So What’s the Skinny on Ozempic?

Like most people during the pandemic, I avoided doctors like the plague. In the first year, when I was already overdue my annual physical, my family doctor sent me a preemptive email saying she was only seeing patients by Zoom and, even then, only for important issues. Respiratory distress was an important issue; an annual physical could wait. That was fine by me. I had no desire to sit in a crowded reception room while all around me sick people wheezed into their poorly fitted masks. I would look after myself, make healthy meals, do YouTube workouts, use a skipping rope I ordered from Amazon, burpees, planking, push ups, anything that would work in the confined space of a condo during lockdown. Later, when our condo Board decided to reopen the gym, I went downstairs wearing an N95 mask and rode a stationary bicycle, motivating myself by pretending I was being chased by a horde of rabid Covid-infected zombies.

By the fall of 2021, I was satisfied that I was getting my weight and general fitness in line. Another few pounds and I’d be able to book an appointment for my physical and face my doctor without feeling too much shame. A little shame, but not overwhelming soul-crushing shame. Then, at the end of November, the omicron variant arrived and the condo Board closed the gym and my doctor once again stopped booking in-person appointments. By 2021, whatever motivation I felt in 2020 had evaporated. In 2020, despite the anxiety and inconvenience, there was something about the novelty of the situation that made it feel like an adventure. But by 2021, the adventure had turned to drudgery. I lost my will to exercise, I watched more streaming TV, and each week I cracked open a couple more bottles of wine than I had in beforetimes. Whatever weight I’d lost in 2020 I gained in 2021, and then some.

Finally, in the fall of 2022, I booked an in-person physical examination. By then, I had resumed my visits to the gym, and while I wasn’t losing any weight, I wasn’t gaining any weight either. I congratulated myself on the fact that, in spite of myself, I could do a sustained cardio regimen without needing an ambulance. However, my doctor wasn’t so congratulatory. She plugged my vital stats into her BMI calculator and announced that sometime during 2021 I had crossed the threshold from fat to obese. BMI calculators! What do they know? I’m big-boned. I’m broad across the shoulders. I carry it well. With all my cardio, I’m a fit fat. I lobbed my rationalizations and she quietly batted each of them back in face. Yes, she said, in the short term you’ll probably be fine; but as the years go by, you won’t be able to sustain your current level of health; there will be a reckoning. Then there’s your sleep apnea.

Oh yeah, I forgot about my sleep apnea.

The Contract With My Doctor

That’s when my doctor posed an unexpected question: Have you heard of Ozempic? Semaglutide? No I hadn’t. She explained that it was an injectable medication that had been developed to treat people with type 2 diabetes. However, many users reported that it had the incidental effect of promoting weight loss and so, increasingly, doctors were prescribing it for this off-label outcome. She was willing to prescribe it if I was willing to do a few things on my side. It was a contract. She’d give me the scrip. In return, I would do three things: 1) make healthy food choices; 2) exercise several times a week; and 3) cut back on my consumption of wine because wine is a significant source of useless calories. The idea was that this new weight loss medication would buy me time to implement some serious lifestyle changes, reset personal habits, rejig my relationship with food.

I can’t say exactly why I agreed to the contract. Part of it I’m sure is that, as with new technology, there’s something appealing about being ahead of the curve. It was something novel; I could try it out and report on the experience. Part of it too is that I’m tired of getting nowhere when it comes to managing my weight. I know I need to lose weight or, later in life, I will suffer serious consequences. Only a few years ago, I sat by my grandmother’s bedside as she succumbed to complications from congestive heart failure which itself was a consequence of a lifetime living as an obese woman. In effect, she suffocated because she was fat. Maybe it’s the image of my grandmother’s final laboured breaths, and the way the memory of her death undermines all my clever rationalizations, that lies behind my willingness to enter into a contract with my doctor.

