My doctor didn’t tell me I was too fat at my September physical. She didn’t tell me my hemoglobin A1C level was too high — a critical sign of diabetes risk. She didn’t tell me that if I took weight loss drugs my joints would thank me, or I’d feel less anxiety, or I’d live longer for my kid, or I’d have better sex.
She said the choice was up to me.
“Yes, you weigh more than last year. Your BMI is very high,” she said while clacking a keyboard and looking at a monitor. “But, your biomarkers are all fine. It’s the Wild West of these drugs — that’s the truth. A lot of my patients have lost a lot of weight with them. If you want to try, I’ll support you.”
I started to cry. I didn’t want to cry, so I stared at the print of Gustav Klimt’s ”Mother and Child” that she’s had in this exam room for a decade. I made myself lean back in my chair.
“Well.” I rubbed my nose. “Fine. OK, look. I’m ashamed sometimes to be in public and not be thin.”
She waited. My voice shrank.
“It’s like a horrible scratchy mouse in my head squeaking that everyone thinks I’ve failed and I can’t live my real life until I’m thin. I should hide. It’s so stupid to be 47 and thinking this. I mean, I know that. But I have the mouse. But I don’t trust the mouse. I don’t know what’s right.”
She asked if my body size made my daily life difficult or kept me from exercise. I told her that I feared taking the drugs would make me lose interest in sharing food with my family. She told me the side effects that her other patients experienced. We talked about my sleep apnea. She said that she’d see if my insurance would cover Mounjaro, despite my unremarkable A1C.
I nodded my agreement. “But I’m going to think about it for two weeks before I take any shots,” I said. I glared at the sleeping Klimt baby, daring him to wake up and disagree.
Later that afternoon, I paid $12 and received a pale green paper bag holding the rectangular cardboard box with four injection pens that the big-eyed, smiling pharmacist said must be kept cold.
At home, I shoved the bag into the top right corner of the fridge, displacing a tube of mustard and an ancient jar of pickled beets.
A lot of people have Mounjaro, or Zepbound, or Wegovy, or Ozempic, in their refrigerators right now. Doctors wrote more than 9 million prescriptions for these kinds of drugs in the last three months of 2022 alone. Ozempic made pharmaceutical company Novo Nordisk more than $14 billion in 2023.
Some folks are using these drugs to treat Type 2 diabetes. Some are trying to lose weight. Many look like me: white, female, midlife, high BMI, not too many other health concerns. This isn’t a surprise. In multiple weight loss drug trials funded, designed and overseen by Novo Nordisk and Eli Lilly and Co., large, white, midlife women accounted for the majority of participants. My body is the market Mounjaro was made for.
That felt fantastic. I wanted to change my shape, and now I could! I had the power!
“I think I should take it,” I said to my husband on the back porch.
“OK.”
He watched me with a little, patient smile. He rocked in the ratty outdoor rocking chair while I sat on a blue hassock. He’s been married to me for a long time. He knows I like a long runway to figure things out. He’s also been thin, and fat, and thin, and fat again as a result of trying hard to be thin, like me. Neither of us makes quick decisions about our bodies anymore.
Sitting with him while our 12-year-old kid played Minecraft in the corner, I imagined being thin this time. Thin at last! Fitting into all the clothes! Being the same size as everyone on TV! Never expecting random people at the gym to say, ”Good on you for trying!” Never fearing that I’d lose out on a job because I’m not a size 6! Feeling safe from the mockery, insults, neglect, bad-faith science and violence that the world dumps on fat people! Hearing my dad call me beautiful again!
My dad.
I hadn’t told him about my well-chilled Mounjaro. Why would I? I was too old to run medical decisions by a parent. Besides, during his annual visit, when my kid was 4, my father took me aside for a private talk.
“I want to say something that’s hard to say, but it’s because I love you,” he told me, holding my hands as we sat on the side of my bed. “I’m worried about your weight. I just want you to be healthy.”
That conversation ended two sentences later. I told him that my weight was not his business, and I never wanted to hear about it from him again. To his credit, he didn’t mention it for eight years.
Until I did. I brought it up. I called him. My weight still wasn’t his business, but that early glow of I have the power! was fading. I’d discovered the dodgy origins of the “obesity epidemic” from the podcast “Maintenance Phase.” I was reading journalist Virginia Sole-Smith’s “Fat Talk: Parenting in the Age of Diet Culture” and learning about the nonsense of the BMI. “Fearing the Black Body: The Racial Origins of Fat Phobia” by Sabrina Strings was next on my list. I needed a smart, kind, third-party person to talk to, even if he didn’t have a pristine track record on body talk.
I called my dad, and he said hello and told me a story about playing mandolin at his senior center. Then he asked what was up.
I sat on my bed and lay down on my side. The low afternoon sun made shadows on the far wall of the thick rhododendron leaves outside. I closed my eyes.
“I want to share something that’s hard to share, because this has been fraught between us,” I told him. “But I trust you. It’s about losing weight. I have a box of weight loss drugs in the fridge.”
“OK. The fridge? Tell me more,” my dad replied.
