Today, Explained - What Ozempic can't fix

Episode Date: February 26, 2024

Fat women make less money than thin women and get fewer raises and promotions. It’s going to take more than a wonder drug to fix fatphobia in America. This episode was produced by Victoria Chamberlin, edited by Jolie Myers, fact-checked by Anouck Dussaud and Laura Bullard, engineered by Patrick Boyd, and hosted by Noel King. Transcript at vox.com/todayexplained Support Today, Explained by making a financial contribution to Vox! bit.ly/givepodcasts Learn more about your ad choices. Visit podcastchoices.com/adchoices

On Friday's show, we talked about the economic potential of the drugs Ozempic and Wagovi. The biggest problem right now for No Nordisk is producing enough. They cannot meet demand. Some of you told us to calm down. I really appreciated the listener who wrote to me saying, Ozempic can cut a percentage of body weight, but it's not the end of obesity. Heard, chef. Many people who've lost weight on these drugs are thrilled. I'm 5'7". I'm 28. As of today, I am 198.8 pounds. I couldn't be happier.

I'll go like seven hours and I won't even think about food. And it's magical. But there isn't a single responsible medical professional claiming this is an end to overweight and obesity. And what's more, this is supposed to be the age of body positivity, fat acceptance, loving the skin you're in. Haven't we moved on? Coming up on Today Explained, we really have not, but maybe we could. Oh, oh, oh, oh, oh, oh, oh. Simple. It's Today Explained. I'm Noelle King. Alice Fullwood covers Wall Street for leading magazine The Economist.

Weight and weight loss are often the province of magazines like Glamour and Cosmo. But about a year ago, Alice wrote a piece called The Economics of Thinness that would end up becoming, by far, she says, the most red thing she'd ever written. It was about the very real economic penalties that women face for not being thin. For most of my life, as long as I can remember, I have felt like there is this sort of pressure or this idea that the sort of right way to be, the right sort of way to look is to be thin. Here's how I went from thick to thin in six months. You want to keep the focus on vertical lines. Here's my easy breezy diet routine. It's how I stay thin with minimal effort. It seems to be sort of all around us in the ether a lot of the time. And it's one of those things that I had sort of taken almost as a sort of given. And one day I was sort of at home working. And actually, my husband called me into his office

to show me a chart that he was looking at, which was on the CDC website, and it plotted BMI against income. And all over the world, there is a sort of negative relationship between BMI and income so the richer you are the thinner people tend to be and what was really striking about this chart is that they'd broken out that line into men and women and for men there actually was no correlation at all this sort of line was was almost completely flat but for women the line sloped very sharply downwards. And I sort of in that moment had this realization that, you know, there's this sort of pressure that women feel this sort of, you know, the vibes in the ether, I guess. It's not just, you know, vanity or magazines. Actually, you know, perhaps there's this really powerful economic incentive that being thin as a woman

helps you to become rich in a way that it maybe doesn't for men. Do you think that women are aware of this on some level? Yeah, I think this is a sort of great point because I, it's obviously, you know, sort of a chicken and egg situation. Well, sort of why do beauty standards exist and why are they potentially enforced by the market? And I think there sort of is an beauty standards exist and why are they potentially enforced by the market? And I think there sort of is an underlying awareness. There is a sense that people that do well on TikTok and social media, they tend to be thin and attractive people who do well in the workplace. But I also think there is sort of an element of you either don't sort of fully recognize or in some ways potentially sort of self-deceive. You

know, a lot of the time when you talk to women about whether they want to be thin or whether they want to look a certain way, people say that they're sort of trying to lose weight for sort of wellness and health. The daily habits of thin people. If you are solely focused on thinness, losing weight and being skinny, you're not going to be successful in the long term. As I always say, when you focus on health, you lose weight as a side effect. But when you focus on weight loss, you lose health as a side effect. I was thinking about how my friends and I, when we're talking about like expensive Pilates classes, we'll refer to it as like, it's an investment in me. And it's

not like we're following that down the rabbit hole and being like, and next year I'm going to get paid more. But there is the language of economics when we're talking about like, oh And it's not like we're following that down the rabbit hole and being like, and next year I'm going to get paid more. But there is the language of economics when we're talking about like, oh, it's expensive, it's 50 bucks, but I'm going to do it. It is interesting. I did start to think about it in that sort of, you know, okay, you're almost making like a capital investment in yourself that will pay dividends and you don't really know sort of when or sort of what those might be. But I think sort of in general, this way of thinking about the issue actually sort of makes a lot of sense. All right. So you saw this chart and you decided to report on whether there is an economic penalty for not being thin. Where did you start?

