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Lentis/The Cultural Politics of Obesity Drugs in the US

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Introduction

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Obesity is classified as having a Body Mass Index (BMI) greater than 30 and currently affects over 40% of adults in the United States, with another 30% classified as overweight (BMI between 25-29.9). Despite increasing public awareness, the obesity epidemic in the US shows no sign of declining[1]. Critics argue that BMI is an outdated metric, created for 19th-century White European males, which fails to account for muscle mass and other external attributes.[2]

The diverse responses from pharmaceutical companies, regulatory agencies, advocacy groups, and cultural movements complicate efforts to tackle this epidemic. Recent shifts in treatment, such as weight-loss drugs like Ozempic and Wegovy, present both hope and controversy. These drugs are widely marketed through pop culture and social media but face criticism for long-term effectiveness and limited accessibility.

To determine how each of the aforementioned participants influence the politics around obesity, we examined specific cases in each to understand the bigger picture of the cultural politics of obesity drugs in the US.

Pharmaceutical Companies

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Obesity drug manufactures like Novo Nordisk have seen a surge in market value, driven by aggressive advertising campaigns and lobbying efforts.

Marketing & Social Influence

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Novo Nordisk's campaigns leverage pop culture, using social media platforms like TikTok and Instagram to promote their drugs. These advertisements focus on quick results, often resonating with audiences seeking convenient alternatives to traditional weight loss methods like diet and exercise. Critics argue that such marketing may oversimplify the complexities of weight management and encourage dependency on medication.

Lobbying & Political Influence

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The pharmaceutical industry actively lobbies government bodies to expand drug coverage and access. In 2023 alone, they spent $3.2 million lobbying Congress to expand Medicare coverage for their drugs.[3] This lobbying raises ethical concerns about whether regulatory decisions prioritize public health or corporate profits. Despite these efforts, issues like high costs and insurance barriers limit the accessibility of these drugs, leaving marginalized communities at a disadvantage.[4]

Regulatory Bodies

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Regulatory agencies like the Food and Drug Administration (FDA) and the National Institutes of Health (NIH) play critical roles in overseeing the safety, efficacy, and accessibility of obesity drugs. These bodies establish guidelines for drug approval and monitor post-market safety, but their integrity is often challenged by external pressures.

Drug Approval & Monitoring

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The FDA oversees the rigorous approval process for obesity drugs, ensuring that manufacturers meet safety and efficacy standards. After approval, the agency continues to monitor these drugs for adverse effects, issuing warnings or recalls if necessary. For example, the FDA has raised concerns about unapproved weight-loss drugs, highlighting the need for vigilance in this rapidly evolving market​.[5]

In addition to approving new drugs, regulatory agencies combat the proliferation of counterfeit products, which can pose significant health risks. By issuing public warnings and collaborating with law enforcement, the FDA helps protect consumers from harmful substances masquerading as legitimate weight-loss solutions​.[6]

Influence of Lobbying

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While regulatory bodies are tasked with protecting public health, their decisions are sometimes influenced by lobbying from pharmaceutical companies. This dynamic creates potential conflicts of interest, as regulators must balance the demands of industry stakeholders with the health and safety of the public​.[7]

The Food Industry

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The cultural politics surrounding obesity drugs are intricately tied to the food industry, reflecting how the growing popularity of GLP-1 drugs intersects with consumer behaviors and corporate responses.

