feature image by Toronto Star / Contributor via Getty Images

My doctor suggested Mounjaro, a similar but different drug to Ozempic, almost a year ago. Sitting in one of the two patient chairs beside the exam table, I watched her look at my chart with a familiar sigh.

“As you know, there are a few different ways to curb pre-diabetes,” she began. “We’ve tried Metformin and Glipizide, and you’ve been working hard to change your diet and lifestyle. You’ve been doing a great job, but clearly, these changes aren’t doing what we need them to. This leaves us with a final option.”

At first, I resisted, mainly because of the celebrity hype and stigma around the drug. I felt comfortable enough to voice this to her, to which she supportively replied: “A lot of my patients here have benefited from Ozempic, and I’ve seen a lot of positive results, especially for folks who feel like they’ve tried everything else.”

She was right, I had tried everything else. She told me she would send me more information and answer any questions. I left her office actually feeling a bit relieved. Maybe all the hype isn’t for nothing.

The pinnacle of Hollywood’s weight loss craze can be summed up by Jimmy Kimmel’s joke at last year’s Oscars: “Everybody looks so great. When I look around this room, I can’t help but wonder, ‘Is Ozempic right for me?’” Sure, the joke stabs at our country’s commercial prescription obsession peddled by big pharma, but more acutely, Kimmel’s joke highlights the cultural dissonance of so many celebrities using this diabetes drug to lose weight just at a time many have considered a  turning point towards more plus-size inclusivity in popular media. Many stars have confirmed their Ozempic use, including Charles Barkley, Remi Bader, Elon Musk, Chelsea Handler, Khloe Kardashian, Anthony Anderson, Heather Gay, Sharon Osborne, and queer icon Rosie O’Donnell. This spike in the conversation around Ozempic has also led to public assumption, shame, and degradation of celebrities who have seemingly lost weight, the comments sections of many celebrities’ social medias suddenly rampant with “accusations” of Ozempic usage, further stigmatizing the drug and complicating the way it’s talked about by the public. Lizzo, Kelly Clarkson, and Mindy Kaling (among many, many others) are all folks who’ve been “accused” of taking these drugs after “suddenly” losing weight. Go to any “plus size” celebrities’ TikToks or Instagrams, and you’ll see these drugs mentioned all throughout their comment sections.

In response to the Oscars joke and an uptick in fatphobia, Jameela Jamil posted a warning against the drug, in addition to calling out rich people using the drug to lose weight, thus creating a drug shortage that actively harms individuals who rely on it to treat medical conditions.

This is complicated. Taking GLP-1s (glucagon-like peptide-1, the main mechanisms in these drugs) is regarded as the “easy way” to lose weight. For many folks, especially friends of friends or those on streaming commercials, it’s as simple as taking a drug and miraculously dropping a few sizes a month or two later. So the question facing fat celebrities is: If you can lose weight, why not? If you don’t want to live in your body, you don’t have to now. So everything’s ok now, right? We have fixed the “obesity epidemic.”

Writer and editor Brandon Taylor explains this twisted cultural phenomenon happening in his Ozempic essay:

“When a person who took Ozempic to lose weight and the public thinks they don’t deserve the medicine, there is a route to criticizing that person because they should just love themselves. And so the public begins to wish for them to return back to their original body, at which time, they point and jeer and, say look! see! You should have stayed fat and now you’re fat again! hahaha! It’s essentially using a person’s body as a punishment for not loving their body.” 

Formerly fat celebrities suddenly appearing thin has cast a shadow over the once-growing body-positivity/inclusivity movement. For example, TikTok fat fashion influencer Remi Bader built her career on representing plus-size women. When she was on Ozempic and losing weight, many folks like me who looked up to her for this type of content felt disheartened and confused.

But she was prescribed Ozempic for type 2 diabetes, which is its original intended use. She even renounced the idea of the drug being a “trend”, saying she medically needed it. Similarly, in a video Rosie O’Donnell posted about her experience, she aptly reported, “You have to have diabetes to get a prescription. That’s what I heard. I don’t know. People are doing Ozempic parties here in L.A., where they all do Ozempic. But I have diabetes too, and that’s why I’m on it.” Judging other’s medical choices or any choice about their body is never our place, but in this instance, does their reason matter?

As a quick primer: Ozempic is known for being an extremely innovative and life-saving option for people with type 2 diabetes. According to the FDA: “It’s approved to lower blood sugar levels in adults with type 2 diabetes mellitus, in addition to diet and exercise.” The significant mechanism in drugs like Ozempic and Wegovy is semaglutide, which “mimics the GLP-1 hormone released in the gastrointestinal tract in response to eating.” Further, GLP-1 “prompts the body to produce more insulin, which reduces blood glucose (sugar).” It also sends signals to your brain and stomach that you’re full, decreasing the amount you eat. More recently, Mounjaro (the injection I was prescribed) has been released for similar purposes.