I told him about the prescription and the two-week thinking period. About the attraction and the skepticism I felt. He’d listened to “Maintenance Phase” on my recommendation, and he asked what I knew about the history of the drugs and their side effects. We talked about ableism, about processed food, about birds and morning walks.
After 25 minutes, we fell quiet. Dusk smudged the shadows.
“Actually, Pops, there’s something else.” My middle-aged heart came into my throat. “I’m sad. It’s foolish, I know it. But I’m sad because it’s been years since you told me I’m beautiful.”
“Oh, honey,” he said. “I haven’t? I had no idea. I’m so sorry. I guess I didn’t think it mattered — you’re so grown-up. My daughter! You are precious to me. You are my daughter! I love you and you are so, so beautiful.”
It was foolish to feel such peace as I felt when we said goodbye. Yet I felt peace. Also foolish, to want another foolish human’s approval. Foolish to feel free from fear when I got it. Yet I felt free from fear that my dad didn’t love me, and then free from needing to earn the love — or prove it. What a gift my father gave me.
A series of WTF realizations about the drugs quickly followed.
I found the work of Ragen Chastain. She’s a writer and researcher on weight science, weight stigma and health care. Her scrupulous dissection of the pervasive, deceitful, WTF messaging of obesity as a “disease” made it very, very clear to me that the companies behind weight loss drugs are concerned about profits, not my well-being. Chastain has also examined the documented side effects of both Wegovy and Mounjaro. She argues that the Food and Drug Administration approved these drugs under the false assumption that a high BMI is such a threat to health that any and all side effects are worth it. Weight research doesn’t bear this up. I don’t reject medications automatically on side effects alone, but I’m not interested in risking everything from nausea and constipation to something much worse because of inaccurate BMI-justified bias.
According to the research I did, it appears that no trial for these weight loss drugs has lasted longer than about two years. It’s unclear what would happen if I continued to take these drugs at the dosages required for weight loss. And yet, I’d have to take them forever or gain the weight back. In this two-year study, participants started regaining weight just as the trials ended. In either case, I could end up weight cycling, which could increase my risk of... dying. WTF?
The math doesn’t work for me. I’m currently “small fat,” as fat activists refer to my body type, meaning that I fit into the smaller end of plus sizes and I don’t have to worry about size-based accessibility. But numbers-wise, I weigh a lot! Say I lost 20% of that weight, an approximate average of how much people lose on Mounjaro. I would still be fat! My body would be large! My BMI, trash though the measure is, would still be high! This whole idea is silly for me. WTF!
Liberation is a community effort. On one of my morning walks, I realized that no matter how much I changed myself, I’d never feel the freedom and safety I associated with thinness. Even if I were magically size 2, my sense of liberation would be a mirage. The threat of rejection, discrimination and violence would always be there, controlling my decisions, because cruelty and injustice would still be happening to fat people. In fact, I’d be stomping on their necks, cementing their second-class status, to get myself away from them. WTF to that. Feeling good about my own body, with drugs or without, is one thing. Experiencing freedom and safety in the world takes a group to agree that everyone deserves it.
My choice crystallized the next Sunday morning. I was in the porch rocking chair, watching bees fly loop-de-loops in our little marigold bed, while my kid sat on the floor next to me and read Minecraft fan fiction.
This was the choice: I could keep chasing thinness. Keep tying my life to it. Or I could let the quest go. Just let it go. Let the freaked-out mouse go. Live in this body. Be fat.
I slowed the chair. I am fat. Maybe that will change, or it won’t. I let thin go. Here is my life. I choose my life.
I patted my kid’s head, got up, pulled the Mounjaro out of the fridge, and threw the box in the trash. I kept the bag, though. It’s a nice bag.
I didn’t feel giddy. I felt calm and strong. I felt dignified.
I also understood right away what allowed for the dignity of my choices. My doctor gave me weight-neutral support and information. I had trustworthy public intellectuals and a 60-year fat activism movement to learn from. I had time and space to think. My job didn’t and doesn’t rely on my appearance. I have money to get weight-neutral help for my struggles, including disordered eating and sleep patterns. (Shoutout to Victoria, my nutrition counselor!) I have a strong marriage, a safe place to live. My father is a loving, emotionally mature adult. My mother, too. A Luddite hippie elf, she’s just more interested in tomato seeds and the free-book bin at the grocery store than weight.
My community supported me as I made my choice — and let’s be clear: This is my choice. It’s the one that feels right for me. I can’t say what is right for you or anyone else.
Now I have more confidence and love to give back. More than being fat or thin, or taking weight loss drugs or not taking them, I care about people having the dignity to make their choices. If there’s an ethic of health that I want for everyone, for you, here it is.
At our telehealth follow-up, I told my doctor that I chucked the Mounjaro.
“It wasn’t right for me,” I said. “But I’m sorry I wasted the dose.”
She waved my apology away. “It was one dose. It’s OK.”
She looked down, made a note. She looked up, right at me, and then she said the most heroic, generous thing: “All right, Becky. Let’s move on.”
Becky Karush is a writer, a developmental editor and a coach for emerging and established authors. She hosts the “Read to Me” podcast,” which teaches writers how to listen for and articulate what they love in exceptional writing. In the Read to Me newsletter, she writes about learning literary craft, creating art practices and reading work that makes us glad to be alive.
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