> Charissa Forrest Book Review Case #70 - Progress

The weight-loss epidemic

August 30, 2024

Charissa Forrest

Have you ever jumped on the scales and been dismayed at the number that came up? Or put on a pair of jeans to find that they no longer do up? Many of us know these scenarios all too well. And there are two broad responses we tend to have at times like these: to try and lose the weight or to choose to accept our bodies as they are. But choosing between these options is not straightforward. There are lots of complicating issues involved. There are questions of health. There are the challenges of actually achieving the desired weight loss. There are the issues around the stigma associated with being overweight. And there is more—from the impact of highly processed foods to the complicated relationship many of us have with eating to the way social media portrays beauty ideals and body shape. But into this already complicated environment a new player has arrived, the weight-loss drug Ozempic.

Popular author Johann Hari has written a book, Magic Pill, detailing his own conflicted journey with Ozempic. He examines the benefits and risks, and along the way discusses some of the difficult questions around obesity, weight loss and weight stigma. He concludes that ‘[w]hen it comes to food and diet, we crave simple solutions, but this is a topic fraught with complexity’ (p19). With the caveat that this is a very complicated issue, I am going to look at what Hari has to say about this new drug and particularly the impact that it may have on how we view those who are seen as overweight.

There is no denying that in the last 50 years average weights in the Western world have increased dramatically. The World Health Organisation claims that since 1990 adult obesity has doubled and adolescent obesity has quadrupled. Hari explores why this has happened and what the implications are for our health. The problem, he claims, began when we stopped buying fresh foods and making our own meals and started buying pre-packaged, processed foods (p46). These foods are not food at all but a concoction of chemicals, fats and sugars (p52f). And they have a terrible impact on the way we eat. They ‘turn off’ the biological signals that allow us to recognise when we are full and so we continue to eat way past our need to satisfy our hunger (pp56, 59). This of course leads to weight gain.

Hari directs his greatest criticism towards the food industry and the way it has created a food system that is so dysfunctional and dangerous to our health that we needed to create drugs like Ozempic (p285). But until we reform our food system, Hari argues, we need to deal with the problems that it is producing—a massive increase in obesity and its associated problems. This is where the new weight loss drugs come in. They work by targeting the inability to recognise satiety that is brought on by our processed food diet. Essentially the drugs, known as semaglutides, are replicating a gut hormone that signals to our bodies that we have eaten enough (p32). And unlike previous weight loss drugs, these new drugs have had amazing results. In trials, participants lost 15-24% of their body weight and many of their associated health issues (pp34, 93).

These drugs have the potential to improve the health and lifestyle of many people but also raise many questions.

We know that the uptake of drugs like Ozempic has been huge. In the last 3 months of 2022, doctors in the US wrote more than nine million prescriptions for drugs like this. Many of these were for people who suffered from diabetes and heart disease. But we also know that there are many people who are taking Ozempic to look good, not for health reasons. Hari admits that this is what alerted him to the existence of the drug in the first place. After attending a Hollywood party, he was struck by how thin all those attending had become and became aware that Ozempic was responsible (p1f). In a world where how we look has a huge impact on how we are treated, the ability to take a drug to maintain a particular image has the potential to further impact those who struggle with their weight.

A 2023 New Yorker article articulates some of the problems well:

It is possible to imagine a different universe in which the discovery of semaglutide was an unalloyed good—a powerful tool to untangle the knot of genetic tendencies, environmental forces, and behaviors that conspire to make more and more Americans gain weight. We might recognize metabolism and appetite as biological facts rather than as moral choices; rising rates of Type 2 diabetes and obesity around the globe could be reversed. In the actual universe that we inhabit, the people who most need semaglutide often struggle to get it, and its arrival seems to have prompted less a public consideration of what it means to be fat than a renewed fixation on being thin.

Attitudes to people perceived as overweight have long been extremely negative. In fact, Hari sites heartbreaking statistics that claim that 5% of overweight men and 10% of overweight women are insulted or discriminated against every day. This increases to 28% and 45% respectively for those with a Body Mass Index (BMI) over 35. (The BMI range considered healthy is 18.5-24.9.) Being overweight can be an alienating, shameful and dehumanising experience. Shelley Bovey, who Hari interviewed for the section of his book exploring this issue, said ‘I wasn’t a proper human being. I didn’t belong …You’re not really a person—you’re just a body and it’s a bad one.’ (p221)

The Body Positivity Movement arose in response to this kind of stigma. It aims to be:

a social movement focused on the acceptance of all bodies, regardless of size, shape, skin tone, gender, and physical abilities, while also challenging present-day beauty standards as an undesirable social construct.

