Two months ago, I was at a party when I overheard two friends talking about “Ozempic face.” I only caught the tail end of the conversation, but it was enough to pick up on the tone of judgment in their voices and looks of horror at the idea of women taking these new “diet drugs.”
My hair stood up on the back of my neck, and I felt a lump in my throat — I tried to say that the drug doesn’t really age your face, it’s just the changes that happen when you lose weight, but I trailed off. I’m usually immune to well-meaning, offhanded comments about weight and wellness: from diet trends to new exercise regimens, and from talk about how fat people should be more health-conscious to the idea that fatness itself is an epidemic.
But this time was different. What my friends didn’t know is that I was already on one of those drugs. I was too ashamed to say it out loud, but the drug was working, and I wasn’t sure how I felt about it.
I want to say it all started six months ago, but that’s not really true.
I’ve lived most of my life as a “curvy” girl — the “you have such a pretty face” girl — but otherwise fit into standard sizes until the last few years. As my size changed, so did the way the world treated me — the eye rolls when I found my seat on the plane, the invisibility when out with thinner friends, the mean comments from nosy family members, the suspicion that I’d been overlooked for promotions.
I could write books, run a newsroom, provide for my family, be a good friend, and be on time for anything, but I couldn’t be thin or get thin — and, somehow, that felt like it negated everything else. What was the point of all this success if I’m still fat?
We live in an anti-fat culture where weight gain is, on its own, seen as a personal failure. (Weight loss, on the other hand, is viewed as a sign of sacrifice and commitment — you have to earn it to be worthy of it, as writer Helen Rosner points out). Fat people like me have a harder time getting appropriate medical care; we face discrimination in finding work and housing; we are humiliated when flying; we are disbelieved when raped. We are ridiculed and shamed, whether when teased as children or heckled in public as adults.
In the last few years, I found respite in the body-positivity movement, which posits that none of us deserve to be humiliated or discriminated against because of our sizes. And I’ve worked hard to love myself at my size: I refuse to try a fad diet, refuse to follow extreme exercise regimens, refuse to do anything that I perceive as giving in to the pressure to constantly obsess about my weight and hate my body.
Around the same time that I slid across the curvy divide and into fat-landia, my father, who had struggled with obesity-related diabetes and heart disease for most of his adult life, died of complications from his diabetes and the resulting dialysis. It was not an easy death — and it was made worse by my own recognition that, on some level, I had believed he could’ve stayed with us had he taken better care of his body in exactly the ways I lately wasn’t taking care of my own.
Eight months ago I found myself tired all the time, tossing and turning at night, overheating. I’d lose my breath exerting myself. I was eating compulsively and struggling to take care of myself. When you are fat, though, it’s hard to know what you actually need and harder to know how to get it.
The thought of going to a health-care provider who might be rude or shame me about my weight — let alone put me through a cycle of self-punishment that would add to my mental health woes — had made me avoid the reality of my health for two years. Finally, one day I woke up so exhausted that I couldn’t focus, and I knew I had to take action. I needed to do something about my health without going back to hating my body.
Six months ago, after some research, I found a doctor, a woman of color who had investigated generational health issues in her own family, who appeared to have a holistic approach to weight and health, and finally booked an appointment. My bloodwork showed that I wasn’t diabetic, but I was as close as you can get; my cholesterol was elevated, but not to the point that I needed to be on medication. I was at the stage at which patients are usually encouraged to try keeping a food diary, drinking more water, getting more exercise, and cutting calories, all in a mild lead-up to some sort of herculean weight-loss effort we all know won’t really work forever anyway. I explained that I knew short-term dieting didn’t and wouldn’t work for me, but I was struggling to make any meaningful long-term lifestyle changes.
My doctor suggested I try weight-loss medication.
