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It’s no exaggeration to say that Ozempic, Wegovy, Mounjaro, and the other novel GPL-1 drugs are among the most revolutionary medications to hit the market in decades. The drugs decrease appetite, which fuels weight loss and helps prevent and treat diabetes, lowers blood pressure, and lowers blood sugar level. They decrease the risk of serious illnesses including heart and kidney disease, improving health and prolonging life. For many of the millions of people who have used them, these drugs have quieted the “food noise” in their brains. The demand for them is so extraordinary that there is a global shortage, which some think could create a budgetary problem enormous enough to break the U.S. health care system. And you know these drugs have really hit the big time because Oprah just did a special on them.

Much has been written about GPL-1 drugs and their potential impacts on our bodies, our culture, our feelings, and our money. But few of the conversations about these novel medications mention one of the primary culprits behind the ill health that necessitates them in the first place: Big Food.

Who would naturally be the ones talking about Big Food’s responsibility, perhaps even proposing that Big Food should bear the cost of these wildly expensive and effective drugs? Liberals. But since these novel weight loss drugs hit the market, liberals have seemed especially unsure of how to respond to them. How might they compromise hard-earned wins for body positivity? Will they challenge some progressive narratives about weight and health? Well, no—liberals aren’t really wading into it. (Conservatives, for their part, seem happy to adopt the Big Food line that one’s health and what one eats are matters of individual responsibility, and should be free from government interference.)

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And yet, the reality remains: American Big Food industries have spent decades funneling highly processed, nutritionally deficient food products into American and global markets. These ultraprocessed foods are engineered to tap into our biological desire for salt, sugar, and fat, ingredients that are not on their own necessarily bad, but are particularly harmful to human health when Frankensteined into products made via industrial processes, and often rife with additives and chemicals or reconstituted in ways not found in traditional whole-food human diets. Ultraprocessed foods are designed to be so addictive that, as a Lay’s potato chip ad campaign put it, you “can’t eat just one.” And they are painstakingly developed to hit our pleasure and desire centers, to avoid our satiation points, to make us want more—to paraphrase Michael Moss, who has written two books on Big Food, to make us eat impulsively and compulsively. And our bodies do not seem to process these foods the same way we do whole or even less processed ones.

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Ultraprocessed foods now make up more than 60 percent of what Americans eat. Study after study has linked ultraprocessed foods to a range of health problems, from numerous cancers to depression. Some researchers now believe that processed and fast foods kill more Americans than cigarettes. It’s a $1.5 trillion industry.

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In other words, what has happened is that corporations have gotten rich selling ultraprocessed products to Americans, and those products have made generations of Americans sick. Now, large pharmaceutical companies are swooping in with an injectable miracle cure—and also getting very rich.

GPL-1 drugs can be lifesavers. It is very clear that “diet and exercise” are not prescriptions that work for a great many people. And the way we eat is killing us. But before we simply add another expensive link to the circular chain of corporate food products and pharmaceutical solutions to treat the problems those food products cause, we should at least consider that there are also other places where we might break the chain—or, at the very least, put the responsibility squarely on the Big Food companies that have made so many Americans need miracle drugs to survive. The problem is that would require politicians and activists across the political spectrum to question some of their respective side’s claims and assumptions.

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Despite the fact that millions of Americans are trying to get their hands of them, using GPL-1 drugs remains taboo. This may be particularly true for the celebrity set: Americans have a complicated relationship with body size, wanting our celebrities to be extremely thin, but also wanting them to remain relatable, which is why “hot skinny famous woman eating a cheeseburger” is a trope from Carl’s Jr. commercials to old editions of Us Weekly to the actual Instagram feeds of those same celebrities. Two unreconcilable things are supposed to be true: Thinness is supposed to be effortless, but thinness is also a sign of moral goodness—something you should always be working for.

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Fat-acceptance activists have pushed back on these narratives, arguing rightly that body size is not the only measure of health and that we would all be better off if we appreciated our bodies and did not attach moral judgments to them.