I mean, the first thing I did was I went off and I sort of looked to see whether this was true in other countries. This sort of trend seems to hold in wealthy, developed countries. It's very different in developing countries, but it seems to hold sort of across the Western world. And then I started thinking about sort of the reasons that people often think that there might be this sort of negative relationship between weight and income, because that was not a new piece of information. So that's something that I think a lot of people are aware of. The sort of novel thing was that it only seems to hold true for women. And from that sort of point, I felt like a lot of the explanations people had sort of come up with in the past for why there might be a negative relationship between income and weight. You know, they didn't tell the whole story. So often they were things like, you know, if you live in poverty, it's very difficult to carve out time to go to the gym. It's sometimes you don't have access to sort of fresh fruits and vegetables. It's sort of difficult to eat well.

And I think all of those things are true, but they can't be the sort of main reason for this correlation because they would hold true sort of equally for men and women. So there sort of has to be something else going on here. And then I sort of started reading a lot of the academic literature on, you know, in the workplace, if you look at women's wages and you sort of control for things like their degrees that they've taken, so bachelor's, master's, doctoral degrees, if you control for the types of jobs they do, all these kinds of things, is there still a sort of wage penalty for BMI or weight? And a lot of the literature does sort of back that up. There does seem to be a penalty for overweight women, particularly highly educated overweight

women in the workplace. When we talk about, for example, like the gender wage gap, we can say, oh, for every dollar that a man earns, a woman might be earning somewhere between 60 and 80 cents. And those stats get like pretty firmly entrenched over time. Were you able to figure out if thin women make more money over time than women in bigger bodies? Could you tell us how much more money we're talking about or what that adds up to? Yeah, I didn't actually come up with a sort of neat, as neat a stat as the sort of like 80 cents on the dollar. Very hard. But the figure that I put in the piece, at least, was that for an overweight or obese woman, so someone with a BMI of above 30,

it is roughly as beneficial for her to lose 50, 60 pounds in weight to get her BMI back into that normal range as it would be to do an additional year of education. So about sort of half as valuable as getting a master's degree. Wow. That seems to be the magnitude of the penalty. And what you're saying is the same does not seem to hold true for men. I think we have to be a sort of bit careful about that because there are papers that say that sort of, especially for sort of very, very overweight men, there are penalties in the workplace. I'm

sort of willing to believe that sort of men are discriminated against especially if they're sort of very overweight as well but I think that the distinguishing thing for me about how this seems to affect women is that it seems to be sort of very pervasive across all kinds of careers at every level of income the relationship is so strong that it shows up at this macro level, that you can sort of look at this chart of sort of generalized population of women, and you can still see this sort of very strong relationship. So I wonder what you think about taking Ozempic or Wegovy or another weight loss drug. It is very expensive, for sure. But what do you think about that as a rational choice, an economically rational choice?

In terms of sort of whether or not it's rational to take Ozempek, I mean, it is very expensive at the moment. I do think, given sort of where, at least sort of given the evidence I've seen on where the sort of relationship lies at the moment, it does seem like that would also be sort of a rational choice under the sort of framework that we have described. So yes, although it is very expensive, and I guess you might have to look sort of more granularly at a personal level of sort of what you think the sort of payoff will be versus the cost. Alice Fullwood of leading magazine The Economist coming up fat phobia and fat acceptance in the age of Ozempic.

Support for today explained comes from Aura. Aura believes that sharing pictures is a great way to keep up with family, and Aura says it's never been easier thanks to their digital picture frames. They were named the number one digital photo frame by Wirecutter. Aura frames make it easy to share unlimited photos and videos directly from your phone to the frame. When you give an Aura frame as a gift, you can personalize it, you can preload it with a thoughtful message, maybe your favorite photos. Our colleague Andrew tried an AuraFrame for himself.

So setup was super simple. In my case, we were celebrating my grandmother's birthday and she's very fortunate. She's got 10 grandkids. And so we wanted to surprise her with the AuraFrame. And because she's a little bit older, it was just easier for us to source all the images together and have them uploaded to the frame itself. And because we're all connected over text message, it was just so easy to send a link to everybody. You can save on the perfect gift by visiting AuraFrames.com to get $35 off Aura's best-selling Carvermat frames with promo code EXPLAINED at checkout.

That's A-U-R-A-Frames.com, promo code EXPLAINED. This deal is exclusive to listeners and available just in time for the holidays. Terms and conditions do apply. BetMGM, authorized gaming partner of the NBA, has your back all season long. From tip-off to the final buzzer, you're always taken care of with a sportsbook born in Vegas. That's a feeling you can only get with BetMGM. And no matter your team, your favorite player, or your style, there's something every NBA fan will love about BetMGM. Download the app today and discover why BetMGM is your basketball

home for the season. Raise your game to the next level this year with BetMGM, a sportsbook worth a slam dunk and authorized gaming partner of the NBA. BetMGM.com for terms and conditions. Must be 19 years of age or older to wager. Ontario only.

