The Decibel - Ozempic's effect on the body positivity movement

Episode Date: July 20, 2023

Ozempic and other medications for type-2 diabetes have shown to be effective treatments for obesity. But this discovery has led to many people, who do not medically need the drug, using it for vanity reasons.Not only has this led to supply shortages and concern around less discussed long-term effects, but it’s also changing the way we talk about body image and the body positivity movement.Dr. Sarah Nutter, Assistant Professor in Counseling Psychology at the University of Victoria, whose primary research is on weight stigma, explains how this may be harmful in the chase of a so-called ‘ideal’ body and how we treat our bodies as trends.Questions? Comments? Ideas? Email us at [e-mail]

These past few months, we've been hearing a lot about Ozempic. Drinking Ozempic every day, it's not working. I take Ozempic. Yeah, how's it going? Good, I'm down 35 pounds. Did you forget to eat? Yeah. So I'm going to fix my Ozempic face using filler and Botox.

As a lot of you know, I've lost over 100 pounds using Ozempic or semi-glutide injections. Kardashian started taking Ozempic. Supposedly. She started taking Ozemp Ozempic don't really need it. For a few years, there was lots of talk about finding ways to feel good in your body, no matter your shape or size. But now, Ozempic, and other drugs like it, are reinforcing the idea that losing weight is inherently good, even if it's at the expense of your health. Today, we're speaking with Dr. Sarah Nutter. She's an assistant professor in counseling psychology at the University of Victoria, and her main research is on weight stigma and body image. Dr. Nutter will tell us how Ozempic has impacted the body positivity movement and what happens when we treat our bodies like trends. I'm Mainika Raman-Wilms, and this is The Decibel from The Globe and Mail.

Dr. Nutter, thank you so much for being here today. Yeah, thanks so much for inviting me. So excited to be here. So I really want to hear your perspective on this because we've been hearing a ton about these weight loss drugs in the last few months. But as someone who studies weight stigmas like yourself, what's going through your mind when you're hearing all of this? What is on my mind most is how drugs like this are going to or might be reinforcing what body image and weight stigma researchers and activists call diet culture. And I'm happy to define what I mean when I say diet culture, if that's helpful. Yeah. Yeah. What do you mean when you say that?

So the word diet culture can mean different things to different people, but is essentially used to refer to how common it is to be dissatisfied with our bodies in our culture and to engage in dieting behaviors for the purpose of weight loss. Right. Okay. And I think we should maybe also define, we're talking about weight loss drugs, but maybe we should define a little bit in general terms how these medications actually work. So when we're talking about things like Ozempic, also known as Wagovi, how do they actually work in the body? So that drug specifically is a GLP-1 receptor agonist, which is a fancy way of saying that it mimics the body's GLP-1 hormone.

And that is a hormone that's released in response to eating. So when these medications are given at lower doses, it can help the body produce more insulin and perhaps help the liver suppress the amount of glucose that's produced. So really, it started about 10 or 15 years ago as a treatment for type 2 diabetes. But when given at higher doses, these GLP-1 receptor agonists trick your body into making you feel full. So you feel less hungry and therefore you eat less. And that's what people are excited about. So with approvals for the use of this drug for medically supervised weight loss, we're seeing this drug be used for a weight loss purpose by anyone and everyone. And this idea of not feeling hungry and being able to lose weight sounds really appealing to a lot of people.

And that's what I'm worried about. So Sarah, let me let me ask you, I guess, how this relates to your work that focuses on the body positivity movement as well. Because I think a lot of people are fairly familiar with that term. But but how would you describe what body positivity actually is? I think body positivity is like diet culture defined by different people in different ways. And I see it as a movement that has emerged and gained popularity as a response to the ways in which traditional media and advertising has spread the messaging of diet culture. So body positivity then pushes back. It's a movement that pushes back against these messages of what an ideal body should look like and challenges these,

you know, beauty standards as unrealistic. And when you say ideal body, I mean, the crazy thing about that, too, is it is often changing, right? Like this is not necessarily a set thing. It's always it's kind of a trend if we if we can put it in that term. still thinness over the last maybe, you know, 10, 15 years or so, but with selective areas of the body being allowed to be bigger. So we think, you know, the chest, the hips, the butt, these were okay to be bigger. It was part of this more thin but hourglass ideal. And this ideal is completely unrealistic and really only achieved through cosmetic surgery and other such interventions. And we're seeing a trend back to something that looks more like what we were seeing in the 1990s. But I think no matter what, body ideals in our culture focus on thinness,