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But we have by no means figured out, even in liberal corners of society, how to talk about the relationship between body size and health, or even whether we want to acknowledge that such a relationship exists. This has left us with a generally confused understanding of health and weight, even as we increasingly understand that larger people routinely face medical bias, that individual measures of health cannot be reduced to body mass index, and that health is vastly more complex than thin = good/fat = bad. (Plenty of thin people are unhealthy and plenty of fat people are very healthy; two people could eat the same way and exercise the same amount and they will not wind up living in bodies that are the same size.) But in some circles, important and accurate critiques of long-held assumptions that fat = bad have metastasized into arguments that body size and weight have virtually no relationship to health, that body size has little to nothing to do with diet or exercise, or that there should be no hierarchy of good versus less-good foods when it comes to human health.

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I am not here to referee each of these disputes, which are complex and could each be afforded their own column. But one thing is now apparent: Highly effective weight loss drugs interrupt all of this.

It is clear that, for many people, significant weight loss and then sustaining a lower weight through diet and exercise alone is exceedingly difficult if not nearly impossible; more often, weight loss is followed by weight gain, a cycle Oprah herself has gone through publicly over many decades. GPL-1 drugs have allowed patients to lose weight without requiring the kind of sustained and unmanageable self-discipline to refuse food or eat less, impulses that human beings have spent millennia developing for our basic survival, and that are so often foundational for pleasure and connection. By treating obesity as a disease rather than as a moral failing, these drugs and the doctors who champion them do bolster the more righteous aims of fat activists to divorce size from moral judgment. But these drugs also exist for weight loss, and their entire justification is the argument that obesity is a health problem that demands treatment.

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These drugs now also raise the question: Are you thin because you’re self-disciplined and therefore morally good, or are you thin because you’re rich enough to afford these drugs for primarily aesthetic aims? (Before GPL-1 drugs, this question was more like: Are you thin because you’re self-disciplined and morally good, or are you thin because you’re rich enough to afford to high-quality whole foods and the leisure time to exercise?) Eventually, once there is no longer an acute shortage of GPL-1 drugs, they are likely to reinforce stigma against larger people, even though these drugs do not in fact magically make everyone skinny: Why are you still fat if Ozempic exists? And these drugs may be one more contributor to American inequality, which extends even to body size: The richer tend to be thinner, healthier, and longer-living, and the poorer tend to be fatter, more prone to a series of diseases, and die sooner. Costly weight loss drugs may exaggerate this divide.

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GPL-1 drugs make clear that there is a relationship between eating, body size, and health. The drugs inhibit desire for food, which in turn means people eat less of it, which in turn means that they lose weight—leading to better health outcomes, including diabetes management and the avoidance of serious and sometimes deadly disease. What these drugs can’t solve is what people eat, but they do seem to interrupt the same brain processes that ultraprocessed foods seek to maximize.

Scientists are still sorting out how, exactly, GPL-1 drugs work. But it does seem clear that these drugs work on our brains, not just our stomachs. Processed foods, as it turns out, operate similarly. And these foods are simply what more people can afford: Walk into your average American grocery store and it’s significantly cheaper to pick up a couple of frozen pizzas for dinner than the ingredients for, say, a roast chicken and fresh chopped salad. And that’s if the shopper in question is even able to get to the kind of grocery store that has fresh ingredients, or has the time after multiple jobs or shift work to prep, chop, and clean up. Americans eat a tremendous volume of ultraprocessed foods because these foods are designed to be addictive, but we also eat lots of ultraprocessed foods because, especially for Americans on the lower end of the socioeconomic scale, these are the foods that are available, affordable, accessible, and fit into lives made unnecessarily hectic and stressful by too much work and too few resources.

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The government could do something about this by both making people’s lives less perilous and better managing what goes on grocery store shelves. But Big Food companies fight any effort to regulate them. And they fall back on familiar narratives of individual choice and personal responsibility—even as they manufacture products to break down our innate sense of “enough” and our individual ability to resist.