Please play responsibly. If you have any questions or concerns about your gambling or someone close to you, please contact Connex Ontario at 1-866-531-2600 to speak to an advisor free of charge. BetMGM operates pursuant to an operating agreement with iGaming Ontario.

Support for this show comes from the ACLU. The ACLU knows exactly what threats a second Donald Trump term presents. And they are ready with a battle-tested playbook. The ACLU took legal action against the first Trump administration 434 times. And they will do it again to protect immigrants' rights, defend reproductive freedom, fight discrimination, and fight for all of our fundamental rights and freedoms. This Giving Tuesday, you can support the ACLU. With your help, they can stop the extreme Project 2025 agenda. Join the ACLU at aclu.org today. Today, today explained.

I'm Kate Mann, and I'm an associate professor at the Sage School of Philosophy at Cornell University, and I'm also a writer. Kate's first book was about misogyny. Her new book is called Unshrinking, How to Face Fat Phobia. You will perhaps not be shocked to hear that she believes the two are related. So during my final two years of high school, I entered an all boys school, the year it integrated in Australia, as one of three girls. Oh, I know. It was really a rude introduction to the subject of misogyny. And it meant that for me as a then chubby teen, I really encountered an enormous amount of fat phobia, which was the way misogyny manifested itself. I was called a fat bitch. I had that scrawled on my locker as well, which was doused with fish oil to be the

kind of ultimate expression of misogynistic disgust towards a female body. And I ended up being voted the person most likely to have to pay for sex at the final. Oh my God. The high school leaders assembly. What a horrible place. Okay. So the idea I think generally for most of us is, okay, when you're a teenage girl, boys are terrible and then everybody grows up and they grow out of this. Is that what you found happening? So things suddenly got better for me personally, and I was relieved to find that what I had encountered in those forms of bullying and cruelty was usually not nearly as explicit when it came to ways I was treated as a fat adult,

but it was still there. And certainly my research into this backed this up, that fat phobia in particular isn't really getting better. It's actually on the rise, according to some measures. Right now, there's a big body positivity movement underway. It definitely seems to have reached the mainstream. There are podcasts like Maintenance Phase, which is very, very popular. Guys, it's great over here. It is like genuinely so phenomenal. Whatever your size is, to get right with the body that you have is the body that you have. Why don't you take care of it? Companies will have plus size models. Fashion brands, fashion labels will have plus-size models. It definitely seems,

if you're looking for evidence that things are getting better, I feel like you can definitely look around and be like, oh yeah, I see it everywhere. Things are getting better. You're saying data doesn't necessarily show that. What data are you looking at? What are you finding? Yeah. So Harvard researchers in 2019 published a really interesting study showing that when it came to prejudice and bias across various categories, they looked at race, skin tone, disability, age, sexuality, and weight. And they found that anti-fatness, so weight bias, was the only form of implicit bias that was actually increasing. And it was also the form of explicit bias that was decreasing the most slowly. So one possibility is that we've seen more body positivity and more representation, but also pretty bad backlash to those progressive social movements. We know beauty standards. We know what's attractive and what's not attractive. It's not that phobic to have a preference. It's not that phobic to

not be attracted to overweight people. You're not allowed to like yourself if you're thin, and God forbid you wear a bikini and say you're proud of your body when you're thin, then you get routinely attacked. And at the same time, it's sending a signal to other women that they shouldn't want to better themselves. So I think it has a number of manifestations and that makes it something systemic that occurs across different sectors of life. So it happens in education. It means that fat children are more likely to be bullied in school. It's probably the most common basis for childhood bullying, according to the research I've seen. It's also something where teachers harbor negative stereotypes about fat students, holding that they're less able and less gifted as they gain weight, even though their

test scores, objective measures of achievement haven't changed. It's something that we see in employment. And finally, we see huge gaps in terms of the treatment patients get within the healthcare system. So fat patients are subject to a number of really pernicious stereotypes. We're seen as lazy, non-compliant, weak-willed, having done this to ourselves. And doctors tend to blame any and every symptom that we come to seek treatment for on our weight rather than looking at the true cause of those symptoms. It was very scary to sort of exist in a body that I thought was failing me and have medical professionals who didn't seem to take me seriously. So there was another really interesting and telling study of physicians

