My one big quibble with the Tolentino piece is that we can assume most of the New Yorker’s audience is very likely not aware of the many, many false assumptions undergirding our medical and social attitudes towards weight.
There really is no solid evidence directly linking weight to health outcomes (without controlling for the myriad factors that could make these outcomes correlations rather than causations and without making room for the fact that human beings can not be evaluated with one-size-fits-all standards), and the medical establishment’s eagerness to lean on a drug that is clearly bad for people is yet another in a long line of shortcuts towards making people’s bodies fit what is considered acceptable, with no real proof at all that this drug will facilitate better long term health outcomes. She hints at this, but to me, this is the most important part of the ongoing battle for fat acceptance, without which people, especially women, will continue to jeopardize their health and well-being in order to fit the status quo.
The smoking/lung cancer analogy is a nice gotcha, but is still predicated on the idea that smoking & lung cancer are analogous to eating & weight. This is a false equivalence--many people doctors consider “obese” are, by all other metrics, healthy. The analogy suggests that all fat people are addicts who need help managing their relationship with food through preventive measures, which only perpetuates the misconceptions driving both the medical establishment and society to treat people differently because of their size.
The cat's already out of the bag on Ozempic. Tolentino's piece is at least the 4th somewhat long feature I've read on this in the last couple of weeks. I expect a continuing wave of think pieces on this subject, especially if the projections are true that these are going to be the most valuable class of drugs ever.
Hua Hsu's piece on prep hewed so closely to the story arc in the Articles of Interest podcast but didn't drop the reference to that podcast until so late in the piece that I was almost wondering if there was going to be some plagiarism scandal brewing. As such, I didn't get too much more out of this than from the podcast, but it's still a good story and I can appreciate an article that summarizes something already interesting in a thorough manner.
Jia Tolentino's article (and the phenomenon of cosmetic Ozempic use in general) reminded me of Meg Elison's 2020 scifi / horror short story "The Pill." The story plays out the social, cultural, and sexual consequences of a diet pill that works perfectly for 90% of people and gruesomely kills the remaining 10%. Tolentino, I think, presents taking Ozempic as more or less just another expensive, if unusually and unpredictably risky, beauty practice that people choose in optimizing their bodies, like injections and fillers. But to me, it feels different -- I can't exactly articulate why but I think "The Pill" does. The story confronts something that Tolentino's article alludes to (in providing the historical & pop cultural context for fatphobia, in describing Ozempic as "an injectable eating disorder") but skirts around addressing directly: the casually expressed but intense terror many people feel about becoming fat and the casual disgust, expressed or not, that they have for fat people, and what they're willing to give up to avoid becoming fat as a result. Maybe that's just not the kind of thing that can be expressed truthfully in a feature article in The New Yorker.
EDIT: I reread the short story after posting this comment, got worried it was too over the top to recommend... and *then* I read the NYMag article and was like, nope, not too over the top at all.
Great link. I honestly felt Tolentino *did* eventually present the drug as a result of that terror, she just aimed for a slow-build with that as the ending punch… but I’m sympathetic to the view that the piece didn’t quite hammer the point home hard enough to make that unambiguously clear.
Yes! I do think she achieved the slow burn horror in re: the long-term social & cultural consequences for (esp. fat) people, but she didn't get into the undignified scrabbling fear & vanity of cosmetic users that the NYMag article exposes. That makes sense, because getting rich people to give humiliating quotes is what NYMag does best.
Except that the Ozempic class of pharmaceuticals aren't "unusually and unpredictably risky", the risks and side effects are known. How individuals react to the medication will vary, which is true of a large number of mass consumed prescription drugs.
Are you suggesting that this medication is too risky for treatment of diabetes, even though it's been proven to be effective? What should people with diabetes be using instead?
For diabetes? No, absolutely not. Please don't jump down my throat about something I didn't actually say. For folks with diabetes, the benefits obviously far outweigh the risk. The drug is life-changing for them, and it's incredibly exciting that the drug can help reduce reliance on injected insulin.
I *am* suggesting that non-diabetics taking Ozempic to become thinner *are* exposing themselves to known and unknown risks for solely cosmetic reasons. Only the short-term risks and side effects *for diabetics using the patented drug specifically* are known. We don't know about long-term risks and side effects for anyone, or the short-term risks and side effects for non-diabetics, especially non-diabetics taking gray market research chemicals from a Floridian pill mill.
