Last year, Oprah Winfrey publicly announced that she was taking weight loss-related medications (GLP-1 drugs) in a refreshed attempt to lose weight – an announcement that brought a barrage of media coverage and public opinion on the topic. As a public figure and celebrity, Winfrey has historically been scrutinized, criticized, and analyzed for her battle with weight.  In an interview with People magazine in December 2023, she said it had become “public sport” for people to make fun of her and that the blame and shame had been going on for more than 25 years.

However, thanks to GLP-1 medications, such as Ozempic® and Wegovy®, Winfrey has recently dropped a substantial amount of weight and says she is feeling better than she ever has before. She chronicled her weight loss journey and experience with weight loss medications in An Oprah Special: Shame, Blame and the Weight Loss Revolution, which aired on ABC on March 18.

“The fact that there’s a medically approved prescription for managing weight and staying healthier, in my lifetime, feels like relief, like redemption, like a gift, and not something to hide behind and once again be ridiculed for,” Winfrey said. “I’m absolutely done with the shaming from other people and particularly myself.”

Winfrey’s special also included a collection of weight loss doctors and other patients with obesity who dove into the topic of the chronic disease, the social stigma surrounding it, and the new range of obesity-related medications that are available. Viewers were left with several key takeaways.

Obesity IS a Disease

There is a common misconception that obesity is a matter of willpower and a “self-inflicted” issue, as discussed by W. Scott Butsch, MD, during Winfrey’s special. In general, people tend to blame the person who is struggling with weight gain rather than understanding that obesity is a disease that is beyond their control.  Winfrey likened obesity to substance abuse, another condition that is commonly misunderstood as a problem with willpower.  Dr. Christopher McGowan, founder of True You Weight Loss, shares his perspectives.

“Obesity is a complex, multifactorial disease with genetic and environmental underpinnings. For those individuals prone to obesity, their drive to eat may be more significant, their propensity to increase weight may be higher, and their ability to preserve weight is stronger,” Dr. McGowan says.  “These factors can’t be overcome by willpower alone, and are not due to a lack of willpower. Truthfully, the individual affected by obesity is working far harder than their normal-weight peers. The difference is that the battle is steeply uphill.”

According to Dr. McGowan, the brain of a person with obesity is wired differently, which leads to greater caloric intake.  This is not an addiction that is necessarily akin to alcoholism, but the concept is similar, he says.  With obesity, there is an innate, genetically driven desire to consume more, which is hardwired and challenging to overcome.

The Obesity Stigma That Leads to Shame

Guests on Winfrey’s special revealed their personal experiences and feelings surrounding what it’s like to live with obesity.  Name-calling and other methods of poor treatment have left many feeling unworthy and ashamed.  One guest even said that her children were treated poorly due to her obesity.  The special highlighted that people often blame themselves for obesity by thinking they are flawed or weak.

“The bias against obesity is deeply ingrained in our culture,” Dr. McGowan says. “‘Fat-shaming’ remains the last culturally-acceptable prejudice, with devastating implications. Obesity has long been (erroneously) equated with laziness and a lack of willpower. Naturally, individuals affected by obesity may internalize this and direct the blame inward.”

But why has this treatment persisted? For one, Dr. McGowan explains, the medical community only recently acknowledged and accepted that obesity is a disease. In fact, the American Medical Association did not officially recognize obesity as a chronic disease until 2013. Before then, obesity was never viewed as a disease but purely as a lifestyle choice, and that continues to be perpetuated in our daily lives and interactions.  Further, obesity is visible and closely associated with appearance.

“The good news is that the tide is beginning to shift,” Dr. McGowan says.  “The more discussions about the disease of obesity — by Oprah, other celebrities, and medical professionals — the more rapidly we can erode these biases.”

Anti-Obesity Medications Can Also Elicit Feelings of Shame

Because there is a popular narrative that obesity is related to a lack of willpower, any intervention to treat that condition will likely be viewed as a shortcut or a cop-out, and therefore, many find themselves too ashamed or embarrassed to ask for help. 

According to Dr. McGowan, many patients with obesity will never seek treatment because of the bias they receive from healthcare professionals, friends, and family members. As an obesity medicine provider, Dr. McGowan often hears from patients that they “don’t want to resort to a shortcut” when considering weight loss medications.  However, he reminds us that this is not a concern for other common diseases or conditions.

“Treating blood pressure or cholesterol is not considered a shortcut. If you need insulin for diabetes, it's a life-saving treatment,” Dr. McGowan adds.  “But anti-obesity medications, or even bariatric surgery, are viewed as the ‘easy way out.’ My first goal when meeting with a patient is to offer support and reassurance. It’s okay to seek help. There is zero shame.”