On the morning of Monday October 17^th, 2022, I gave myself my first injection of Ozempic, a 0.25 mg dose through a fine needle into the fatty tissue around my stomach. Although subtle, the effect was immediate. By immediate, I don’t mean I felt a change the instant I jabbed myself; I mean that, during the course of the week, I felt a settling effect. The usual compulsion to snack between meals vanished, as did the need (first instilled in me as a child) to finish everything on my plate. For breakfast, I started eating fresh fruit with plain yoghurt along with a slice of toast. If I felt like a mid-morning snack, I ate slices of apple. That gave me a boost of energy to support my daily session of cardio before lunch. No more junk food in the home, as that’s a needless temptation. As an oenophile who likes to cellar big Bordeaux wines for 10 or more years, the agreement to reduce my intake of wine has been a challenge. Nevertheless, I’ve managed to abstain during weekdays, offering myself the reward of a single bottle on weekends. Weekday dinners are simple, fish or chicken along with grilled veggies. Maybe something more elaborate on Saturday evenings to go with my wine reward. And no dessert. Nothing. Nada.

On returning for my first follow-up appointment, my doctor quizzed me about side-effects. I reported that I felt nothing significant, only a non-specific tightness in my gut and a little constipation which was easy enough to deal with. Subsequently, I’ve read about a whole raft of potential side-effects: nausea and vomiting, diarrhea, lethargy, even changes in the way food tastes. My understanding is that more marked side-effects are relatively uncommon; like me, most users find the injections unremarkable except, of course, for one thing: the weight loss. A month after starting the injections, I flew to the west coast for 10 days to visit family and had to buy new pants because I wouldn’t have been able to come home without losing my pants when I took off my belt to pass through airport security.

It was also then that I began to noticed a spate of articles about the so-called skinny jab on various news platforms, most of them skeptical. Straight up reportage focussed on the issues: semaglutide hasn’t been approved by regulatory bodies for weight loss treatment; we don’t have sufficient data to talk about outcomes for long term use; users will probably have to be on it for life otherwise they’ll bounce back to their original weight; this is a fad that has been promoted by Tik Tok influencers, the Kardashians, and Elon Musk and, as with all diet fads, it will have its day then fade away; demand for the off label use is diverting supply from people who really need it; the cost is prohibitive for those who aren’t insured or aren’t wealthy. And so on.

More interesting to me are the op-eds, and they all follow a pattern. Typically, the writer is a self-identified fat person who takes a stand against the drug. They would never use Ozempic or Wegovy because that would mean they had succumbed to societal pressures to conform to an arbitrary (thin) body type. These pressures take cover under patronizing lectures about personal health and self-care but, really, it’s all about fat phobia. Our society has a bias against large bodied people and finds any number of ways to give expression to its prejudice. Typically, the writer goes on to offer the familiar rationalizations, the very rationalizations I trotted out for my family doctor during my post-pandemic physical: sure, goes the writer, I’m a big person, but I’m a regular at the gym and although I carry a few extra pounds, I’m fit. Then comes the clincher: I’ve worked hard to nurture my identity as a fat person and I’ll be damned if I give in to the social forces that try to delegitimize me as a person. In fact, I’m going to dig in my heels and advocate for the interests of my fat brothers and sisters.

This shift to identity politics is a move I understand and have made myself in another context. Remember the sleep apnea I mentioned earlier? Before I was diagnosed with sleep apnea, I spent years suffering from severe chronic depression that left me hospitalized, often heavily medicated (often with weight-related side effects), subject to extreme therapies like shock treatment, until a clever psychiatrist connected the dots between dreadful sleep and dreadful mood and sent me off to a sleep clinic. After years of chronic depression, I had resigned myself to the fact that this was simply the way I was. Low mood went to the very core of what it means to be me. I took my cue from Robert Goss’s famous queer mantra and declared: “I’m nuts! I’m here! Get used to it.” If I was doomed to pass my life in chronic and depthless depression, then I was going to own it, lean in to it, make something special of it. After that, I got involved in groups where I met like-minded depressives. There were artists who only painted panels of solid black. Musicians who refused to play in major keys. Stand up comics who refused to tell jokes that were funny. If life was truly miserable, then together we were going to wallow in it.

