Why Aren’t You On Them? The GLP-1 Pressure No Woman Can Escape Right Now
There’s a new question following women around. It isn’t always spoken out loud. Sometimes it’s just a look. But if you’ve been on the receiving end of it, you know exactly what it means.
A client told me recently that she’d been out for dinner with a group of friends. Someone mentioned they’d started on one of the new weight loss injections. There was a general ripple of interest around the table. Questions, enthusiasm, a few knowing nods. And then a pause. A glance in my client’s direction. Not unkind, exactly. But loaded.
She knew what the glance meant. Why aren’t you on them?
She didn’t say anything. She picked up her wine glass and changed the subject. But she carried that look home with her, and she was still carrying it when she sat down with me.
I’ve heard versions of this story more times than I can count over the past couple of years. The specifics change but the theme is the same. A social moment. A reference to Ozempic, Wegovy, Mounjaro. And then a silence that says: you could fix this, you know. There’s a solution now. Why wouldn’t you take it?
That look is not new. Women in larger bodies have been receiving it their entire lives. What’s new is that it had greatly reduced. And now it’s back.
Something was changing
Cast your mind back five or six years. Something genuinely different was happening in the culture. The body positivity movement, and its more nuanced sibling body liberation, were gaining real traction. Diet culture was being named and critiqued openly in ways it hadn’t before. Intuitive eating moved from the margins into mainstream conversation. Health at Every Size was getting serious clinical attention. The word ‘diet’ had become almost unfashionable. Even Weight Watchers felt the pressure, rebranding as WW in what looked suspiciously like an attempt to pretend it was no longer about weight.
In the media, something was shifting too. Body diversity was appearing in advertising. Plus-size models were on magazine covers and in mainstream campaigns. Brands that had never shown anything other than a very narrow body type, began to widen the frame. It wasn’t perfect, and it wasn’t nearly enough. But it was movement, and it was real.
For the women I work with, that shift mattered enormously. Many of them had spent decades at war with their bodies. Decades of dieting, restriction, self-surveillance, shame. And perhaps for the first time, the culture was offering something different: the tentative, radical suggestion that it might be acceptable to exist in their body without spending every waking hour trying to escape it.
That work is not easy and it doesn’t happen quickly. It requires dismantling beliefs built up over a lifetime, challenging messages absorbed from family, from doctors, from every magazine opened in a waiting room. But it was happening. And the culture, for once, seemed to be nudging in the same direction.
And then the snapback
GLP-1 weight loss medications arrived. Everyone calls them Ozempic – the way a vacuum cleaner is called a Hoover – but Ozempic is actually a diabetes drug. The weight loss versions are Wegovy and Mounjaro, the same or similar active ingredients at higher doses, chasing a bigger version of a side effect that was never the original point. More on that in a follow-up post. What matters here is the cultural moment they created. And the thin ideal didn’t just creep back. It roared back, with a pharmaceutical justification attached and a celebrity endorsement budget that made the old diet industry look modest.
Suddenly we were back to the silhouettes of the seventies, eighties, nineties and early noughties. The very thin body, celebrated again, held up as aspirational again, everywhere again. On red carpets, in magazines, across every social media feed. And this time it came with a framing that made it harder to argue with: it’s not vanity, it’s health. It’s not diet culture, it’s medicine. Women in larger bodies face the greatest pressure – the look I described at the start of this post lands hardest for them. But this isn’t only their story. Women in mid-size and even straight-size bodies are taking these medications too, injecting weekly to become a smaller version of a body the culture had already deemed acceptable. The thin ideal, it turns out, has no floor.
The cultural permission that had been slowly, painstakingly extended – not only to women in larger bodies, but to all women exhausted by the relentless project of self-improvement – was silently revoked. And in its place came the old question, dressed in new clothes. Why aren’t you doing something about it? There’s really no excuse now.
I watch this with my clients and it is painful to witness. Women who had done years of genuine, courageous work on their relationship with their bodies. Women who had reached a fragile but real place of something approaching peace. And now the rug pulled again. The goalposts moved again. The message that their bodies were acceptable, retracted.
Let’s follow the money
I want to offer something that might sound like a conspiracy theory. It isn’t. It’s just following the money, which is something worth doing when examining health messaging. (If you’ve read my post about Cancer Research UK’s ‘obesity’ campaign, you’ll know that a well-known dieting company had donated over £14 million to the charity since 2013. Worth knowing, when evaluating the campaign.)