Children Under Age 18 Can Take These Drugs

Thirteen-year-old Maggie Ervie was a guest on Winfrey’s special, and her mother, Erika Ervie, helped retrace Maggie’s weight loss journey.  Maggie reached almost 300 pounds, and doctors expressed concern that she would die young.  She had bariatric surgery and took Victoza® (liraglutide), a less-known weight loss medication.

“When she started to lose weight, it was like a butterfly emerging from a cocoon,” Ervie said.  Maggie is now in high school and has lost 108 pounds.

“This is a sensitive topic,” McGowan acknowledges. “The treatment of obesity in adolescents has additional layers of complexity, but early treatment of obesity can delay or prevent future health problems, including diabetes, heart disease, and premature death.”

Anti-Obesity Medications & Side Effects

In the special, Dr. Jennifer Ashton, ABC News chief medical correspondent, discussed weight loss medication side effects, as well as safety and efficacy data.  She added that the side effects were usually only mild to moderate and that they tended to be “overhyped.”  Dr. McGowan disagrees.

“GLP-1 side effects are not ‘overhyped,’” Dr. McGowan explains.  “All medications have side effects, and the incidence of side effects with GLP-1 medications is relatively high. The majority of patients will experience at least one side effect during treatment. Most are mild and short-lived, such as nausea or bowel habit changes. However, they can be severe and persistent, such as dehydration. Some patients struggle for months, which may hurt quality of life, and research shows that many patients discontinue their medication due to side effects.”

Therefore, patients on GLP-1 medications need frequent follow-up and support from their medical team. Typically, side effects can be mitigated and overcome with relatively minor interventions, but patients should not expect to manage them alone.

There’s No Real “Weight Loss Miracle”

With weight loss, nothing is a quick fix. Diet, exercise, and lifestyle modifications are important to any weight loss plan, and Winfrey says she incorporates these into her life as well.

“Anti-obesity medications are not designed to be used in isolation and must be paired with a diet and lifestyle program,” Dr. McGowan explains. “Through clinical trials, we know that lifestyle modification remains the foundation of any chronic weight treatment. Patients should consult with a registered dietitian whenever possible to assist with macronutrient goals, meal planning, and optimizing nutrition.”

Dr. McGowan shares one of the greatest challenges he sees related to these medications is that many patients believe they can take the drugs in the short-term, achieve results, and then stop taking them with the idea that they can maintain long-term weight loss on their own.

“Unfortunately, that’s just not how these medications are designed – and we’ve seen time and again that this approach just isn’t successful. Instead, patients spend thousands of dollars on a short-term fix – and when the weight inevitably returns, they’re more discouraged than ever. That’s why I spend a great deal of time with my patients explaining the long-term commitment required to use these medications successfully.”

Dr. McGowan also recommends that patients seek help from other professionals, such as certified professional trainers and even behavioral support providers.  This, he says, will provide the optimal framework for success.

Overcoming the Obesity Stigma & Understanding Treatment Options

What can we as a community do to help conquer the misconceptions about obesity and support those around us who struggle with their weight?  An important first step is understanding that obesity is a disease that must be treated medically.  No one who suffers with obesity should be blamed or shamed for laziness or a lack of willpower, nor should they be ridiculed for seeking medication that can help transform their health.  GLP-1 weight loss medications are not a “cheat code,” and combining them with metabolic and bariatric surgery can be a gamechanger for many people who have been suffering for their entire lives.

“The newest generation of GLP-1 medications is far more advanced and effective than anything we’ve known before,” Dr. McGowan says. “However, the most proven treatment for obesity remains metabolic and bariatric surgery, which should not be discounted. For some patients, this remains their best treatment option.”

Sources:

Oprah Winfrey Takes GLP-1 Medications for Weight Loss, Wants to End Stigma: Healthline.com
https://www.healthline.com/health-news/oprah-shares-weight-loss-journey-glp-1-drugs

Oprah Winfrey Reveals She Uses Weight-Loss Medication as a ‘Maintenance Tool': ‘I’m Absolutely Done with the Shaming’ (Exclusive): People.com
https://people.com/oprah-winfrey-reveals-weight-loss-medication-exclusive-8414552

Oprah’s TV Special on Weight Loss Drugs and Obesity: 5 Things to Know: Healthline.com
https://www.healthline.com/health-news/oprah-tv-special-weight-loss-drugs