Company Responses

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Morgan Stanley predicts that 24 million people or 7% of the US population will be taking weight-loss drugs by 2035.[8] As more Americans start using these medications, consumer eating and buying habits could shift, potentially affecting food industry profits. According to research, these drugs could lead to a reduction in calorie consumption, particularly in sugary and high-fat foods, by up to 5% by 2035.[8]  Companies such as Nestlé have introduced new product lines specifically catering to GLP-1 users, including portion-controlled, high-protein meals that align with the dietary shifts weight-loss drugs encourage.[9] Meanwhile, other industry leaders, like the CEO of snack brand Kellanova, are watching Ozempic trends, but say “it's just far too early to forecast" how they will be affected.[10] The CEO of Smuckers defended the future of their products against weight-loss drugs, expressing confidence that consumer preferences for snacks and sweets will persist.[11] Grocery retailers, such as Walmart, have already reported shifts in purchasing patterns, with data showing smaller basket sizes and lower-calorie selections among consumers.[10] However, other sectors, like the sugar industry, have shown resistance to acknowledging these changes. At the New York Sugar Dinner, industry stakeholders largely dismissed the potential impact of weight-loss drugs, focusing instead on traditional market concerns like production and supply.[12] These varied responses highlight the difference in approaches within the food industry as it navigates the potential disruptions caused by obesity drugs. In contrast, leaders of fast food chains have had no direct statements surrounding the speculated impact of these drugs, despite predictions that this segment of the restaurant industry may be the most affected.[13] Additionally, the National Restaurant Association (NRA) has engaged with issues related to nutrition and public health, including obesity, primarily through initiatives aimed at promoting healthier menu options.[14] The NRA has expressed concerns about the FDA’s proposed redefinition of “healthy” food labels, cautioning that overly broad regulations could restrict restaurants’ ability to guide consumers toward healthier options.[15] However, the NRA has not publicly articulated positions on obesity medications or their potential impact on the food industry.

Advocacy Groups

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Advocacy groups play a critical role in shaping public understanding and policy related to obesity drugs.

Association of American Medical Colleges

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The Association of American Medical Colleges (AAMC) offers an informative perspective on weight-loss drugs, reflecting its mission to improve the health of all people by advancing medical education, research, and healthcare.[16] The AAMC acknowledges the benefits of GLP-1 drugs like Wegovy in improving the health of individuals with obesity but highlights challenges, including high costs, insurance coverage issues, and potential side effects.[17] They emphasize that these drugs are not a quick fix, noting that patients often regain weight after discontinuing the medication, which must be paired with proper nutrition and exercise to be effective.[17] Their advocacy includes publishing peer-reviewed research, engaging policymakers to improve healthcare legislation, and collaborating with federal agencies such as the FDA and NIH to ensure these medications are integrated responsibly into obesity treatment strategies.

Obesity Action Coalition

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The Obesity Action Coalition (OAC) focuses on empowering individuals affected by obesity through education, advocacy, and support.[18] The OAC works to improve access to prevention and treatment, including advocating for insurance coverage of weight-loss medications, surgeries, and counseling. Additionally, the OAC fights against weight bias and discrimination by leading public campaigns to reduce stigma, educating healthcare providers, and raising awareness about the societal challenges faced by individuals with obesity.[19] Through initiatives like the “Your Weight Matters” convention, the OAC provides evidence-based educational materials and fosters community-building opportunities. In addition to providing education and resources, their efforts of advocacy through public policy platforms and collaboration with state and federal legislators, as well as the FDA aim to ensure that patients have equitable access to obesity treatments while addressing broader cultural challenges.[20]

American Academy of Pediatrics

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The American Academy of Pediatrics (AAP) also integrates obesity drugs initiatives into its broader mission “to attain optimal physical, mental, and social health and well-being for all children around the world”.[21] The AAP includes GLP-1 drugs as part of multidisciplinary treatment plans for childhood obesity, emphasizing their use alongside lifestyle changes, such as improved nutrition and increased physical activity.[22] Recognizing the importance of early intervention, the AAP advocates for insurance coverage of obesity drugs and supports clinical guidelines to ensure these medications are used appropriately and effectively.[22] Their approach highlights the importance of combining medical and behavioral interventions, aiming to provide children with comprehensive resources to combat obesity and improve long-term health outcomes.

Together, these advocacy groups highlight the varying agendas and priorities involved in integrating obesity drugs into healthcare. Their efforts leverage regulatory agencies to tackle financial, societal, and educational barriers in ways that advance their specified objectives.

