Should you have to suffer to be thin? (mihailomilovanovic via Getty Images)

February 21, 2024   6 mins

Ten years ago, I was moved to tears by a fruit salad. I was on a stationary bicycle at the gym, half-heartedly scrolling Tumblr while my feet pushed the pedals, and suddenly, there it was: a tapestry of blueberries, blackberries, and mandarin orange wedges in a glass jar. I remember this photo the way some people describe the moments before a car crash, every glistening detail captured in adrenaline-spiked slow motion. The blackberries like dark and precious jewels, the mandarins glowed as though shot through with sunshine. The longing I felt as I looked at them — and as I started to cry — was something beyond hunger.

I was training for a bodybuilding competition, and it had been weeks since I had eaten fruit, because fruit contained sugar, and sugar was off-limits. The only time I was allowed it was immediately after workouts, in the form of half a Gatorade mixed with a scoop of protein powder, gulped down to prevent my starving body from consuming its own lean mass.

There are few pictures of me from this time in my life, except the ones I took weekly to track my progress. I posed in a sports bra and underwear with my muscles tensed, and sent the results to my trainer. Your midsection is showing more separation every week!, he wrote, as my abdomen morphed from a smooth, flat expanse to a rippling six-pack. (The sports bra was a mere formality by then; breasts consist mainly of fat, and mine had shrunk down to nothing.) Ten years later, the thing I remember most is not how great I looked but how much work it was. If I wasn’t eating or exercising, I was thinking about these things: planning, prepping, setting timers so that I’d remember to swallow whatever was on the menu within however many minutes of a workout. By the time I abandoned my training regimen — around the time I found myself weeping over fruit on the internet — my body had become a vehicle whose maintenance was my full-time job.

All of which is to say, when I read about Ozempic patients who are losing weight not just without trying, but without having to think about trying — the ones who, to quote one user, “just don’t think about food anymore” — I want to squawk with indignation. What do you mean, you don’t think about it?! That’s not fair; it’s cheating. But even among people who don’t share my peculiar history (okay, obsession) with manipulating the size and shape of their bodies, that instinctive reaction is commonplace. Whatever one’s reasons for losing weight, the common wisdom is that it’s not supposed to be easy, physically or mentally.

Indeed, any experience to the contrary tends to inspire suspicion, even among those who believe wholeheartedly that being able to effectively cure obesity, and its litany of associated health conditions, would be an extremely good thing. The impulse to view Ozempic and other medicines of its ilk with mistrust, even derision — the equivalent of buying indulgences instead of performing atonement — has been compared with the taboo against Suboxone among former addicts, who “were skeptical of a fix so expedient, so simple, so biological”.

It’s not a bad analogy; Suboxone and Ozempic both work in their own way to suppress a person’s appetite, curbing an undesirable behaviour by eliminating the basic urge to engage in it. Another comparison might be the contemptuous moralising aimed at people who quit smoking by substituting tasty-flavoured vapes for combustible tobacco. It’s not that vaping doesn’t work; it’s that it’s too easy, too enjoyable. If smoking is a sin, quitting should be a crucible — or at the very least, it should not taste like cake. And in a world where an overweight body is seen as a sign of moral failure, thinness is seen as the just reward for those who atone through deprivation.

“Thinness is seen as the just reward for those who atone through deprivation”

This ascetic immiseration is a chief characteristic of what social critics refer to as diet culture, which is adjacent to but separate from losing weight. Consider how many people are either perpetually on a diet — or at least, say they are — or just off one with little to show for it: it’s almost as if the point is not successful weight loss, but the show of compliance. You are depriving yourself of food not because it will make you thin — often, it does not do this — but because you are performing, for yourself and for the world, the role of a person who wants to be thin and is willing to hurt for it. Ordering the salad instead of the steak is a form of virtue signalling: “I am trying to be good.”

This entanglement of the moral with the biological has a long history, in which even doctors have been unable to entirely separate the two. The Victorian era, a time of ground-breaking advancement in the medical sciences, was also a time of great permeability between the social zeitgeist and the scientific community, in which cultural notions of beauty and femininity often reappeared in a doctor’s office disguised as medical advice. Among these dictums was the notion that appetite, particularly for women, was a signpost of both poor health and poor character. Then, as now, a slender figure was valued — and then, as now, achieving one was supposed to be accomplished through exquisite self-control. The ideal woman in the eyes of society and science alike not only ate very little, but made a show of it, demonstrating sovereignty over her appetites one dainty nibble at a time.

