By Helen Lewis

Weight-loss drugs affect identities and relationships as much as waistlines.

On Labor Day weekend, 35 excited guests arrived at a campground in Newark, Ohio, for a retreat dedicated to “fat joy”—a place where people could swim, dance, do yoga, roast marshmallows, and sleep in cabins with others who had been made to feel guilty about their weight. The point of Camp RoundUp was “really diving into the joy of being at summer camp, the joy of being a fat little kid again,” Alison Rampa, one of the organizers, told me.

She and a friend, Erica Chiseck, had created Camp RoundUp to counter the shame and stigma that fat Americans report experiencing because of their size. They wanted to establish somewhere that “ladies and theydies” could feel comfortable in shorts or a swimsuit, with no awkwardness in the lunch line over portion sizes or second helpings.

But even somewhere as body-positive as Camp RoundUp couldn’t avoid a subject that has captivated the American media and divided couples, communities, and friendship groups. At a session called “Compassionate Conversations,” someone eventually said the word: Ozempic—the best-known name in a class of new weight-loss drugs.

At Camp RoundUp, the discussion began with bariatric surgery, a more established medical intervention. But the conversation quickly drifted toward Ozempic. “A couple of the girls were talking about how either they had been on it or they had been offered it by their doctor,” Chiseck told me. “They were just all sharing horror stories, basically,” Rampa told me. Known generically as semaglutide, the drug causes nausea and other side effects in some patients, a fact that Rampa found “triggering.” It meant that people “are voluntarily making themselves ill—to not look like us.”

Spend any time in communities dedicated to weight and Ozempic, however, and you will also hear about the opposite experience. Kristen Hall, 52, a member of Reddit’s Ozempic forum who has taken semaglutide since May, told me she felt stigmatized by those who didn’t want medication. As her weight loss became apparent, some of her friends peppered her with questions. “These were not questions asked out of curiosity,” she said via email. “I heard nothing but judgment in their voices … The ironic thing is that it wasn’t the naturally thin friends that I felt judged me (they were happy for me), it was the friends who ALSO struggled with their weight and/or had disordered eating. Like I was cheating.”

So far, much of the news coverage of Ozempic and similar drugs has focused on whether they work—and what their side effects might be. But the real story will begin when this emergent form of treatment becomes utterly routine, as it almost certainly will. Most people in America, the richest country in the world, are fat. Almost three-quarters of adults older than 20 live with obesity or overweight. And given the popularity of existing weight-loss treatments, we can deduce that most of those people would rather not be fat. The consequences of the Ozempic revolution will be economic and social, as well as medical. The new drugs will transform people’s relationship with eating—and with one another.

Ever since a series of studies showed semaglutide’s effectiveness for weight loss, Novo Nordisk has developed a problem. The Danish company simply cannot make enough Ozempic and Wegovy—its other brand name for the drug. In September, Novo Nordisk overtook the luxury-goods retailer LVMH to become Europe’s most valuable company. Its market capitalization—an estimated $450 billion as of Friday—was higher than Denmark’s annual GDP.

Originally approved to treat diabetes, semaglutide falls into a category of drugs, called GLP-1 agonists, that slow digestion, control blood-sugar levels, and suppress the appetite. Other pharmaceutical companies are now joining the gold rush by introducing their own GLP-1 agonists. On November 8, the American firm Eli Lilly got FDA approval for Zepbound, a weight-loss version of its diabetes drug Mounjaro (tirzepatide). The potential market is enormous: In Europe, 59 percent of adults qualify as overweight or obese, according to the World Health Organization. (Throughout this article, I have used interviewees’ preferred terms. Although doctors have moved toward terms such as living with overweight, some activists like the unapologetic nature of fat.) In China, obesity rates tripled from 2004 to 2018. Overall, analysts estimate that by the end of the decade, GLP-1 agonists could be worth $100 billion a year worldwide.

After decades of helping clients laboriously control their calories, WeightWatchers has already conceded defeat, acquiring a telehealth company to dispense semaglutide alongside its established diet—sorry, “wellness”—plans. Chris Edson, who runs the British weight-loss-support start-up Second Nature, has made a similar pivot. “A lot of our narrative was: no drugs; we’re going to help you do this through behavioral science alone,” he told me. “And I remember pitching venture-capitalist investors and them saying, Have you seen this thing in the States?” The investors were talking about semaglutide, and that prompted Edson to look into the available research. “And then I completely changed my mind,” he said. Second Nature now offers straightforward lifestyle support, as well as support plus semaglutide—at least, as much of the drug as it can, given the supply shortages.

Spend any time in online weight-loss forums, and you will hear ecstatic reactions to the new drugs. “The first shot I took, I was cured of all the food noise that was siphoning off my mental energy,” one 35-year-old New Yorker told me, adding that she had gone from 247 pounds to 200 pounds since starting Ozempic in February. Her knees hurt less, she said; she was more focused on spending time with her friends instead of thinking about food, and she felt less “invisible.” (Many of the people I interviewed had positive experiences with semaglutide. But I was struck by how many requested anonymity to discuss their decision to take the drug, its effect on their personal relationships, or both.)

