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Oprah Winfrey’s��TV special Shame, Blame and the Weight Loss Revolution has been streamed more than 4 million times since it aired in March 2024. In it, the talk show host described Ozempic as being “the relief and support and freedom” that some people have been waiting for their whole lives.
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This might have been easy for a billionaire like Winfrey to say. Weight-loss drugs can be game-changing for people who are obese, but getting hold of them is far from a level playing field, with knock-on effects for the obesity levels of the rich versus the poor. But this inequality is just one of many societal issues on the horizon. Ultra-slim beauty norms may be re-emerging, and some analysts predict changes to our collective appetite for junk food. In the era of Wegovy, we could also see an increase in the stigma around obesity that exists in some countries.
This article is part of a special series investigating the GLP-1 agonist boom. Read more here.
In the UK, only those with a body mass index of more than 35 (within the obesity range) and at least one weight-related health complication are generally eligible to receive Wegovy or Mounjaro on the National Health Service (see “How they work”, below). In the US, the use of these drugs for weight loss often isn’t covered by insurers, which means many people are paying out of pocket. With costs of and between £150 and £200 a month in the UK, “better-off people will have access and poor people won’t,” says at University College Cork, Ireland.
Inequality
Given the strong link that already exists between lower incomes and a higher risk of obesity, this inequality of access to GLP-1 drugs “will just cement the association between being fat and being poor”, she says.
Others concur. “If we don’t make these medications available to people who can’t afford to buy them privately, then we will definitely be widening the stigma and the societal divide that we see in obesity already,” says at Imperial College Healthcare NHS Trust in London.
What’s more, a lack of understanding around these access issues could mean people with obesity are judged for not taking these drugs. “There might be an attitude of, ‘Why aren’t you on Ozempic?'” says at University College London. “That, in itself, becomes a judgement in the way that some people think, ‘Why don’t you just stop eating so much?'”
Even ignoring the costs, the drugs aren’t for everyone. Like all medications, they have side effects and , the average reached in trials for semaglutide. And some people may simply not want to take them. In response to Oprah’s Ozempic special, and , both at the University of Michigan, argued in the journal Critical Studies in Media Communication that “viewers did not hear from someone who was fat and happy. We do exist.”
Obesity aside, a “cultural desire for thinness” will drive demand for these drugs, says at the University of Galway, Ireland. In societies where being slim is prized, this may prompt people without obesity to take drugs like Ozempic, which could take them from what is considered a healthy weight to being underweight. There are already signs of a return to a more waif-like aesthetic, judging by some recent appearances on the red carpet. And if the general weight of the population goes down too, “so may the norms, whether that is [what is] attractive or normal or something you should strive for,” says at the Norwegian University of Science and Technology.
Obesity
More optimistically, some researchers hope that these medications may support obesity being seen as a medical condition, rather than a moral failing. “These drugs will help people to understand that obesity is a biological, physiological, metabolic problem, rather than a psychological problem or a motivational problem,” says Finucane.
But these drugs can only do so much. Losing 15 per cent of body weight may take someone from having severe obesity to milder obesity. “The social stigma of that probably is still quite high, right?” says Steptoe. is “pretty entrenched in our society”, he says. “That would take quite a lot of shifting. I wouldn’t hold my breath.”
However, GLP-1 drugs may change the landscape of obesity in a rather different way. Reports increasingly suggest they reduce “food noise”, dialling down obsessive thoughts about eating. Ozempic “seems to take away that extra voice that’s always telling you you’re hungry”, says Steele. For instance, one trial found that people taking semaglutide not only , but had a reduced preference for fatty, energy-dense foods compared with participants taking a placebo. Another study found that US households with at least one person taking GLP-1 drugs and spent 9 per cent less at fast-food chains and coffee shops.
Such findings prompted strategists at Barclays bank to . And some researchers are optimistic that junk food outlets may start shutting their doors thanks to Ozempic, which could go some way to preventing obesity for the general population. “Your genes set the table for obesity and the environment serves it up,” says at ConscienHealth, an obesity advocacy group in Pennsylvania.
“This intervention has the power to influence the food environment,” says Scholtz. And then? “Our children and the generations that come after us have a better chance of not developing obesity in the first place,” she says.
How they work
Drugs such as semaglutide (sold as Wegovy for weight loss and Ozempic for diabetes), liraglutide (sold as Saxenda and Victoza) and exenatide (sold as Byetta) mimic the actions of glucagon-like peptide-1 (GLP-1). This hormone promotes the feeling of fullness, or satiety, after eating and stimulates insulin production, lowering blood sugar levels.
Overall, this means that these drugs – technically known as GLP-1 receptor agonists – reduce hunger levels, leading to reduced energy intake from food and significant weight loss for most people when used long term. Recently, a drug called tirzepatide (sold as Mounjaro and Zepbound) has also come on the market, which mimics GLP-1 plus another satiety hormone, GIP.
