The Weight of Shame – When it Comes to Obesity You’re Damned if You Do and Damned if You Don’t

If you spent even a brief moment online this year, you know, Ozempic (semaglutide) which belongs to a class of medications called GLP-1 receptor agonists was the topic of all conversations pertaining to weight management and obesity. In addition to its primary function of managing blood sugar levels, Ozempic has shown significant weight loss effects. For people with type 2 diabetes who struggle with obesity or weight management, this dual benefit of improving glycemic control while aiding in weight loss has been life-changing.

With more than 41.9 percent of adults in the U.S. living with obesity, it was only a matter of time before Ozempic became the drug of choice for managing obesity. This created two problems, one, it became nearly impossible for those living with type 2 diabetes to fill their prescriptions, there are several reports of drug shortage involving Ozempic; when people use Ozempic off-label for weight loss, type 2 diabetes patients who rely on Ozempic struggled to fill their prescriptions.

Second, those who have used and found success with Ozempic as a weight management tool were shamed for using the drug, instead of taking the traditional route for managing obesity.

On the surface, one could easily believe that most people speaking on the misuse of Ozempic, do so out of concern for type 2 diabetic patients who are unable to receive their meds, but when it comes to body image, diet, and women, the concern is never black and white.

Diet culture is pervasive, it promotes the idea that self-control and willpower alone should suffice for weight management. Perpetuating the notion that weight loss should solely come from diet and exercise. Seeking external assistance through diet aids is seen as a deviation from cultural norms, which breeds shame and immense guilt.

Diet culture support the idea that obesity is a choice, it is something that obese people have full control over and therefore, do to themselves.

On November 8th, 2023, FDA approved a new drug Zepbound (tirzepatide) injection for chronic weight management in adults with obesity (body mass index of 30 kilograms per square meter (kg/ m2) or greater) or overweight (body mass index of 27 kg/m2 or greater) with at least one weight-related condition (such as high blood pressure, type 2 diabetes or high cholesterol) for use, in addition to a reduced calorie diet and increased physical activity.

Tirzepatide, the active ingredient in Zepbound, is already approved under the trade name Mounjaro to be used along with diet and exercise to help improve blood sugar (glucose) in adults with type 2 diabetes mellitus.

Zepbound is administered by injection under the skin once weekly, and the dosage must be increased over four to 20 weeks to achieve the target dosages of 5 milligrams (mg), 10 mg, or 15 mg once weekly. The maximum dosage of Zepbound is 15 mg once weekly.

Such news should have shifted the conversation and provide relief to those people concerned about the misuse and shortage of the diabetic drug Ozempic, but that’s not the case. Many are calling this perceived shortcut, supporting a lack of willpower and giving lazy people an easy way out.

Lack of willpower and determination are misconceptions used by society to create a stigma around obesity. This oversimplification ignores underlying health complexities and places undue responsibility and shame on individuals struggling with weight.

To accept that they are those for whom diet and exercise are just not enough, is to accept that obesity, is a complex health condition influenced by various factors, such as genetic, environmental, and psychological factors. It emphasizes the importance of informed decisions and individualized approaches.

It forces us to examine those complex factors that contribute to obesity, countering the misconception that it’s solely a result of personal choices and that most obese people are not simply sitting at home eating fried foods and bonbons, for sport.

It forces us to reflect on the weapon of shame, particularly against women. The power of shame as a tool to confine, control, and limit women is a reflection of deeply embedded societal norms. It weaves its threads through the fabric of our lives, imposing boundaries, limitations, and a confining box. Shame says there is only one way to behave, look, live, and succeed.

Shame feeds into a demoralizing sense of self, evoking a sense of failure for not adhering to conventional weight loss methods. Linking one’s self-worth to the ability to lose weight naturally without external aids.

Shame forces those who have found success with prescription diet aids, to keep quiet and continue to push the lie that weight management is two parts will and two parts determination. While no one is obligated to share their story or their behind-the-scenes, keeping silent due to fear of being shamed, perpetuates the lie that success, in all areas of life is only acceptable when the journey is hard and seemingly unattainable.

We will at some point see a shift in our response to how someone loses or maintains weight. Fatphobia and Ageism are two of the most accepted forms of prejudice. As weight loss meds continue to be introduced and made available to the public, and being thin becomes commonplace, the focus will turn to convincing women that their skin is not plump enough, glowy enough, dewy enough, and of course, youthful enough.

Soon the focus will move from will and determination, to not being regimented and committed enough, because celebrating diverse expressions of womanhood, is never an option.

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