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The one thing Ozempic still can’t fix

Americans still have a toxic relationship with weight. It’s hurting GLP-1 users.

GLP-1 drugs promised to usher in a new era of treating obesity as a disease. We could leave behind the anti-fat biases of the past, which blamed obesity on moral failing or personal weakness. Instead, these drugs would allow us to approach it as a medical condition, a complex matrix of genetics and other forces which could be changed with the right dose of these powerful new medicines.

Or so the thinking went.

While the clinical potential of these drugs remains immense, they have yet to change how the broader US culture perceives and engages with weight and weight loss. Even as millions of Americans shed pounds in bulk for the first time, they are also contending with fierce stigma and shaming from others — instead of being criticized for being fat, they are being criticized for using GLP-1s.

The social media communities that have blossomed around GLP-1s are filled with tales of awkward conversations and much worse. Partners who berate a significant other who wants to go on Wegovy or Zepbound. Coworkers who blame the drugs for their rising insurance costs. Even dismissive and unsympathetic doctors and nurses.

Some people who take GLP-1s must contend with an uneasy sense of living behind enemy lines: Many people describe being at work or out in public and overhearing people talking about GLP-1s and passing judgment on people who they think are taking a “shortcut” to lose weight.

“It’s like you’re being stigmatized without the person who’s [saying] it even realizing it, necessarily,” said Adriana, a 33-year-old GLP-1 user who lives in the Chicago area. (Vox agreed to identify the people we spoke to by their first name, to protect their privacy when discussing stigma.)

“There’s a lot of internalized stigma and judgment we have from the culture about our bodies and ourselves.”

This is not just evident from anecdotes. Researchers have put the question to the test. And they have found that Americans not only feel more negative stigma toward somebody who lost weight with a GLP-1 than somebody who lost weight through diet and exercise — they also feel more negatively about the GLP-1 user than somebody who never lost weight at all.

“It seems like people are really reacting negatively to the idea that somebody who has lost weight with a GLP-1 might be, quote-unquote, ‘taking the easy way out’ or cheating the system,” said Erin Standen, a psychology professor who studies health and behavior change at Rice University and led one such study. “There’s a lot of internalized stigma and judgment we have from the culture about our bodies and ourselves.”

Americans have internalized the message that being overweight is a personal failure so thoroughly that, now that the kind of extraordinarily powerful weight-loss shots and pills long hoped for are here, many people struggle to see it as good news. They see it as cheating.

GLP-users feel damned if they do, damned if they don’t

GLP-1 users have found themselves in a trap. They’ve felt judged for years for their bodies: Studies have found that up to 42 percent of adults with obesity have experienced some kind of weight discrimination; and between 40 and 50 percent have internalized weight bias. One survey from this year found that 81 percent of people taking GLP-1s said that they had felt social pressure to be thin, and more than half said that those attitudes influenced their decision to take one of the new weight-loss drugs.

And yet, now that they’re cutting weight, they’re being judged for how they lose it. In the same survey, 69 percent of GLP-1 users said other people saw the drugs as a cheat code, 23 percent said that it was hard to handle other people’s feelings about the meds, and 43 percent said that they didn’t like talking about their GLP-1 use for fear of judgment.

“Culturally we have a widespread belief that weight isn’t complex — it’s simply energy in versus energy out,” Susan Persky, a behavioral scientist........

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