This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!
In the column “The Ethicist” in the New York Times, a letter writer was concerned that his friend was fat and, as she had asked him not to talk about her weight, he wanted to know if he should go behind her back to talk with her children.
I wrote about that column in Part 1. In the comments of that article many of you wrote about a separate column in which someone wrote in concerned about friends who were taking weight loss drug semaglutide, marketed by Novo Nordisk.
The letter says:
Recently, two of my good friends (neither of whom is ob*se*) have joined the masses taking semaglutide for weight loss. Because the three of us live in different parts of the country, our friendship is maintained by annual visits and frequent texts. Lately in our text thread, all they can do is rave about how these drugs have been “life-changing” in helping them drop the stubborn 20 pounds they’ve been wanting to lose since hitting their 40s. I’m conflicted about the safety and popularity of these drugs for weight loss, and so I’ve remained silent whenever this topic comes up. Our annual trip is coming up, and I fear I’ll be forced to offer my opinion about their weight loss, especially since the trip involves time at the pool. Should I compliment them to keep the peace? Or is there a tactful way to make my differing opinion about these drugs known? — Name Withheld
One thing I want to note that is concerning is the letter writer’s choice to point out that their friends are “not ob*se” which can imply that the safety concerns about the drug would not be valid if the friends’ weight was higher. This is a type of weight stigma that we see from lay people and healthcare practitioners alike, where risk is predicated on size and based on the idea that people’s lives and quality of life are less valuable and more riskable if they weigh more.
Let’s get to the The Ethicist’s answer. He begins:
It’s not the job of friends to play doctor.
What’s that now? Make no mistake, I absolutely agree with this statement, I just can’t help but remember that when the subject of the letter was fat the ethicist was comfortable with everyone from the letter writer to the subject’s children to The Ethicist himself playing doctor.
People who have been prescribed semaglutide will have received medical advice about possible side effects. More than a few will have experienced them.
The truth is that people who have been prescribed semaglutide SHOULD have received medical advice about possible side effects but the reality of the experience of fat people is that often healthcare practitioners vastly underplay the truth about side effects as just one of the ways that they try to manipulate us into doing what they think is best. This can be exacerbated when companies like Weight Watchers and Noom become weight loss drug pill mills.
You imply there’s a moral problem about taking the drug, but you don’t say what it is.
There’s nothing in the letter that suggests, to me, that the writer’s concern is focused on anything but the safety of the drugs, of course I could be missing it.
Maybe your concern is that your friends have been prescribed a semaglutide medication for an “off label” use, one that hasn’t been authorized by the F.D.A. But physicians use off-label therapies all the time (including for serious conditions like macular degeneration, with backing from E.U. and U.K. authorities). You’d want to be specific about why this off-label use is objectionable.
I wonder why The Ethicists chose macular degeneration as an example of off-label prescribing instead of, say, Fen-Phen, a weight loss drug cocktail that was heavily prescribed off-label, and was finally pulled from the market but not before it killed some people and harmed many others. In truth, not only don’t we know if this is the letter writer’s concern, it seems that The Ethicist might not be aware that semaglutide sold under the brand name Ozempic is not indicated for weight loss, but sold under the brand name Wegovy is authorized by the FDA for weight loss and thus wouldn’t be off label.
Or maybe you’re worried that they’ve been using a drug that has been in short supply, posing difficulties for those with diabetes who need it. That was a real issue — though, as manufacturing has ramped up, a temporary one. You might still feel they had been selfish to make even a minuscule contribution to that shortage. (There are millions of semaglutide prescriptions in the United States alone.) If so, you might invite a broader discussion with your friends about the problems to which your own various habits of consumption are making similar contributions.
