Jess, 38, has lost 75 pounds since she started taking Wegovy last year. She’s thrilled with the results—in addition to losing weight, her blood work and sleep apnea have improved—but the changes to her life and body feel too fraught to talk about with her friends, who want nothing to do with her weight loss.
Years ago, Jess, who asked to use only her first name for privacy, and her friends embraced the principles of the Health at Every Size movement, which fights against anti-fat bias and argues that weight is not an accurate indicator of health. But last summer, despite her support for that school of thought, Jess decided that she wanted to lose weight to feel better in her body. When she mentioned that decision to her friends, “they told me, ‘We have no interest in this conversation. We do not want to discuss this with you. We don’t agree with your choice,’” she remembers. “I respect their boundaries, but it’s been difficult not to share certain milestones with them or even talk about day-to-day things. It’s been kind of sad and lonely.” These days, she only discusses her weight loss with her doctor and her husband.
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Weight loss has always been a fraught topic. But it’s especially complex to talk about in 2024, as body-positivity movements collide with the popularity of drugs like Ozempic, Wegovy, and Zepbound. Largely because of these medications, weight loss is all over the news and social media—and nobody, it seems, knows exactly how to feel or talk about that.
“It’s such a sensitive topic because we can hide so much about our lives,” says Rachel Goldman, a New York City-based clinical psychologist who specializes in weight management and has consulted for a health care company that prescribes anti-obesity medications. “But if you’re gaining weight or losing weight, somebody’s going to see it.”
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Even many health care providers, who talk about sensitive topics all day long, find weight loss a uniquely challenging subject, says Charlotte Albury, a medical anthropologist at the University of Oxford in the U.K. who studies communication in health care settings. That’s in part because there’s so much “shame and blame and stigma that society perpetuates around obesity,” she says, and in part because “lots of clinicians feel very undertrained in talking about obesity.”
If clinicians feel undertrained, where does that leave the rest of us?
When it comes to societal opinions about weight loss, the pendulum has swung far in only a couple of decades. Not too long ago, nearly all of mainstream culture treated weight loss as aspirational. Now, although weight stigma is still a significant issue in the U.S., the weight-loss discussion includes far more dissenting voices than it once did.
In March, when Oprah Winfrey aired a (mostly positive) television special about GLP-1 drugs, the technical name for medications like Ozempic and Wegovy, she alluded to the myriad opinions about modern weight loss. “For people who feel happy and healthy in celebrating life in a bigger body and don’t want the medications, I say, ‘Bless you,’” Winfrey said. “For all the people who believe diet and exercise is the best and only way to lose excess weight, bless you, too, if that works for you. And for the people who think that this could be the relief and support and freedom…that you’ve been looking for your whole life, bless you, because there is space for all points of view.”
Often, though, those points of view butt up against one another. Some people trying to lose weight, like Jess, feel conflicted, both glad that society is taking a hard look at diet culture while also hesitant to say anything positive about weight loss for fear of being accused of fatphobia. (A recent New York Times article highlighted the tricky situation some body-positivity influencers face when they get smaller, with their followers sometimes viewing weight loss as a “betrayal.”) Margit Berman, a Minnesota-based psychologist who fights against diet culture in her practice, says some of her clients also hide that they’re using GLP-1 drugs for diabetes, the condition for which Ozempic and Mounjaro are approved, because they’re afraid of being blamed for being sick because of their weight.
Other people apparently don’t feel as conflicted. Demand for GLP-1 medications is booming, with some projections estimating that around 10% of the U.S. population will be using one of these drugs by 2030. And while many people use these medications based on the advice and prescription of a physician, some are so eager to drop pounds that they’re willing to buy drugs like Ozempic from compounding pharmacies, med spas, Internet companies, and other questionable sources.
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Then there are people who are open about wanting to lose weight, but only the old-fashioned way—that is, with diet and exercise, rather than “cheating” by using medications. In a 2024 Pew Research Center poll, about half of U.S. adults said drugs like Ozempic are good weight-loss options for people with obesity, while roughly as many either said they’re not good options or weren’t sure what to think.
Similar trends are playing out among physicians. Some doctors talk about GLP-1s as revolutionary treatments for the chronic disease of obesity, lauding not only their ability to help people shed roughly 20% of their body weight but also their benefits for cardiovascular health. Goldman adds that anti-obesity medications may help reduce weight stigma, because they may help people see obesity just like any other disease requiring treatment.
Other doctors, meanwhile, argue GLP-1s come with significant drawbacks—side effects include GI issues and, possibly, increased risk of thyroid tumors, and most people gain back the weight they lost if they stop taking them—and help perpetuate harmful beliefs that smaller bodies are automatically better and healthier. Berman thinks GLP-1 drugs contribute to “magical thinking” rooted in anti-fat bias: that weight loss is the easiest way to a good life.
Dr. Silvana Pannain, director of the University of Chicago Medicine’s weight-loss program and an advisor to companies that make GLP-1 drugs, thinks that disagreement has probably always been there, but social media and the buzz about GLP-1 drugs are now amplifying it. “It’s not necessarily a different way of thinking, but that more people feel the right to voice their opinion about obesity,” Pannain says.
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Berman, however, has noticed a change. When she started speaking out against weight-loss culture in the early 2000s, “People looked at me like I had three heads,” she remembers. “The culture was that fat hatred was acceptable, and everyone should be trying to lose weight. There wasn’t the same [weight-positive] countercultural stream that there is now.”
Still, thin-preference remains dominant in the U.S. Even as more people outwardly embrace body positivity and acknowledge that weight loss is a complex topic, a significant percentage of U.S. adults say they want to slim down—as of 2023, about 55% of women and 47% of men, roughly the same numbers as a decade ago. Almost 30% of U.S. adults said in a 2023 study that their worry about having obesity has increased since the COVID-19 pandemic, with about 6 million saying they’d considered surgery or medication in recent years. Americans still want to lose weight; they just may not feel comfortable announcing that intention proudly anymore.
Jess, the woman using Wegovy, says all she wants is to land on a middle ground, somewhere between rabid diet culture and feeling shunned by her friends because of her GLP-1 prescription. “We need to somehow neutralize” the idea of weight loss, removing the moral baggage attached to either deciding to drop pounds or deciding not to, she says. “In a world where a lot of us believe that our body is our choice, this is another one of those things that should go into that category.”
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