In particular, she suggested that we try a newer class of these drugs — either semaglutides or tirzepatides — that were developed to treat diabetes but have also shown great success in helping patients lose weight. Some, like Ozempic and Mounjaro, are currently only approved for people with diabetes, those who have a high risk of developing diabetes, or those who are prediabetic with high A1C (a number that tells you how much sugar is in your blood and if you are nearing diabetes), while others, like Wegovy, are approved for weight loss in overweight and obese people. All are injectables that mimic your own hormones (what doctors call GLP-1 or GIP) that are supposed to control our feelings of hunger and make us feel full sooner when eating. (They are also really expensive for people without insurance, which doesn’t always even cover them, and their recent off-label overuse has resulted in these drugs becoming less available to patients with diabetes. )
She said taking one — she recommended Mounjaro — would help suppress my appetite and bring down my blood sugar while I slowly make some gradual-but-permanent lifestyle changes like moving a little each day and eating higher-quality foods.
I walked out of the doctor’s office white hot with shame about my health, despite my doctor’s optimism. How could I let it get this bad? Was I now my father? And, beyond that, the thought of taking a “weight loss” drug felt both like giving up on and a betrayal of the body positivity I’d struggled so hard to achieve.
I did what I always do when faced with a major life decision: I started talking to people — other doctors (“This drug is revolutionary”); friends who have faced similar questions (“Would you judge someone that needs an inhaler for their asthma?”); and, worst of all, I talked to straight-size people. “Do you really need this medication yet?” one friend asked me. “Have you really tried everything else?”
I realized something awful in this process: Not only do I struggle with the belief that the size of my body is my fault and a result of my neglectful actions, some other people feel that way, too.
But after many appointments and many questions, I decided to go on the drug. I knew I needed some kind of intervention to help stabilize my body and my health while I figured out why I was eating my feelings, why I was struggling to even go for a walk, and why I thought good health and self-care were only about sacrifice. I had to interrogate why I believed I deserved to be sick because I couldn’t “control” myself, but I couldn’t allow myself to keep getting sicker while I did so.
So now I’ve been on Mounjaro for several months, and each time I want to refill my prescription, I have to go to visit the doctor to talk through how I’m feeling, how the side effects — constipation, nausea, some insomnia — are going and how my relationship to food and my body are changing. (Because my doctor is a holistic practitioner, and because I made it very clear I don’t want to be on this for longer than I need to be, this is slightly above and beyond as I understand it.) It’s been an adjustment. Behavior change is not impossible; it’s just really, really hard, and a drug like this is meant to be one tool of many, which for me includes therapy, movement, and mindfulness.
And I have lost some weight, though not the enormous amounts you read about in some breathless reporting. It’s given me some space to breathe between meals — and it’s even helped me crave healthier foods. (It apparently makes it harder to digest greasy, fried, and sugary foods). My A1C has dropped 0.5 points, a strong indicator that my genetics don’t mean I have to develop diabetes, which has given me a tremendous sense of relief. That’s what I’m staying focused on — my actual health and the indicators that determine it, even if everything and everyone wants me to just focus on losing weight.
But, perhaps most profoundly, having a medication that can regulate my hormones is teaching me that when I eat compulsively, it is not just about internal willpower or self-control. And that when such behavior began threatening my health, it was okay to get help. Getting treatment was not a personal failure; it was good medical care for me.
Undoubtedly, anything touted as a “weight-loss miracle” is troubling because, as writer Aubrey Gordon said on Slate’s The Waves podcast recently, “when we get this spun up about a weight-loss drug this early, it’s usually a bad sign because it means that people will get more attached to the fantasy of weight loss.” (Also, it’s worth noting, the long-term effects of these drugs are still being studied.)
What these drugs can’t fix is what underlies the “obesity epidemic” — a culture that continues to hate fat people, a health-care system that incentivizes our weight loss over our actual well-being, and a food system that denies us access to whole, healthy foods.
But my body alone can’t remedy all that. Perhaps it was my commitment to body positivity’s insights into the diet industry that made me hesitant to consider a drug that would result in weight loss. Until I realized that body positivity is also about doing what is right for you and your body as you see it. Allowing myself to step away from the externally imposed shame and the sense of impossibility that has come with living in this body and really trying to figure out what is best for myself ended up being the key to truly accepting myself.