Not everyone who struggles with weight will benefit from the drug. Some people have insurers that won’t cover it. Others find the results underwhelming or the side effects intolerable. “One minute I would be fine, and the next minute I would be talking to Ralph on the big white phone,” former British Prime Minister Boris Johnson wrote in June, in typically lurid prose. “I am afraid that I decided that I couldn’t go on.” The plus-size influencer Remi Bader said in January that after she stopped using Ozempic, she binged her way to a higher weight than before.

The Ozempic revolution is, therefore, also creating an Ozempic divide. Until now, very few people living with obesity could lose enough weight, and maintain that loss, to satisfy their doctors. But now a gulf has opened up not just between naturally thin people and the plus sizers, but within communities dedicated to larger people—whether those are groups for weight loss or body positivity. Do you take Ozempic or not?

At the individual level, Ozempic and its sister drugs might also rewire millions of personal relationships, changing the dynamics of a family that has always had a “thin sister,” or a couple who bonded over a shared love of nachos and beer, or friends who stay in touch by sharing a restaurant meal. “I have quit drinking and my partner has not, and honestly, our relationship had a pretty strong foundation based on our shared love of wine and cocktails,” Kristen Holloway, 42, from Kansas City, Kansas, told me. (A lack of interest in alcohol is a widely reported side effect of semaglutide.) She hadn’t realized how much of their social life revolved around drinking. Even the couple’s in-jokes—such as a spoon rest that reads tea is my daytime wine—were predicated on alcohol. “It’s been an adjustment, and we’re working through it,” Holloway said.

Even many Ozempic enthusiasts are coy about disclosing why they’re looking slimmer. Nathan, a 41-year-old Redditor who asked to be identified only by his first name to discuss his medical history, told me that he lost 40 pounds on Rybelsus, another brand name for semaglutide. He began to notice that he could once again wear his favorite rings, button his collar, and cross his legs. His family and friends were supportive, as was his pastor, he told me via email. “Even at church, one of my priests saw me at the communion rail and she said: ‘This is the Body of Christ … BTW—you look great.’ Talk about validation.”

But Nathan was still concerned about the wider reaction. “It seems like if the drug were used for diabetes, no one expressed any opposition. The moment weight loss became the goal, everyone had an opinion, and it was overwhelmingly hostile,” he said. “The general consensus was that it was a ‘cheat,’ a ‘shortcut,’ or the ‘easy way out.’” Notably, when Remi Bader spoke about her experience with the drug, she said she had taken it because of “​​actual health issues.” The Reddit Ozempic forum has an explicit rule that states: “No posts pitting diabetic patients against weight loss only patients.”

Not long after his pastor complimented his weight loss, Nathan received a text from a longtime female friend. He was on vacation, on a guided tour, and didn’t respond immediately. So the friend messaged again, Nathan recounted, “saying my silence and not texting her back fast enough was me thinking I was too important to talk to her. She actually said: ‘I’m so glad your life is getting fuller and you’re getting thinner, and now you want to cut me out of your life.’” They had never discussed his weight loss, or the methods he was using. “All I can figure is she saw my photos and side-by-sides on social media.”

Nathan decided to block her number, reasoning that he cared more about his weight loss—and the health benefits it brought, such as reduced cholesterol and better sleep—than easing his friend’s hurt feelings. “It’s beyond ridiculous for her to act like this,” he said. “But as Samantha Jones said [on HBO’s Sex and the City]: ‘I love you, but I love me more.’”

Envy was a drumbeat of many Ozempic stories that I heard, because guess what, life is easier if you’re more conventionally attractive. “Being the chubby guy was part of my personality—my identity,” Tim, a British 40-something who asked to be identified only by his first name, told me. He had dropped from 224 pounds to 190, having been overweight since sustaining a sports injury as a teenager. He found that people were much more enthusiastic about talking to him, and he received far more attention from women at parties. “I always had the feeling of being outside everything, like there was a velvet rope. And there is.”

These sentiments can be hard for Ozempic refusers to hear. Being fat is not like having high blood pressure, or cancer, or even athlete’s foot. Being fat has always meant living in a blizzard of other people’s opinions. And one of those opinions now is: Why don’t you just take Ozempic? Tigress Osborn, the executive director of the National Association to Advance Fat Acceptance, is concerned that these drugs might roll back years of work by the fat-liberation movement, such as lobbying tech companies to provide more inclusive images in search results. She wants to warn people about “this narrative that weight loss is easy, anyone can do it, now there’s a magical pill; so if you’re not doing it, you deserve whatever happens to you.” In an interview, she ticked off ways in which people might be pressured to use the drugs and punished if they don’t: “Why don’t you just take that pill and lose weight, when your boss is not giving you the promotion because you’re too fat? Why don’t you just take that pill and lose weight, when your landlords are threatening to evict you because they say your footsteps are too heavy?”

