Alison Stewart: This is All Of It. I'm Alison Stewart, live from the WNYC Studios in SoHo. Rabbit, rabbit. Thanks for spending part of your day with us. I'm grateful that you're here. On today's show, we'll speak with the historian Dave Wondrich, the author of The Comic Book History of the Cocktail: Five Centuries of Mixing Drinks and Carrying On. Eater editor Melissa McCart joins us with her list of unique coffee shops in the city, and want to hear about your favorite spots. We'll mark the 25th anniversary of the release of Coldplay's debut album Parachutes. That is our plan. Let's get this started with a conversation about weight loss drugs and body positivity.

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Alison Stewart: Last month, 23-time Grand Slam Champion Serena Williams revealed she lost 31 pounds after taking the GLP-1 drug, Zepbound, and she became an investor and a spokesperson for the company. She joins a list of athletes and celebrities like Charles Barkley, Amy Schumer, and Whoopi Goldberg who've all been open about their use of weight loss drugs, sometimes for health reasons, sometimes to reduce their weight. However, a podcast raises suspicions about the marketing and increased popularity of the medications, which, according to CNBC, is a multi-billion-dollar industry.

The podcast is called GLP-1 Truth Serum, hosted by author and anti-weight discrimination activist Virgie Tovar, who covers the plus-size market and how to end weight discrimination at work for Forbes. She's also the author of the book, You Have the Right to Remain Fat. On the podcast, she looks at the marketing of the drug, the body positivity movement, the risks of weight loss medications for those with eating disorders and and for children. Virgie Tovar joins me now. Hi, Virgie.

Virgie Tovar: Hi. Thank you for having me.

Alison Stewart: You opened the podcast with this story about receiving a marketing pitch for a GLP-1 medication that was sent to you via email. Tell us about your first reaction when you received this email.

Virgie Tovar: My first reaction was this must have landed in the wrong place because this is against every single thing that is a stated value for me online. If anybody could look me up up in five-- whoever's targeting me probably had five minutes to look me up. My thought was, "How did they come away with the sense that I would be happy to take this medication and potentially really go against my values publicly for my audience?"

Alison Stewart: What felt off about the initial pitch to you? How was it pitched to you?

Virgie Tovar: I get pitched a lot for all kinds of things. I'm a content creator, I'm a journalist. I do a lot of different things. Normally, the pitches are very aligned, like in the way that if every single post on your Instagram was about cats, and you got 99% of your pitches were about cats. I felt like this was sort of like I'm talking about cats, and I'm getting a pitch about orange juice. Obviously, the case here is that clearly my values are around anti-diet, which, for people who don't know, it's basically a political term, but it's also a healthcare term around people who are intentional around not using food as a way to control their weight.

People who are anti-diet often have a fraught history with either body image, or food, or eating disorders, or all three. For me, as someone who grew up with a lot of weight shaming in my life, I'm somebody who was one of those really the bad case scenarios of diet culture, which is I developed an eating disorder, it really began to destroy my health. I'm anti-diet for my own mental and physical health. I have stated anti-diet values online. I have stated weight neutrality values, which means that I don't think that one body size is naturally better than the other. I have health at every size values online, very clearly stated online.

In general, if a marketer is looking at my content, they're looking for values alignment. When I'm saying I'm anti-diet, I'm health at every size, I'm weight neutral, I don't know how somebody who is selling weight loss thinks that I am a fit. That was where-- again, I gave the benefit of the doubt, like, "This is just a mistake." Then the email started to flood in, and I started to realize that I was being targeted.

Alison Stewart: It made you realize, "I'm going to start a podcast about this." What gap in the public discourse were you hoping to fill with this podcast, GLP-1 Truth Serum?

Virgie Tovar: Honestly, I have to tell you the story, which is that I have a dear friend named Isabel. I only see Isabel once every few months. She lives in Puerto Rico. Every time she came to visit, apparently, I would just be raving about how frustrated I was by the lack of critical coverage about GLP-1s by media. Literally right before the podcast, she said, "You need to do a project. I am not listening to one more conversation. It has been months and months and months of you talking about this, and I just need you to do something about it." She even gave me the names, like, "Why don't you call it GLP-1 Truth Serum or something?" She's this kind of natural master marketer.