Cultural Influences

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The Body Positivity Movement

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The Body Positivity Movement is a social movement that champions the acceptance of all bodies, emphasizing their inherent value regardless of size, shape, skin tone, gender, or physical abilities. Rooted in the idea that bodies should be appreciated for their functionality and health rather than their physical appearance, the movement has sparked significant cultural shifts in the way that personal health is viewed in the US. Advocates highlight that self-love and body acceptance are vital, regardless of societal beauty standards. The National Association to Advance Fat Acceptance (NAAFA), founded in 1969, is often credited with pioneering "fat activism" in the United States[23]. According to the current NAAFA chair, body positivity reinforces the message that "our bodies are good enough," prioritizing love and acceptance over appearance. The movement gained substantial momentum around 2012, fueled by the rise of social media platforms like Instagram. Inspired by a heightened debate about cultural beauty standards, the body positivity movement arose as a response and argument in favor of embracing all body types, and feeling confident about one's own body even with any flaws. Though men are not immune to body image pressures, and often face expectations to conform to an idealized masculine physique, the body positivity movement has predominantly focused on women[24]. Such reflects the belief that societal beauty standards exert greater pressure on women than on men, supported by the higher prevalence of eating disorders among women.  These societal ideals can contribute to anxiety, body image concerns, and disorders such as body dysmorphia, anorexia nervosa, and bulimia nervosa. Despite these challenges, eating disorders and body image issues in men are less frequently diagnosed and discussed, leading to underrepresentation in public and clinical discourse[25].

Criticism of the Body Positivity Movement

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However, the heightened presence of body positivity in popular media and marketing has drawn criticism. Corporations, such as Mattel, have been accused of leveraging the movement's values to sell products, raising concerns about commercialization overshadowing genuine advocacy[26]. Additionally, public health critics, including those writing in the International Journal of Obesity, argue that the movement may inadvertently contribute to public health issues by normalizing or downplaying the risks associated with obesity. Studies published by the journal found a rising trend in the underassessment of overweight and obesity status[27]. Critics link this trend to the “normalization of larger bodies,” and suggest this could stem from a broader cultural shift in how bodies are perceived and evaluated. The body positivity movement has been criticized for encouraging lifestyle habits that negatively affect one's health, as excessive approval of obese individuals could dissuade them from desiring to improve health. Among health professionals, agreement with the movement is very low; a 2012 study found that among a sample of 1,130 dietitians, nutritionists, nurses and medical doctors, only 1.4% had "positive or neutral attitudes" regarding body fat[28]. While supporters maintain that body positivity fosters mental health and combats harmful stereotypes, ongoing debates continue about its implications for public health and societal attitudes toward wellness and body image.

Skinny Culture of the 1990's & 2000's

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Many believe that modern Body Positivity rose in response to the toxic body image populated in the 1990s and 2000s, an era heavily influenced by toxic skinny culture and the "heroin chic" look popularized by the fashion industry. During this period, mainstream media promoted unattainable body ideals, reinforcing unhealthy behaviors and body image issues.  The phrase “heroin chic,” a tongue-in-cheek term used to describe one of the trendiest looks of the mid-90s to early 2000s, glorified gaunt thinness akin to that of a hardcore drug user and contributed to harmful societal beauty standards[29]. One model famously credited with popularization of "heroin chic" was Kate Moss, who became known in the fashion industry for her size zero frame[30]. Her gaunt figure in campaign’s such as Calvin Klein Jeans in 1992 and Vogue in 1993 shot her to supermodel status, and her catchphrase, "Nothing tastes as good as skinny feels," became emblematic of the era's unhealthy ideals.

This cultural obsession with thinness extended into advertising and public commentary. For example, in a 1995 MTV promo at "Lunch at the Mall,” featuring the stars of the hit movie Clueless, the actors refused a Caesar salad in favor of a side of lemons because “croutons exceed daily fat intake for a teenage girl,” highlighting the fixation on minimal calorie intake. In the popular 2001 film like Bridget Jones’s Diary, even a woman weighing 136 pounds was portrayed as "fat," with her New Year’s resolution focused on losing 20 pounds—further cementing unrealistic expectations[31]. Public discourse also reflected this harmful culture. In 2002, Anna Nicole Smith, former playboy model and reality TV star, was humiliated on an episode of The Howard Stern Show, where she was offered $3,000 and an Xbox to be weighed live. Stern belittled her appearance, saying “if she knew she was a big woman she wouldn’t dress the way she does.” Similarly, the portrayal of a contestant named Robin on America’s Next Top Model in 2003 as "plus-sized" despite her relatively average build exemplifies how the fashion and entertainment industries distorted perceptions of normal body sizes[32]. Such examples underscore how the media and entertainment industries shaped toxic narratives that equated self-worth with extreme thinness, promoting poor body image and eating disorders, that have had lasting societal impacts.

