Ozempic and the Harder-Better Fallacy
The problem with Ozempic is not that it makes weight loss easier. The problem is that weight loss is not a good goal in the first place.
I‘ve been thinking a lot lately about what I call the harder-better fallacy. That which is the most difficult to achieve is deemed the most worthy, regardless of its actual desirability or value. Often, this sense of worth has a distinctively moral dimension: it’s hard for most of us to get up at 5am—so there must be something admirable about it. It’s hard for many mothers and other parents to breastfeed or chestfeed—so it must be crucial for their infants’ development and long-term prospects. It’s hard to keep your house beautiful and Instagram-ready at all times: so doing so must make you an all-around better person. It’s hard to stay thin: so doing so must be morally superior.
These ways of thinking are all self-evidently silly, when you reflect on it for a moment. There’s nothing inherently worthwhile about an activity just because most people happen to struggle with it. And the evidence suggests that, in all of these cases, the harder thing isn’t actually vital, or even better at all, most likely. (Before you @ me about breastfeeding, the evidence as I understand it is that there are very modest short-term benefits, such as less diarrhea, for the baby. But many of the other purported benefits simply haven’t panned out—and not for lack of research—as compared to formula-fed infants whose parents have access to high-quality formula and clean water, which is sadly far from a given in this country among others. If you do have such access, though, breast and formula-feeding are about the same on most dimensions, at least according to Emily Oster.)
But it’s also extremely understandable that people would buy into the hype, both psychologically and socially, with any of these practices. Put yourself in the shoes of somebody who’s struggled for many years to do the hard thing—whatever it may be, exactly. Being told that that hard thing isn’t really superior, and that they may as well let themselves off the hook, can feel like a punch in the gut. All that effort wasted? It can’t have all been in vain. I totally get the feeling.
And for those of us who haven’t yet gone down the hard road, we see other people struggling and don’t want to feel like we’re taking the easy way out. We don’t want to be, or be accused of being, lazy. More insidiously, the sheer fact that it’s hard means few will succeed in the endeavor. So the hardness of a practice means it gives rise to a human hierarchy: those who can at the top, those who can’t or won’t at the bottom, and, in the middle, those of us who keep struggling in spite of the difficulty—sometimes succeeding, sometimes failing, and feeling bad about ourselves in the process.
It can be hard to let go of the aspiration itself. It can also be important, lest we all keep tilting at windmills, and wasting time, money, energy, and bandwidth that would be far better spent elsewhere. You stop trying to get up at 5am, as someone naturally prone to be a night owl, and you may well find yourself more productive, creative, less stressed, and, most importantly, happier.
This brings me to weight loss. This is part of a much longer argument that really requires a whole book chapter, even a book in its entirety, to make satisfactorily. I’m working on it. But in the meantime, you can read many other authors—including Aubrey Gordon, Virginia Sole-Smith, and Ragen Chastain—whose read of the overall evidence is similar: the health problems associated with being fat have been systematically exaggerated—and for reasons rooted in anti-Black racism, as Da’Shaun L. Harrison and Sabrina Strings have (independently) argued. Many fat people are healthy, while many thin people are not. Fatness is not a death sentence. You cannot assume someone’s health status based simply on their appearance. And many fat people would be healthier than we are if we weren’t subject to the pervasive problem of weight stigma, which causes demonstrably harmful forms of stress, impedes our access to adequate health care, and makes healthy behaviors like exercising fraught with the risk of humiliation.
Moreover, whatever the health impact of fatness, the process of trying to lose weight is frequently both futile and unhealthy in itself. Although many people lose weight in the short term through diet and exercise, the weight tends to return, with extra pounds for company, over the next few years. Many people (between one and two thirds) end up heavier than they started, as their metabolisms slow down and their appetites ramp up as a protective response to what the body perceives as starvation. And the process of losing and gaining weight repeatedly, which is known as weight cycling, is also very harmful to people’s health, independently of their starting weight.
The upshot is clear: it’s hard to lose weight through diet and exercise. And, contrary to the harder-better fallacy, it’s probably not worth it for the majority of people, given the long-term costs, risks, and dangers—including the possibility of developing disordered eating, or even a full-blown eating disorder.
But that is a difficult message to digest for a number of reasons. For one thing, given the fatphobia endemic in society, it can feel like giving up on yourself to let go of the goal of weight loss. For another thing, when something is so hard, it can feel worth doing, just because of the harder-better fallacy.
And that’s where drugs like Wegovy and Ozempic—the commercial names for semaglutide—come in and have divided people. There are all sorts of good reasons not to take them: particularly Ozempic, a drug intended for patients with Type 2 diabetes, which is now in short supply for those who actually need it. (Wegovy, meanwhile, is a stronger formulation—and is thus even likelier to cause side effects, some of which can be serious as well as unpleasant.) We have very little sense of what these drugs might do to our health in the long term. And the track record of weight loss drugs, historically, is a very grim one.
Of course, there’s also the problem that, once these drugs are discontinued, the weight will typically return. Let’s be clear: there’s nothing wrong with taking a drug for a long time, or indeed forever, and many people need to do this with a blood pressure medication or an anti-depressant, for example. But the new generation of weight-loss drugs are much less of a known quantity. And they will also cost you well over $1000 a month without health insurance coverage, which remains rare at the time of writing. That is going to add up quickly.
But there’s often an obscure sense within discussions of these drugs that they’re an easier, and therefore inferior, option, to grinding along trying to lose weight via diet and exercise alone. So let’s be clear: the problem with Ozempic and such is not that it is “cheating,” somehow, to lose weight more easily, and that doing it the “hard” way is somehow better. That, as we’ve seen, is simply a fallacy—and very much of a piece with the intersection of diet culture and perfectionism and grind culture (whose Venn diagram, I’ve often suspected, is scarily close to a circle).
Easier is good. Easier is better, actually—if, and only if, the goal is worth achieving and is both achievable and sustainable. I don’t believe that this is the case when it comes to weight loss, and I’m trying to make that case in my book, Unshrinking, which I hope you’ll consider reading when it comes out next January. In the meantime, I want to ask you to ponder, dear reader: is there a practice in your own life where you think you might be buying into the harder-better fallacy? What do you gain by so doing? And what might you stop losing if you were to give it up—in terms of your time, your money, your health (including your mental health), and, most importantly, your well-being?
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I'll start. I think I've been snobbish about so-called convenience foods, especially for my kid. (What's the alternative? Inconvenience foods?) I love to cook and that’s fine. But when I don't or can't, I am going to try to lean into the frozen French fries or whatever with less guilt
Your broader observation about the fallacy of harder = better is an excellent one. Better should be based on “more valuable,” not on whether it is difficult to accomplish. At the same time, many things that are valuable are, in fact, difficult to accomplish. Being an MD is highly valuable to society yet very difficult to accomplish; a superb chef likely got there with much effort over a long period of time; an excellent musician no doubt spent years of hard work honing their craft. I think where the confusion comes in is here: Because most things of great value are hard to accomplish, many people simply assume that “difficult” always means “better,” when that is not the case.