The rebuttal to medicalized obesity is not fat activism.

Two illogical positions don't obfuscate the fact that there is a serious obesity epidemic that needs to be solved.

The discourse over GLP-1 RAs and weight-loss research has created precarious situation, because no longer is obesity viewed form the perspective of lifestyle and dietary changes but now through the paradigm of pharmaceutical intervention.

You can no longer lose weight and get healthy by willpower and consumption of whole foods alone, but instead by taking medications that will help curb your appetite. As Oprah and other people have lamented it’s no longer about willpower- you cannot show self-restraint and control because it’s all within the brain. It’s a disease that must be treated with pharmaceutical intervention alone.

This language has been extremely dangerous because it removes body autonomy and introspection. It removes one’s ability to look at their own diet and lifestyle and understand why the foods they eat and their lack of activity may be responsible for their weight gain. By ushering in an era of pharmaceuticals and obesity as a disease we have now shifted the discourse onto predominately focusing on medicalization to essentially treat food addiction.

And so it’s not just the side effects that should worry people, but also whether our relationship with food is being co-opted by a relationship with Big Pharma.

Unfortunately, the arguments against Ozempic and similar medications hasn’t focused on educating people on better nutrition and consumption of less processed foods. Instead, the leading mainstream arguments combating Ozempic are just as illogical- that these drugs are further inducing fat stigma and fat shame.

Yes, the battle against medicalization of obesity is being fought with social justice ideology. And make no mistake this is not “an enemy of my enemy is my friend” sort of situation.

Although I’ve talked about this in the past it appears that articles fighting against supposed fat stigma have been garnering more attention in the mainstream press.

For instance, there’s articles such as this one published in The Conversation from a few weeks ago, which I must say is one of the less radical articles out there (even though it’s still ridiculous):

From The Conversation.

It still has some of the same talking points as fat activists, but again it’s not quite the most egregiously absurd articles out there:

Many have declared drugs like Ozempic could “end obesity” by reducing the appetite and waistlines of millions of people around the world.

When we look past the hype, this isn’t just untrue – it can also be harmful. The focus on weight, as opposed to health, is a feature of diet culture. This frames the pursuit of thinness as more important than other aspects of physical and cultural wellbeing.

The Ozempic buzz isn’t just rooted in health and medicine but plays into ideas of fat stigma and fat phobia. This can perpetuate fears of fatness and fat people, and the behaviours that harm people who live in larger bodies.

An even worse example is one article published in none other than NPR:

From NPR.

This one is even more alarming given the fact that the author appears to be a physician, with the initial portion of the article describing a patient who wanted to lose weight following a recent pregnancy and considered Ozempic as an option:

The other day in my primary care practice, one of my patients asked me to prescribe Ozempic. She had recently given birth, and her body had changed.

"I want my body back," she told me.

Did her body really go away? I wondered, privately. I've had a lot of conversations like this recently, spurred by the onslaught of media coverage of Ozempic and Oprah's ecstatic endorsement of its benefits during a special TV segment she did this week.

My patient's blood pressure was normal, her labs looked perfect. The only issue was that she had gained maybe 25 pounds over the last two years, most of which she had spent gestating and breastfeeding a new human life. It's an amazing feat, and it's unsurprising that it required a little extra adipose tissue.

This type of scenario is rather common so it’s not quite the main issue with this article.

And the initial response isn’t a problem as well, and in fact there’s a lot that’s worth thinking about regarding the response:

"I'm not sure Ozempic will bring you peace with your body," I suggested, gently.

This response itself is important because we probably shouldn’t be turning to drugs in order to gain a better perspective on how we deal with food. Taking drugs to lose weight is probably not a viable when it comes with continuously poor eating and lack of exercise.

It’s as the idiom goes- change the things you can and accept the things you can’t. Finding peace comes with balancing what we are able to change with understanding what things are outside of our grasp, and it’s given that weight itself is something we have a good deal of control over.

But this isn’t the direction the author is going to, and instead the above response is followed by the following:

Medically, I told her, I didn't think she needed to lose weight.

Keep in mind that this isn’t a comment made by a random person, but by this person’s very own physician. A doctor is directly telling her patient that, based on her medical opinion, the patient in question should not lose weight. Not that Ozempic may not solve her body problems, but that she just doesn’t need to lose weight period!

And this approach by Gordon seems to be part and parcel for her practice:

I've written publicly about my size-inclusive approach to medicine – I don't direct my patients towards weight loss, and I have a loyal following of patients who come to me specifically because I don't harass them about their body size.

But for every patient who seeks out my weight-neutral approach, I have ten who have been sold the lie that losing weight will fix every problem in their life. That myth is nothing new, but it's been newly medicalized in the era of Ozempic and Wegovy, a class of medications known as GLP-1 agonists. And patients are showing up at my door, eager for the promised panacea.

So rather than educating patients that their problems can’t be solved by medications alone, the apparent approach here is to act as if there are no problems at all!

This creates all sorts of problems because it just shifts to the opposite end of the obesity discussion, and instead seeks to validate the idea that people are supposed to be inherently obese.

And sure, there is likely a problem regarding doctors misdiagnosing obese patients by focusing on their weight as the cause of certain maladies, but this also doesn’t mean that obesity is not associated with increased risk of cancer, diabetes, cardiovascular problems, etc, etc. One problem can be tackled without pretending that another doesn’t exist.

This problem is made even worse when it comes under the guise of expert authority- so-called “body positive” doctors will inherently cause people to assume that you can be obese and healthy, and that such ideas are backed by THE SCIENCE.

