Othella Esposita had been on her period for four months straight when she went to the gynecologist last January. The sales administrator from Kansas City has polycystic ovary syndrome (PCOS), a hormonal imbalance that messes with her menstrual cycle, and was trying to get pregnant. Esposita asked her doctor how to regulate her period, but instead the OB/GYN brought up a “new drug on the market”: Ozempic.
The 38-year-old, who calls herself “super fat,” was confused. “My goal was not to lose weight,” Esposita says. “The whole reason I was there was the bleeding.” She told the doctor she doesn’t have diabetes and thought women trying to get pregnant weren’t supposed to be on the medication. “With your weight, you can’t get pregnant anyway,” the gynecologist said, adding that even if Esposita did, she or the baby would likely die from health complications. “I was shaking and tearing up,” Esposita says. “I was trying to still advocate for myself.” She worried that her insurance wouldn’t cover Ozempic, but her gynecologist kept pushing. She told Esposita that she and several of her staffers were on it, offered to prescribe alternative weight-loss drugs if Esposita’s claim was rejected, and told her about a voucher that would bring down the cost. “I could not keep fighting,” Esposita says. She left the office with a prescription that she didn’t plan to pick up.
Ozempic, the so-called miracle drug, is rapidly changing the way doctors look at all sorts of health conditions. It mimics a digestive hormone that can lower blood-sugar levels, curbs appetite, and slows digestion, leading celebrities and normies alike to seek out the drug for its slimming side effects. While it’s only meant to treat type 2 diabetes, its counterpart, Wegovy, is approved for weight loss in adults with obesity. Scientists are also studying how its revolutionary ingredient, semaglutide, could help everything from Alzheimer’s to liver disease. (There is already some anecdotal evidence that it helps with insulin resistance caused by PCOS.)
But the exciting milestone in medicine has also created an incredibly tough and taxing moment for fat patients who, as study after study has shown, don’t receive proper care because of bias. I spoke to several who told me that instead of addressing their back pain, fertility struggles, or other chronic conditions, doctors pushed Ozempic on them for weight loss. Meanwhile, their immediate health concerns are ignored. Esposita says the interaction with her gynecologist “made me feel like all she could see was a fat body, and that she had to worry about the fat problem before she could see a patient underneath it.”
Without even saying, ‘Hey, let’s run some tests. Are you ill? Is anything else going on?’ It was just, ‘Here, take Ozempic.’
Marcy was diagnosed with lymphedema, a condition that causes fluid to build up in her legs, in 2021. The 53-year-old from Queens, who didn’t want to share her last name for privacy reasons like other sources in this story, wanted to work with a nutritionist to follow an anti-inflammatory diet that she hoped would lessen the pain and swelling. Her primary-care doctor made a referral last year, but the callback came from an office administrator at a hospital weight-management center. The person told her that she’d need to be evaluated and then choose between having weight-loss surgery or going on Ozempic. Marcy, who describes herself as “visibly plus size,” told them there must be a misunderstanding. Her goal was to develop better eating habits, not to lose weight. But the administrator said that in order to work with a nutritionist, Marcy had to join the weight-loss program, which a nurse reiterated in a follow-up call.
It felt to Marcy like these health professionals had seen her BMI and made the assumption that “All fat people are unhealthy.” Though her medical chart says she’s obese, Marcy doesn’t have diabetes, high cholesterol, or high blood pressure. The swelling from lymphedema has made her gain weight, but she doesn’t eat regularly because the pain “kind of curbs my appetite.” And yet, medical workers are “focusing on the number on the scale,” she says. “You’re ignoring my diagnosis. How am I supposed to get better?”
Some patients told me they were pressured to go on Ozempic despite having health issues the drug could exacerbate. (And it’s not just fat patients, either: One woman with a family history of osteoporosis told me that her psychiatrist suggested Ozempic, which can lessen bone density, when she brought up SSRI-related weight gain.) Alisa, who identifies as “super fat,” has struggled with an eating disorder since she was a child. The 51-year-old also has osteoarthritis and went to see a specialist last year about her debilitating back pain. The doctor showed Alisa some devices that could be implanted into her spine to help strengthen lower-back muscles. Then, he pivoted to ask: “What are you doing about your weight?” “I have an eating disorder,” she told him. “I am not involved in any intentional weight loss.” Still, without making eye contact, he suggested she go on Ozempic.