When you have a marginalizing experience like major mental illness, it’s tempting, especially if you’re a straight white male like me, to flip the switch that converts it into a matter of personal identity. In a culture that has shifted, at least on the Left, to open up more space for marginalized voices, there is an incentive for people like me to try to shoehorn our experience into marginalized identities in order to preserve our position on platforms that, historically, we have dominated. At its most extreme, it can produce reverse passing scenarios like the case of the author, Joseph Boyden, who insists he has Indigenous ancestry despite the absence of evidence to support his claim. I would like to think my situation is a little more benign. Yes, mental illness is a stigmatizing and marginalizing experience. But does it really justify claims around personal identity? As a practical matter, once I’ve settled into a sense of personal identity that incorporates mental illness, I begin to believe there’s nothing I can do about my situation. I live in a fixed state and that’s the end of it. The same can be said of being fat. If a fat person invests everything they are into a narrative of fatness as a marker of personal identity, then they have consigned themself to a fixed state which they cannot change.

Brendan Fraser and Representation

In tandem with the matter of personal identity is the matter of representation. In the context of fat identity, the question arises: where are the representations of fat identities in our culture? On January 23^rd, 2023, word came down that Brendan Fraser had received an Oscar nomination for his role in The Whale. Based on a play by Samuel D. Hunter, this Darren Aronofsky film tells the story of a morbidly obese English teacher trapped in his apartment and trying to reconnect with his estranged daughter before he succumbs. On March 12^th, the Academy awarded him the best actor Oscar for his performance. Unsurprisingly, public response was sharply divided. But those who criticized the film as fat phobic struck me as divided even amongst themselves. There were those like @fatnutritionist who viewed the film as irredeemable voyeurism aimed at reinforcing thin norms:

“fat tragedy also serves a function of motivating thin people to “keep themselves in check,” by serving as a powerful reminder that once they lose the privilege of their thinness, they lose the protections, the compassion, the access to resources it engenders”

But others, like @RifewithKatie, implied that maybe the film could have been redeemed if it had involved actual fat people:

“You can tell that no actually fat peoples were involved in the production b/c of a major plot point where the protagonist is dying, but refuses to go to the hospital even though he has money to pay the bills.”

In both cases there’s no controversy around fat identity; that’s a given. Instead, the lingering issue boils down to representation. We are invited to wonder if Brendan Fraser’s performance in The Whale is the fat equivalent of Al Jolson’s performance in The Jazz Singer? Is a fat suit the fat person’s black face?

For practical reasons, representation of fat people in film can be problematic, especially if, as in The Whale, the character in question is so morbidly obese that they are about to die. If a production hired an actor meeting that description, it wouldn’t be able to insure the actor; no insurance company would underwrite such a risk and the production would fold before it even got started. There are exceptions, of course. I think, in particular, of the 2009 Oscar winning film, Precious, in which Gabourey Sidibe plays a 16 year old mother of two. However, such roles are rare.

Representation in literature is another matter, and while it doesn’t face the same practical challenges we find in film (since fictional characters don’t need to be insured), nevertheless fat representation remains relatively rare. If we start our search in the Bible, we merely reinforce the observation that fat representation is sparse. Most fat references in the Bible relate to animal sacrifice and rituals around the disposal of animal fat. However, in 2 Samual 1:22 we have this verse:

From the flood of the slain,
from the fat of the mighty,
the bow of Jonathan did not turn back,
nor the sword of Saul return empty.

The passage associates fat with power. In bronze age Palestine, only those with wealth and power had the resources to support a sedentary lifestyle and the luxury of surplus food. And, well, that’s about it for the Bible. There is surprisingly little room for fat people in the Judeo Christian scriptural tradition.

In English literature, early fat references play upon expected tropes. In Edmund Spenser’s Fairie Queene, the allegorical figure of Gluttony follows Idlenesse in a parade of the seven deadly sins:

And by his side rode loathsome Gluttony,
Deformed creature, on a filthie swyne;
His belly was up-blowne with luxury,
And eke with fatnesse swollen were his eyne,
And like a Crane his necke was long and fyne,
With which he swallowed up excessive feast,
For want whereof poore people oft did pyne;
And all the way, most like a brutish beast,
He spued up his gorge, that all did him deteast.