Basically, as a journalist myself, I was finding all of these moments that I would consider newsworthy that were not being covered. One example is when one of the GLP-1 manufacturers would say something really, in my opinion, over the top and little bit edging on unethical, like, "We're going to end weight stigma," or they would suggest that they're going to end weight stigma. I would say, "What do they mean? Is there a value proposition that they're going to get rid of every single fat adult and child? Is that how they're going to end weight stigma?" Because this is the mechanism of action that's happening. This is what they do.

I was very alarmed by marketing terms and suggestions like that. What I was finding was there was no interest in critically engaging with the marketing. Thankfully, a few months after my own experience, which was January 2024, where I'm getting these emails, thankfully, ultimately the Washington Post covered the story and broke it wide open. I had been really troubled by how there was a big focus on almost trying to make the body positivity movement, which is a largely woman-led grassroots movement, seem toxic. That seemed to be the only thing that the mainstream press was interested in doing was praising GLP-1s and throwing this incredibly important historical movement under the bus.

Alison Stewart: Who did you decide to talk to as a journalist? Who did you know you needed in this show?

Virgie Tovar: Well, I actually reach out to people who were, frankly-- I work very, very closely with many, many people who are deeply impacted by weight stigma and who are deeply impacted by diet culture. My audience, who I would consider the vulnerable population that is being left behind by GLP-1 discourse, I asked them who did they want to hear from, and they unequivocally said people who are doctors. I think that it was this sense that there was this sort of ubiquity, and you-- there was this ubiquity of medical agreement. That was the sense that people had.

When they had concerns as people with eating disorder histories or as people who maybe don't believe in intentional weight loss, both from a personal perspective and from a data perspective, they felt the-- the word is gaslit. They felt confused because of the way in which the marketing is-- I call it lab coat washing. The marketing is so lab coat-washed. It's really difficult to have a moment where you think, "Well, if every doctor believes this is positive, then am I the problem? Do I just need to cave? Do my values need to change?"

What I started to do was look at people who are clinicians and talk to people who are clinicians. I've talked to people like a friend who's a psychiatrist at Georgetown and adolescent psychiatry, Dr. Corey Williams. I've talked to Dr. Lauren Hartman, who's also in pediatrics. I've talked to a few people who are in the eating disorder world long-term and who really understand the fallout of what intentional weight loss, especially rapid intentional weight loss, can do to a person.

Alison Stewart: My guest is weight-based discrimination speaker, author, and Forbes contributor, Virgie Tovar. She's the host of GLP-1 Truth Serum, a new podcast exploring the weight loss drugs. Listeners, we'd like to hear from you. When did you first hear about Ozempic, Wegovy, Mounjaro, and other GLP-1s? Have you considered using one of these weight loss drugs for yourself? Why or why not? If you've used one, how have you felt after using the medications? Did it work for you? Did it work for your body image? Or is it the same? 212-433-9692. 212-433-WNYC.

Virgie, in the first episode, you talk about the history of weight loss drugs and appetite suppressants. I want you to put this in perspective for us. How do GLP-1s function differently than some of the drugs we've seen rise and fall in the past?

Virgie Tovar: This is something I drive home a lot in the podcast, which is that GLP-1s have changed the how but not the what. The what is appetite suppression, fundamentally. Fundamentally, all diets work by restricting calories in one way or another. In that way, GLP-1s are not any different historically than any other medication because they work through the same mechanism. However, they do it differently. The method of doing that is different.

A lot of people don't know this, but when you feel hungry, it's a hormone that's being emitted and sent into your brain that tells you, "I'm hungry." There are sensations that we associate with that hormone, and then there's another hormone that's emitted when you're full, and it goes to your brain. They're reprocessed each separately in different parts of the body. Just kind of know there's a fullness hormone and there's a hunger hormone. What GLP-1 ones do is they've created a synthetic version of the fullness hormone.