Plus, weight cycling in itself damages heart health -- and given the cost of the medication and the practice of using the drug before major life/career events, I suspect many, many cosmetic users will end up doing exactly that. Being underweight also has serious risks, as does malnutrition. (If you're not eating very much, it's easy to develop all kinds of nutritional deficiencies.) Would an already thin non-diabetic often end up underweight after using Ozempic? That's pretty obviously the goal for a subset of already thin cosmetic users. For them, it really is an injectable eating disorde, and having an ED is its own kind physical and psychological hell.
Diabetics are much more insulated from these risks. They'll likely be taking the drug indefinitely, which will protect them from weight cycling, and since they are under ongoing medical supervision, they're unlikely to become underweight. They are taking the drug to treat a life-threatening, potentially disabling chronic condition. The chemical may be the same as (well, similar to) the one(s) cosmetics users are taking, but the social & medical context is completely different, as is their psychological framework for the drug.
Tl;dr: The risks for diabetics and for cosmetic users overlap, yes, but not completely. While it's reasonable to assume diabetics will generally become much more healthy and gain more years of life and enhanced quality of life through taking the drug. We don't know if that's the case for cosmetic users, many of whom are using the drug in an inherently risky way.
There's no evidence that it's inherently risky for the vanity users, beyond the already known side effects.
The focus is on a small number of vanity users, who have sufficient wealth to pursue this instead of investing in traditional weight loss methods. The rich and vain will do what they do.
For people struggling with obesity, this would be life changing. But I suppose that doesn't generate moral outrage.
Sure, but absence of evidence is not evidence of absence. I think it’s totally reasonable to be concerned, especially when we consider the fatphobia driving so many of those that feel the need to seek medical solutions to something which is not, *in and of itself,* a health issue. Certainly in combination with other factors (smoking, drinking, poor diet, lack of exercise) it *can* be, but those are health issues for the skinny too.
There's an obsession with what the rich and vain do to achieve their appearance. Because this doesn't apply for most people in the world, it's an unhealthy obsession, but great click bait in all media platforms.
This class of drugs could have real benefits for people who are over weight, and for people with alcohol concerns. Instead it's being demonized because some of the KKs suddenly got skinny. It's a pity that trite still bests potential medical progress for those who actually need it.
I’m so glad I read that story, thanks so much for sharing it. I’m skipping the Tolentino article and all further Ozempic discourse not written by fat people
I’ll be the one to swim against the stream by saying that Tolentino’s piece, like every Ozempic story I have read, is absolute trash that never bothers to center the people taking Ozempic for legitimate medical reasons because that would get in the way of the moral panic over fatness/thinness/capitalism/whatever the author’s particular hobbyhorse is.
While fat has always been a feminist issue, I don't think the moral judgement of weight has ever had a left or right of politics dimension. Either side of politics is equally likely to propose nanny-state solutions to individual health or lifestyle decisions.
Social change may have created the rise in obesity, however, for all but a small percentage of people, the cause is personal choices. Those on the left of politics are definitely making a moral judgement, they're not forgiving of undisciplined people!
Conflating access to Ozempic with a critique of telehealth is an odd detour. Lax clinical and prescribing practices have historically, and still do, happen in real life. No one has ever said that telehealth is a panacea for something already embedded in medical practice. Telehealth is invaluable for people who live in regions or rurally, or who have disabilities or mental health concerns, which have previously been significant barriers to gaining easy access to essential healthcare. Let's not damn telehealth just because a bunch of people want to lose some weight, they're not the target market for telehealth.
Most of the MSM coverage has been about the use of Ozempic for what we might call vanity weight loss. Why is the potential use for alcoholism not gaining any excitement in clinical or media circles? There seems to be more than one life changing / saving use for this class of drugs. Clearly a lot of avenues that warrant more research.
Thin remains the cultural ideal, especially for women. Why is anyone surprised, or playing a moral red card, when a miracle cure for achieving the social ideal is available for the asking?
Damned if they do, damned if they don't. Pick a side people.
My one big quibble with the Tolentino piece is that we can assume most of the New Yorker’s audience is very likely not aware of the many, many false assumptions undergirding our medical and social attitudes towards weight.