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This new generation of weight loss drugs is revolutionary in large part because it shatters that “personal responsibility” argument, treating being overweight as a health problem, not a failing of personal discipline. Generally, progressives have been on the forefront of challenging personal responsibility narratives, pushing the idea that everything from poverty to COVID is a collective problem demanding collective solutions. And it has been liberals and progressives who have fought the large industries that are making us sick, shortening our lives, and enriching themselves in the process. This is the story of the battles against everything from water polluters to oil companies to opioid manufacturers. But Big Food has largely been met with a shrug—and sometimes, efforts to regulate the food industry have even been met with progressive pushback. I suspect this is because many liberals and progressives feel stuck between two ideals, one of holding big corporations responsible for the harm they cause, and another saying that being fat is not a moral failing and that we should stop moralizing about what people eat.

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But how we eat is not, in fact, simply a matter of personal choice or individual responsibility—and nor, in turn, is our health. The way we eat is shaped by opportunity, by the resources we have, by the choices our governments make, and very much by the big corporations that profit when we eat what they sell us. How we eat is a moral issue—not an individual moral achievement or moral failing, but a social one.

It is good that movements for fat acceptance have challenged simplistic narratives about weight and health. It is good that people are able to get the medications they need to improve their health. But for many Americans, these drugs are necessary in large part because of what big companies sold them as food. And it’s those companies that should be paying for the damage they’ve done.

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QOSHE - Here’s Who Should Pay for Everyone’s Ozempic - Jill Filipovic
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Here’s Who Should Pay for Everyone’s Ozempic

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02.04.2024
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It’s no exaggeration to say that Ozempic, Wegovy, Mounjaro, and the other novel GPL-1 drugs are among the most revolutionary medications to hit the market in decades. The drugs decrease appetite, which fuels weight loss and helps prevent and treat diabetes, lowers blood pressure, and lowers blood sugar level. They decrease the risk of serious illnesses including heart and kidney disease, improving health and prolonging life. For many of the millions of people who have used them, these drugs have quieted the “food noise” in their brains. The demand for them is so extraordinary that there is a global shortage, which some think could create a budgetary problem enormous enough to break the U.S. health care system. And you know these drugs have really hit the big time because Oprah just did a special on them.

Much has been written about GPL-1 drugs and their potential impacts on our bodies, our culture, our feelings, and our money. But few of the conversations about these novel medications mention one of the primary culprits behind the ill health that necessitates them in the first place: Big Food.

Who would naturally be the ones talking about Big Food’s responsibility, perhaps even proposing that Big Food should bear the cost of these wildly expensive and effective drugs? Liberals. But since these novel weight loss drugs hit the market, liberals have seemed especially unsure of how to respond to them. How might they compromise hard-earned wins for body positivity? Will they challenge some progressive narratives about weight and health? Well, no—liberals aren’t really wading into it. (Conservatives, for their part, seem happy to adopt the Big Food line that one’s health and what one eats are matters of individual responsibility, and should be free from government interference.)

Advertisement

Advertisement

Advertisement

Advertisement

And yet, the reality remains: American Big Food industries have spent decades funneling highly processed, nutritionally deficient food products into American and global markets. These ultraprocessed foods are engineered to tap into our biological desire for salt, sugar, and fat, ingredients that are not on their own necessarily bad, but are particularly harmful to human health when Frankensteined into products made via industrial processes, and often rife with additives and chemicals or reconstituted in ways not found in traditional whole-food human diets. Ultraprocessed foods are designed to be so addictive that, as a Lay’s potato chip ad campaign put it, you “can’t eat just one.” And they are painstakingly developed to hit our pleasure and desire centers, to avoid our satiation points, to make us want more—to paraphrase Michael Moss, who has written two books on Big Food, to make us eat impulsively and compulsively. And our bodies do not seem to process these foods the same way we do whole or even less processed ones.

Advertisement

Ultraprocessed foods now make up more than 60 percent of what Americans eat. Study after study has linked ultraprocessed foods to a range of health problems, from numerous cancers to depression. Some researchers now believe that processed and fast foods kill more Americans than cigarettes. It’s........

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