From my (non-professional) understanding, Mounjaro generally showed up in my body the same way other similar injections seem to — appetite suppression, lower A1C, weight loss — just through slightly different means. When I spoke with my primary care physician about which to take, she recommended Mounjaro because it works the same way, but patients have had fewer side effects. I decided to try it, mostly because I trusted this particular doctor (I don’t trust a lot of doctors these days). Aside from the long-term health effects we can’t know, my main hesitation stemmed from popular health culture. All my anti-fatphobic, holistic, and diverse health news outlets seemed to give mixed reviews. However, they all agreed that the impact of these drugs on one’s social and cultural status is unparalleled. It’s a low(er)-risk, high-reward, quick approach to long-term lifestyle changes many folks were encouraged to make. It’s known as a miracle drug for many folks with chronic and severe medical conditions. Those patients are finally seeing results they’ve been working toward for years. However, with drastic results comes drastic fatphobia.

It’s no longer “lose weight, workout more, and eat less carbs.” Well, it’s still that, but with a simple weekly injection to help you get there. Most folks are prescribed this class of drugs for diabetes management or prevention, and, under most insurances, the price isn’t astronomical. In my experience, costs ranged from $5-$40 per month. What’s shifted the market is the focus on a weight loss drug that otherwise healthy folks will spend thousands of dollars on for weight loss purposes, ultimately, as TIME writes, “exposing the cracks in the body positivity movement.” The birth of these drugs induced an ongoing shortage in 2022, primarily because of its “miracle drug” qualities. This high demand forces us to face that the body positivity and inclusivity movement is unraveling — or maybe we’re seeing the reality that fatphobia prevents patients’ access to life-saving care.

Many folks are calling these injections a cheat code for losing weight. Those of us with pre-existing conditions, especially those that modern medicine doesn’t fully understand (like PCOS), know that you can diet and exercise strictly for years and still not see any change to overall health. We finally have something that will help us get to an average level of functioning health. However, I would be lying if I said weight isn’t a big part of that conversation. When I lose weight, everything improves, including the severity of my sleep apnea, fatigue, and menstrual cycle, among other factors. However, I was never in my life able to achieve even the tiniest bit of weight loss without medicine.

When the words “you’re pre-diabetic” came out of my doctor’s mouth, I wasn’t surprised. They’ve been telling me that since I was 10 years old. I consequently picked up some disordered eating habits that oscillated as I grew into adulthood. Over the past few years, I’ve been more accepting of my body and what I put in it, mainly because there were many days when getting food in my system at all was a win. But for the past few years, the words “pre-diabetic” had begun to hit differently. I could feel the gravity of potential health risks: heart attacks, heart disease, and actual diabetes, among many other complications. When I was 21 and depressed, having children and staying alive didn’t matter to me. Now, they do. I feel my biological clock ticking, and even if I didn’t, my doctor doesn’t feel comfortable with me going rogue without preventative medication. Diabetes scares me, so I started with the most basic option I could.

They put me on metformin, which is the go-to diabetes management drug. This was fine, except it weakens the liver, and I already have liver issues (my doctors should have caught this within the two years I was on it!). I was then presented with an oral pill called glipizide. It didn’t seem harmful, and I hadn’t heard anything negative about it, so I assumed this was probably good. I simultaneously committed further to watching what I eat in a sustainable way and doing exercise I actually enjoy. But the medication made my blood pressure drop so drastically throughout the day that I almost fainted on the job many times. When I spoke with my doctor after these incidents and got bloodwork done, she pretty much said this medicine wasn’t doing anything since I wasn’t losing weight and was experiencing intense side effects. That’s when I felt like I needed to take the dreaded last resort: Ozempic.

Accepting my fate, I turned to my only trusted source: the podcast Maintenance Phase, which had recently released an episode about Ozempic. They presented the facts but were more critical of the rhetoric around weight loss drugs than the actual drug itself. Michael reported, “Even in the shorter-term trials, people have better blood pressure. They have better cholesterol. They have improved A1C levels. Also, with the longer-term trials, we’ve seen modest, but also like kind of big deal reduction in heart attacks and strokes.” They noted that, like with any new drug on the market, there’s a lack of comprehensive research, but shared about the many clinical trials where people experienced additional side effects such as weight loss and gastrointestinal issues. Even then, the risks didn’t seem to outweigh the reward.

I threw a lot of hope into Mounjaro when they started me on it at the beginning of the year. For the first few weeks, it didn’t seem to do much. My weight stayed the same — it may have even increased — but I wasn’t as hungry. After a month, I started noticing all types of subtle differences. I was slowly losing one to two pounds, but more important than that, I felt better. My stomach didn’t feel like a constant bloated balloon. I felt hungry exactly three times a day. I had sustained energy from when I woke up to when I went to bed. I slept better. I felt more capable of putting energy back into things like making a grocery list, going to the grocery store, meal prepping, or even just making a meal for myself, period.

