Oprah Winfrey, a global media leader, producer, philanthropist, actress, and author, has once again placed herself at the forefront of a national conversation, this time tackling the complex and often stigmatized topic of weight loss. Just months after revealing publicly she uses a medication for weight loss, Winfrey returned to television to shine a spotlight on the topic. Her journey, marked by both public triumphs and personal struggles, has deeply influenced public perceptions of health, wellness, and personal transformation. In "An Oprah Special: Shame, Blame and the Weight Loss Revolution," which aired March 18, 2024, on ABC and the next day on Hulu, Winfrey opened up about her own weight ups and downs, documented publicly over the past several decades. The special delves into the prevailing questions and concerns surrounding the impact on our health care, economy, lifestyle and culture. Speaking in front of a live studio audience, Oprah gathers the country's leading medical experts and everyday people who are in the battle of one of the biggest health care crises the world has ever known.
Oprah's Public Struggle with Weight and Shame
Winfrey's weight has been a recurring theme throughout her career, starting with the 1988 “wagon of fat” episode where she showcased her 67-pound weight loss on the Optifast diet. For 25 years, Winfrey was host and producer of the award-winning talk show "The Oprah Winfrey Show," engaging in range of multifaceted cultural conversations. "I have to say that I took on the shame that the world gave to me," Winfrey said in the special. "For 25 years, making fun of my weight was national sport." She recalled being "ridiculed" on tabloid covers and on late-night talk shows for over two decades, recalling that one headline she'll never forget described her as "bumpy, lumpy and downright dumpy." At the height of her talk show fame, Winfrey recalled how she "starved" herself for several months on a liquid-only diet and then wheeled out a wagon of 67 pounds of fat on her show to display the weight she had lost. She said that by the next day, she had started to regain the weight.
Winfrey has been open about the emotional toll her weight struggles have taken, admitting, "I still hate myself because of my weight," on her show in 1986. She described her defeatist mindset: "All the fame and the success doesn't mean anything if you can't fit into the clothes. If you can't fit into your clothes, it means the fat won." In 2010, she said, "I've never liked the term 'food addict,'" noting that she had referred to herself that way "casually" over the years. "But I realize that I really have been one. And believe me, I-like so many of you-have punished myself for that."
This public battle has led Winfrey to advocate for a shift in how society views weight and obesity. On Monday night, Winfrey told viewers, "I come to this conversation with the hope that we can start releasing the stigma and the shame and the judgment, to stop shaming other people for being overweight or how they choose to lose -- or not lose -- weight, and most importantly, to stop shaming ourselves."
The Weight Loss Revolution: Medications and Shifting Perspectives
As part of that conversation, Winfrey spoke with some of the nation's leading medical experts about the latest breakthroughs in obesity medicine research, specifically medications for weight loss that have spiked in popularity over the past year. One of the central themes of Winfrey's special is the evolving understanding of obesity as a disease rather than a character flaw. This shift emphasizes that obesity requires more than personal choice and calls for a nuanced, empathetic approach to management and care. The American Medical Association officially classified obesity as a “complex chronic disease” in 2013.
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Winfrey confirmed in December that she uses a medication to help maintain her weight after losing weight steadily over the past two years with a combination of diet and exercise. Winfrey has not named the type of medication she is taking. "I now use it as I feel I need it, as a tool to manage not yo-yoing," Winfrey told People. "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." She continued, "I'm absolutely done with the shaming from other people, and particularly myself."
In her special on Monday, Winfrey revealed what she wanted viewers to learn about weight and obesity. "The number one thing I hope people come away with is knowing that [obesity] is a disease, and it's in the brain," Winfrey said. During the show, ABC News chief medical correspondent and obesity medicine physician Dr. Jen Ashton told Winfrey, "It is conclusively known that the conditions of overweight and obesity are complex, chronic disease states, not character flaws … so they should be managed accordingly." "Oh, I love that so much, Dr. Jen," Winfrey said.
Winfrey has said previously that she had an "aha" moment about using medication for weight loss after moderating a panel on weight for her Oprah Daily outlet last summer. Winfrey said after the panel that she "released my own shame about it" and consulted with her doctor, who prescribed a medication for weight loss. "I had the biggest 'aha' along with many people in that audience," Winfrey told People magazine. "I realized I'd been blaming myself all these years for being overweight, and I have a predisposition that no amount of willpower is going to control. Obesity is a disease. It's not about willpower -- it's about the brain."
The Science Behind Weight Loss Medications
The special also delves into the science behind these medications, particularly GLP-1 agonists like semaglutide and tirzepatide. These drugs mimic the naturally occurring hormone GLP-1 to help reduce weight. This hormone signals satiety to the brain and regulates blood sugar by enhancing insulin secretion. Semaglutide was first introduced as Ozempic in 2017 for diabetes management, later finding use in weight management as Wegovy, its higher-dosed counterpart. Tirzepatide (Mounjaro) combines the actions of GLP-1 and GIP (gastric inhibitory polypeptide), amplifying its effects on blood sugar control and appetite suppression. These medications are administered through weekly injections into areas like the arm, thigh, or abdomen. Ideal candidates are adults with a BMI over 30, or 27 if associated conditions like hypertension or diabetes are present. These effects collectively help manage body weight, especially when combined with lifestyle changes like diet and exercise.
During the show, Oprah introduces Dr. Amanda Velazquez, Director of Obesity Medicine at Cedars Sinai’s Center for Weight Management and Metabolic Health. Dr. Velazquez explains the mechanics of GLP-1 medications and their impact on reducing “food noise”-the constant preoccupation with food-making it easier to maintain a healthy diet.