Media Response to Body Positivity

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The body positivity movement has received mixed responses from the media, highlighting both its cultural impact and the controversy surrounding its message. In September 2020, Lizzo became the first self-proclaimed “fat woman” to appear on the cover of Vogue[33]. Her feature signaled a major step forward for body positivity, as she aimed to redefine societal beauty standards and challenge traditional norms. Lizzo expressed a desire to move beyond the term "body positivity" toward what she called "body-normative," emphasizing the importance of normalizing all body types. In the interview she said, “I think it’s lazy for me to just say I’m body positive at this point. I would like to be body-normative. I want to normalize my body.” However, in May 2024, South Park aired a satirical skit that mocked Lizzo’s prominence within the body positivity movement[34]. The skit likened her name to a fictional "new obesity drug" for those unable to afford weight-loss medications like Ozempic. It ridiculed the movement's message with claims, such as “Lizzo controls all your cravings to be thin by not giving a f***,” suggesting a disregard for weight management entirely. Those on the new drug Lizzo can “eat what [they] want and keep physical activity to a minimum,” while “70% [of users] no longer care about [their] weight.” This portrayal highlights the tension between celebrating body diversity and the skepticism or pushback it can receive in mainstream media. While prominent celebrities in the body positivity movement champion inclusivity, media responses often reveal the persistence of societal discomfort with body acceptance, reflecting ongoing debates about health, beauty, and representation.

The Reemergence of Skinny & "Ozempic Face"

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The rise of obesity drugs like Ozempic has ushered in a renewed fascination with thinness in popular media, sparking a shift back toward a "skinny ideal." These medications, originally intended for individuals with clinical obesity, have gained widespread attention for their dramatic weight-loss effects, often becoming a shortcut for celebrities and influencers to achieve rapid body transformations. This has fueled the resurgence of a thin-focused aesthetic, reminiscent of the culture of the 1990s and early 2000s. In November 2022, the New York Post published an article titled ‘Bye-bye booty: Heroin chic is back,’ and it immediately sparked controversy online[35][36]. Alongside this trend, the term “Ozempic face” has emerged to describe the gaunt, hollowed-out appearance that can accompany rapid weight loss, as the face loses volume and definition[37]. Critics argue that the popularity of these drugs and the accompanying media narratives perpetuate unrealistic beauty standards and a fixation on thinness, overshadowing the complexities of body positivity and holistic health[38]. This trend also raises concerns about the societal pressures driving individuals to use such medications for cosmetic purposes rather than medical necessity.

Portion Distortion: Abnormal American Eating Habits

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Portion distortion, the gradual increase in serving sizes of food and beverages over the past few decades, has significantly influenced eating habits in the United States. This trend has led to a normalization of larger servings, both in restaurants and at home, contributing to higher caloric intake and escalating obesity rates. Fast food chains, restaurants, and packaged goods have normalized oversized portions, making it challenging for individuals to gauge appropriate serving sizes[39]. Studies have shown that many foods and beverages are now served in portions that are two to three times larger than they were 20 years ago[40]. This phenomenon contributes to overconsumption and, by extension, rising rates of obesity and related health issues. Public health initiatives often focus on educating individuals about standard serving sizes and encouraging mindful eating practices, and aim to promote healthier lifestyle choices. In a culture increasingly shaped by weight-loss trends and body image pressures, portion distortion and normalized overeating may account for the surge in interest in obesity drugs like Ozempic. As it becomes increasingly popular for Americans to strive to achieve extreme thinness through medications, the prevalence of oversized portions highlights contradictions within the culture. On one hand, larger portions fuel overeating and weight gain, while on the other, societal standards and weight-loss trends stigmatize those who do not conform to thin ideals. Addressing portion distortion could be a critical step toward fostering healthier relationships with food, while simultaneously challenging the unrealistic beauty standards perpetuated by media and popular culture.