that showed that physicians don't just harbor implicit bias against fat patients, they harbor explicit bias. They will say that they are less willing to help fat patients, that they regard fat patients as more of a waste of their time, and that fat patients are more likely to annoy them. There's a knee-jerk reaction I've seen to almost everything that you just laid out. And the knee-jerk reaction is, there are now drugs that can fix this. What was your first reaction when you started reading that there is a class of drugs

that really seem to be helping people lose weight? So I want to be clear that I'm not against these drugs in any blanket way. But when it comes to weight loss, I do worry that these drugs are getting a bit overhyped for a bunch of reasons. One is just in terms of the math of it. So these drugs do have a greater effect, at least in the short term, than diet and exercise, which tends to take between 5% and 10% of people's weight off, and then the weight comes back really inexorably. Whereas these drugs look like they lead to an average of about 15% weight, according to pretty optimistic estimates under

pretty ideal conditions with a pretty select group of patients. So it's more than diet and exercise, but it's not vastly more. And it does look like the weight comes back again, really inexorably following discontinuation. What is it that we're actually thinking when we're thinking, oh, Ozempic is the solution to everything? who are in that high weight category do want to lose weight and I don't want to be dismissive of that desire and it's being based in something real which is I think mostly fat phobia but there are also a lot of us who are happy with our bodies the way they are and the expressive potential of having this message around that says you really need to change your body because now we can, and why wouldn't you want to change? It doesn't just feel insulting. Sometimes it can feel like

we're not really welcome in the world anymore, that people just look at our bodies and wonder why we haven't availed ourselves of a solution to what for many of us seems like a bodily non-problem in simply having more flesh in our bones. And it's not as though, I mean, if we're talking about the U.S. today, it's not as though when we talk about people in bigger bodies that we're talking about this tiny, tiny, tiny minority. No. We're talking about many, many, many people. It's between two-thirds and three-quarters of Americans. Upwards of 70% of Americans are either overweight or obese, according to the BMI charts, which are super problematic. But, it drives a sense that we're a crisis, we're a problem, we need to be fixed or else, in ways that don't always track the epidemiological

evidence that suggests that people in the quote-unquote overweight categories aren't at greater health risks in terms of all-cause mortality than their so-called average weight counterparts. I want to draw kind of a crude comparison here, but bias or prejudice against minorities is a thing that happens. You encounter people who are different, who are not like you, and your back goes up and you think there's something wrong with them. And then more of those people move in. And then a couple of years down the line, the biases seem to go away.

Like in polite society, we don't stare cross-eyed at people in interracial marriages, for example, because we're used to this now, right? Like America is this constantly changing society. And yes, we still do have racism and biases. But there are, I think there are theories that if you interact with people more, you become less likely to be prejudiced against them. Why do you think that is not happening with people in bigger bodies? What you've just laid out is a very good summary of what's called the contact hypothesis, that contact with members of marginalized groups will have this effect of diminishing prejudice. And I think, in fact, the empirical evidence suggests that the contact hypothesis is not especially reliable for any form

of marginalization. But when it comes to fatness in particular, I think it doesn't work for a couple of additional reasons too, which is that a lot of fat people ourselves feel like there's a thin person waiting to come out triumphantly, like after the next diet or exercise plan or, you know, set of ozempic shots or whatever it is, that we're really not fat people deep down, that somehow the thin person is going to emerge victorious. And so we don't really identify as fat people and lobby for political change and momentum. We don't demand thin allies stand up for bodies means that we don't always get the political Like, do you think possibly there's's a simpler way to cut through this? So I think we're certainly worried about this drug for some of the wrong reasons. So one point that that article made that I did like is, look, why should we insist that people do this the hard way when for many people losing weight through diet and

exercise is not just hard but nigh on impossible. Easier is actually better. It's just a fallacy to think that harder is better. I call this the harder better fallacy in my work. It's very American. Yeah. If it's harder, that's actually worse, all else being equal. So that particular story featured a patient of that physician who had a lot going on. She was unhoused. She was a wheelchair user. She was a type 2 diabetic. And she was put on Ozempic and she'd lost 10 pounds over a month.

Why was the focus on her weight loss rather than the things that this woman obviously needed in her life, like access to fresh foods and reliable health care and a home. She needed housing. And yet the idea was, let's celebrate. Ozempic is such a good thing because she lost 10 pounds. I'm just not sure this relentless focus on weight would do such a patient many favors. That was philosopher Kate Mann. Her new book is called Unshrinking.

Victoria Chamberlain produced today's episode. Jolie Myers edited. Anouk Douceau and Laura Bullard fact-checked. And Patrick Boyd engineered. I'm Noelle King. It's Today Explained. episode, Jolie Myers edited, Anouk Douceau and Laura Bullard fact-checked, and Patrick Boyd engineered. I'm Noelle King. It's Today Explained.