And then, a few weeks ago, when I went to refill Mounjaro, I got a call that not only did my insurance stop covering this medication, but it also no longer covered this particular primary care doctor, the only doctor I’ve ever had who has been fat herself, anti-fatphobic, and generally extremely understanding of comorbid diagnoses in AFAB patients. I wasn’t just devastated; I was infuriated. I called every stakeholder to try and understand why this happened and how I could resume my medication or re-establish primary healthcare, and no one had answers. My old primary care doctor didn’t have answers. Their receptionist didn’t have answers. Their nurse-on-call didn’t have answers. My OBGYN didn’t have answers. My new primary care team didn’t have answers. That generic number on my insurance card didn’t have answers. The three different patient health portals I have accounts with didn’t have answers. The three different pharmacies I’ve used in the past seven months didn’t have answers. One nurse at my doctor’s office said she would try to get Zepbound covered to temporarily fill in the gaps. When I went to my pharmacist, she said Zepbound had a $500 copay even after insurance balances.

I’m now finishing this piece without any GLP-1 injections or pre-diabetic medications. My new PCP refused to continue my prescription of Mounjaro, saying she doesn’t believe in it. Not only is that a questionable thing to say as a doctor, but there I was, again, being completely ignored by someone I’m paying to hear me out. I waited a whole month to see my new doctor again and today, she said: “Sorry, this is only a 15-minute virtual lab result visit; you’ll need to schedule another in-person visit to discuss this.”

I share all this to say: It’s a long, complicated road to get on and stay on these drugs. Oftentimes, many folks have exhausted other options, including a 180 lifestyle change, with no results. Watching folks without sound medical concerns casually deplete the drug supply while those who need it for medical reasons struggle with access is infuriating. It’s infuriating to hear people say, “It’s the easy way out,” when it’s far from easy.

But I also feel so much shame and guilt around wanting the weight loss side effects. Even more, I feel I’ve betrayed my community just as I was taking up space in the body inclusivity movement. I could research the health outcomes and risks for years and still feel conflicted about how to feel about the drug’s impact on our culture and the ways we talk about bodies.

As co-host of Maintenance Phase Aubrey Gordon summarizes: “Every celebratory story about Ozempic that comes out now, that’s all going to be mirrored by future panicky think pieces on the rising costs of obesity and how fat people are bankrupting us once again […]  And all of that is going to come back to scapegoating fat people once again. Right now, we’re saying it’s frivolous housewives and whatever. When we get into the insurance conversations, we’re not going to be scapegoating rich people. We generally don’t do that. We scapegoat poor people, BIPOC, fat people, queer people. You know what I mean? We’ve got a list of people we scapegoat.”

So here I am, a BIPOC, queer, broke, fat person, ignored by the healthcare system and being gaslit by healthcare professionals and peers into thinking the problem is that I’m lazy and would rather just eat sugar and carbs uncontrollably than be thin, a prognosis that will clearly solve all my problems.

I’ve overthought the ethics and morals of Ozempic a million times over. Like the reviews I’ve read in medical journals, podcasts, and tabloids, I’m not seeing any adverse outcomes for myself. At the end of the day, I felt better on Mounjaro. I felt like I could actually live the life I wanted to live. Why should I judge someone for wanting to do that? And why am I being prevented from trying by a cruel, dismissive, and fatphobic healthcare system?

My limited personal experience with these drugs has been exceedingly positive but met with an astronomical amount of obstacles and frustrations. If I were rich, had a job with health insurance, or could even afford health insurance that isn’t Medicaid, maybe things would be different. However, the people struggling the most are, like me, at the mercy of greedy insurance and pharmaceutical companies. Ozempic and other GLP-1 agonists are only a tiny example of the many intricate injustices in the U.S. healthcare system affecting marginalized folks the most. The wealthy have always had more access to medical care than poor people, and Ozempic’s rise will continue to exacerbate that. Fat people have long been stigmatized and harshly judged as not “doing enough” to take care of themselves, disregarding the impact of socioeconomic factors on people’s access to healthy food or even having time to exercise. Now, when all that can be fixed with just a simple drug, we’ll be judged for not taking it, disregarding the socioeconomic reality that not all of us can afford it.

Seven months out from beginning this journey, I now see a new doctor in a new part of town, who greeted me by stating, “we don’t prescribe Ozempic or anything like it here.” Like every other PCP appointment I’ve ever had when moving to a new place, I was referred to an endocrinologist and nutritionist, who all told me the same things. Just eat better and exercise.

So, I finish this essay with my hands up in exhaustion. Ozempic (technically Mounjaro) was right for me, but I begrudgingly was not right for it.

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