In Spenser, fatness reflects a sinful nature. Excessive eating comes at the expense of those who don’t have enough. The final line—“He spued up his gorge”—calls to mind the fat man in Monty Python’s The Meaning of Life.

Shakespeare is slightly more sympathetic. Julius Caesar expresses his preference for fat men whose bellies are full; they are docile and less likely to stage a coup:

Let me have men about me that are fat,
Sleek-headed men, and such as sleep o’ nights.
Yond Cassius has a lean and hungry look.
He thinks too much. Such men are dangerous.

And in the Henry IV plays, the corpulent Falstaff—“that trunk of humors, that bolting hutch of beastliness, that swoll’n parcel of dropsies, that huge bombard of sack, that stuff’d cloak-bag of guts, that roasted Manningtree ox with the pudding in his belly, that reverend Vice, that grey iniquity, that father ruffian, that vanity in years”—figures as a lovable larger than life character.

Dashiell Hammet’s The Maltese Falcon introduces us to Mr. Gutman:

The fat man was flabbily fat with bulbous pink cheeks and lips and chins and neck, with a great soft egg of a belly that was all his torso, and pendant cones for arms and legs.

Meanwhile, Puffin Books hired sensitivity readers to scour the pages of Roald Dahl’s oeuvre and they have changed the description of Augustus Gloop, an obese 9 year old character in Charlie and the Chocolate Factory. He is no longer “fat” but “enormous”.

While I can see how there might be an incentive to retroactively change representations that cast characters in an unfavourable light, I wonder what editors would do with fat characters who receive a sympathetic treatment. One of the kindest portrayals of a fat character comes from a surprising source—George Orwell. In the opening pages of his “English” novel, Coming Up For Air, we meet the main character, George Bowling. While having a scrub in the tub, he has this to say of himself:

The truth is that I’m inclined to be a little bit on the fat side. I don’t mean that I’m like something in a sideshow at a fair. My weight isn’t much over fourteen stone, and last time I measured round my waist it was either forty-eight or forty-nine, I forget which. And I’m not what they call ‘disgustingly’ fat, I haven’t got one of those bellies that sag half-way down to the knees. It’s merely that I’m a little bit broad in the beam, with a tendency to be barrel-shaped. Do you know the active, hearty kind of fat man, the athletic bouncing type that’s nicknamed Fatty or Tubby and is always the life and soul of the party? I’m that type. ‘Fatty’ they mostly call me. Fatty Bowling.

Although there’s probably nothing to this, I find it interesting that both Hammett and Orwell suffered from tuberculosis and, as a consequence, were rail thin.

While my survey is far from exhaustive, the challenge of finding works that feature large bodied characters illustrates the fact that this category of representation in literature is relatively uncommon. To the extent that it occurs at all, it tends to be functional. Fatness is allegorical, or figurative, or metaphorical, or symbolic. There is an assumption that readers will understand the cultural meanings associated with fatness. We are expected to interpret the character’s external features as a sign of their interior lives. A slovenly appearance suggests a slovenly spirit. In a society dominated by Late Capitalism, we go further and interpret the character’s external features as symbolic of an entire people’s moral condition. In the 2020s, a fat character is a consumerist Everyman.

Even a sympathetic character like George Bowling doesn’t escape the interpretive grinder. There is a sense in which Orwell’s novel is a cautionary tale about growing soft, about escaping into an easy life of nostalgia and complacency while all around (the novel was set in the late 1930s) fascism is on the rise, nationalistic jingoism is everywhere, and even the Left is selling out. Fatty Bowling isn’t just a character; he’s a symbol for the times. If we weren’t so resistant to the idea of symbolism in today’s wordy enterprises, Fatty Bowling could easily be a symbol for our times.

Does Representation Even Make Sense?

Does it make sense to worry about representation? The argument for representation is that it helps normalize a given identity and, if representation is widespread, will promote acceptance of that identity. If we see lots of body-positive messaging, those of us who identify as fat will feel better about ourselves, and those of us who don’t, will be more accepting of those who do. I guess. Maybe. But within the admittedly narrow confines of a reading life, I’m not convinced that’s how words work.

