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Brian Lehrer: It's The Brian Lehrer Show on WNYC. Good morning again, everyone. Chatter about Ozempic, the seemingly miraculous weight-loss drug, can be found everywhere, from TikTok doctors to jokes at the Oscars, but what exactly is Ozempic? Is it safe? Is it going to revolutionize how we think about weight, and how we lose it, and how we think about our bodies? In her latest piece titled, Will the Ozempic Era Change How We Think About Being Fat and Being Thin, Jia Tolentino from The New Yorker, and author of Trick Mirror: Reflections on Self-Delusion, explores these questions and more, and now she joins us to share her discoveries. Jia, always great to have you. Welcome back to WNYC.

Jia Tolentino: It's great to be back. How are you?

Brian Lehrer: Let's start off with the basics. What is Ozempic for people who don't know, and how did it become not just a medication, but a cultural phenomenon?

Jia Tolentino: Ozempic has, as you said in that intro, it has gotten this reputation as this miracle wonder drug that will instantly cause people to shed all of their weight with no trouble and no side effects, and no complications. That is far from the truth. It's part of a class of medications called GLP-1 agonists which first reached the market in another form in 2005. They've been around for a little bit of time. It's not something that was invented yesterday. They also haven't been on the market for that long.

What these drugs do is they effectively-- most of them come in the form of a shot that you inject once a week. It's a synthetic version of a hormone that our bodies naturally release called GLP-1. These shots effectively replicate that hormone in the body. It triggers a sense of satiation, it slows the rate at which your stomach empties out the food in it, and the overall effect is that people's average blood sugar level drop significantly. They become fuller much faster. They eat the way that patients after bariatric surgery eat. You have to eat very small portions, you have to watch what you eat very carefully to avoid getting sick, and doctors have been pretty optimistic about these drugs as ways to treat Type 2 diabetes and obesity.

Brian Lehrer: What's the difference between Ozempic and some of the other brand names we've heard of in the same category? I don't even know if I'm saying these right, but Wegovy, Mounjaro. Is it an Ozempic thing or is it all of these things?

Jia Tolentino: I forgot to answer the second half of your question, which is when did it become this buzzword trend phenomenon thing. Ozempic has become a bit of a shorthand for the whole category, like Kleenex thing. I think it's because these pharmaceutical companies have been advertising these like crazy. If you have a TV, you might be familiar with the Ozempic ad campaign, which has this jingle that sings it to the tune of this one-hit wonder song Magic.

Ozempic is semaglutide which is the same substance that is in Wegovy, which is also sold by Novo Nordisk. Mounjaro was a little bit different. All of them, however, are in the same class of medications, these GLP-1 agonists. Ozempic, it's caught on almost like a meme. It has done so because of something that-- this medication is ostensibly supposed to be conducive to health for the difficult constellation of medical issues that can but do not always result from obesity. These drugs became prominent because of celebrities and socialites in New York and LA who were already thin, and are trying to be thinner, and have publicly lost a lot of weight in a very short amount of time.

Brian Lehrer: Let's get to the psychological and social questions here. For one thing, is Ozempic use in those who are not diabetic dangerous in any way? Not to be crass, but could this be considered a type of eating disorder induced by medication and advertising, and social pressure?

Jia Tolentino: One of the things that interested me in Ozempic as a subject is that it is both a tool that could be incredibly conducive to health for some people and a tool that also captures and draws on an incredibly pathological and flat-out unhealthy obsession with thinness that grips our culture. These two things exist at the same time and they are simultaneous uses of the same substance. I find that interesting and terrifying.

Yes, absolutely, these drugs have not been tested in terms of large-scale clinical trials on people of a "normal weight". They come with significant risks. They come with-- there's dangers of kidney malfunction, and liver malfunction, and pancreas, and gallbladder, all of these things, serious issues with your organs that are central to just these basic metabolic processes that allow us to live.