It sends almost like the feeling you have after Thanksgiving dinner. Sometimes times two, three, four, five, six, seven times more intense than that. They send that amount of fullness signal to your brain. It sends a signal that says, "I am very full" even though you have maybe eaten nothing or maybe eaten just a couple of bites. It creates that hormone when there's a lot of it can create aversion to food, it can create a change in the taste of food. The other thing that's important to understand is that-- this is one of the things I talk about with one of my guests, Dr. Corey Williams, who's a Georgetown psychiatrist.

There are implications for that extended state of deprivation, which we call starvation states. Starvation state is when you're in a consistent caloric deprivation. It's not literally you don't eat any food, but when you're in that state, you're at risk for developing something called anhedonia, which is when you have difficulty feeling pleasure because food is deeply connected to the pleasure and reward centers in our brains. One of the things that's potentially a risk for GLP-1 users is if they have pre-existing psychiatric vulnerabilities. This could land them in the emergency room or hospitalized because of this impact that caloric deprivation has on mood.

Alison Stewart: Let's take a call. This is Wendy on line 2. She's calling in from Westchester. Hi Wendy, thank you for taking the time to call All Of It. You're on the air.

Wendy: Hi. I totally respect what your guest is saying, but I want to ask her her opinion about this. There seems to be a lot of body positivity influencers online who have a lot of followers and who subsequently use these GLP-1s and lose a lot of weight, and they say they're much happier. Then they disappoint all their followers, and it's very difficult. I'm just wondering if a lot of these people promote body positivity because they are overweight and they can't lose weight, and it's kind of justifying it, and then when people are able to lose weight, they seem much happier. I'd just like to hear her response.

Alison Stewart: Virgie, go ahead.

Virgie Tovar: Yes. I think there's a variety of types of people who are content creators in the body positivity movement. The people who have very strong embedded values around this, they just aren't getting any coverage because it's not very interesting news to hear person maintain same values for 10 years. Like somebody like me-- a number of my colleagues who have not changed their stance, have not taken GLP-1s. I want to respect that there's a diversity of reasons why people come to body positivity.

Absolutely, Wendy, one of those archetypes is a person who maybe felt like weight loss previous to GLp-1 did not feel accessible, and maybe felt like deep down that they really wanted that, but that they were going to maybe try different values on and see how they fit. I don't want to downplay that there's this diversity of people for whom this weight loss is or is not a priority, because that's the reality of the situation. I think, fundamentally, my overall response is that it's very difficult to look at GLP-1s in a vacuum. You can't just look at GLP-1s without looking very, very closely at our culture of weight stigma and the amount of pressure that GLP-1 marketing has placed not only on all the culture.

I think about moments like I'm in New York and I walk out of the subway, and every single ad for 30 feet is a GLP-1 ad. That kind of pressure. I think it's important to understand, like I was mentioning earlier, our community was explicit targeted for a campaign of-- that was very, very, I would say enthusiastically attempting to dismantle publicly this movement. I believe that it was a marketing strategy. I think it's important to understand that these-- Absolutely, I don't want to downgrade anybody's values or priorities, but it's important to understand that, one, we live in a culture that is extremely fatphobic. It's very difficult to say no to that, whether you're a body positive influencer or not.

Then, when you add the layer of GLP-1 targeting for our movement, I think you've got a situation where it's just important to think about all of these factors as we're looking at this.

Alison Stewart: GLP-1s such as Ozempic and Wegovy were originally intended to treat patients with diabetes, and they've been life changing for many people. They also happen to aid in weight loss. Here's a question. How do you balance the good medications, what they may do, which is good, with the harm they may do for people who want to engage in body neutrality?

Virgie Tovar: I don't think it's actually that complicated. I think there's lots of things in our culture that are really fantastic for one thing, and maybe should not be used for other cases. I want to specifically say, I think of myself as an advocate for vulnerable populations, which is I would say, probably one in four, one in five, the people who have these eating disorder histories, people who have body image disturbance histories. These are the communities that-- we all have a friend, we all have a family member who is in this community. These communities are not being properly considered when we're talking about this medication.