I worry that it might be impossible to deploy representational logic within the strictures of a literary work without undermining the literariness of that work. Metaphor is the engine that drives literature, but the demand for representation seeks to monkey-wrench the gears. (Cognitive metaphor theory goes one further and argues that metaphor is the engine that drives human thought, but that lies beyond this discussion.) Metaphor demands that the reader make wild associative leaps. For example: Metaphor is an engine. Metaphor isn’t really an engine, of course, but we understand what is intended by the phrase because we are human beings and for that reason cannot help but use the basic structures of language in precisely the same way.

But representation? Ah, representation. An effort at representation would seek to describe the engine in absolute detail, its pistons, its valves, the smell of the grease. Taken to its logical conclusion, a true representation would produce a one-for-one correspondence between the representation and the thing represented. At the mention of an engine, a writer committed to representation would trot out a working engine. Nothing less would do. That would be absurd, obviously, but I offer this absurdity to illustrate (as opposed to represent) that when we speak of representation, we don’t really mean representation. We mean something that feels like representation. We mean someone less white than Al Jolson, someone more fat than Brendan Fraser, but still an actor since, after all, that’s what actors are for.

While representation is intimately tied to the idea of identity, and while I have suggested that this may be problematic within a medium that depends upon metaphor, there may be a more general problem. The recourse to identitarian argument may in fact be a disingenuous manoeuvre that takes us down an absolute shit hole.

Here, I pause to lay bare an assumption, namely that my readers share with me a vaguely centre left view of the world. By centre left, I don’t mean centre left as positioned on the American political spectrum which has yanked itself so far to the right that a centrist like Bernie Sanders gets labelled a socialist. I write as a Canadian for whom centre left (at least historically) means something like social democracy, with socialized health care, robust public education, and a willingness to regulate banks and telcos. Oh yeah, and I throw into that mix a disgust for the fact that I hold degrees from an institution of higher education that once granted tenure to Jordan Peterson.

Wokeness and Victimhood of the Tribe

Despite all that, I find myself drawing a line in the sand beyond which my centre left politics will not venture. Here, I speak of wokeness. I need to protect myself from the mushy headed woke politics that demands, among other things, that publishers protect my feelings by excising the word “fat” from certain texts and replacing it with the word “enormous” when talking about rotund children. As improbable as it may seem, there is a cogent critique of wokeness that comes from the Left and its chief proponent is the philosopher, Susan Neiman. In her book, Left Is Not Woke, she argues that you cannot simultaneously claim to be woke and draw yourself into the classical liberal fold. There are three fundamental features of classical liberalism that wokeness does not share: 1) it claims that its values have universal application whereas wokeness focusses on the victimhood of the tribe; 2) it insists upon justice whereas wokeness focusses on power and empowerment as the solution to the inequitable distribution of life’s goods; and 3) the Left insists upon the possibility of progress even if it doesn’t currently manifest itself whereas wokeness views the extension of history into the present moment with pessimism.

While Neiman’s full treatment deserves deep investigation, it is her first distinction which is most germane to my present concern. We can see how fat advocates work to turn fatness into a site of victimhood which triggers the language of rights including the right to a voice. Those who fall within the tribe are, by definition, victims. Only they can speak of and for themselves since that is wrapped up in the package of rights conferred by membership in the tribe. If you don’t belong to the tribe, then your speech is, by definition, offensive.

A problem with identities grounded in tribal victimhood is that they assume fixed limits. However, as personal experience has illustrated, the markers we use to describe our identities may be more flexible than we suppose. I think, for example, of my efforts to forge an identity based on mental illness, all pretense of which dissolved when I began to sleep with a CPAP machine and found that my mood gradually improved. If I had invested significant emotional resources in my identity as a crazy person, I might have experienced my good health as a loss. The same can be said for my weight loss. I have passed from obese to overweight and in a couple months expect to shift by one more BMI category into the healthy weight range. If I had clung to a fat identity, using all the usual rationalizations—I’m big-boned; I’m a fit fat—, I would have experienced my current thinness as a moral failure. That would be absurd, of course, and yet it is an absurdity that wokeness embraces.

