The promise of skinny in a world dying to be thin
Does she or doesn't she?
Only her doctor knows for sure.
Have you been noticing that some of your friends and acquaintances are looking slimmer lately? One of my neighbours emerged from winter hibernation with a face that has morphed from round to rawboned. At a recent work-related event, two colleagues speculated on the physical transformation of a third: She's rake," said one. It's got to be Ozempic," said the other.
It's not just women who are using Ozempic as a weight loss drug, but I have no doubt they far outnumber men since we women have been historically obsessed with our weight. I'd also wager that midlife women, for whom packing on post-menopausal pounds is pretty much inevitable, are especially intrigued by Ozempic's potential to help them get back to their more youthful shape.
Women's obsession with weight continues well into older age, too. Just ask Pat Dickinson, a petite 85-year-old retired Hamilton educator who describes herself as chubby" in her youth and who, despite losing 40 pounds decades ago, admits to still being preoccupied with her size. She and her 95-year-old sister will even occasionally compare how much they each weigh. I look at myself in the mirror more than I should," says Dickinson. I don't think it ever ends for women."
She's right. It doesn't. Blame oppressive cultural beauty standards that make women long for an unattainable physical ideal" and internalize the messaging that every inch of their body, from the roots of their hair to the tips of their toes to the end of their lashes, and, most especially, the number on the scale, needs improving. Following fad diets, whether it's Atkins, Keto, South Beach or Ayds Reducing Plan Candy (was anyone else's mom on that one?) has been a fixation since Victorian times when women swallowed tapeworm pills that hatched in their stomachs so they could fit into fashions that demanded a tiny waist.
For every perceived flaw on a woman's body, there's a solution that costs money. There is no Sephora for men. Or Spanx for that matter. Women's insecurities about their appearance make corporations rich.
Drugmaker Novo Nordisk is certainly getting rich because of Ozempic. Its value has doubled in two years to $300 billion. Demand skyrocketed thanks to viral TikTok posts of people showing off their progressive weight loss (the hashtag #Ozempic has 800 million views) and speculation that it's responsible for suddenly slim celebrities, including Kim Kardashian, Mindy Kaling and Adele.
The drug helps people with type 2 diabetes control blood sugar levels and reduce their risk of heart disease, but it's also being used by those who want to lose weight since one of its side effects is fast fat loss. (Novo Nordisk re-released the drug with a specific indication for weight loss under the name Wegovy, but it's not currently available in Canada due to supply issues).
Ozempic is being hailed as a miracle drug and a possible solution to the worldwide diabetes and obesity epidemic. Some 12 million Canadians have diabetes or prediabetes and 17 million are obese or overweight. Both conditions reduce life expectancy and have an elevated risk for heart disease and stroke. A new effective treatment could save the healthcare system billions of dollars and result in happier and healthier lives.
The problem is the people taking it for vanity, not health, and physicians who are prescribing it to patients who may require solutions other than an expensive drug costing hundreds of dollars a month (if you don't have insurance) that must be taken for the rest of your life. (If you stop the drug, you are likely to gain back all the weight, and then some. Plus-size model and influencer Remi Bader, 27, who has more than two million followers on TikTok, says her binge eating worsened after going off the drug and she put on double the pounds she lost.)
Even though Ozempic has not been approved by Health Canada for weight loss, physicians may prescribe it off label," for people interested in its weight loss benefits, resulting in shortages of the medication for people with diabetes.
My friend Jennifer Purdie, a retired bookkeeper in her 60s who has long struggled with her weight, traces her sugar addiction back to childhood when she began to use sweets to self soothe because of a stressful home life. My grandfather left us his coin collection when he died. I was 10 years old the first time I stole a silver dollar to buy candy."
Jennifer had bariatric surgery several years ago and, after putting on weight, went to see her doctor. The first thing he offered was Ozempic." She opted not to take it because of its serious potential side effects, such as thyroid tumours and cancer, and common side effects, including nausea, diarrhea, vomiting, constipation and abdominal pain. I think referring me to a nutritionist or a psychotherapist first would have been better."
Dr. Karen Kumar, a professor of medicine at McMaster University and chief medical officer of Body Brave, Hamilton's eating disorder (ED) program, is concerned about the trend of women like Jennifer increasingly being prescribed weight loss drugs while their possible eating disorders and underlying psychological issues are left untreated.
One million Canadians (mostly women) have an ED diagnosis, the mental illness with the highest mortality rate (between 10-15 per cent of those afflicted will die of the disease). Drugs such as Ozempic can be catnip to someone desperate to lose weight. There is almost no discussion of the dangers of this drug for ED," says Dr. Kumar. Most doctors are not trained in ED and don't screen for it. They might not realize the person in front of them has an ED - you can't tell if someone is unwell just by measuring their weight. If you prescribe Ozempic to someone who has an ED or is prone to one, it is very likely to trigger harmful thoughts and behaviours."
It's also concerning that weight loss drugs have such a long and terrible history when it comes to their safety profiles, dating back to the 1930s when diet pills containing the appetite suppressant amphetamine began to be prescribed with reckless abandon. In 1997, Fen-Phen was withdrawn from the market because it caused heart valve problems. In 2004, dietary supplements containing Ephedra were banned after these products led to deaths. In 2010, after a decade on the market, Merida was pulled because of the risk of heart attack and stroke. As, recently as 2020, another weight loss drug, Belviq, was withdrawn because of its risk for cancer.
Fears about the long-term effects of Ozempic have caused some people, such as another woman I know, who did not want her name used, a 70-year-old Toronto psychotherapist, to stop taking the drug. Her psychiatrist prescribed it after she gained weight from being on antidepressants. She lost 30 pounds in six months but the nausea and acid reflux were too much to stomach - and she realized she didn't want to be on the drug for life. Do we really know enough about Ozempic?" she asks. I didn't want to be complicit in my own ill health."
Most people are fighting a losing battle when it comes to losing weight. This is because weight gain as we age is entirely normal, not something to be pathologized. Epidemiologists observe the average person typically gains one to two pounds a year from early adulthood to middle age due to factors such as hormonal changes and declining muscle mass. That's a potential 40 pounds between the ages of 20 and 60.
Dr. Kumar herself says she has faithfully" gained a pound a year from age 25 to 65. I'm just fine with it"
If only more of us could have her attitude. What would it feel like if we embraced our bellies, grateful for its softness, that it may have carried life, that we are privileged enough to feel the sensation of a full stomach, that those extra pounds might be a cushion to stave off the gauntness of illness?
A full life is not measured by a flat stomach. If you are over 50 you are never going to look like you did in your 20s. And why bother trying? It's as futile as longing to look young again.
Speaking of which, another of Ozempic's side effects is facial aging and sagging caused by quick weight loss, leading to the condition known as Ozempic face." Of course, there are plenty of remedies for this, too, from Botox to dermal fillers, fat grafting and cheek implants. When it comes to fixing" what's wrong with women's bodies there's no end to the profit-making improvements."
The woman who started and then stopped Ozempic, has a 50-year history of trying to fix" her body, going back to when she was 16 years old and 96 pounds. Back then I was on the verge of being anorexic." Now, she says, her focus in her later years is going to be on thriving and being vital, and not about losing weight, because so much of it is beyond our control."
She has an 18-month-old granddaughter. When I look at her and consider the diet culture that has had such an impact on me, I think to myself: I don't wish any of this on you.'"
Anne Bokma is a journalist, author and writing coach in Hamilton. Find her at annebokma.com