I just want to contextualize that I absolutely believe in the ways in which GLP-1s-- I've seen the ways in which GLP-1s really help people with diabetes manage their A1Cs, and I think that's fantastic. I don't think that means we need to throw the baby out with the bathwater.

Alison Stewart: It's really interesting. In one of your more recent episodes, you sat down with Dr. Laura Hartman, a pediatrician, who talked about prescribing GLP-1 weight loss drugs to children. What was her biggest concern? We're going to play a clip from the podcast. What was her biggest concern?

Virgie Tovar: I think that her biggest concern was that just the existence of the medications themselves and the fact that doctors were suggesting them, were creating and perpetuating and perhaps worsening the message that something is wrong with your body when you're a kid.

Alison Stewart: Let's take a listen. This is from GLP-1 Truth Serum.

Dr. Lauren Hartman: Amongst my colleagues, amongst other adolescent medicine doctors and other adolescent medicine doctors specifically with eating disorder expertise, there's a lot of concern and a lot of kind of holding our breath and feeling really anxious about these medications and really about the rise and how quickly they are being prescribed to kids. There was a study in 2024 that said the rate had increased by 600% prescriptions for kids and young adults over the past three years. I can just imagine what that looks like today. That was in 2024. These are being prescribed to kids.

When we think about adolescence and think about childhood, that is a time where you're supposed to be growing. Your bodies are developing. We're supposed to be going through puberty, and having your brain develop, and having your bones become strong and gain adult height. I think the panic is when we think about what is happening when we are suppressing weight at a time when kids are supposed to be growing, and developing, and gaining weight. The truth is we don't have that data. We don't know what happens when you are suppressing weight for these kids at a time when they're supposed to be growing.

Alison Stewart: That's from GLP-1 Truth Serum, the podcast. My guest is Virgie Tovar. She is the host of the podcast. Let's talk to Megan, who's calling in for Murray Hill. Hi, Megan, thank you so much for calling All Of It. You're on the air.

Megan: Thank you. I wanted to say the first time I heard of a GLP-1, I think it was two years ago, a Super Bowl ad. The ad started with, "The weight loss system is broken. It's a billion-dollar industry. Aren't you sick of this?" Then the ad ended with, "Try our weight loss solution. We are the drug that's going to help you." It was like a hook, line, and sinker. I couldn't believe they thought the audience was so naive to hear you start an ad saying, "This is bad, but try ours because ours is good."

Alison Stewart: Megan, thanks for calling in. Your thoughts, Virgie?

Virgie Tovar: Oh, yes. [laughs] It's a brilliant rhetorical move. I want to say, anecdotally, that exact Super Bowl ad that Megan is referencing, I was just talking to a colleague who works at an eating disorder clinic, and she was saying that the day that they got the most calls was after that Super Bowl ad. Just to talk about how this doesn't just have a theoretical ripple, this has real-life consequences for people who are in these vulnerable populations. I want to say, [clears throat] fundamentally, what GLP-1s had to do, because the body positivity movement had been so successful at dismantling diet culture, is they had to fundamentally say, "We're not diet culture."

This is where all this co-optation of weight stigma language; they co-opt the critique of diet culture, even though they're part of diet culture. What they're doing is they're setting the theoretical parameters, and they're giving consumers talking points. Even if you're not taking GLP-1s, you're bringing these talking points into conversations with people, which is just brilliant marketing. I want to conclude by saying we cannot allow pharmaceutical companies to set the rhetorical parameters of this conversation.

We cannot treat this as if it's total, like we've never seen anything like this before, when we know that appetite suppressants have had over 100 years to prove that they work, and there have been various iterations. This is just the newest one. Again, I think Megan brings up a really good point that this circular logic of how terrible weight stigma is so bad even though we're monetizing it. Diet culture is terrible, even though we're part of it, but we're not doing that. Again, like I was saying, that sense of confusion that a lot of people feel, I think that's in some ways part of the point of the marketing.