Sources

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  1. ↑ "Products - Data Briefs - Number 508 - September 2024". www.cdc.gov. Retrieved 2024-12-10.
  2. ↑ "The really old, racist, and non-medical origins of the tool we use to measure our health" (in en-AU). ABC News. 2022-01-01. https://www.abc.net.au/news/2022-01-02/the-problem-with-the-body-mass-index-bmi/100728416. 
  3. ↑ "Nearly 24 Million Medicare Beneficiaries Now Have Prescription Drug Coverage". PsycEXTRA Dataset. 2006.
  4. ↑ Adams, Ben (September 29, 2023). "As Novo Nordisk boosts Wegovy, Ozempic ad spend, analysis finds 'a rising tide lifts all boats' for diabetes, weight-loss drugs". Reuters.{{cite web}}: CS1 maint: url-status (link)
  5. ↑ Research, Center for Drug Evaluation and (2023-07-18). "Development & Approval Process | Drugs". FDA.
  6. ↑ Research, Center for Drug Evaluation and (2024-07-18). "Notify FDA of Illegitimate Products". FDA.
  7. ↑ Unsal, Omer (2020-01-01). "Two faces of corporate lobbying: Evidence from the pharmaceutical industry". The North American Journal of Economics and Finance. 51: 100858. doi:10.1016/j.najef.2018.10.006. ISSN 1062-9408.
  8. ↑ a b "Could Obesity Drugs Take a Bite Out of The Food Industry". Morgan Stanley. September 5, 2023.
  9. ↑ "Vital Pursuit Hits Shelves Nationwide". www.nestleusa.com. 2024-09-18. Retrieved 2024-12-10.
  10. ↑ a b Peck, Emily (2023-10-06). "How weight loss drugs like Ozempic could radically reshape the food business". Axios. Retrieved 2024-12-10.
  11. ↑ Lucas, Amelia (2023-10-01). "Big Food vs. Big Pharma: Companies bet on snacking just as weight loss drugs boom". CNBC. Retrieved 2024-12-10.
  12. ↑ "Weight-Loss Drugs Menace a Sugar Industry in Denial Over Impact" (in en). Bloomberg.com. 2024-05-28. https://www.bloomberg.com/news/articles/2024-05-28/weight-loss-drugs-are-coming-to-bite-a-sugar-industry-in-denial. 
  13. ↑ Mary Sophia, Deborah (October 26, 2023). "Weight-loss drug worries add to US restaurants' weak traffic woes".
  14. ↑ "White House Conference on Hunger, Nutrition, and Health cites restaurants' efforts to provide health". NRA. Retrieved 2024-12-10.
  15. ↑ "FDA's proposed change to 'healthy' label would stretch to restaurants". NRA. Retrieved 2024-12-10.
  16. ↑ "About Us". AAMC. Retrieved 2024-12-10.
  17. ↑ a b "What doctors should know about popular weight-loss drugs". AAMC. Retrieved 2024-12-10.
  18. ↑ "OAC Mission, Vision and Goals". Obesity Action Coalition. Retrieved 2024-12-10.
  19. ↑ "Weight Bias". Obesity Action Coalition. Retrieved 2024-12-10.
  20. ↑ OAC (2023-11-28). "Doctors and Advocates Call for Better Testing and Labeling of Drugs for People with Obesity". Obesity Action Coalition. Retrieved 2024-12-10.
  21. ↑ "About the AAP". www.aap.org. Retrieved 2024-12-10.
  22. ↑ a b Hampl, Sarah E.; Hassink, Sandra G.; Skinner, Asheley C.; Armstrong, Sarah C.; Barlow, Sarah E.; Bolling, Christopher F.; Avila Edwards, Kimberly C.; Eneli, Ihuoma; Hamre, Robin; Joseph, Madeline M.; Lunsford, Doug; Mendonca, Eneida; Michalsky, Marc P.; Mirza, Nazrat; Ochoa, Eduardo R., Jr (2023-01-09). "Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity". Pediatrics. 151 (2): e2022060640. doi:10.1542/peds.2022-060640. ISSN 0031-4005.