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It is important to note that while medications like Ozempic and Wegovy contain the same main ingredient, semaglutide, Ozempic is FDA-approved to treat Type 2 diabetes, but some doctors prescribe the medication "off-label" for weight loss, as is permissible by the FDA. Wegovy, is FDA-approved for weight loss. In November, the FDA approved Zepbound as a weight loss management treatment for people with obesity, or those who are overweight with at least one related underlying condition, such as high blood pressure -- the same prescribing guidance as Wegovy. As a diabetes drug, Zepbound is sold under the brand name Mounjaro, as the two medications contain the same active ingredient, tirzepatide.
Personal Stories and the Impact of Weight Loss Medications
The special features personal stories to underscore the impact of these medications, beginning with Amy, who lost 160 pounds, transforming her life through these medications. She shares her struggle with weight, which stemmed from childhood and deepened due to hardships like the premature birth of her son, the death of her father, and isolation during COVID-19. After losing 160 pounds, her bloodwork returned to normal, and the constant food noise that once controlled her thoughts quieted. She no longer feels dominated by food.
The special then shifts to Maggie’s story, exploring the obesity epidemic among children and the ethics of prescribing weight loss medications to kids. In 2023, the American Academy of Pediatrics recommended obesity medications for adolescents over 12. At 11, she weighed nearly 300 pounds, significantly impacting her quality of life. Her mother Erica recounts that even as a baby, Maggie had an unusually large appetite. At age 13, Maggie underwent bariatric surgery. Despite this, her doctors felt the weight loss was insufficient and prescribed Victoza, a liraglutide used for Type 2 diabetes but also effective for weight loss in some patients, to use such medications for weight management. Before surgery and medication, she was prediabetic with fatty liver disease. The combination of surgery and medication proved transformative, as she has since lost 108 pounds.
Addressing Concerns and Controversies
While the special champions the potential of weight loss medications, it also touches on concerns and controversies surrounding their use. These include potential side effects, accessibility, and the long-term implications of using these drugs.
The special then briefly discusses the side effects of these medications. Rolanda, an audience member, shares her experience with severe nausea and vomiting, leading her to discontinue the medication and seek emergency care. Dr. Amanda Velazquez responds, arguing that most side effects are mild to moderate and manageable with proper support. Common side effects include gastrointestinal discomfort, which can often be managed through dosage adjustments.
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Oprah then interviews representatives Negelle Morris from Novo Nordisk and Rhonda Pacheco from Eli Lilly, who highlight the challenges in securing insurance coverage for obesity treatments. Oprah questions why insurance companies are hesitant, suggesting skepticism over obesity as a legitimate disease. Morris notes Novo Nordisk has long recognized obesity as a disease and advocates against stigma to improve access.
The special then shifts to Weight Watchers, with Oprah noting that she left the board to avoid any perceived conflict of interest. She invites Sima Sistani, CEO of Weight Watchers, to discuss the organization’s evolution from a diet company to one incorporating weight loss medication through their “Sequence” program, which provides access to GLP-1 medications for weight loss.
Gaps and Criticisms of the Special
Despite its comprehensive approach, Winfrey's special has faced criticism for certain omissions and potential biases. Some critics have pointed out the absence of Registered Dietitians and therapists as expert commentators, as well as the lack of discussion about eating disorders. The Collaborative of Eating Disorders Organizations (CEDO) expressed concerns about the lack of consideration for eating disorders in Oprah’s Special, stating that the use of GLP-1s in pursuit of weight loss can increase the risk for developing an eating disorder, contribute to relapse for those who have previously struggled, and exacerbate the symptomatology in individuals who are currently struggling.
Others have noted the brief mention of side effects and the historical context of Oprah’s previous weight loss endeavors, raising concerns about the long-term sustainability of these solutions. The special also lacked discussion about the misuse of weight loss medications by those trying to lose only 5-10 pounds, often obtaining them from med spas with compounded versions of the drugs.
Some critics also argue that the special gives more oxygen to the negative interpersonal consequences of weight-loss-drug usage and that the special occasionally feels like a project designed to blunt any public disapproval of Winfrey herself using weight-loss medication. It has also been argued that although some of the public obsession with her body is still baselessly vitriolic, Winfrey has, perhaps more than any other figure, helped popularize some of the most harmful weight-loss myths and unsustainable diets.
Oprah's Evolving Perspective on Weight Loss
Winfrey’s journey reveals the powerful blend of personal narrative and celebrity influence in shaping public health perceptions. Throughout her career, Oprah Winfrey has both inspired and stirred controversy through the guests featured on her shows, raising important questions about the responsibility of media figures in disseminating information, especially when it involves health and well-being. Winfrey has always been a mirror to the cultural zeitgeist influencing and being influenced by it. Her impact on how we perceive health and wellness is undeniable.
Winfrey has also reflected on her role in perpetuating unsustainable weight-loss methods. While hosting a Weight Watchers YouTube live special on Thursday (May 9), the 70-year-old media mogul host acknowledged that she had been a "major contributor" to modern diet culture and stated that she is "done with the shaming." "I wanted to gather all of us together because I believe that we have reached a pivotal moment in the way we talk about and the way we think about our bodies," Winfrey told the in-person and virtual audience. "I've been a steadfast participant in this diet culture. "Whatever your path, let's stop the shaming," she said.