After a lifetime of dieting, cleanses, and exercising, I finally felt at peace with my body—or so I thought. No longer the 98-pound college student, I’d freed myself from the tyranny of the scale. I embraced my booty and boobs in the “curves are in” era, even as my arms started to droop, and my stomach, formerly flat, started to floop.

“I’m a woman growing older. This is what I’m supposed to look like,” I thought, manifesting body positivity. “Screw anyone who isn’t okay with that.” I am woman. Hear me roar!

Then my mom came to visit. As we ordered pasta, she commented, “I’m worried about how much weight you’ve gained.”

“MOM!” I looked up from my menu. “Under no circumstances is it okay to comment on a woman’s body without invitation,” I said firmly. “Most women gain weight during menopause. This is normal.”

She dug in. “But I’m concerned about your health.” Seriously mom? So much worse.

Why, I pondered, was I so pissed? Was I actually not confident in my body? Or was this an example of how much influence our moms—and society—have on our beliefs, even as grown-ups?

A month later, I started taking Wegovy, the weight loss medicine that has taken the world by storm. But was I betraying myself, and the body positivity movement?

GLP-1: Ozempic, Wegovy, and the Gila Monster That Made It All Possible

The Gila monster, a giant venomous lizard, hibernates with no food while maintaining stable blood sugar. After scientists identified the lizard peptide responsible for this miraculous feat, they tried for decades to create a mimic that might do the same for people. Our bodies make glucagon-like peptide-1 (GLP-1) which reduces appetite and slows digestion—but disintegrates too quickly to aid diabetes or weight loss.

Finally, Novo Nordisk created semaglutide, a long-lasting GLP-1 mimic that lowers blood sugar. Wha-la: Ozempic was born. After clinical trials, the U.S. Food & Drug Administration (FDA) approved it for diabetes in 2017.

“The drug was created to treat diabetes or something stupid,” jokes comedian Jim Gaffigan in his Hulu special, The Skinny. “But once it got out that there was a diabetes medicine that made people not crave donuts, every fat person was like, ‘I just got diabetes’.”

Is It About Body Positivity, Vanity, or Vital Signs?

Lucky for me and, apparently, my mom’s concerns, the FDA also approved semaglutide for weight loss in 2021. With the early shortages over, these medications are now widely available—though pricey without health insurance.

Both Wegovy and Zepbound, a slightly different formulation, are “GLP-1 receptor agonists” often called GLP-1s. The semaglutide molecule fits in cell receptors like a lock and key, slowing the stomach’s emptying and reducing appetite.

“I feel a little awkward when I tell people that I’m on it, because there’s that attitude that it’s just for vanity,” said Kellie Snider, an artist in her 60s. Snider started Ozempic for Type 2 diabetes, with weight loss an added bonus.

Other than nausea—worse when first starting—and the “horrible” constipation, Snider is happy with the results.

That nausea can be a double-edged sword. It feels yuck, but that yuck makes you avoid eating. “The nausea was so bad that I wasn’t sure I was gonna stick with it,” said Snider. “But I read that there’s benefits from [the medications] too, like improving your heart health, a lower stroke risk, and things like that,” so she powered through.

She’s not wrong: Not only do GLP-1s help people lose up to 20 percent of their weight, but they also appear to improve outcomes for cardiovascular disease, neurodegenerative conditions including Parkinson’s and Alzheimer’s, and even addiction to alcohol, drugs, and smoking. The FDA has not yet approved GLP-1s for these conditions, but results seem promising.

When Extra Weight Becomes a Real Health Risk

A few years before GLP-1s were officially used for weight loss, some doctors prescribed Ozempic “off-label.” When Susan Dabbar, editor-in-chief of PROVOKED by susan, chose to have a procedure done, her surgeon recommended she lose weight since her BMI was a little high. “Nobody wants to hear that you’re ‘high risk’ to have elective surgery,” said Dabbar. “What if I have to have emergency surgery? That was a lightning bolt for me.”

Extra weight, particularly in our midsections, is linked to poor health outcomes: a higher risk of developing Type 2 diabetes, cardiovascular disease, high blood pressure, obstructive sleep apnea, osteoarthritis, and other musculoskeletal conditions. Being overweight impairs mobility, making it harder to get around and to exercise. It’s also connected to psychological disorders including depression.

And, as Dabbar learned, it adds risk when undergoing surgery. So when her doc recommended she try Ozempic, she did: once weekly injections, starting at a low dose and gradually working to higher doses. This titering allows the body to adjust to the side effects of nausea and even vomiting that can occur.

“I lost about 40 pounds. It was a very easy journey,” said Dabbar. Dispelling the societal notion that overweight people are lazy, Dabbar, who has always had a larger body type, emphasized, “We’re not lazy people. I’ve never been lazy. And it doesn’t matter. There are certain people who have metabolic issues, thyroid issues, whatever it is.” For her, semaglutide helped what dozens of diets didn’t.

Many women who have reached a weight they’re pleased with—including Dabbar—take a lower dose to maintain the lower weight. Semaglutide may rewire the brain’s neural circuitry connected to appetite and reward, with its effects lasting even after stopping the medicine.

“It shuts down the ‘food noise’ so I’m not thinking about food at 4:00 in the afternoon or 8:00 at night, which are my trouble times,” said Dabbar. Plus or minus five or six pounds, she’s kept the weight off for three years this way.

Is Weight Loss a Betrayal of Body Positivity?

While some have expressed dismay at society straying from the body positivity movement of the past decade, I disagree that desiring to end the obesity epidemic means that we somehow want to get rid of fat people. It made me wonder: Are we betraying the body positive movement by wanting weight loss?

The truth is, while I had started to feel happy with my body before, I’m even happier 25 pounds lighter. My mother’s well-intentioned—although misguided—comments wouldn’t have made me exercise more or try another diet. But inject myself weekly with medication? I’m down. And I’m not sorry about it.

Changes to the Western world’s food options, less physical activity, and the pervasiveness of obesogens—chemicals that cause weight gain including phthalates, PFOAs, and bisphenols—have contributed to fluffier people than in generations past. So if a drug has few side effects, as we currently understand, and massive benefits, what do we have to lose, except weight?

What We Really Gain From Losing Weight

Ditching 25 pounds while not depriving myself feels like a big win. My clothes fit better. I stopped snoring and my blood pressure has reduced. I even lost my taste for alcohol.

“If I look good and I feel healthy, I have more confidence,” said Dabbar. “And that confidence shows up in the way of positive energy—and that’s what’s contagious.”

If, at the same time, we reduce obesity-associated diseases while benefiting from the positive health effects and good vibes, I say: Bring it on.

The real betrayal is believing our value, or anyone else’s, is tied to our appearance.

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