Alison Stewart: We're talking about a new podcast called GLP-1 Truth Serum with its host, Virgie Tovar. We're going to take more of your calls, and we'll have more with Virgie after a quick break. This is All Of It.

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Alison Stewart: You're listening to All Of It on WNYC. I'm Alison Stewart. My guest is Virgie Tovar. She is the host of a new podcast called GLP-1 Truth Serum. We've been getting a lot of calls about people saying, "It's changed my life. I've been very happy on it." I did want to talk to Stephanie from New Rochelle because she introduces the nutritional aspect that goes along with the drugs. Hi, Stephanie. Thank you so much. Would you share your opinion with us?

Stephanie: Hi. Hi. Thank you for taking my call. Yes, not at all removing anything that you are all discussing, but adding to rather is the aspect. I work in the medical field and I see a lot of people on this medication. I'm not a provider myself. While I really praise it to help people bring down their A1C to help people in that respect, it seems to me that while it's a great support, there is no talk about nutrition. There is no discussion with that person who has an A1C or problem with cholesterol or anything like that. We're not touching upon the foundation of it. The malnutrition is what's causing a lot of these problems. Not all of them, but a lot of them.

I feel like there is no discussion about that. There's no discussion about how to teach people how to eat correctly. By that I mean differentiate between processed and non-processed foods, whole foods, grains, vegetables, the old school thing, the chart that used to be [chuckles] in our schools, and we learned about. It seems to be there's a void. It's just like, "No, now you can only eat one McDonald's meal instead of three because you won't have appetite to eat all three," or something. It doesn't say, "Hey, let's talk about eating well as a long-term goal rather than always being on this medication."

Alison Stewart: Stephanie, thank you for sharing your opinion. What do you think about that, Virgie?

Virgie Tovar: Yes, I think Stephanie brings up an interesting point around nutrition. There's all of these absences in the conversation. I think it's important to really understand that the people who are saying, "This medication is amazing and it changed my life," there's a self-selection bias here. I think what we need to understand is that when people are very attached to weight loss-- I'm someone who historically was exceedingly attached to weight loss. It was a very, very big part of my values, both from a health perspective, but also from every other perspective, I felt that weight loss was a very important part of my life.

It's important to understand that the people who are going on GLP-1s are likelier to be lifelong weight cyclers, are likelier to be the people who when there is failure or problems, they're likelier to blame themselves for those errors, those problems, those failures. I don't want to paint with a broad brush that is not everyone. I'm just speaking from personal perspective as someone who maybe 15 years ago would have very happily lined up to take GLP-1s and not been concerned at all about any of the warnings or any of the consistent starvation state I mentioned earlier.

It's important to understand that the presence of that voice and the loudness of that voice does not mean that we should not be critically considering other populations who maybe don't have that commitment. I want to say, even for people who love GLP-1s, there are existential concerns that are going to need to be addressed for them, too. That includes things like most people go off of GLP-1s by year one. The research I have is 71% go off by year one, 80% by year 2. Also, the other problem is these medications plateau after a certain point.

When we're talking about taking these medications for life, even for someone who has theoretically consented to that, what is their dosage going to look like in 2 years, in 4 years, in 10 years? Then we're talking about not only dosage and impact, but we're talking about cost. There are existential-- Again, another one which I mentioned earlier was mood. Like how being on GLP-1s impacts your mood. Even the people who invented Wegovy and Ozempic have mentioned that there are concerns that they have users who may develop almost like existential ennui, like boredom, because of how little food they're eating and how connected food is to reward center.

I just want to say whether you're pro GLP-1, or anti GLP-1, or something in between; these are very important long-term questions that need to be looked at.

Alison Stewart: If you are interested in the long-term questions, you should listen to Virgie Tovar's podcast, GLP-1 Truth Serum. Virgie, thank you so much for calling. We really appreciate it, and thanks to everybody who called in.

Virgie Tovar: Thank you.