The weight loss industry was under genuine pressure during the body liberation years. Intuitive Eating and Health at Every Size were gaining clinical credibility. Diet culture was being publicly dismantled. People were beginning to question whether the product the industry was selling – the promise of a different body – was one they wanted to keep buying. That is a threatened business model which had, till then, relied on repeat customers.
And then along comes a product so medically legitimised, so dramatically effective at producing short-term weight loss, so enthusiastically celebrity-endorsed, that it doesn’t merely survive the body liberation moment. It decimates it. Novo Nordisk, the manufacturer of Ozempic and Wegovy, briefly became the most valuable company in Europe on the back of these drugs. The global GLP-1 market is already worth tens of billions and climbing – one of the most lucrative pharmaceutical expansions in recent history.
But markets like this don’t simply appear. They depend on how problems are defined. The medicalisation of body size into a disease category – contested even at the point of its adoption – transformed weight into something to be treated, billed, and sold. The result is not just a breakthrough in treatment, but the expansion of a market that medicine itself helped to make possible.
A peer-reviewed paper published a few weeks ago by Ragen Chastain, Angela Meadows and Louise Adams found that the ‘miracle drug’ narrative around these medications has been largely constructed by the manufacturers themselves, often with support from doctors and researchers holding significant undeclared financial ties to those same companies. Whether the collapse of body liberation and the rise of GLP-1s is coincidence or something more purposeful, the effect on women is the same. The breathing room disappeared and the work got harder. And a great deal of money is being made.
What this does to a person mid-journey
Imagine doing the slow, unglamorous work of building a different relationship with food and your body. Learning to recognise hunger without panicking. Eating without negotiating with yourself. Coming to a place of acceptance and appreciation for the body you have now. Starting, tentatively, to trust that your body is not your enemy. That work happens powerfully and in increments and there’s little or no applause.
And then the culture shifts. The body you have been learning to live in is back on the wrong side of a cultural line. Your friends are losing weight fast and the general assumption in every room – and quite possibly in your GP’s surgery too – is that this is straightforwardly good news for everyone. The look is back. The silence is back. And underneath it, the question you had almost stopped hearing: why aren’t you doing something about it?
For someone with a history of disordered eating, this moment carries real clinical risk. Dr Joshua Wolrich, a medical doctor who recently presented a detailed webinar on GLP-1 medications and their relationship to food, notes that eating disorder history is not prominently listed in prescribing precautions for these drugs – a significant gap, given that at higher doses they work primarily through pharmaceutical appetite suppression. But I want to be clear: the concern doesn’t only apply to women with a clinical history. A doctor who cannot show you peer-reviewed evidence that weight loss itself – not a change in behaviour, not a confounding variable – improves your specific health markers, and that this is the safest and most sustainable route to that improvement, is working from cultural assumption rather than science. That burden of proof belongs with the prescriber. Not with you.
The work is still the work
The look across the dinner table has always been about power. Who gets to take up space. Whose body is acceptable. The drug is new. The look is very old.
What I know, from years of sitting with women who have been on the receiving end of that look, is that no external solution reaches the place where the real work happens. The shame that look brings. The way it can perniciously unravel months of careful, patient effort toward a relationship with food and your body that is actually liveable.
The body liberation movement wasn’t a trend that ran its course. It was pointing at something true: that the war on larger bodies has caused enormous harm, that behaviour matters more than size, and that the pursuit of a smaller body at any cost has never been the same thing as the pursuit of health. Those things are still true. A pharmaceutical industry making billions doesn’t make them less true. It just makes them harder to hear.
My client is still doing her work. Quietly, in increments nobody can see, without anyone clapping. The look she carried home from that dinner table is real, and the culture that produced it is real, and the pressure she is navigating is genuinely hard. But the thing she is building – a relationship with her body that doesn’t depend on the culture’s approval or a weekly injection – is more solid than it looks from the outside. Nobody can take it from her with a glance across a restaurant table.
That is worth protecting. Especially right now.
If this has landed somewhere for you, I’d love to hear your thoughts in the comments. And if you’re ready to explore what that inside work might look like, you can find out more about working with me here.
References
The O-Word Is the Second Preventable Cause of Cancer After Smoking. Is It True? Is It Helpful?
Hi, I'm Vania.
I'm passionate about helping you break free from the exhausting cycle of yo-yo dieting, body shame, overeating, bingeing, and emotional eating.
For decades, I was at war with my body and food. It wasn't until I found an approach which didn't involve strict rules, diets and a focus on weight, that my relationship with food and my body transformed into one of ease and peace. There’s a lightness in living when food no longer holds power over your thoughts. If you're seeking that kind of freedom — where food becomes simple and life feels full — I’d love to walk that journey with you.
Work With Me Online Courses