Oprah Winfrey, a figure whose own weight struggles have been publicly scrutinized for decades, recently hosted a primetime special on ABC titled An Oprah Special: Shame, Blame and the Weight Loss Revolution. This program tackled the transformative impact of new weight loss medications, such as Ozempic and Wegovy and other GLP-1 weight loss drugs. It further explored how these drugs have affected individuals grappling with obesity and related conditions. The special featured medical experts and individuals who have used these medications. The special aired on ABC on March 18 and became available for streaming on Hulu on March 19.
A Personal Journey
Oprah Winfrey opened the special by recounting her own well-publicized challenges with weight. She recalled a 1990 TV Guide cover that cruelly labeled her "bumpy, lumpy, and downright dumpy." This experience led her to pursue a series of diets, including a five-month regimen. The positive results inevitably faded over time. Winfrey challenged viewers, Hollywood, and the news media to abandon fat jokes. "For more than 25 years, making fun of my weight was national sport," she said. "I come to this conversation in the hope that we can start releasing the stigma and the shame and the judgment."
In late 2023, Winfrey revealed that she was taking anti-obesity medicine, which was met with both support and criticism. Soon after, she stepped down from the board of WeightWatchers after almost 10 years.
Obesity as a Disease
The special highlighted that many patients struggling with obesity are wired differently in their brains. Winfrey reported the findings of top scientists and researchers that some people are more prone to holding on to their fat. Cleveland Clinic’s W. Scott Butsch, MD, noted on Oprah’s special that people have an “uneducated belief” that obesity is a matter of willpower and a “self-inflicted” issue. Butsch said, "It's not a matter of willpower."
Christopher McGowan, MD, a gastroenterologist, obesity medicine specialist, and founder of True You Weight Loss, explains, “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. These factors cannot be overcome by willpower alone, nor are they the result of a lack of willpower.”
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Butsch likened it to being underwater, where a person will eventually need to come up for a breath. Similarly, someone with obesity will eventually regain weight without assistance. Drugs like Ozempic and Wegovy quiet “food noise,” keeping people fuller longer and reducing the drive to eat. The CDC also lists genetics, socioeconomic factors, and medications as potential causes of obesity, defining it as a “complex disease that occurs when an individual’s weight is higher than what is considered healthy for his or her height.”
Michael Glickman, MD, the founder and CEO at Revolution Medicine, says, "There is still so much misinformation in our society that many patients and even healthcare providers still believe that obesity can be permanently reversed with enough willpower and counting your calories in versus out. As in the alcohol analogy, you would not tell a patient struggling with alcoholism that they should just willpower their way out of it. Alcoholism requires comprehensive multidisciplinary treatment, just as obesity should. The brain ultimately controls our body and our actions, and it should be the primary focus of our treatment approaches."
The Role of Medications
Winfrey dedicated a significant portion of the special to promoting weight loss medications. She lauded the drugs and how they have changed her perspective on food. Amanda Velasquez, M.D., director of obesity medicine at L.A., stated, "We're seeing double the amount of weight loss you can achieve with this class of medications compared to what we've had in our tool box for the last several decades."
Drugs like Ozempic and Wegovy quiet “food noise,” keeping people fuller longer and reducing the drive to eat.
A Comprehensive Approach
Winfrey stressed that medication alone is not a cure-all. "I use it as a tool combined also with hiking three to five miles a day, or running," she said. "It's not just one thing, it's multiple things. It's weight resistance training." Velasquez emphasized the need for a multidisciplinary approach, "the same way we would treat cancer."
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McGowan says, "Anti-obesity medications are not designed to be used in isolation and must be paired with a diet and lifestyle program. This is how they were studied in clinical trials, and we know that lifestyle modification remains the foundation of any chronic weight treatment." McGowan suggests working with a registered dietitian and personal trainer. “You can only expect to lose weight effectively with help, support, and accountability,” McGowan says. “A comprehensive weight management program that offers medical supervision, nutrition counseling, and behavioral support is the optimal framework for success.”