There have been some criticisms about the movement being co-opted by marketing companies to appeal to a wider audience, or redefining weight loss as wellness while still putting the same pressures on people to conform to a certain body shape and size. But the movement has helped us re-examine some of the assumptions society makes about people who are overweight.

Take, for example, the relationship between obesity and health. Obesity does increase the likelihood of developing diabetes, cardiovascular disease, joint pain, stroke, and some forms of cancer (pp86ff). But these risks are not higher for people who are classed as overweight (BMI 25-29.9). They start to increase at a BMI over 30 (classed as obese) and are significant at BMIs over 35 (extremely obese). Moreover, having a BMI in the normal range does not preclude being metabolically unhealthy. This means that there is not a straightforward relationship between weight and health—there are other factors involved. And it is only at high levels of obesity that the dangers are significant.

The relationship between weight and diet has also been re-examined. We have been taught that the way to keep our weight under control is to watch what we eat and exercise regularly. But there are also factors apart from diet and exercise which have an impact on our weight. Some people have a much slower metabolism for example. And it is notoriously difficult to lose weight and keep it off with diet and exercise alone. The most optimistic studies have found that only around one in five people were able to lose at least 10% of their body weight and keep it off for over a year (p132). Being overweight does not necessarily mean that someone is greedy and overeating, as society has often taught us. There are many factors involved in weight gain, and diet is only one of them. Many sectors of society have caused unnecessary pain for people struggling with weight by perpetuating this false idea, including health professions and the church.

Recognising some of these things has resulted in a broadening of society’s acceptance of people of different sizes and shapes.

There has been a growing use of a range of different sized models in advertising and greater size inclusivity in clothing brands. There is still a lot that pushes against this acceptance, but it did seem that progress was being made in reducing the stigma against bodies that don’t meet the cultural ideal. What will the arrival of Ozempic mean for this little bit of acceptance that we have achieved? If anyone with access to Ozempic can lose unwanted weight, even if it doesn’t impact their health, what happens to those whose bodies don’t conform to the skinny standard? To those for whom Ozempic doesn’t work? To those who cannot take it or cannot keep taking it due to cost or health complications? To those with eating disorders?

Despite the small inroads of the Body Positivity Movement, a world where we live online and where images are currency, where people who are perceived as beautiful are more successful in work and relationships, is not a world where those who are seen as overweight find acceptance. It is telling that even though Hari was motivated to take Ozempic because of his elevated BMI (not in a dangerous range) and his family history of heart disease, even he was not sure whether these reasons were ultimately what led him to take the drug. At one point he recounts a friend calling him out because she was convinced that he was more concerned about his appearance than his health. She challenged him, saying ‘everyone taking these drugs who isn’t seriously obese or diabetic is helping to change the culture and make it different—to make it value thinness even more’ (p215).

So how should we as Christians respond to these new drugs? Firstly, we should acknowledge the benefits. They are extremely effective in treating Type 2 diabetes and obesity. We need to celebrate these successes. But as with any new technology, there are also unintended consequences, and in a culture obsessed with outward appearance the ability to lose unwanted weight by taking a drug is redefining what body shapes are acceptable. And this will lead to greater stigma against those who don’t meet these standards.

As Christians we should value all people as being made in the image of God, no matter what their size or their health issues. This inherent value of each individual is at the heart of all Christian ethics, so we should be careful not to let the world shape how we value others. We should not look at the outward appearance and think that determines someone’s value or worth. We may think this is obvious, but the world shapes us in insidious ways and we need to check ourselves.

There are also broader considerations that can help mitigate the harms of the current situation. Where possible, we need to make sure that those who would most benefit from the help these drugs provide are able to access them by prioritising the drug for those who have medical conditions and providing subsidies where needed. Not for the sake of someone’s appearance but for the sake of their health and their ability to enjoy a life that is free from pain and limitation due to disease. Policies that promote access to healthy and affordable food for everyone—and limit the availability of harmfully addictive processed foods—are also something that Christians can advocate for in the name of loving our neighbours.

The Bible also gives us guidance about true beauty. Time and again it reminds us that the beauty God wants us to pursue isn’t on the outside but on the inside: in fearing the Lord (Proverbs 31:30); in gentle and quiet spirits (1 Peter 3:4); in the things that the Lord sees (1 Samuel 16:7); in our hearts (Luke 6:45). So as Christians our effort should go towards cultivating a godly character and a heart that pursues God, and not be caught up in meeting the outward beauty standards of the world around us or in judging others by those standards.

Charissa Forrest has a degree in Theology and has recently returned to Australia after 10 years of serving in international ministries in Jordan.