but that thinness is just packaged in different ways. That's interesting. Yeah. From what you've seen, Sarah, like how would how would you describe the general popularity of these drugs like Ozempic? How are these impacting the body positivity movement? Yeah, so I think the excitement around these drugs has been focused almost exclusively on weight loss. And I think that's potentially really problematic for body positivity movements. So I know that there potentially really problematic for body positivity movements. So I know that there are people who are trying to have conversations about the potential health

benefits of these medications, but I'm unaware of any discussion about potential health benefits that doesn't also center weight loss in some way. And for me, it's this focus on celebrating weight loss that I think is potentially problematic and can reinforce the idea that people need to lose weight or need to be a certain body weight in order to be healthy or in order to be attractive. And I think this intentionally or unintentionally can reinforce the central message of diet culture about what health looks like. And especially when high profile people like celebrities and fitness influencers are using the drug. Yeah, I think that's an interesting point. I do want to push back on one point you're talking about, though, because we've been talking about

the negative effects of this discussion around weight loss. A lot of people are saying, you know what, a Zempik is the one thing that has worked for me. I've struggled losing weight, and this is actually something that has really helped me in this way. So there must be positive aspects to this, too. Oh, yeah. Well, you know, I'm not going to tell somebody that they shouldn't feel excited about the impact of this medication for them. What I am critical of as a researcher is, you know, why do we need weight loss in order to feel good about ourselves? Why do we need to use a medication that potentially we might not need from a cardiometabolic health perspective. And I think, you know, if this is

something that somebody has been, you know, medically approved for, for a health condition that is ongoing, that they're struggling with, and they're engaging in a treatment that they find helpful, and that, you know, demonstrates a health benefit to them. And when I say health, I don't mean weight, then absolutely, I'm not going to discourage anybody from engaging in a medical treatment that is going to benefit them. I guess where I'm critical and where I make sure I talk about diet culture is that for a lot of people, that's not the case. That's not why they're so excited about these drugs. Yeah, fair point. So let's maybe focus on this segment of people who are using it then. These drugs are not without side effects, right? There are some consequences potentially to taking these. So can we just touch on some of the side effects to taking something like Ozempic? Intestinal distress, dizziness, fatigue, headaches, all of those sound unpleasant enough, especially if they're ongoing for weeks or months at a time.

There's other potentially more serious consequences such as thyroid tumors, thyroid cancer, gallbladder disease, pancreatitis, kidney damage, increased resting heart rate, which if our heart rate increases too much, that can lead to some risk for cardiovascular events like heart attacks, for example, and even vision loss. And although these more serious risks are only for a very small percentage of people, I think it's really worth then thinking, is know, is it is it worth this small risk just to look a certain way? Or are there other health risks that are the tradeoff for me here? And, you know, it hurts me to think of how many people are taking these risks for purely aesthetic reasons. We'll be right back. monthly range. You have to do this every month as well. That's in the U.S. In Canada, it's a little bit cheaper, $250 to $300 per month. Sometimes can be covered insurance, not always though.

But the point is these drugs can be very expensive. So I wonder, does the cost of it create an even bigger divide of the people who can afford this kind of drug and those who can't? I think people who are motivated to use these drugs will find a way. But absolutely, having money and connections has helped people to access these drugs. And I think this is how some celebrities have been able to use this drug for, say, aesthetic purposes while people with type 2 diabetes are struggling to access it as part of their diabetes care. And I find that lack of coverage really interesting. So even though we know that weight isn't an accurate indicator of health, these drugs are referred to as weight loss drugs rather than drugs specific to health conditions and health risks that they aim to treat. And given, you know, diet culture's messaging in

our society that weight is controllable and an individual responsibility, once I start to dig a little deeper, it doesn't really surprise me then that insurance companies don't want to cover these medications for health purposes because it's easier to deny people these benefits and to blame them for having, quote unquote, done this to themselves. And one other thing we should say about something like Ozempic is, you know, generally this is, you're on this for a long time. If you stop taking it, you're likely to gain the weight back. So it's kind of like a decision for life here too, in a way. Yeah. I'd like to talk a little bit about, because we're talking about the cost of these drugs, but can we relate this a little bit to how environment and society plays into weight?