  23. ↑ "What is the history of body positivity?". BBC Bitesize. Retrieved 2024-12-10.
  24. ↑ "Apparently, This Is What the Ideal Male Body Type Looks Like". Men's Health. 2023-04-18. Retrieved 2024-12-10.
  25. ↑ Striegel-Moore, Ruth; Rosselli, Francine; Perrin, Nancy; DeBar, Lynn; Wilson, G Terence (July 2009). "Gender Difference in the Prevalence of Eating Disorder Symptoms". National Library of Medicine. Retrieved December 10, 2024.{{cite web}}: CS1 maint: url-status (link)
  26. ↑ Abrams, Rachel (January 28, 2016). "Barbie Adds Curvy and Tall to Body Shapes". The New York Times. Retrieved December 3, 2024.{{cite web}}: CS1 maint: url-status (link)
  27. ↑ Muttarak, Raya (2018). "Normalization of Plus Size and the Danger of Unseen Overweight and Obesity in England". Obesity. 26 (7): 1125–1129. doi:10.1002/oby.22204. ISSN 1930-739X. PMC 6032838. PMID 29932517.{{cite journal}}: CS1 maint: PMC format (link)
  28. ↑ Swift, J. A.; Hanlon, S.; El-Redy, L.; Puhl, R. M.; Glazebrook, C. (2013). "Weight bias among UK trainee dietitians, doctors, nurses and nutritionists". Journal of Human Nutrition and Dietetics. 26 (4): 395–402. doi:10.1111/jhn.12019. ISSN 1365-277X.
  29. ↑ Nash, Alanna (September 7, 1997). "The Model Who Invented Heroin Chic". The New York Times. Retrieved December 1, 2024.{{cite web}}: CS1 maint: url-status (link)
  30. ↑ Faulkner, Carola Kolbeck and Lucy (2023-01-30). "From Kate Moss to Bella Hadid - The Dangers of Reviving Heroin Chic". injectionmag. Retrieved 2024-12-10.
  31. ↑ Tee, Alex (Apr 19, 2021). "The Toxic Body Image of The 2000s". Medium. Retrieved November 19, 2024.{{cite web}}: CS1 maint: url-status (link)
  32. ↑ Konstantinovsky, Michelle (2022-09-29). "If You Survived the Early 2000s Without Body Issues, Congratulations". Glamour. Retrieved 2024-12-10.
  33. ↑ Paris, Calin Van (2020-09-24). "Lizzo Wants to Redefine the Body-Positivity Movement". Vogue. Retrieved 2024-12-10.
  34. ↑ Ronald, Issy (2024-05-27). "Lizzo reveals how she really feels about that 'South Park' obesity episode". CNN. Retrieved 2024-12-10.
  35. ↑ "Heroin Chic Is Back. But That's Not the Real Problem". equip.health. 2022-12-29. Retrieved 2024-12-10.
  36. ↑ Diaz, Adriana (2022-11-02). "Heroin chic is back and curvy bodies, big butts are out". Retrieved 2024-12-10.
  37. ↑ "What is "Ozempic face" and how can people avoid it?". www.medicalnewstoday.com. 2023-03-30. Retrieved 2024-12-10.
  38. ↑ Fucci, Eliza. "Celebrities Are Not at Fault for Using Ozempic". Horizon. Retrieved 2024-12-10.
  39. ↑ Zelman, Kathleen M.; RD; LD; MPH. "Avoid Portion Distortion". WebMD. Retrieved 2024-12-10.
  40. ↑ "Portion Sizes and Obesity, News & Events, NHLBI, NIH". www.nhlbi.nih.gov. February 13, 2013. Retrieved 2024-12-10.
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