In the end, I find conversations about fatness and fitness, the virtues or evils of injectable semaglutide pharmaceuticals, the representation of fat bodies in the arts, the importance of body-positive messaging, all of it, I find all of it boring. Fat talk is simply an instance of a broader mode of communication and it is this mode that I find more interesting. Did I say interesting? I meant to say frightening. There is something about woke communication which, despite styling itself a left-leaning progressive kind of talk, bears a remarkable resemblance to the proto-fascist blether dribbling down the chins of Republicans and Brexiteers and the Twitterati. The tribalism. The insistence on the purity of membership. The carefully regulated boundaries. The dog whistling. The utter absence of humour.

In its tribal identitarianism, what woke victimhood holds in common with proto-fascism is that it eschews the universalism that grounds classical liberal values. One could easily speak more generally of values like kindness, the importance of personal dignity, and the acknowledgement of private suffering, without ever having recourse to the tightly circumscribed boundaries of identity politics. That would have the incidental benefit of affording us a measure of flexibility in our sense of self. If I want to shift from one BMI category to another, I can do so without worrying that oppressive social forces might be bearing down on me. Unfortunately, that doesn’t seem to be the way we talk to one another these days.

I hesitate to think in terms of root causes when writing about hostility, especially on social media, towards those who use semaglutide products to lose weight. I don’t think there are root causes; people, especially on social media, just enjoy being hostile; it gives them an adrenaline kick which is its own reward. Instead, I prefer to think in terms of rationalizations. What reasons do people offer to justify their hostility? Quite apart from the threat it poses to a deeply held sense of personal identity, critics frequently point out that it’s “cheating”. People like me who resort to Ozempic are lazy, looking for a short cut around the hard work that honest people devote to weight loss.

Merit and Grace

This latter criticism plays upon a tension that rests on the very bedrock of Western culture: the tension between merit and grace. I suspect that it goes back 500 years to the conflict between Martin Luther and the Roman Catholic Church. Luther objected to the Church’s sale of indulgences, arguing that human salvation was a matter for God and was immune to our manipulations. But the problem with grace is that it eliminates the incentive for people to do good works. Why bother being nice if it has no effect on whether or not you get to paradise in the afterlife? The tension has never been resolved to anybody’s satisfaction and has given rise to pathological attitudes towards work (hence the Protestant work ethic). In a sense, we’ve backslid, fostering greater hostility towards the notion of grace than when the Roman Catholic Church excommunicated Luther. Today’s economic orthodoxy insists that you get what you deserve and you deserve what you get by working for it. Meanwhile, economic forms of grace, like universal health care and guaranteed basic income, attract derision. God forbid anyone should find support from others in this life.

One way to tear at the corners of grace is to frame it in terms of privilege. In the lexicon of contemporary woke politics: suffering good, privilege bad. The irony is that unearned benefits like universal health care and guaranteed basic income are precisely the outcomes that woke social action claims to be fighting for. However, such outcomes get punted far enough into the future that they dissolve into a misty abstraction and cease to be real. As we’ve seen above, thinness is a form of privilege because it gives undeserved access to good jobs, media appearances, social acceptance, blah, blah, blah. And if you’ve cheated to gain that privilege, then your privilege is doubly undeserved.

In response to this prevailing attitude, I have observed in my own thinking a strange twist: I am not truly thin; I am passing. In reality, I’m a fat person hiding out inside a thin person’s body. As a result, I’m embarrassed to tell people that I’ve been using Ozempic because that would reveal how I’ve betrayed my tribe. I would be admitting that I endorse a regime that privileges thinness. Never mind that it also reduces the risk of heart disease and rheumatoid arthritis, the need for joint replacements, promotes better sleep, and boosts my mental wellness. Never mind, too, that my insurer happily pays out because it acknowledges the long term savings of carrying policies on healthier clients.

But in the end, I write this, not to persuade anybody of anything, but simply to record the kinds of social conversations that are engaging us at this particular cultural moment. I suspect that, a hundred years from now, people will cast a backward glance on these times and, turning to their incredibly thin and privileged companions, shake their heads and say: “Un—fucking—believable!”

In the meantime … I’m ripped! I’m here! Get used to it.