We talk about, you know, food deserts or lack of access to healthy food, how that can contribute as well. Can you speak a little bit about that, Sarah? Yeah, I think some of the factors that we know that contribute to weight relate to what you just said. You know, the food industry, our food environment, as well as, say, our physical activity environment. So absolutely, these are things that contribute to the health of somebody and may also contribute to the body weight that a person has. So socioeconomic status can be really important to consider here, because if somebody is, you know, working multiple part-time jobs, they don't necessarily have the time and or the resources to pay for a gym membership and to go to the gym if they're struggling to make ends meet in other

ways. And in addition to food environment and physical activity environment, we also have to think about our broader culture as well as biological factors. So the physiology of weight is really important to consider. And you said biological factors there. What do you mean by that? So body weight is genetic in nature. So regardless of the impact on, you know, whether or not somebody is healthy, we know that weight is genetic. So there's been specific genes and gene mutations that have been linked to increases in body weight. We also know that certain health conditions are associated with having higher body weights or treatments for certain health conditions. So for example, I'm trained as a psychologist, that's my training

background. And, and a lot of people who come to psychologists for therapy for depression, get really worried about the side effects of antidepressant medications when it comes to body weight. And so, you know, that's a conversation I've had a number of times with clients in therapy. So if we should be focusing, I guess, on health, healthy lifestyle, like I wonder how you define that. How would you define health? I think health is so much more than what we eat and how much we move our body. Those things are important, absolutely. And I think that we need to think about health in a bigger way. So health can be, you know, social and emotional health. So connections to important people in our lives, how we're feeling from a mental health perspective.

When I'm thinking about engaging in healthy behaviors, such as physical activity and nutrition, I'm not thinking about the impact of those behaviors on body weight, but on what's happening internally in my body. And even if somebody has a higher body weight and is experiencing poor health, that shame is never a motivator. And so, you know, helping people to live the healthiest lives they can in an empathic way and in a way that doesn't shame them for their weight, I think is really important. I also want to come back to this idea of treating our bodies like trends. This is often the case, right, when trends are set by celebrities like the Kardashians, for example, right? A lot of people want to look like them. So maybe last year they were getting a

butt lift and now they're on Ozempic. What actually happens though, Sarah, when we approach the shape and the size of our bodies in this way? I think that when we start to approach our bodies in that way, we see our bodies not as our vehicle for life, but as an object for the viewing pleasure of others. And when we view our body as an object, we are motivated to want it to be viewed in a positive way. And we might start comparing our bodies to the bodies of other people and thinking, oh, I don't look like Kim Kardashian, and that makes me feel bad. Or we might start to think about, you know, how our body looks towards other people in the way that we hold our bodies throughout the day, the clothes that we wear, you know, do I do I look okay in this to other people,

the way I'm sitting right now? Do I look okay to other people rather than am I comfortable in the clothes that I'm wearing or in the way that I'm sitting right now? And so I think this objectification is what body image researchers call that. This objectification of our bodies, this comparison of our bodies to other people, really reinforces the idea that we have to look a certain way to be beautiful and can lead us to feel body dissatisfaction. So the idea, I guess, would be some kind of solution, I guess, in some way would be to focus really on yourself and how you're feeling rather than thinking all the time about how other people are thinking of you. Yeah, I think, you know,

it's really important to become more critical of the culture that we live in broadly and of celebrities and influencers and say, you know, the owners of platforms who seek to profit off of body dissatisfaction. These individuals and companies might also be influenced by the messaging of diet culture in our society, but they have a lot of power with their platforms. And rather than thinking about these messages critically and engaging in actions that might reduce the harms of body dissatisfaction and the harms of weight stigma, they are, you know, potentially choosing to engage in behaviors that exploit this body dissatisfaction and weight stigma for their own monetary gain. And so, you know, I question and I feel quite strongly that it's not

about the health and well-being of anybody. It's really about making money by selling this idea that people need to look a certain way. And, you know, we can get some quick fixes that we can sell people that don't actually work. And all of that, I think, is incredibly problematic. It seems like for a while there, though, there was this period of talking about body positivity, right? I mean, there was kind of this trend to be more accepting towards ourselves and to others. But now it seems like with the Ozempic stuff, we've kind of moved in the other direction. So was body positivity just another fad? Oh, goodness, I hope. I hope it's not just a fad. Yeah, I think

that I think it'll be a slow process. I think it has been a slow process. But I've also been studying weight stigma for just over a decade. And since the time that I started as a, you know, new graduate student, I've seen a lot more uptake in these conversations. There's a lot more conversation happening in the media conversations like what we're having right now. And that's really exciting for me. I think there's, you know, a lot more body positivity content that's accessible out there in the world. That said, you know, it's a bit of a tug of war. It's a push and pull. There's tensions in the conversation because diet culture is not going to give up that easily. And so I think that there's still a lot of work to be done. But I have hope for the future.

It's a good place to end. Sarah, thank you so much for taking the time to speak with me. Yeah, thanks so much. That's it for today. I'm Mainika Raman-Wells. Our summer producer is Nagi Nia. Our producers are Madeline White, Cheryl Sutherland, and Rachel Levy-McLaughlin. David Crosby edits the show. Adrienne Chung is our senior producer.

And Angela Pachenza is our executive editor. Thanks so much for listening, and I'll talk to you tomorrow.