I began watching Oprah’s show last night, I thought , “Can’t wait to read what Kate has to say on this!” Oprah tried to cover a vast topic in far too little time.
Excellent article Kate.
I wouldn’t want to be in Oprah’s shoes. I think being in control has become the constant in navigating her life. The one thing she’s always wanted: a slim body, has eluded her. In celebrity land & many cultures besides the American culture , looking beautiful has always been associated with thinness. It’s tough to have a love/ hate relationship with your genetic body type. Coming to terms with it (your genetic body type) can be one of life’s biggest challenges .
I’m so tired of pharma deluding people with their fabrications of the truth in the name of more & more profits. They’ve become the legalized “ pusher man” !
Thank you for this! I really appreciate your writing, and as someone who weight cycled most my life, and has been recently diagnosed diabetic I also really appreciate the care with which you discuss diabetes.
A measured and expert deconstruction of what sounds to have been a biased and irresponsible broadcast/advert by Oprah. Thank you, Kate.
Oprah's infomercial... Kate Manne was quoted in a recent NY Times piece earlier this week. I agree with her very perceptive conclusions in her column here.
This is one of the rare times that I actually agree with the insurance industry's refusal to pay for what they say are "cosmetic" drugs. It is sad to see how desperately the doctors and the drug companies are scrambling to force insurance (including medicare and medicaid) to pay to make them rich. I don't feel very good about agreeing with the insurance industry about anything, but here I am.
Some doctors want people to take these meds for health reasons. But the overwhelming majority of fat patients (and some not-so-fat) want to take them for other reasons with which we are all too familiar--the nightmare of living in a society that hates the size and shape of your body, and wants you to hate it, too.
After I guested on Oprah's show in the 1970's in Chicago, before it became nationally syndicated, she treated me well (as well as the other guest who was a larger woman who was an officer of the local NAAFA chapter in Chicago), although the notion of accepting one's larger size was obviously foreign to her. In the intervening years, Oprah has several times said that "Any woman who has a weight problem but says she is happy at her size, is lying" or words to that affect. She still believes that.
Amen! Thanks for this summary of why this kind of BS is so damaging. AND! Even the premise "You’re not to blame for your weight." is based on the assumption that if you aren't in a specific size window, there must BE someone/thing to *blame* for your weight. Which is false and is the rhetoric of healthism/sizism (I just wrote a post on healthism so this is top of mind!). So frustrating that this is the message that is put in our collective consciousness.
I'd be interested in hearing what others thought of Tessie McMillian Cottom's opinion piece today on the Oprah special in the NYT's. She's a smart sociologist but seemed to play it NYTimes-safe by focusing only on the cost of and differential access to the new weight loss meds. She only grazed over the side effects and just lightly alluded to the larger issue of social sanctioning of body size. Although also interesting--even poignant--to read that she's had a life long psychosocial relationship with Oprah's fight with her body. That says something.