I think it is-- I said it in the piece and I don't mean this flippantly, but it can effectively amount to an injectable eating disorder. It's an interesting thing coming after a decade of what was ostensibly a widening discourse about the fact that we can be healthy at any size, that being overweight is not in any way necessarily a one-to-one correlation with being unhealthy. Then suddenly we have this resurgence of an obsession with thinness that feels older, and it feels like these older pathologies that have resurged in full force.

Brian Lehrer: Listeners, we definitely invite you in on this with Jia Tolentino from The New Yorker. Her article called, Will the Ozempic Era Change How We Think About Being Fat and Being Thin? 212-433-WNYC. Anyone on Ozempic or another semaglutide treatment as that class of drugs is called? What's been your experience on the medication? Have you had issues obtaining it even due to high demand? Doctors, have you prescribed Ozempic in your practice?

What do you make of the risks of it becoming an eating disorder or being used off-label at all for people who just want to use it for weight loss, for social or cosmetic, or whatever you want to call it, purposes rather than to treat an actual disease? 212-433-WNYC, 212-433-9692, or tweet @BrianLehrer. What are you getting at with your title at the deepest level? I know you don't write the titles for your articles, nobody does, I presume you don't either, but Will the Ozempic Era Change How We Think About Being Fat and Being Thin? What is that getting at?

Jia Tolentino: Thank you for asking that question. What I meant by that and a deep interest I have in the subject is I think that we have really, really heavily moralized weight in this country. We moralized thinness as a state of salvation, that should only be a state of moral salvation that should only be achieved by work, and fatness as a state of damnation or punishment that should only be crawled out of by penance. It's almost this Protestant work ethic deeply, deeply, deeply flawed, really harmful framework that governs the way that people think and talk about weight.

I think that Ozempic could interfere in this in an interesting way. The fact that you can inject the body with a version of a hormone that all of our bodies make naturally, but in different proportions and in different ways, and suddenly radically change people's relationship to appetite, radically change their metabolism, I think it's such a clear indication that all of this moralization of weight and weight loss is just absolutely wrong. That so much of the size of our bodies and the way that we navigate our appetites, so much of that is due to metabolic chance and just how our hormones are working.

We interpret it as matters of personal responsibility and discipline, but I think that the way that Ozempic works is such a clear indication that so much about the way our bodies manage our weight is out of our control.

Brian Lehrer: Let's take a phone call. Willa in Sleepy Hollow, you're on WNYC. Hi, Willa.

Willa: Hi. Can you hear me?

Brian Lehrer: Yes.

Willa: I just wanted to say that I've been struggling with anorexia for about 10 years. I'm in recovery now but I have a lot of thoughts on this topic. I think the positives are like your guest was saying that there is this whole diligent discipline and control mindset that goes into weight. That's been really damaging for me. I have mixed feelings about it but I am curious to see how Ozempic changes that whole mindset because I think it does need to be challenged.

I'll also say that the fact that it's becoming a trend and that it's being used mostly by people like the Kardashians and celebrities and people who don't necessarily need it and is changing the whole like, "Do we like curves or do we like thinness now ?" Changing that whole beauty standard it's pretty triggering.

Brian Lehrer: Jia, you want to talk to Willa who's being triggered by--

Jia Tolentino: Yes. Willa, I am glad to hear that you've been in recovery. That's a word that I heard from so many of my friends. My cohort, I'm in my mid-30s, we grew up as adolescents in the early 2000s when this diet culture was at a particular really pathological peak and disorder and everything was pretty normalized. It does feel like all of that is coming back through the celebrity use case and the socialite use case. I think it's incredibly harmful. I think that a lot of people-- Brian, I don't know if you've seen the Ozempic ads that are all over the subways.

There's this company called Ro that is advertising a quick weight loss shot. They're presenting it under the guise of last decade's vocabulary of wellness and self-care when, in fact, it harkens back to language and practices that are extremely harmful and triggering to many people. I think that it's something that I think is incredibly worrying and incredibly pervasive that people who are heavier, even people who are normal weight will be encouraged to lose weight, have been and will be encouraged to lose weight "for their health" when, in fact, the actual reason is a cultural fear of fat or of any "excess weight" whatsoever.

