In the US, weight loss medications are transforming obesity care, but a double stigma is emerging—one that perpetuates shame about having obesity and about seeking treatment. Tackling this stigma can empower more people to access life-changing care.
With new treatments for obesity comes a new kind of stigma which depicts medications as a quick fix for people too lazy to eat better or exercise more regularly. Photo: Unsplash
Glucagon-like peptide 1 (GLP-1) agonists are a class of drugs used to regulate blood glucose levels. They have long been used to treat type 2 diabetes, and in recent years have also expanded to treating obesity. A 2024 Gallup poll found that about 6% of adults in the US, or 15.5 million people, use these injectable diabetes medications to reduce weight, including 3% who are currently using them.
But with the advent of these new treatments for obesity comes a new kind of stigma: one that depicts the medications as a quick fix for people too lazy to eat better or exercise more regularly. Not only are people feeling a sense of shame to have obesity to begin with—they also feel shame disclosing that they are seeking treatments for it.
As GLP-1 medications become increasingly common as a tool for losing and managing weight, how best can the interlocking stigmas that exist between obesity as a chronic illness and the methods people use to treat it be interrogated and overcome?
The rise of weight loss drugs in the US
Obesity is a pervasive global health issue. Recent figures from the World Health Organization (WHO) reveal that as of 2022, one in eight people globally has obesity. An estimated 2.5 billion adults are considered overweight, and 890 million adults are living with obesity.
In the US, where much has been reported on obesity’s burden of disease, prevalence of the condition rose from 30.5% in 1999–2000 to 41.9% in 2017–2020, according to the CDC. An estimated 9.2% of US adults have severe obesity.
In 2014, a GLP-1 agonist drug called liraglutide, which was traditionally used for diabetes treatment, received US Food and Drug Administration (FDA) approval for weight management. It was the first of this class of drug to be prescribed for this purpose.
From there, the flood gates opened. Semaglutide, which is popularly known and sold under the brand names Wegovy and Ozempic, followed, receiving approval in 2021 for chronic weight management. The approval for tirzepatide, sold as Zepbound for weight loss, came after that. Zepbound was originally approved and sold as Mounjaro for diabetes management.
For many people with obesity, these drugs have proved a game changer. Most often given as an injection under the skin, they reduce food intake, appetite, and hunger, which often results in weight loss.
A landmark 2021 clinical trial of semaglutide found that approximately 70% of participants who took the drug achieved a weight loss of at least 10% over 68 weeks, and approximately 50% achieved a weight loss of at least 15%. Similarly, a large group of randomised controlled trials called STEP trials, lasting 1.3–2 years, consistently found that weekly 2.4mg semaglutide injections led to 6–12% greater weight loss compared to placebo or alternative interventions.
“With people who lose weight with these medications, the big thing they discuss is that they no longer have a lot of ‘food noise’.”
“Everyone who is on it [GLP-1 drugs] is almost giddy, happy,” says Dr Marijane Hynes, internist and clinical professor of medicine at George Washington University School of Medicine.
“I find with people who lose weight with these medications, the big thing they discuss is that they no longer have a lot of ‘food noise,’” she says of psychological and physical cravings for eating large quantities of food. “They don’t have this burden of having to worry about how to lose weight every day—it permeates who you are as a person to not have to think about it all the time.”
Dr Diana Thiara, an internist and medical director for the University of California San Francisco’s weight management program, says many of her patients feel similarly positive about the drugs.
“For my patients, it’s an amazing tool to help improve their health. For a lot of people struggling with chronic obesity for a long time, [having access to] something medical and not surgical that shows long-term benefits on health, they’re looking at this positively,” she says.
Obesity stigma affixes to new medications
Despite the impressive results, there are signs that the same negative narratives and pervasive stigma that have long surrounded obesity are beginning to affix themselves to these newer treatments. Mckinzie Burrows from the Obesity Action Coalition (OAC), a US-based national nonprofit, says there is “undoubtedly a societal stigma attached to using medications for the treatment of obesity”.
Much of this stigma centres around claims that taking obesity medications like Ozempic and Wegovy is ‘cheating’ at weight loss or the ‘easy way out’. “This belief can make patients feel ashamed or hesitant to seek treatment, even if their doctor recommends it,” Burrows says. “They may feel anxious explaining to loved ones or other healthcare providers that they are using medication to support their weight loss efforts.”
