Weight, Food, and Shame in the Age of Ozempic

Oprah Winfrey’s recent prime time special—Shame, Blame, and the Weight Loss Revolution—promoted the use of weight loss medications, increasing the already-sky-high interest in these drugs on a national scale. In the middle of all this buzz, you may have clients who are wondering about Ozempic, Wegovy, or any of the other new weight loss drugs available to the public.

So how can you best support clients who are considering the use of medication to lose weight? Consider the lived-experience and underlying feelings each client has regarding weight and food concerns. The shame and blame that people experience around body size is a serious issue that impacts physical and mental health, and approaching this topic from a trauma-informed lens is key to making sure clients don’t stay stuck in the shame/blame cycle.

What You Should Know

In 2013, the American Medical Association declared “obesity” to be a disease, against the advice of their own scientific advisory board. This framework means that anyone over a certain body mass index (BMI) is considered to have a disease, even if all their health markers fall into the normal range. From a trauma-informed view, pathologizing people based on a characteristic (weight) rather than identifiable markers (blood pressure, blood sugar, cholesterol, etc.) and positive, sustainable behaviors (good sleep patterns, physical activity, stress management, etc.) means that they cannot escape stigmatization.

Why Weight Loss Drugs May Seem Like the Answer

Research shows that exposure to weight stigma increases risk for both physical and mental health conditions. With a disease model, the individual is seen as having no control of their relationship with food and weight; the issue is physiological, and medication is the answer. As pharmaceutical companies and some in the medical community have sought to view “obesity” as beyond a person’s control, there has been a well-planned campaign to have insurers and the public view “obesity” as a chronic, progressive, and misunderstood disease that requires long-term medical management, resulting in large profits.

Why We Take a Different View

Oprah has her own story and journey; as a higher weight Black woman, she has encountered tremendous scrutiny and pressure. At the same time, using her platform to influence others comes with a responsibility. In 1988, she pulled a red wagon across the stage to promote Optifast. In 2015, she joined the board of WW, formerly known as Weight Watchers. Predictably, these weight loss plans failed. The pharmaceutical market has also seen many other weight loss drugs come and go over the years.

The medical model portrayed by Oprah’s “experts” in March of 2024 (who were acknowledged to be paid consultants by the pharmaceutical companies) correctly stated that weight regulation is more than calories in and calories out, and that weight regulation is beyond a person’s conscious control. However, they failed to acknowledge the role that the diet cycle plays in a person’s body size and out-of-control eating. Research shows that the more people diet, the higher their weight range, known as set point, becomes as the body attempts to protect itself again future famines (which is how the body perceives a diet). This means that individuals pursuing weight loss are in a precarious bind: they get the message that their body size is unacceptable and unhealthy; they follow restrictive plans to alter their shape and size; they almost always find themselves eating their forbidden foods as a natural response to deprivation; and they regain weight, often more than what they lost on the plan. The blame and shame fall at the dieter’s doorstep rather than understanding that the so-called solution (pursuing weight loss) actually facilitates greater weight gain. In other words, people don’t fail their diets—their diets fail them.

Rather than thinking of “obesity” as a disease, we take the stance that disordered eating or bingeing and the preoccupation with food are almost always the response to the restrictive eating promoted in diet and wellness culture. For some clients, the reach for food is also connected to regulating emotions or trauma. As we typically see with the clients we work with, ending the deprivation of the diet mindset and reconnecting to hunger and fullness cues allows most people to heal their relationship with food.

One segment of the Oprah special introduced a mother who shared that society’s view of her children has improved—and that people are nicer to them—now that she’s thinner. In this example, we can see how a fat-phobic culture can easily cause shame surrounding body size. The fact that people are treated more positively because they’ve lost weight with the aid of medications illuminates the troubling attitudes in our society regarding body size—these viewpoints directly result in the shame that people in higher weight bodies experience.

Ultimately, we need to change cultural views, not individual bodies. In our book, The Emotional Eating, Chronic Dieting, Binge Eating and Body Image Workbook, we offer a path to making peace with food and reducing body shame. If you are a mental health professional, the Clinician’s Corner sections in each chapter will help you to examine your own attitudes toward body size, educate your clients about why 95–98 percent of people who go on a diet will fail (and it’s not their fault!), and familiarize yourself with research that shows how implementing specific behaviors mitigates or completely eliminates the risk of health conditions associated with “obesity.”

Informed Consent

If you have clients who are planning to talk with their doctors about the use of weight-loss medications, they should be aware of the possible consequences. These medications require lifelong use. If stopped, weight regain occurs, and there is also an increased risk for binge eating. Clients should be informed of both the common and serious side effects that are noted on the label and reported in the literature.

The Role of Compassion

Everyone has the right to body autonomy as they make decisions about what will best serve them. But because of the widespread fat shaming and anti-fat bias, many people will hope to use a weight loss drug to lose the shame. If you are a clinician, it can be helpful to have your client explore the part of themselves that considers using weight loss medications to escape marginalization or to feel more worthy, as well as to ask permission to let them know some of the possible outcomes of these medications.

Time will tell what happens, but it will be unsurprising to us if it is discovered that being on these medications for a lifetime comes with unwanted consequences or if weight is regained by the many of those who begin use of these medications. If weight regain does occur, it is important not to blame the individual, but to understand that this is a predictable consequence of trying to manipulate body size.

If you or your clients are looking for a positive alternative to heal chronic dieting and out-of-control eating and to ease body shame, we offer our workbook so you can help clients learn to:

• Trust their bodies to know what it needs to feel comfortable and satiated
• Break free from the rigidity of dieting and the chaos of binge eating
• Unlearn messages about when and what they’re “supposed” to eat
• Understand the emotional connection that everyone—yes, everyone—has with
• Let go of internalized weight stigma and body shame
• Dispel myths about weight, health, and fitness
• Recognize diets disguised as wellness or health plans

May people of all sizes be treated with dignity and respect.