I think that a lot of people will be urged towards or nudged onto these drugs because of cultural reasons that will masquerade as the old medical excuse that if you have any, again, "excess weight" whatsoever, you must be unhealthy and you should do whatever possible to lose it. That is an attitude that we know is incredibly harmful psychologically and medically. The way that these medications are not just being used widely by celebrities and other wealthy thin people it's the fact that we're already seeing this influx of wellnessy messaging around this medication. It's extremely worrying.

Willa: Can I say one more thing about that?

Brian Lehrer: Please.

Jia Tolentino: Please.

Willa: I think that also part of it is the discomfort of the drug. I heard I think you were on the New Yorker Radio Hour about this but how it makes people. I think that it would distort people's relationship with food which is, in a way, more damaging than being overweight. In a way, I feel like a big problem is that Americans and the diet culture we just struggle a lot with our relationship with food. A new drug that would make us more full and easily sick would make food pretty scary and just not as enjoyable. That just makes me sad because obviously [inaudible 00:13:57] simple joys of life and how we share culture, especially in New York, there's so many different kinds of foods. I don't know. Yes, I think that-- [crosstalk]

Brian Lehrer: Thanks for your thoughtful call, Willa, keep calling us.

Jia Tolentino: On Willa's last point if I could just add.

Brian Lehrer: Yes, please.

Jia Tolentino: That's something that hasn't come up yet. It does strike me like we pathologized appetite but we are human. Our appetite is what makes us human, our desire for food and for pleasure. If we can have a healthy relationship with that desire, appetite is worth preserving. This is where the two ends of the spectrum get complicated because there are some people who are able to experience a healthy relationship to their appetite for the first time through drugs like this because their metabolic processes have gotten out of whack but for the use case of thin people who want to be thinner, many of whom talked to me while I was writing this piece I would always say it's not worth having food make you sick.

Brian Lehrer: You question the assumptions that people make now about the relationship between weight and disease. I'm just going to read one part of one paragraph from your article so people can hear it. "Generally, the body mass index implies a precise weight-to-health correlation that does not actually exist. A recent study examined subjects' BMIs in relation to their blood pressure, cholesterol levels, and insulin resistance, nearly a third of people with a 'normal BMI' had unhealthy metabolic metrics, and nearly half of those who were technically overweight were metabolically healthy. About a quarter of those who were classified as obese were healthy too."

That blows up so much of what people assume about the risks of diabetes in particular as well as heart disease from having a certain weight or a certain weight in relation to your height.

Jia Tolentino: Yes. I don't want to make a [unintelligible 00:16:13] comparison here. There are other activities like people who are cigarette smokers, we know that's unhealthy, that has a much cleaner correlation with shorter lifespan and risks of certain diseases. We don't treat people who smoke the same way that we treat fat people. Doctors don't condescend to and misinterpret and mistrust smokers even in the same way that they do fat people.

As you were saying, that study which shows that plenty of thin people are metabolically unhealthy, plenty of overweight people and obese people are metabolically healthy, it's another thing that I think the existence of Ozempic points to is that we think thinness is something achieved through health and order and fatness is something that is slid into through the lack of health and disorder in some way. Ozempic is a reminder that thinness itself is not healthy always, and it's not always achieved through healthy ways. An overweight person on the train could be much healthier than the skinny person sitting right next to them.

That fact which was talked about more in the last decade than it ever has been it's at risk of being swallowed again by this fixation on thinness that Ozempic is allowing to facilitate, but at the same time, there's something that I heard from people who are on the drug who were actually experiencing medical complications related to weight and high blood sugar, and who themselves might face stigma from people saying like, "You're taking this drug, you're cheating. You're getting this injection, you're losing weight, that's cheating." That I think is also flawed too. That's also harmful and indicative of these harmful ways of thinking about goodness in that.

Brian Lehrer: Listener tweets. Julio on Twitter writes, "I was on Ozempic for two years on supervision with my weight management doctor, changed my life. Was able to start exercising regularly. Now with the fad, my insurance has declined coverage and I can no longer afford it. This has real-life effects. That's a whole other wrinkle.