But probably one of the most ridiculous articles is one that was published in The New York Times just this past week:

From The New York Times

Sole-Smith is apparently a Substack writer and has published several books in the past years, with one titled “The Eating Instinct: Food Culture, Body Image, and Guilt in America” appearing to be the source of what is now-called intuitive eating. Intuitive eating, in this case, is not a suggestion that we can intuit proper portion sizes and the apparent calorie count/healthiness of foods, but that we intuitively know how much food our body needs.

That is, one should eat until they feel like they should stop¹.

The argument here is an inherently radical position, and again obfuscates the real issues regarding these GLP-1 RAs for another illogical position- eating until you feel full will likely lead one to continue to eat more as their body craves more food.

There’s quite a lot to this article, and quite frankly I suggest that readers read it for themselves so that they can form their own opinions. For me, I find that there’s quite a good deal of absurdity to Sol-Smith’s approach, such as the fact that she allows her children to eat whatever they want and in whatever order they choose:

She asserts her own right to be “fat,” the preferred adjective in her corner of the internet. In Sole-Smith’s house there are neither “good” or “bad” foods nor “healthy” or “unhealthy” ones; doughnuts and kale hold equivalent moral value and no one polices portion size. By relieving herself and her family of rules about eating, Sole-Smith believes she will have a better chance of raising children who are proud of their bodies, trust themselves to enjoy their food and leave the table when they’re full. She serves dessert and snacks, like Cheez-Its, along with the dinner entree; her kids can eat their meal in any order.

And if your kids come over to her house then be mindful that it’s free-reigns on whatever the kids want:

What most riles readers who encounter Sole-Smith is the calm assurance with which she lays down arguments that seem to defy common sense. This is especially true when she talks about Oreos, as she has done many times, and did again when I asked her about them in Cold Spring. Her position is, in a way, the wedge that divides her fans from her haters and draws attention online. Sole-Smith says that parents need not be concerned about how many Oreos their children eat (the same goes for Halloween candy and ice cream), and when I asked her whether a boundary — say, three Oreos at a time — might be sensible, she pushed back.

“What happens when your kid goes on a play date to my house? I can tell you. Your kid eats nine Oreos,” she said. If parents put restrictions on foods, then children will never figure out how to eat according to their bodies’ own needs, she explained.

What’s important to note is that some of Sol-Smith’s perspectives on eating were shaped by her daughter Violet who was born with a congenital heart defect and was fed through feeding tubes for a good portion of her early years.

This is certainly a precarious situation, however the framing here leaves various questions:

She did not begin to reconsider her relationship to food and fat until 2013, when Violet, then four weeks old, was diagnosed with a severe congenital heart defect. Violet required a dozen surgeries, and for most of the first two years of her life was fed through tubes. One consequence was that when she was physically strong enough, she did not know how to eat. Having been passively nourished for so much of her life, her brain did not recognize her appetite.

“The Eating Instinct: Food Culture, Body Image, and Guilt in America,” Sole-Smith’s first book, published in 2018, described how she learned to relinquish her fantasies about motherhood and nourishing her child so that Violet might survive.

Again, a situation that most parents shouldn’t have to go through. That being said, it appears that Violet was around 2 at the time that she was taken off of feeding tubes and had to learn how to eat. Personally, when presented with this information I have to wonder if Violet’s inability to recognize appetite or her relationship with food was due to the passive feeding, or her just frankly being 2. I don’t know how many toddlers understand that they should eat fruits and vegetables and few processed foods. This time period serves as the formative years where children begin to learn of different foods and feeding themselves, and it also comes at a time where their taste buds begin to change causing them to become more picky with the foods they eat.

But it’s the job of parents to ensure that their children don’t become accustomed to poor foods that may shape their relationship with food in the future that comes with an understand of foods that one should eat and ones that should be eaten in moderation/limited quantities.

In this case I wonder if Sol-Smith has incorrectly extrapolated from her scenario, possibly misinterpreting behaviors that may be normal for toddlers and is using it to improperly encourage readers to follow along in her stead.

Again, I’m not sure if this is the case, and I don’t want to infer too much from her situation. And quite frankly there’s a lot regarding other aspects of Sol-Smith’s argument that require scrutiny anyways, as she appears to have taken to arguing the apparent “racist” aspects of criticizing obesity.

---

So as of now we are dealing with a shift in how we perceive obesity. There are forces that are trying to tell us that our weight is not within our own control. While companies continue to push unhealthy foods into our diets pharmaceutical companies are trying to provide us the allegedly only solution possible, with these comments being backed by celebrities- all of whom may have a stake in getting as many people as possible onto these medications.

And yet at the same time the rightful pushback against this narrative is predominately being provided by fat activists who see these medications as undermining their ideology- these newfound weight-loss medications aren’t bad because it doesn’t address poor eating habits and lifestyle choices, but are bad because it seeks to address something that activists argue isn’t a problem.

But this is the invariably the problem that we must deal with. While we rebut the idea that these weight-loss medications are the only way to lose weight and get healthy we must also rebut the idea that one can be obese and healthy. Both narratives are wholly illogical, and we don’t need to argue to one in order to criticize the other.

There needs to be far greater pushback to both narratives- something that the mainstream press and ideologues are not willing to entertain.

---

If you enjoyed this post and other works please consider supporting me through a paid Substack subscription or through my Ko-fi. Any bit helps, and it encourages independent creators and journalists such as myself to provide work outside of the mainstream narrative.

Click on the image above or visit the website at https://ko-fi.com/moderndiscontent

Photo by Samuel Ramos on Unsplash

1. Bear in mind that this is my assumption regarding intuitive eating.