There really is no solid evidence directly linking weight to health outcomes (without controlling for the myriad factors that could make these outcomes correlations rather than causations and without making room for the fact that human beings can not be evaluated with one-size-fits-all standards), and the medical establishment’s eagerness to lean on a drug that is clearly bad for people is yet another in a long line of shortcuts towards making people’s bodies fit what is considered acceptable, with no real proof at all that this drug will facilitate better long term health outcomes. She hints at this, but to me, this is the most important part of the ongoing battle for fat acceptance, without which people, especially women, will continue to jeopardize their health and well-being in order to fit the status quo.
The smoking/lung cancer analogy is a nice gotcha, but is still predicated on the idea that smoking & lung cancer are analogous to eating & weight. This is a false equivalence--many people doctors consider “obese” are, by all other metrics, healthy. The analogy suggests that all fat people are addicts who need help managing their relationship with food through preventive measures, which only perpetuates the misconceptions driving both the medical establishment and society to treat people differently because of their size.
Very well put. I felt she did a bit more than "hint" at it, but I agree with you that these points could have been foregrounded.
The cat's already out of the bag on Ozempic. Tolentino's piece is at least the 4th somewhat long feature I've read on this in the last couple of weeks. I expect a continuing wave of think pieces on this subject, especially if the projections are true that these are going to be the most valuable class of drugs ever.
Hua Hsu's piece on prep hewed so closely to the story arc in the Articles of Interest podcast but didn't drop the reference to that podcast until so late in the piece that I was almost wondering if there was going to be some plagiarism scandal brewing. As such, I didn't get too much more out of this than from the podcast, but it's still a good story and I can appreciate an article that summarizes something already interesting in a thorough manner.
Jia Tolentino's article (and the phenomenon of cosmetic Ozempic use in general) reminded me of Meg Elison's 2020 scifi / horror short story "The Pill." The story plays out the social, cultural, and sexual consequences of a diet pill that works perfectly for 90% of people and gruesomely kills the remaining 10%. Tolentino, I think, presents taking Ozempic as more or less just another expensive, if unusually and unpredictably risky, beauty practice that people choose in optimizing their bodies, like injections and fillers. But to me, it feels different -- I can't exactly articulate why but I think "The Pill" does. The story confronts something that Tolentino's article alludes to (in providing the historical & pop cultural context for fatphobia, in describing Ozempic as "an injectable eating disorder") but skirts around addressing directly: the casually expressed but intense terror many people feel about becoming fat and the casual disgust, expressed or not, that they have for fat people, and what they're willing to give up to avoid becoming fat as a result. Maybe that's just not the kind of thing that can be expressed truthfully in a feature article in The New Yorker.
Here's a link: https://web.archive.org/web/20210215222359/https://blog.pmpress.org/2021/02/15/the-pill/
EDIT: I reread the short story after posting this comment, got worried it was too over the top to recommend... and *then* I read the NYMag article and was like, nope, not too over the top at all.
Great link. I honestly felt Tolentino *did* eventually present the drug as a result of that terror, she just aimed for a slow-build with that as the ending punch… but I’m sympathetic to the view that the piece didn’t quite hammer the point home hard enough to make that unambiguously clear.
Yes! I do think she achieved the slow burn horror in re: the long-term social & cultural consequences for (esp. fat) people, but she didn't get into the undignified scrabbling fear & vanity of cosmetic users that the NYMag article exposes. That makes sense, because getting rich people to give humiliating quotes is what NYMag does best.
Except that the Ozempic class of pharmaceuticals aren't "unusually and unpredictably risky", the risks and side effects are known. How individuals react to the medication will vary, which is true of a large number of mass consumed prescription drugs.
Are you suggesting that this medication is too risky for treatment of diabetes, even though it's been proven to be effective? What should people with diabetes be using instead?
For diabetes? No, absolutely not. Please don't jump down my throat about something I didn't actually say. For folks with diabetes, the benefits obviously far outweigh the risk. The drug is life-changing for them, and it's incredibly exciting that the drug can help reduce reliance on injected insulin.