Jia Tolentino: Yes. This is the kind of use case that is not talked about so much because people are always understandably talking about people like the Kardashians who are the most prominent. I don't want to say that they're the users of this drug. I don't know what they're taking or not taking, but the discourse tends to center around celebrities whereas I actually think the vast majority of people who are taking these drugs are people who are like your listener on Twitter here for whom these drugs have been an incredible tool to health, that have gotten metabolic function in line and allowed people to run around on the playground after their kids and do things that were inaccessible to them by no fault of their own right.

People who may have been eating perfectly healthy before and their bodies just continued to put on weight. There have been enormous shortages both Ozempic and Wegovy are on the FDA shortage list. These drugs are incredibly expensive out of pocket. In the United States, they can be over four figures per month. As such, insurance companies are always trying to kick people off of it and employers don't love to cover these drugs for their employees. Yes, there are medical consequences to taking these drugs and suddenly not being able to. There are risks to your organ function. The way your blood sugar levels are being regulated. It's the fad aspect of the drug is harmful in this way too.

Brian Lehrer: Karen in Edison, you're on WNYC. Hi, Karen.

Karen: Hi. This is a longtime listener, second-time caller. I'm 58, diabetic. My blood sugars were getting high, my A1C was high, so my doctor tried me on Ozempic and it worked. As I was titrating up, the first week I was fine, and the second week I was a little seasick, and the third week I felt like I was on a ship in a storm. The fourth week I could eat bananas, rice and mint tea were the only things I could keep down.

I did lose weight, [laughs] but I was really glad to hear your guests say that this is an eating disorder in a pen. If your body won't tolerate it, it doesn't matter how badly you need it. [laughs] She tried me on Trulicity and I had the same result. Here I am struggling with managing it with the old-fashioned way. [laughs]

Brian Lehrer: You said you lost weight, did you also return to a more normal A1C or glucose level?

Karen: It did bring my A1C and my glucose level down, and then as your guest mentioned, when I had to go off it, it shot right back up again. It's been a bit of a battle. We're getting there, we're making progress, and actually, there's a combo now of insulin and one of these GLP-1 things. It's shorter acting. It's a daily and it's shorter acting, and I'm tolerating that and it's working, so there's hope. I want to second also what I heard Willa say about the food being a connector, and especially around the holidays to be coming up on a holiday, and literally have your stomach turn over at the -- there was a point where I couldn't even think about food, let alone smell it.

Brian Lehrer: Karen, thank you.

Karen: I spent whole days curled up in the fetal position. [laughs]

Brian Lehrer: Karen, thank you for your story. We have other people calling to talk about side effects when they've been on it, other people calling to say how wonderful it was for them, and we're running out of time. I guess really the bottom line is we haven't figured out as a society, and I guess especially for women, what to think about our own bodies and finding how much is medically necessary in terms of controlling weight for the potential for disease, versus how much is social stigma and being reinforced by this kind of thing. A last thought, Jia?

Jia Tolentino: Yes. I think it will be a long time before any of these extremely complicated knots are untangled for any individual person who's dealing with it. In my most -- I'm not entirely optimistic about the GLP-1 phenomenon. As Karen was saying, though, hopefully there would be versions of these drugs that would allow people to lower their A1C, lose weight if they needed to, that would not come with only needing to eat bananas and rice for four weeks and hiding in the bathroom and drug thanksgiving because everything so nauseating.

One would hope that in an ideal version of this, these drugs are tools towards health and not towards the pathological fixation with thinness. However, the paradoxical and complex nature of the way that we think about weight in this country means that the obesogenic nature of life in America will always be coupled with a really pathological fat phobia and fixation with thinness. I think it's good that we're just hopefully continuing to talk about the complexity of this, and if we can do so, maybe we'll all be in the process of untangling all of it together.

Brian Lehrer: Jia Tolentino, who always does such a great job tackling complexity in The New Yorker, her latest article is called Will the Ozempic Era Change How We Think About Being Fat and Being Thin? Thanks a lot, Jia.

Jia Tolentino: Thanks, Brian.

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