Alisa, who lives in Atlanta, reminded the doctor that the drug would trigger food restriction and damage her mental and physical health. “Well, that’s what you need to be doing,” he told her. “You are taking in too many calories.” She felt bullied, especially since the doctor admitted later in the appointment that there was no specific BMI requirement to get the back surgery. “He was on a personal mission to get me to diet,” Alisa says. “He saw this fat Black lady sitting in his chair and he’s thinking, ‘I’m gonna fix this woman. She’s gonna do what I told her to do.’” She cried on her way home from the appointment and later filed a complaint. “He treated me as if I was disgusting and beneath his services,” she wrote in an email to the hospital. “I am fine with my body and my weight and do not need a doctor berating me and triggering my eating disorder.” Someone from the hospital called Alisa to apologize — then described the doctor’s behavior as “understandable,” given her size.
Another woman who has struggled with an eating disorder tells me an endocrinologist who was aware of her history encouraged her to go on the weight-loss drug. When she texted the doctor about her elevated blood-sugar levels, the doctor responded, “How about Ozempic for better control and weight loss?” “My first thought was, Well, fuck you,” she says. “Without even saying, ‘Hey, let’s run some tests. Are you ill? Is anything else going on?’ It was just, ‘Here, take Ozempic.’” Within two weeks of her first injection, she passed out from eating so little and was rushed to the hospital. The next day, she emailed her doctor: “I have discussed with multiple providers that I struggle with disordered eating, including you. It feels like this is being treated like some kind of joke or an excuse because I am perceived as fat, lazy, and disagreeable.”
It’s really hard to realize that my doctors haven’t been trying to help me so much as shrink me.
Laura, a medical social worker in the San Francisco Bay Area, experienced a similar bias at a recent appointment with an endocrinologist to discuss her high cortisol levels. The doctor said her hormones weren’t an issue and then brought up her size. “We need to get this weight off you. And we need to do it now,” he told her. “That’s not what I came here for,” she said, pointing out that he hadn’t asked about her medical history. “I had an eating disorder that went undiagnosed for a long time. I feel that dieting for me is extremely risky.”
The 44-year-old describes herself as being in a “smaller fat body.” Still, as someone who works in a hospital, she sees parallels between how doctors treat her and how they “yell and berate” patients struggling with their mental health or drug addiction. “They are blaming people and trying to motivate them by scaring them,” she says. “Most providers want to help patients, but I think we have gotten away from what that is.” Part of the issue, she explains, is the medical establishment’s reliance on the outdated body mass index, which doesn’t take race, gender, or the difference between body fat and muscle into account. “There is still this concept out there that fat is going to kill you,” Laura says. “And there’s just a general unwillingness to look at evidence-based research about it.” She ended up ditching the endocrinologist, as well as her primary-care doctor who made the referral. The prospect of finding new providers with a “non-diet” approach is daunting. “I still feel pretty vulnerable,” she says, “like people are just not going to take me seriously.”
Providers’ enthusiasm for the miracle drug can be off-putting even to those with elevated blood-sugar levels, which it helps to lower. Valerie had been seeing an endocrinologist to treat her PCOS who had repeatedly brought up her weight. When her A1C jumped slightly in 2020, the doctor told her she was “prediabetic” — a term the World Health Organization (WHO) has rejected as medically irrelevant — and instructed her to up the dosage of an existing medication and start taking Ozempic. The 35-year-old from Pittsburgh says her doctor made her feel like “a ticking time bomb.” She stuck with the drug, even though it made her lightheaded and triggered her disordered eating. She later found a Health at Every Size (HAES) provider who is trained not to stigmatize fat patients and who asked Valerie why she was taking Ozempic after looking at her A1C levels. The amount of medication she’d been prescribed, the doctor said, was like “trying to kill a mosquito with a machine gun.” “I’m so disgusted and so upset,” Valerie wrote on Facebook after the appointment. “It’s really hard to realize that my doctors haven’t been trying to help me so much as shrink me.”
Marcy, the woman with lymphedema, tells me she recently found a nutritionist who has agreed to discuss an anti-inflammation diet without pushing weight loss. She’s excited to finally work with a health professional who won’t jump to conclusions based on her size. “I’m not on a couch, eating a half-gallon of ice cream,” Marcy says. She now hopes to become more active with the help of a pump to massage the fluid in her leg and compression leggings. “I want to do Alaska next year,” she says, “and I want to be on a dog sled.” It’s something most doctors she’s been treated by didn’t see in her future. “What Ozempic is offering me is not what I need,” she says. “But they assumed because I’m fat that, ‘Oh, you will just want to lose weight by any means necessary.’”
Angelina Chapin , 2024-03-14 17:58:20
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