I *am* suggesting that non-diabetics taking Ozempic to become thinner *are* exposing themselves to known and unknown risks for solely cosmetic reasons. Only the short-term risks and side effects *for diabetics using the patented drug specifically* are known. We don't know about long-term risks and side effects for anyone, or the short-term risks and side effects for non-diabetics, especially non-diabetics taking gray market research chemicals from a Floridian pill mill.
Plus, weight cycling in itself damages heart health -- and given the cost of the medication and the practice of using the drug before major life/career events, I suspect many, many cosmetic users will end up doing exactly that. Being underweight also has serious risks, as does malnutrition. (If you're not eating very much, it's easy to develop all kinds of nutritional deficiencies.) Would an already thin non-diabetic often end up underweight after using Ozempic? That's pretty obviously the goal for a subset of already thin cosmetic users. For them, it really is an injectable eating disorde, and having an ED is its own kind physical and psychological hell.
Diabetics are much more insulated from these risks. They'll likely be taking the drug indefinitely, which will protect them from weight cycling, and since they are under ongoing medical supervision, they're unlikely to become underweight. They are taking the drug to treat a life-threatening, potentially disabling chronic condition. The chemical may be the same as (well, similar to) the one(s) cosmetics users are taking, but the social & medical context is completely different, as is their psychological framework for the drug.
Tl;dr: The risks for diabetics and for cosmetic users overlap, yes, but not completely. While it's reasonable to assume diabetics will generally become much more healthy and gain more years of life and enhanced quality of life through taking the drug. We don't know if that's the case for cosmetic users, many of whom are using the drug in an inherently risky way.
There's no evidence that it's inherently risky for the vanity users, beyond the already known side effects.
The focus is on a small number of vanity users, who have sufficient wealth to pursue this instead of investing in traditional weight loss methods. The rich and vain will do what they do.
For people struggling with obesity, this would be life changing. But I suppose that doesn't generate moral outrage.
Sure, but absence of evidence is not evidence of absence. I think it’s totally reasonable to be concerned, especially when we consider the fatphobia driving so many of those that feel the need to seek medical solutions to something which is not, *in and of itself,* a health issue. Certainly in combination with other factors (smoking, drinking, poor diet, lack of exercise) it *can* be, but those are health issues for the skinny too.
The fat and healthy claim has been debunked.
There's an obsession with what the rich and vain do to achieve their appearance. Because this doesn't apply for most people in the world, it's an unhealthy obsession, but great click bait in all media platforms.
This class of drugs could have real benefits for people who are over weight, and for people with alcohol concerns. Instead it's being demonized because some of the KKs suddenly got skinny. It's a pity that trite still bests potential medical progress for those who actually need it.
I’m so glad I read that story, thanks so much for sharing it. I’m skipping the Tolentino article and all further Ozempic discourse not written by fat people
I’ll be the one to swim against the stream by saying that Tolentino’s piece, like every Ozempic story I have read, is absolute trash that never bothers to center the people taking Ozempic for legitimate medical reasons because that would get in the way of the moral panic over fatness/thinness/capitalism/whatever the author’s particular hobbyhorse is.
While fat has always been a feminist issue, I don't think the moral judgement of weight has ever had a left or right of politics dimension. Either side of politics is equally likely to propose nanny-state solutions to individual health or lifestyle decisions.
Social change may have created the rise in obesity, however, for all but a small percentage of people, the cause is personal choices. Those on the left of politics are definitely making a moral judgement, they're not forgiving of undisciplined people!
Conflating access to Ozempic with a critique of telehealth is an odd detour. Lax clinical and prescribing practices have historically, and still do, happen in real life. No one has ever said that telehealth is a panacea for something already embedded in medical practice. Telehealth is invaluable for people who live in regions or rurally, or who have disabilities or mental health concerns, which have previously been significant barriers to gaining easy access to essential healthcare. Let's not damn telehealth just because a bunch of people want to lose some weight, they're not the target market for telehealth.
Most of the MSM coverage has been about the use of Ozempic for what we might call vanity weight loss. Why is the potential use for alcoholism not gaining any excitement in clinical or media circles? There seems to be more than one life changing / saving use for this class of drugs. Clearly a lot of avenues that warrant more research.
Thin remains the cultural ideal, especially for women. Why is anyone surprised, or playing a moral red card, when a miracle cure for achieving the social ideal is available for the asking?
Damned if they do, damned if they don't. Pick a side people.