She stresses that when people are afraid to seek treatments or feel judged for taking obesity medications, it might dissuade them from accessing care. “Some people may avoid talking to their healthcare provider about potential weight loss options, which can prevent them from getting the help they need to improve their health,” Burrows says.
Conversely, Hynes says people who experience negative side effects from the drugs, like nausea and vomiting, might feel compelled to stay on the medication rather than talk to their doctor about other treatment options like switching to another type of medication.
“This [stigma] means fewer people reach out for help, despite the many weight loss options and resources that are now available.”
There are also potential flow-on effects for access to these treatments and the acceptability of future weight loss treatments. “This [stigma] means fewer people reach out for help, despite the many weight loss options and resources that are now available,” Burrows says.
“It can also make it harder for healthcare providers to provide comprehensive care for their patients, and for new and effective treatments to gain acceptance and be widely used.”
Barriers to access fueling stigma
One of the big hurdles to more widespread adoption of these medications in the US is access. Hynes says about half of the patients she sees do not have access to these drugs because they lack insurance or the ability to pay out of pocket.
Some people might be able to receive coverage for these drugs to treat diabetes, but not for obesity treatment. Hynes says these drugs “are very expensive” and can feel totally out of reach to the average person.
Social media can fuel negative comments around obesity drugs as a quick fix. Photo: Ave Calvar
Socioeconomic inequities that influence who has access to these drugs can fuel further stigmas and stressors for people who might feel at a loss for ways to best treat obesity.
These barriers to access can be particularly painful for people digesting health information on social media and on TV with pop culture figures like Oprah Winfrey extolling the virtues of these drugs.
Burrows says that a lot of the pervading media conversations around these drugs suggest they are a “quick fix” and often “poke fun” at the people using them. “There’s a lot of talk about side effects such as ‘Ozempic face’,” she says, referring to the sagging and aging of facial skin that can occur after weight loss while using the drug. “This leads to negative comments and perceptions about the medications.”
Plus, Burrows says, most product marketing treats these drugs as consumer goods instead of medications. “This kind of messaging reinforces negative stereotypes and can make people feel ashamed or embarrassed about using the medications,” she says.
Likewise, Hynes says that societal messaging promoting an idea that these are ‘magic’ or ‘miracle’ drugs can drive misconceptions. She stresses that to lose a significant amount of weight, the medication must be combined with diet and exercise. People who rely on the drugs as a weight loss cure-all “are not going to lose a lot of weight,” Hynes says.
Using education to refute obesity drug stigma
Education is essential for pushing back against the stigma attached to weight loss through medication, Burrows says. She believes the conversation must centre on obesity as a chronic disease, much like type 2 diabetes or high blood pressure, and eliminate the moral judgment that often guides discussions about the condition.
“It is important to make it clear that using medications to help with weight management does not mean someone is weak, lazy, or unmotivated. This is a legitimate and often necessary treatment option given the complexity of obesity,” Burrows says.
Accurate, evidence-based reporting is a key element of broader public discussions. “The media and pop culture have the ability to influence people’s perceptions of obesity and its treatment options,” Burrows says.
Healthcare providers can continue the conversation by talking openly about the tools available for treating obesity, including medications, and helping people understand what is in their control versus what is not.
“With the rise of GLP-1 medications, more people are becoming aware that these science-based tools exist, which can reduce stigma and encourage others to consider them as treatment options.”
Healthcare providers can continue the conversation by talking openly about the tools available for treating obesity, including medications, and helping people understand what is in their control versus what is not, such as biology and genetics, Burrows continues.
Thiara says factors contributing to obesity and potential treatments are “not taught very well” in medical schools and agrees that healthcare professionals should pitch these drugs as helpful tools that can complement changes to diet and exercise habits.
Improved access to obesity medications, which Hynes says is possible once patents expire and cheaper options become available, may also help to reduce stigma because more people will have firsthand experience using the drugs.
She believes this normalisation can go a long way towards reframing obesity as a condition like diabetes or heart disease that can be helped with medication. Burrows, too, says changing the conversation about obesity medications can improve perceptions about obesity itself.
“Success stories with GLP-1s show that obesity and related diseases can be effectively treated with medication, challenging the idea that weight loss is simply about eating less and moving more,” Burrows says. “More people are realising that obesity is very complex and is not a sign of someone lacking willpower, discipline, or motivation.
“When we recognise that obesity is a chronic and complex disease that is deserving of medical treatment options, it can help reduce stigma and lead to more compassionate care.”
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