Why Oprah’s medical weight loss message is still so muddled

I’ve been an Oprah fan since her eponymous show debuted on national television in 1986. Like a lot of viewers, I saw her as a friend. And as someone who has spent much of my life hating myself for being overweight, I especially identified with her very public struggles to overcome the genetics that render folks like us soft and fleshy instead of the more socially acceptable buff and sleek.

Now, thanks to a new class of drugs that includes Ozempic, Wegovy and Mounjaro, Oprah’s struggles appear to be over. She’s not the only public figure whose figure has shrunk recently, but she’s one of the few who has copped to using medication to slim down (although she hasn’t named the specific drug). And, being Oprah, she’s using her platform to shape the latest public discourse about weight, diet culture and body shaming.

Earlier this year, she stepped down from the board of WeightWatchers. In March, she hosted “An Oprah Special: Shame, Blame and the Weight Loss Revolution” on ABC. In May, she did a three-hour livestream on YouTube, “Making the Shift: A New Way to Think About Weight.” These shows and specials have featured experts including physicians and psychologists, and plenty of stories from the trenches about how difficult it is to be overweight in our fatphobic society.

I’m profoundly glad we’re having these conversations, and I don’t have a problem with people taking weight-loss drugs to live healthier lives. But I’m struggling with Oprah’s message nonetheless. While acknowledging her well-established past role in judgmental diet culture, Oprah now claims to be past that chapter in her life. The implication is that medical weight loss is somehow better — somehow more elevated or pure — than past strategies. Maybe this is not her intention, but her words draw an arbitrary line between different weight-loss strategies while ignoring the societal pressures that push so many people to try them. That’s not the end of diet culture, it’s merely an evolution. 

Oprah opened her May YouTube special with an impassioned monologue in which she told the audience repeatedly and convincingly that she’s done with body shaming and wants them to be done with it, too. But her campaign for body acceptance coincides with her new, more socially acceptable body — one she achieved with the help of drugs that the Food and Drug Administration has approved to treat people with diabetes and the medical management of obesity.

Glucagon-like peptide 1 agonists, also known as GLP-1 agonists or semaglutides, have never been approved for cosmetic purposes in the U.S. — i.e., for weight-loss only — yet that’s what a lot of people use them for. One serious consequence of that kind of off-label use is that it has created shortages for people who need the meds for their intended use.

But another serious consequence of this surge in semaglutides is as predictable as it is retro. Promoting drugs to make people thin regardless of their metabolic profile pathologizes obesity and helps promote the inaccurate belief that a fat body is always an unhealthy one that needs fixing. And that, Oprah, is one of the foundational pillars of diet culture.

When I broke down a few years ago and cried to my general physician Dr. B. about how my parents sent me to WeightWatchers when I was 11, setting me on a course of disordered eating that was still plaguing me nearly a half-century later, she sent me to a nutritionist who helped me to develop a healthier attitude about food and my body. The self-loathing still crops up from time to time, but I’m getting better at quelling it. The reminders from Dr. B. help. “If you’re not ill, obesity isn’t an illness,” she told me.

And indeed, I have no idea what my BMI is — the last time I checked it was north of 30 and that was probably 30 pounds ago. I prefer not to think of myself as obese, though the National Institutes of Health says otherwise. But I am definitely not ill. I’m 63 and my cholesterol, blood sugar and blood pressure are low to normal, my resting heart rate is lower than the average for a woman my age, my colon is clean, and my knees, hips and back (all my original body parts, by the way) work fine. Maybe it’s tempting fate to admit this, but I’m not on medication because I don’t need any.

At some point I’ll get sick and die — that’s how most of us go — but for now I’m healthy. Healthier, I daresay, than the skinny dentist who told me last summer that I should get a new doctor after I mentioned Dr. B. didn’t think I needed to lose weight. I’ve never had high cholesterol. Meanwhile, the skinny dentist had gotten skinnier to avoid taking statins.

One reason I have a healthy metabolic profile is that I eat well and exercise regularly. But even eating well and exercising regularly do not guarantee good health. One of my closest friends weighed 60 pounds less than I, ate better and exercised regularly, and she died at 62 from ovarian cancer. No amount of dieting protects against the mutated BRCA gene that, it turns out, runs in her family. I won a better ticket in the genetic lottery, unless you count the fact that along with my healthy genes I inherited a slow metabolism and a sweet tooth.

I wish Oprah had opened her YouTube show with a monologue about how losing weight helped her to get healthier, and that fat people can also be healthy people. Instead, she buried that critical information in the last half hour of a three-hour program. That’s when she invited a Yale endocrinologist onstage to confirm that our most important health numbers can’t be read on a scale; they’re the ones that reflect markers such as blood sugar levels, blood pressure and cholesterol.

I’m not so naïve as to dismiss the reality that extra weight can be tough on your joints — in fact, it was a comment about joint health from my family doctor nearly 25 years ago that got me to lose 40 pounds on WeightWatchers (which I’ve since regained). I’m also aware that plenty of overweight people are at high risk of developing metabolic disorders.

Weight loss and body image will always be fraught, intertwined topics. But when talking about weight loss and the drugs that make it easier to drop pounds, we need to emphasize the physiological benefits, not just the psychological ones. Continuing to focus on the connection between weight and self-image over the connection between weight and health doesn’t combat body shaming. Quite the opposite: It promotes and exacerbates it. That’s damaging for everybody, especially those of us who are overweight, healthy and secure in the knowledge that our value comes from the good we do, not the way we look.