NAAFA believes in bodily autonomy—if you want to take Ozempic, the group doesn’t judge—but argues that the current atmosphere is coercive. “We believe that in a culture that is so fat-hating, it’s not really an informed-consent choice to opt in to a drug like this,” Osborn told me. She also warned that even if the initial results from studies are borne out, and patients lose 20 percent of their body weight, many people “are still going to be fat, even if they lose the weight that the drug is promising them to lose.”

Body-positivity communities, fat-liberation groups, and even informal support groups have been particularly challenged by Ozempic—as evidenced by the emergence of I’m only taking it for my diabetes discourse. Many of the disagreements are about the drugs’ long-term effectiveness. “I know how Atkins went,” Alison Rampa of Camp RoundUp, who is firmly in the skeptic group, told me. “I know how South Beach went. I know how whole foods went. Yeah, I know how intermittent fasting went. I know how cleanses went; I know how Fiber Factor went. I know how SlimFast and Special K and uppers and cabbage soup—I know how all of them went.” She and Chiseck worry about people who cannot tolerate semaglutide, or cannot afford it, or just plain don’t want to try another weight-loss solution after being burned before.

On the other side are people like Chris Edson of Second Nature. After overcoming his own skepticism of semaglutide, he then had to win over everyone else in his business. His company was founded with the aim of getting people off diabetes drugs that have to be injected daily, by bringing down their blood sugar using behavioral interventions. For that reason, Edson’s decision to embrace weight-loss drugs alongside lifestyle changes was controversial with his employees. “We’ve had people leave as a result of it,” he told me.

Personally, I’m an Ozempic optimist. I do not believe that Americans simply lost their willpower 40 years ago, when obesity rates began to climb. It seems more likely that our bodies, which evolved to navigate constant scarcity, are struggling to deal with the abundant calories and deliciously engineered food of the modern world. Our appetites push us toward sugar and fat, even if we have sedentary jobs. Semaglutide silences that mechanism.

Talking with people who have taken Ozempic—many of whom note the reduction in “food noise”—is a revelation. Suddenly, they have the appetites of the naturally slender. Effortlessly thin people don’t have more willpower than the rest of us. Instead, they don’t need it. They don’t nobly refrain from another helping of cookies; they don’t even want to eat them in the first place. One of my interviewees told me that before she went on semaglutide, “the back of my mind was always focused on food: Should I eat the leftovers; should I order on Grubhub?”

But even the new experience of self-restraint can be alienating. Kristen Holloway, who has lost 75 pounds since May last year, became “repulsed” by the TikTok cookery videos that her husband likes to watch. She also zoned out during a family discussion of restaurant recommendations: “I just found myself completely disengaged and thinking how weird it is to have a whole conversation like that—even though it’s probably not, really.”

One of the most fascinating subplots in Ozempic discourse—and part of the reason that it’s tearing communities and even former friends apart—is the sheer amount of money involved. Each side suspects that the other is being hoodwinked by vested interests. “What we’re up against is the marketing budget of Eli Lilly and Novo Nordisk,” NAAFA’s Osborn said. “So of course, they get more media coverage. I can’t hire Queen Latifah to speak on behalf of my campaign.”

On the other side, several Reddit forums I visited complained about what they saw as constant knee-jerk negativity by the media, for example in reporting every possible rare side effect, or even likening Ozempic to fen-phen—the drug withdrawn in 1997 because of its links to valvular heart disease. (Ozempic has reported no equally severe side effects, despite extensive clinical trials.) “The more rabid the opposition, the more I realized this drug might actually work,” Nathan told me. “I started to wonder, only somewhat tongue-in-cheek, who was so threatened? Big Fast Food? Big Bariatric? Big Pharma (that aren’t Novo Nordisk)? Big Gym? Big Fad Diet? Those only thrive if people stay overweight … and fail.”

Rising rates of obesity have created two Americas. Most residents of the Republic of Thinness want to attribute their size to willpower and personal responsibility, rather than wealth or genetic luck. And if thinness is available to everyone, their social capital is devalued. In the Republic of the Fat, there is an unequal distribution of hope. Some people feel that the miracle they’ve been praying for is finally here, and they are glad to leave behind their identity as the “chubby friend” or the “gentle giant” and cross the border to Thinness. In turn, those who stay put feel doubly judged—by the thin people who always looked down on them, and by their former comrades who have now abandoned them.

I asked Rampa and Chiseck whether anyone at Camp RoundUp felt betrayed by those who took weight-loss drugs. “We would not feel betrayed by anybody who wants to choose to do whatever they want with their body,” Chiseck said. Equally, though, she expects that lack of judgment in return—even from Ozempic evangelists. “It’s my body. It’s no one else’s business. I’m not hurting anyone. The only one I’m truly hurting is the airplane creators that are making the seats smaller and smaller and telling me it’s my fault.”