I think it’s terribly interesting that when the subject of the letter was fat, The Ethicist took a firm “you’re right, your friend is wrong” stance with the letter writer, suggesting that the letter writer talk to their “friend” (or her children!) about the friend’s behavior. When the subjects of the letter aren’t fat (at least not whatever the letter writer’s definition of “ob*se” is) and are pursuing weight loss, suddenly the letter writer should be introspective and have a broader conversation and consider where they are a “problem.” The Ethicist assumes, without evidence, that the letter writer’s habits have some parallels with taking a medication for (what the letter writer suggests is vanity) weight loss, that people with diabetes medically need and for which there is a shortage. Also The Ethicist’s use of “was” regarding the shortage is simply inaccurate. As of June 7th semaglutide (as both Ozempic for Type 2 Diabetes and Wegovy for weight loss) is on the FDA drug shortage list and remains on the list as of this writing (The Ethicist’s article was published on June 28.)
Not knowing what your specific concerns are, I can’t tell you how to broach them
This letter writer was clear that she is concerned about the safety of the drug. Now, suddenly, the same ethicist who was arm-chair diagnosing a fat person, suggesting (with no evidence) that she might be lying about her ability to access drugs, recommending a dangerous surgery and making baseless claims minimizing the risks of the surgery, has no suggestions to offer?
But if what’s really bothering you is the thought that your friends are taking the easy way out, well, I doubt that’s a cogent position.
The letter says absolutely nothing like this. Here, as with the other letter, I feel like The Ethicist may be heavily relying on one of the pharma lobbying groups disguised as an advocacy groups, like the OAC, for talking points and information.
He ends with:
In any case, the evidence is clear: Moralizing weight issues doesn’t help solve them.
The Ethicist has tied himself into knots here to avoid answering the actual question of whether the letter writer should compliment their friends’ weight loss to make them happy or should share concern for their safety. Remember that when the subject of the letter was fat and had specifically asked the writer NOT to share their concerns, The Ethicist made the letter writer into a hero for wanting to share their concerns and suggested that the writer go behind their “friends” to enlist her children, treating the woman as a problem to be solved. Now, when the subjects are pursuing weight loss with drugs that can have serious side effects (they carry the FDA’s strongest warning) being worried for their health is inappropriately moralizing. The hypocrisy here is clear and staggering for someone who literally writes as “The Ethicist.” The Ethicist also takes one last opportunity to re-invest in the deeply flawed body-size-as-disease paradigm.
Were I to answer the letter writer’s question: I would say that if they want to share their concerns about these drugs with their friends, they should ask the friends if they want to hear those concerns and, if not, they should not share them.
I also think that the letter writer (like all of us) has the right to set boundaries, to tell their friends that they aren’t interested in hearing about weight loss and if that’s what the friends insist on talking about, then they will simply find something else to do/somewhere else to be. Also, there is no obligation to compliment people on body size manipulation if we don’t want to. People are allowed to buy into a culture that says that a thin body is a better body and that manipulating one’s body size to be smaller is praiseworthy, but we aren’t obligated to buy into that culture.
For me, complimenting people for becoming (at least temporarily) smaller is buying into and perpetuating a dangerous culture built on weight stigma that harms people of all sizes, with the most harm being done to those at the highest weights and those with multiple marginalized identities. Not to mention that if the friends stop taking the pills, Novo Nordisk’s own reserach shows that they will regain the bit of weight that they lost, and even if they stay on the drug for life, Novo Nordisk’s “long-term” research showed weight climbing at the two year mark, even with people who were still on the drug. Novo’s behavior is certainly worthy of significant ethical scrutiny, but based on these two columns, NYT’s ethicist is not in any position to do that effectively.
Did you find this post helpful? You can subscribe for free to get future posts delivered direct to your inbox, or choose a paid subscription to support the newsletter (and the work that goes into it!) and get special benefits! Click the Subscribe button below for details:
Liked the piece? Share the piece!
More research and resources:
https://haeshealthsheets.com/resources/
*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings’ Fearing the Black Body – the Racial Origins of Fat Phobia and Da’Shaun Harrison’s Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.
Wow, the hypocrisy is just dripping off of "The Ethicist." Their use of that moniker is highly unethical, and, frankly, disgusting. They need to stop writing this column now. Thank you so much for calling out this behavior!
Thank you so much for this series! The response to the first letter was cringeworthy enough. I couldn’t believe the hypocrisy with the answer to the second letter! Thank you for being here to call out this BS!