Those who took pleasure in eating, meanwhile, were viewed as courting disaster, an idea widely reflected in the medical wisdom of the era. John Harvey Kellogg, who in the late 1800s was considered America’s foremost pioneer in the field of gastroenterology, was convinced that robust appetites were inextricably linked with sexual depravity. “Candies, spices, cinnamon, cloves, peppermint, and all strong essences, powerfully excite the genital organs,” he warned in the 1880s. His guidelines for good gastrointestinal health, which included not just a bland vegetarian diet but a regular regimen of yoghurt enemas, were designed with the goal of curbing the desire for food and sex alike.

This sense — that a healthy body is a thin body under control — recurs throughout history. At the turn of the 20th century, Kellogg pumps his patients full of bran flakes at one end and yoghurt at the other; at the dawn of the 21st, a fitness influencer dutifully crams exactly four ounces of chicken breast down her throat before heading to the gym. At the same time, to lose weight in other, easier ways — via liposuction or diet pills or, today, Ozempic — has long been viewed as not just unearned, not just cheating, but perhaps even a sort of devil’s bargain for which a harsh price will soon be paid. The history of scandals in the world of medically-assisted weight loss — the withdrawal of fen-phen from the market in the Nineties after research revealed that it could cause heart valve damage in up to a third of patients, or the rare but ghastly side effects of treatments like Coolsculpting — only serves to validate the moral superiority of the nay-sayers. We told you it couldn’t be that easy.

Of course, maybe this time it is that easy. Sure, there’s the occasional (albeit rare) horror story of Ozempic patients suffering stomach paralysis as a result of the drug — or the less ghastly, more quotidian concern that its appetite-suppressing effects cause the loss of not just fat but precious lean mass. But even if these apprehensions prove unfounded, the capacity of Ozempic to make weight loss not just effective but thoughtless is why it will almost certainly continue to occupy an important place in the medical consciousness, but a fraught place in our moral one.

Imagine: instead of sweating through gruelling workouts at the gym, the only effort you have to make is a weekly jab with a slender needle. Instead of battling your appetite at every meal, it retreats to a quiet corner on its own, until you’ve forgotten it ever existed. This doesn’t just flout the conventional wisdom, the studied science, of what it takes to lose weight; it flies in the face of every narrative in which weight loss is synonymous with redemption, in which every pound lost is a demon conquered.

Time and research may reveal that Ozempic really is the future of weight loss, but I suspect that the stories we tell about it — and the perverse pride of having a body moulded by diet and exercise, yes, but also by focus and discipline and pain and tears — will be far harder to shed. It is almost certainly not a coincidence that my own brief foray into amateur bodybuilding was preceded by about 15 years of a more traditional eating disorder: the common thread in these experiences was not just a longing to be thin, but the satisfaction of putting in work here and seeing results there, of wrestling my body and its appetites alike into submission. Would I have felt so satisfied, so in control, if I had been able to simply neuter myself of those appetites with a weekly shot? Is self-deprivation still a triumph if there’s no desire to triumph over?

Here, it becomes important to note that in at least one way, Ozempic does suffer the same pitfalls as any other weight loss method that relies on eating less: people who stop using it tend to regain the weight. But unlike a diet, the idea of being on Ozempic permanently doesn’t inspire existential dread, evoking the dire image of spending the rest of your life tormented by raging and insatiable hunger. Indeed, one of the things that makes the drug so intriguing is that it curbs all manner of appetites. For food, yes, but also for alcohol, nicotine, gambling, sex — in short, for the pleasures that straddle the line between needing and craving. Ozempic patients will not burst into tears over a picture of a fruit salad. Instead, a lifetime on the drug will be characterised not by desire, but the absence of it. And this is perhaps its own sort of tragedy.

Kat Rosenfield is an UnHerd columnist and co-host of the Feminine Chaos podcast. Her latest novel is You Must Remember This.