Is Ozempic “Cheating”?

This week, Elle magazine published an interview with Serena Williams, in which she revealed and explained her use of GLP-1 drugs for her recent weight loss. She is a famous tennis champion, but also a brand ambassador for one of the emerging telehealth companies that is making Ozempic, Zepbound, and similar medications more readily available for “off-label” use. These online businesses are particularly serving those, like Williams, who may not clinically be defined as “obese” but still want to shed unwanted pounds. Williams explained that her motivation was to lose “extra mom weight,” and a desire to feel “confident” in her body and get to a “healthy place.”

Williams, however, also shared that her purpose in speaking out about her GLP-1 success story is to counter stigma around using these drugs, especially the belief that their use is somehow “cheating” at weight loss. “It’s ok to be on them,” she said.

I’ve heard this same claim of “cheating” often in our research on the experiences of bariatric surgery patients. This is because constant exercising and extreme dieting signal valued moral qualities like hard work and perseverance, and thus suggest someone’s fundamental deservingness of the "reward" of weight loss. Williams is quite right that this notion—that weight loss achieved by other “cheating” means is somehow invalid—does much more to hurt than to help people to become healthy. And, certainly, attempts to challenge this and other aspects of weight stigma are highly valuable to both public health and individual quality of life. I have written elsewhere about why weight stigma is so harmful for both individuals and societies. Being constantly judged and rejected because of a body trait you cannot hide does enormous emotional damage. It also has a serious toll on physical health.

Of all the anti-stigma strategies, celebrity advocacy is one of the most effective. When people we already admire are willing to speak out, it helps normalize conditions so those who share the trait feel better about themselves and are more likely to seek treatment. It also encourages empathy from others. Examples include Elton John and Princess Diana sharing their struggles with bulimia, and Carrie Fisher and Lady Gaga speaking openly about living (well) with mental illness. Ostensibly, Williams is building on such important work to encourage open and shame-free use of this new and highly effective class of weight loss drugs.

The interview—unfortunately—probably does more to reinforce weight-related stigma than undo it. Let’s break down the contradictions in what Williams is saying. A repeated point she makes is that her unwanted weight could not be shed despite extreme levels of personal effort. “I remember training before my last US Open. I was training for four hours in the sun in the summer in July or August … But I didn’t lose anything. I actually had a stomach.” She adds the qualifier: “I don’t ‘just’ take them. You can see all the work that I do...” And that, ironically, is directly playing into the stigma she is claiming to address. The message here is that the judgment-free use of GLP-1s must none-the-less be earned. That is, Williams is suggesting through her own story that GLP-1 use is still somewhat of a cheat…. unless you also can prove you performed the right types and level of effort that qualify you as deserving of weight loss.

I’ve been talking a lot lately with other social scientists who are studying how GLP-1s are being used in people’s everyday lives, including collaborators doing cutting-edge research with users in Brazil and Denmark. And despite working in very different contexts, we share the same emergent concerns about the possible harms of such messaging around GLP-1 medications.

One key point is that the greatest beneficiaries of so-called de-stigmatizing efforts are the manufacturers and—especially—for-profit commercial enterprises that offer direct-to-consumer options. One detailed social science analysis of a telehealth company called Juniper, which home-delivers Ozempic in Australia and the UK, explains how companies claim anti-stigma work and why there is cause for concern. Potential users are told through marketing to “stand up” against judgment and to engage in “shame-free” use. But when considered with a critical scholarly eye, this is mostly a marketing strategy based in claiming the product is about self-empowerment. Such efforts toward the “uberfication” of elective weight loss are also purposefully (and profitably) promoting GLP-1s as self-care and fitness products rather than medical treatments.

The deeper concern is that when Williams and others use anti-stigma claims to promote GLP-1 use, they are simultaneously pushing something that only some can afford and thus benefit from. And in doing so, they create additional judgments against everyone else.

The ideas Williams promotes as an ambassador for the telehealth company Ro, if not covered by insurance, are estimated at the time of writing to cost between US $350 and $1,700 per month—not including the membership fee. For higher earners, this is arguably a bargain for the gain of feeling “confident” and “in a healthy place.” But for those at the other end of the economic spectrum, it is difficult to meet such costs when balancing basic household needs like housing, heating, or retirement savings. Even as GLP-1s come down in price, this financial barrier is maintained by the reality that lifetime use is often needed to maintain results: weight gain is expected after discontinuance.

In a world where weight loss via GLP-1s is promoted as not only easy but also acceptable and expected, “staying fat” becomes an amplified signal of personal failure. It indexes not just laziness or lack of self-care. Now it also suggests a failure to make the financial and personal sacrifices required to “deserve” the drug. That is, high body weight becomes even more stigmatized.