There are television moments from my childhood that I can still replay in my head in eerie detail: the moment the Challenger shuttle crashed (something I watched alongside my grade-school class on a TV that had been wheeled into the room); the Tonya Harding Nancy Kerrigan incident; the baby Jessica rescue; Charles and Diana’s wedding; and the episode of The Oprah Winfrey Show where she revealed her dramatic weight loss by wheeling out 60 plus pounds of animal fat in a Radio Flyer wagon wearing “skinny” Levis cinched tightly at the waist.
That was in 1988. Last week, Winfrey’s weight loss caused a stir again, this time because she revealed that the key to her current dramatic transformation (on display as she does promotion for The Color Purple) came thanks to medication. While Winfrey didn’t specify which drug, many have assumed that she is using a semaglutide (a GLP-1 agonist) like the increasingly popular Ozempic. It was first approved back in 2017 for those with Type 2 diabetes, and weight loss was a side effect—one that didn’t go unnoticed by manufacturers. In 2021, Wegovy became the first GLP-1 agonist approved for chronic weight management, though other semaglutides are now frequently being prescribed off-label (not an uncommon practice in medicine) for the same purpose. The drugs work by stimulating the production of insulin and stalling glucagon, which spikes blood sugar; the effect on the patient taking it is that they get a signal of satiety.
Fatima Stanford, MD, an obesity medicine physician at Mass General Hospital and associate professor at Harvard Medical School in Boston, is intentional about not calling the class of drugs weight loss medications, but instead “anti-obesity medications,” underscoring the qualification by the CDC of obesity as a disease, unlike other chronic conditions such as diabetes or high blood pressure. Though, this is one, she adds, that you wear for the entire world to see. It’s something that can—even if you are an internationally beloved superstar like Oprah—open you up to scrutiny. Stanford’s practice takes a holistic approach, employing a psychologist, a dietitian, and an exercise physiologist, so patients on semaglutides have a multi-pronged protocol.
Before prescribing, Lisa Erlanger, MD, a family physician in Seattle affiliated with UW Medicine who also points to the limited data around these drugs, recommends doctors lead with questions like: What are you hoping to achieve through weight loss? What will it be like to lose your appetite? Do you have a history of a difficult relationship with food? Are you having negative social, psychological, or symptomatic impacts? When thinking about how Ozempic and others are prescribed, it’s important to consider how doctors should be addressing weight more generally.
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