- Oprah Winfrey hosted a new TV special highlighting the use of GLP-1 weight loss drugs and the obesity epidemic.
- On the special, Winfrey invited medical professionals to discuss how the drugs worked and why obesity is a disease, not a character flaw.
- Experts are hopeful Winfrey’s use of her platform will help change the conversation around obesity and how it’s treated.
“For 25 years, making fun of my weight was national sport,” Oprah Winfrey said during the opening monologue for An Oprah Special: Shame, Blame and the Weight Loss Revolution, which aired Monday on ABC and is now available to stream on Hulu.
Though out of the spotlight, millions of people living with obesity have been the subject of similar comments throughout their lives.
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“I come to this conversation with the hope that we can start releasing the stigma and the shame and the judgment, to stop shaming other people for being overweight or how they choose to lose – or not lose – weight and, most importantly, to stop shaming ourselves,” said Winfrey, who in late 2023 revealed she was taking anti-obesity medicine and received both support backlash.
Experts who treat people with obesity say Winfrey’s efforts to reduce the shame and stigma around obesity are important.
“When celebrities speak about weight loss medications, and even weight loss in general, people definitely pay more attention, and it brings more interest in options available for weight loss,” says Mir Ali, MD, a bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center.
In particular, Winfrey’s special called attention to five key takeaways about how we speak about obesity and the new range of drugs used to treat it, such as Wegovy and Zepbound.
The American Medical Association designated obesity as a disease in 2013. However, even people with obesity may not know that.
W. Scott Butsch, MD, noted on Oprah’s special that people have an “uneducated belief” that obesity is a matter of willpower and a “self-inflicted” issue.
“It’s not a matter of willpower,” said Butsch, the Director of Obesity Medicine at the Cleveland Clinic’s Bariatric and Metabolic Institute and a consultant for one of the pharmaceutical companies behind anti-obesity medications.
Winfrey compared obesity to substance use, another condition once thought of as a lack of willpower. She added that not everyone who drinks too much has substance use issues, but some do.
“Obesity is a complex, multifactorial disease with genetic and environmental underpinnings,” says Christopher McGowan, MD, a gastroenterologist, obesity medicine specialist, and founder of True You Weight Loss. “For those individuals prone to obesity, their drive to eat may be more significant, their propensity to increase weight may be higher, and their ability to preserve weight is stronger. These factors cannot be overcome by willpower alone, nor are they the result of a lack of willpower.”
Butsch likened it to being underwater. Eventually, a person will need to come up for a breath. Similarly, someone with obesity will eventually regain weight (without assistance).
Drugs like Ozempic and Wegovy quiet “food noise,” keeping people fuller longer and reducing the drive to eat.
“It’s not a matter of willpower,” Butsch said on the special. “People who perhaps are thin might never think about food the way people who have obesity [do].”
It’s why advice to “just diet and exercise” can fall short for people with obesity — they’ve likely tried, and it was not effective or sustainable on their own.
“There is still so much misinformation in our society that many patients and even healthcare providers still believe that obesity can be permanently reversed with enough willpower and counting your calories in versus out,” says Michael Glickman, MD, the founder and CEO at Revolution Medicine.
“As in the alcohol analogy, you would not tell a patient struggling with alcoholism that they should just willpower their way out of it. Alcoholism requires comprehensive multidisciplinary treatment, just as obesity should. The brain ultimately controls our body and our actions, and it should be the primary focus of our treatment approaches,” he added.
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Amy Kane, a mother who appeared on the special, noted that she dreaded going to the doctor before losing weight. Now, she looks forward to it.
Despite the notion that all health issues can be fixed by losing weight — through diet and movement — McGowan has seen many patients with obesity exercising more and putting a greater emphasis on dietary choices than normal-weight peers.
“The difference is that the battle is steeply uphill. A person with obesity has a differently wired brain, leading to greater caloric intake,” he says. “Is this an addiction akin to alcoholism? Not precisely, but the concept is similar. There is an innate, genetically driven drive to consume more, which is hardwired and challenging to overcome.”
Guests like Kane tearfully recounted their feelings after a lifetime of living with obesity. Kane first felt shame in fifth grade when a peer called her “fat.”
“The bias against obesity is deeply ingrained in our culture,” McGowan says.
Winfrey called fat-shaming one of the last acceptable biases, and McGowan agrees, saying it has “devastating implications.” Again, the misinformation about why someone is living with obesity comes into play.
“Obesity has long been — erroneously — equated with laziness and a lack of willpower,” McGowan says. “Naturally, individuals affected by obesity may internalize this sentiment and direct the blame inward.”
Winfrey and Kane discussed the finger-pointing notion that living with obesity was a personal choice and the shame and confusion they felt when first-line treatments like diet and exercise weren’t enough.
“This is absolutely heartbreaking, and it’s tough to live in a world that is constantly making assumptions about you — solely because of your appearance — and not treating you nicely,” says Dr. Rachel Goldman, PhD a clinical psychologist and Ro advisor.
Now that Kane is no longer living with obesity, she says she’s treated differently, especially in clothing stores. Even her children are treated differently, she told Winfrey.
