Occasionally there comes a news story so on the nose, so illustrative of the characteristic excesses and inequalities of our age, that it would be too inelegant an allegory for JG Ballard. It has been almost two years since I began following the story of semaglutide drugs like Ozempic and Wegovy, when they first began to be spoken about not as the diabetes treatment they were originally conceived of, but as a new weight-loss wonder-fix available only to the super-elite. Over those two years, these drugs have filtered into mainstream consciousness. Already, those prescribed them for diabetes have complained that the boom in demand has impacted their ability to access necessary healthcare, not merely a means to a certain aesthetic.
The company behind such drugs, Novo Nordisk, was accused of choosing to disregard the health of those in developing countries as it announced last week that human insulin would no longer be available in the injectable pen form currently used as standard. While analogue insulin, composed of man-made substances which make it more costly and out of reach for many people of deprived means, will still be available in pen form, those reliant on human insulin will be forced to use outdated glass vials and syringes, a harder and less convenient way to inject. Those affected are angry at what they say is the company’s prioritisation of the profitable new weight-loss industry, into which they have invested an additional $4.1bn to meet demand, over the needs of those suffering from a disease. Novo Nordisk denies these allegations.
Weight-loss injectables quickly captured the cultural imagination when they emerged. Anyone who has struggled with their weight, or dealt with eating disorders and body hatred, has dreamed of a magical fix – a button to press, a pill to swallow that can erase all and simply reset the body. To be obsessed by thinness is an ordeal: not only in the effort required to restrict food punitively, or to exercise to excess, but also in the sense of how mentally draining it is to experience such thoughts every waking hour, for every decision to revolve around them. The exhaustion of being hungry and tired is one form of punishment; the relentlessness of the thought itself is another. I left behind seriously disordered eating more than a decade ago, and yet how repetitive, how embarrassingly boring it is to be in my mid-thirties and still find myself daily standing upright in my kitchen, frozen in thought about whether this yoghurt accords with yesterday’s choice, or whether I can eat pasta for lunch if I am also going out for dinner. The idea of a drug that would not only lead to thinness, but thinness and freedom from the ceaseless subtractions and additions and evaluations which weigh down my day – what an irresistible concept.
No matter what your weight or health situation, to discuss these topics at all inevitably draws out the so-called sensible people who delight in informing that very simple measures – exercise, balanced diet, moderation – will allow you to have a healthy body. This always makes me think of when men, sometime in their thirties, discover the concept of nutrition (or other things women have been subliminally studying since before puberty) and start telling the people in their lives about it. My best friend and I joke about this: her husband telling her she should try shampoo without sulphates, guys asking me if I know about complex vs simple carbohydrates. Dear, sweet men. I knew the calorie count in each piece of fruit by segment and slice before I was old enough to go to the cinema by myself. What do you think?
If it was as simple as deciding on moderation, there would not be untold numbers of women living in the grip of food and weight obsessions. One thing that semaglutide drugs have made clear is how differently people experience appetite, a phenomenon perhaps long misunderstood through variations in “willpower”. Of course, people gain weight for all sorts of reasons. (When I gave up drinking, I replaced it with a nightly pint of ice cream, stoically accepting the consequences.) But the variation in natural appetite is key to understanding how and why we are so different.
A friend taking a semaglutide drug called me late last year and said she only now understood the way that other women – the women she resented – could eat a little of something delicious, do that irritating perfect-European-woman thing of having a single slice of pizza and stopping there, never appearing to be hungry or discontent. “I thought they were just better than I was at hiding how hard it is, or just better than I was in general, but I understand now what it feels like to just not want that much.” To exercise that level of resistance to her natural appetite would once have required so much of her mental energy it would impede her ability to live and work. Now, it was unthinking.
I’m wary of reactionary, parsimonious objections to easy fixes. One professor wrote on social media, “Tackling obesity and all its related issues via an injection, instead of dealing with the cause, would be like saying: ‘Don’t worry about smoking: just take this anti-cancer drug’.” To which most people would respond they would be very happy to take an anti-cancer drug, be they a smoker or not. This type of moralising view tells us that weight loss must be earned by sacrifice and pain.
And yet it is uncomfortable to realise how quickly our society has returned to validating the supremacy of thinness, dismissing the past decade in which it appeared briefly possible for us to make a truce with our bodies. It felt for a few short years that it might no longer be mandatory to obsess over our weight until death. Now, if anything, I feel worse for people coming of age in today’s world, the culture not even coherent in its demands but psychotic, split, spewing violently conflicting messages about what kind of body is valued and what is tolerated. The rise of Ozempic has made it clear that body modification will be a permanent feature of life for decades to come. We can either accept it and opt in, or disengage and fantasise that this reality doesn’t exist – neither of which seem especially happy options.
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