Addressing Side Effects and Challenges
Winfrey addressed the side effects that some patients have experienced, including diarrhea, nausea, and hair loss. However, she noted that these are generally rare. A study showed that nearly 17% of people stop taking semaglutide because of side effects, the majority of which are gastrointestinal.
The biggest challenge for many is the cost of the new drugs and the fact that many insurance companies do not cover them. Butsch attributed this to lingering bias and a failure to recognize the biological roots of obesity as a disease. He stated, "If you don't believe obesity is a disease and you're a policy plan, what are you going to [say to] convince your members?"
While Velazquez called the side effects mostly “over-hyped” on the TV special, McGowan says, “GLP-1 side effects are not overhyped. All medications have side effects…Most of these are mild and short-lived, such as nausea or bowel habit changes. However, they can be severe and persistent for some patients.” McGowan says proper information about side effects is important so patients can be prepared. There are ways to mitigate the side effects in many patients.
Personal Stories
The special included testimonials from individuals using GLP-1 medications, such as Erika and Maggie Ervie, a mother and daughter taking Victoza for weight loss. Maggie was 300 lbs. by the time she turned 11. Doctors feared she’d die young. Maggie, now 15, had bariatric surgery and began taking Victoza at 13.
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Amy Kane, a mother who appeared on the special, noted that she dreaded going to the doctor before losing weight. Now, she looks forward to it. Kane first felt shame in fifth grade when a peer called her “fat.” Now that Kane is no longer living with obesity, she says she’s treated differently, especially in clothing stores. Even her children are treated differently, she told Winfrey.
Societal Impact and Stigma
The testimonials suggested that the growing prevalence of these medications marks the early stages of a sea change in how society views obesity: as a disease influenced by biology rather than evidence of a lack of willpower.
A 2019 scoping review of research from 2000 to 2017 suggested that individuals reported feeling patronized and disrespected, that all of their health issues were attributed to weight, and that they had low trust in their providers. They also mentioned avoiding the doctor.
McGowan says, “The bias against obesity is deeply ingrained in our culture.” Winfrey called fat-shaming one of the last acceptable biases, and McGowan agrees, saying it has “devastating implications.” Again, the misinformation about why someone is living with obesity comes into play. “Obesity has long been - erroneously - equated with laziness and a lack of willpower,” McGowan says. “Naturally, individuals affected by obesity may internalize this sentiment and direct the blame inward.”
Winfrey and Kane discussed the finger-pointing notion that living with obesity was a personal choice and the shame and confusion they felt when first-line treatments like diet and exercise weren’t enough.
Dr. Rachel Goldman, PhD a clinical psychologist and Ro advisor, says, “This is absolutely heartbreaking, and it’s tough to live in a world that is constantly making assumptions about you - solely because of your appearance - and not treating you nicely.”
Experts say belittling people for using these tools is extremely detrimental. Ali says, “If people start thinking of obesity as a chronic disease, like high blood pressure or diabetes, then there may be less stigma associated with using the tools available.”
Goldman says, “We need to shift the conversation away from weight loss drugs. If the focus is on weight, we are never going to get away from this shaming and the criticism that this is the easy way out. If we talk about this in terms of health and seeking treatment for a disease, the conversation will change - it will be less judgmental and more about emotion and empathy. It all starts with the words that we use.”
Concerns and Criticisms
When Winfrey asked why coverage of the drugs for weight loss is still limited, W. Scott Butsch chalked this up to lingering bias and a failure to recognize the biological roots of obesity as a disease. Both Novo and Lilly confirmed that they had no financial involvement in Monday night’s special.
Jennifer Ashton, M.D., ABC’s chief medical correspondent, echoed Velazquez’s claim that reports of side effects have been overblown. Velazquez claimed that concerns for thyroid cancer have not been shown in human studies.
In one of the tenser moments of the night, a woman discussed her experience with taking an anti-obesity medication. She stopped after she vomited blood and needed to go to the emergency room. Her doctor agreed the drug wasn’t right for her, and she’s interested in trying a different one but is hesitant.