Is the resurgence of weight loss drugs a blow to the body positivity movement?

AYESHA RASCOE, HOST:

It's taken some people years to work on loving their bodies just the way they are. And the body positivity movement has made strides, with many big brands showcasing models of all shapes and sizes. But with the rise of weight loss drugs like Ozempic and Wegovy is being thinned the only size allowed. And is that movement in jeopardy? Virginia Sole-Smith is the author of "Fat Talk: Parenting In The Age Of Diet Culture" and writes about diet, culture, health and anti-fat bias. Welcome to the program.

VIRGINIA SOLE-SMITH: Thanks so much for having me.

RASCOE: People are really excited about these weight loss drugs, and it seems like everywhere, people are talking about it. Is this person on it? Is that person on it? How can they get it? What do you think these drugs are doing to the conversations around body image and how we view our bodies?

SOLE-SMITH: I think what we're seeing is the fact that as much progress as we've made on the question of fat rights and on understanding that body size is not under our control and is not something people should be discriminated against for, in our heart of hearts, a lot of us still are aware that fat people receive worse treatment than thin people in our culture, that it is easier to live in a thin body. And so there's this hope that these drugs offer this way to achieve that body that is socially acceptable. And if we can do it in this so-called easier way, then maybe we don't have to feel bad about the fact that we never wanted to be fat in the first place.

RASCOE: And in that way, because these drugs exist, do you think or worry that people who remain what society would consider overweight or fat - are you worried that they will be judged because it's like, well, why don't you just get on these drugs? Why don't you just get on Ozempic?

SOLE-SMITH: Yeah, absolutely. We're really in danger of creating, like, a two-class system, a hierarchy of body sizes because we are so attached to the myth that weight is a choice, that it's just a matter of willpower, or no, it's just a matter of taking a drug, which completely ignores the reality of the situation even with these drugs in the mix. We're talking about really expensive medications. We're talking about, of course, every medication carries side effects. These are not going to be the right fit for everybody or the best health-promoting decision for everybody. And we're talking about drugs you have to stay on forever in order to sustain the weight loss. So if it costs $900 a month forever, who is that going to be accessible to?

RASCOE: Well, what is the difference between - because you're talking about fat rights and fat rights activism. And then you're talking about body positivity. So what is the difference between those two things?

SOLE-SMITH: Yeah, I'm so glad you asked that because it's a really important distinction. So fat rights is a social justice movement that goes back to the 1960s. It's related to queer rights and feminism and disability rights. And it's really arguing that fat people are humans, that we have all the same rights everyone else does, that we deserve equal access to health care. We shouldn't be discriminated against in hiring practices. We have the same rights to access to public space, etc., etc.

Body positivity is a conversation that's become extremely popular on social media which is really more about how you personally feel about your body. And there's a lot of value in that, right? Like, it's super valuable to be able to feel good in your body, to like how you look in the mirror, to not be plagued by a ton of doubts and anxieties. That can be a really useful preventive strategy when we're thinking about how to buffer kids against the risks of eating disorders, for example. But you can love your body all day long and still walk into a doctor's office and not be treated like a human being.

RASCOE: When you talk about those misconceptions, obesity, you know, is classified as a disease by the medical community. And I believe they usually base that on, you know, your body-mass index, which is, I know, controversial in and of itself. And you have said that there were good intentions behind this classification but that maybe classifying obesity as a disease has not been actually helpful. And why do you think that.

SOLE-SMITH: They're using a system that doesn't accurately reflect our health to decide who is and isn't healthy. Now, the decision to make obesity a disease, an actual diagnostic category, I think, was rooted in a belief that that might help reduce some of the stigma, that if we could convince people what we know to be true, that weight is not a choice, that it's not a matter of willpower, we could get people to treat fat people better because we'd be saying, look. It's not their fault they're fat. They have a disease. But the problem is labeling something as a disease brings with it a huge amount of shame and stigma. And you can ask anybody in the disability rights community about this. When we pathologize bodies, we continue to other them and make them something that people feel like they need to be suspect of and judge.

RASCOE: So ultimately, what do you wish you'd see when it comes to the conversation around body image and these weight loss drugs?

SOLE-SMITH: I think we need to talk much more clearly about, as we've been saying, the way bias is driving the marketing of the drugs and the way doctors are talking to them, talking to patients about them. I would love to see doctors doing more training and unlearning around anti-fat bias so they could be really sure that when they're working with a patient, that bias is not part of the conversation, that they're really meeting the patient where they are and assessing what's going to benefit them, not coming in with this agenda.

RASCOE: That's Virginia Sole-Smith. She is the author of "Fat Talk: Parenting In The Age Of Diet Culture." Thank you so much for being with us.

SOLE-SMITH: Thank you for having me. Transcript provided by NPR, Copyright NPR.