It’s almost as if people with obesity can’t win. They’re shamed for their weight. Then, they’re shamed for the way they lose it if they take a medication — like they’ve used a cheat code.
Kane waved off the criticism, chalking it up to misinformation. Experts say the idea is harmful.
“Belittling people for using these tools is extremely detrimental,” Ali says. “If people start thinking of obesity as a chronic disease, like high blood pressure or diabetes, then there may be less stigma associated with using the tools available.”
McGowan echoed these sentiments, saying it’s rooted in the idea that people can will their way out of obesity. He constantly hears patients tell him, “I don’t want to use a shortcut,” when discussing anti-obesity medications.
“If you need insulin for diabetes, it’s a life-saving treatment,” McGowan says. “But anti-obesity medications, or even bariatric surgery, are viewed as the easy way out.”
Hopefully, greater awareness of obesity as a disease will help curb this misinformation. However, Goldman says it would benefit people if we discussed the drugs differently.
“We need to shift the conversation away from weight loss drugs,” Goldman says. “If the focus is on weight, we are never going to get away from this shaming and the criticism that this is the easy way out. If we talk about this in terms of health and seeking treatment for a disease, the conversation will change — it will be less judgmental and more about emotion and empathy. It all starts with the words that we use.”
Maggie Ervie’s mother, Erika, discussed Maggie’s journey — which included constantly feeling hungry as a child and her mother custom-making a Halloween costume so she could be a Disney Princess for Halloween.
Maggie tried sports, camps, and attending an obesity clinic. Maggie was 300 lbs. by the time she turned 11. Doctors feared she’d die young.
Maggie, now 15, had bariatric surgery and began taking Victoza at 13. Victoza isn’t as known as Ozempic or Wegovy.
Wegovy became available to people ages 12 and up in December 2022 after Maggie had already begun Victoza.
“Victoza and Wegovy are both GLP-1 agonist medications, but Victoza is taken daily, and Wegovy is taken weekly,” Glickman says. “Wegovy has also been shown in studies to be more effective for weight loss. Due to the convenience of weekly dosing and better efficacy, Wegovy is much more commonly used today than Victoza.”
Maggie was the subject of an article in The Cut, and the family has received criticism for putting her on medication at a young age. Erika implored people to “walk a mile in our shoes” before judging.
“This is a sensitive topic,” McGowan says. “The treatment of obesity in adolescents has additional layers of complexity, including the patient’s evolving maturity, family dynamics, psychiatric complexities, and social factors. But early treatment of obesity can delay or prevent future health problems, including diabetes, heart disease, and premature death.”
Glickman mentioned Erika’s line was one of his favorites of the night and encouraged parents and adolescents to weigh risks and benefits with healthcare providers.
Winfrey said she combined medications with hiking, running, resistance training, and consuming a “healthy diet.”
Even in clinical trials, like those for Zepbound, participants combine medication with lifestyle interventions like diet and exercise.
“Anti-obesity medications are not designed to be used in isolation and must be paired with a diet and lifestyle program,” McGowan says. “This is how they were studied in clinical trials, and we know that lifestyle modification remains the foundation of any chronic weight treatment.”
McGowan suggests working with a registered dietitian and personal trainer.
“You can only expect to lose weight effectively with help, support, and accountability,” McGowan says. “A comprehensive weight management program that offers medical supervision, nutrition counseling, and behavioral support is the optimal framework for success.”
In one of the tenser moments of the night, a woman discussed her experience with taking an anti-obesity medication. She stopped after she vomited blood and needed to go to the emergency room. Her doctor agreed the drug wasn’t right for her, and she’s interested in trying a different one but is hesitant.
In 2023, a Prime Therapeutics analysis revealed that 6.8% of individuals discontinued a popular anti-obesity medication due to side effects in clinical trials, and only 33% continued use after one year, according to a Reuters report.
Dr. Amanda Velazquez, an obesity expert at Cedars-Sinai and a consultant for an anti-obesity drug manufacturer, called the side effects mostly “over-hyped” on the TV special.
However, other experts disagree.
“GLP-1 side effects are not overhyped,” McGowan says. “All medications have side effects…Most of these are mild and short-lived, such as nausea or bowel habit changes. However, they can be severe and persistent for some patients.”
McGowan says proper information about side effects is important so patients can be prepared. There are ways to mitigate the side effects in many patients.
“If the side effects, such as nausea, become more pronounced, then medication to counteract the side effect can be given,” Ali says.
Glickman says mindful eating can help. However, McGowan doesn’t think patients — or providers — should feel obligated to ignore the side effects.
“Patients can’t expect to manage them alone,” he says.
Oprah Winfrey’s primetime special called attention to the shame and blame around obesity — and that it’s a disease. People with obesity may have trouble quieting food noise and losing weight.
Drugs like Wegovy can help counteract the noise, especially when combined with diet and exercise.
For years, people with obesity have lived with shame and the idea they lacked the willpower to lose weight.
Now, some are receiving pushback for going on anti-obesity medication.
Winfrey and others hope the special helps curb these ideas and reduce the shame and judgment around obesity.
If you’re on anti-obesity medicines, working with a dietitian, personal trainer, and provider who listens to you is crucial.
