Freedom from fatness: Why GLP-1s go after Black bodies

Algorithms and GLP-1 ads

0:00Hey, everyone. You're listening to Code Switch from NPR. I'm B.A. Parker. And I'm Jean Demby. Jean, I got a personal question to ask you. Uh-oh. What does your algorithm look like? You mean like on IG, like Instagram? Yeah. What does it look like? A lot of sports. Yeah. A lot of politics, a lot of news, some cooking stuff. Why? Why are you in my business? This is like a deeply personal question. Like, yes, my social security number is like... I warned you beforehand.

0:32But, like, mine is a lot of that, but it's also a lot of, like, black body positivity. Okay. Lots of, like, Reiki healers. Okay. So, yeah, because you are witchy, that's kind of your thing. Okay. But overwhelmingly, GLP-1 ads. Okay, so I guess before we even go any further, we should do X minus or comma. What is a GLP-1? A GLP-1 is a medication that was initially geared towards people who had diabetes. It's supposed to control sugar. But over the past couple of years, it has, like, evolved into a weight loss drug.

1:05And now it's just everywhere. Are you getting the GLP-1 ads on your Instagram feed, on your socials? Because you follow this body positivity stuff? Like, is that... They're saying, oh, you like this. Then we're going to slide you this thing. Is that what it is? You think the algorithm was, like, do you love yourself? How do we stop that? How do we stop that and monetize yourself a little bit? Exactly. And the thing that's really been haunting me about these ads is that it feels like almost

1:35all of them feature Black women. Like, there's the obvious one, Roe, which has Serena Williams as its spokesperson. GLP-1's helped me lose 31 pounds. One app to hit my goals. This is healthcare. This is Roe. I'm Serena Williams, and I'm a real Roe member. Oh, oh, no. And I saw one the other day that was an AI banana being chased by the cops.

2:05There's an AI GLP-1? There's a lot of AI ads for GLP-1s. We live in a dystopian hell. Oh, my God. And at the end, there's an AI Black woman getting her GLP-1 delivered. Like, even when I left the office the other day, there was a massive billboard in the middle of Times Square of an older, bigger Black woman, and in giant words, it says, obesity medication is now covered by Medicare. I feel like I'm living in an alternate reality. Yeah, it's dark.

2:36And I'm getting these ads at the same time as all this chatter is happening around Lizzo's body and Ariana Grande's body, and it just feels like we're in such a different place when it comes to weight loss discourse. So I reached out to Sabrina Strings. She's the author of Fearing the Black Body, a book about the racial origins of fatphobia. And she actually has a theory as to why all these ads are specifically targeting Black

3:07women and why we can't stop body shaming. I'm so amped to listen.

Historical roots of fatphobia

3:13Let's go.

Historical roots of fatphobia

3:14I spoke with Sabrina Strings, author of Fearing the Black Body, which hones in on the racist origins of fatphobia. And while the algorithm continues to sell me GLP-1 ads, Sabrina says this kind of conversation has always been in the background. My algorithm knows that I'm like a fat Black woman in America. And so, like, they know the kind of content I'm reading about.

3:43I'm reading about, like, fat liberation. I'm reading about all that kind of stuff. But then in between all those, like, every other ad is a GLP-1 ad on my social media. I mean, it's just always been in the cultural conversation, these, like, weight loss tools. Like, when I was a kid, it was SlimFast. There was, you know, Snackwells, Olestra in the chips. And so I'm curious, when did you start hearing about GLP-1s as a weight loss tool?

4:18I didn't start hearing about it until 2023. And it's because of the fact that by that time, its usage had exploded. Consider the fact that this is a drug that was only approved for weight loss in the tail end of 2021. And within 18 months, it became a buzzword in the United States, right? And that's not just because it exists for weight loss. That's because of the tremendous marketing that tells people losing weight is healthy. It wasn't until working on this story that I started realizing just how much of the

4:49marketing for, like, weight loss and all this stuff was targeted towards Black women. Oh, right. It starts to feel so cynical, even sinister. What a lot of these semaglutide manufacturers are doing is that they're making Black women the face of the drug. You know what? Black people have had limited access to health care. But you can get access to this weight loss drug, right? And so in this way, all of the ways in which Black people have suffered within the field of medicine can be rectified through access to weight loss drugs.

5:23I'm like, no, no, no. Weight loss is not reparations. What we need is compassion and care and the understanding that people can be healthy at any size. A shot is so much easier than giving compassion. Well, then you have to train yourself not to stigmatize others, right? And so you have to let go of your notions of superiority. There's so many reasons why people shame. Yeah. There's this concept behind the ads that's always like, you deserve to feel great in your body, which is to say that a fat person doesn't feel great in their body, doesn't feel nimble,

5:56doesn't feel like they have the capacity to, you know, feel content in a larger body. Yeah. And just like, notice what all is being piled on there because the main thing that they keep trying to convince us is that weight loss is somehow going to contribute to better health outcomes. But then they also frayed a bunch of other stuff on top of it. They're like, not only will you have better health outcomes, but you'll be more confident. You'll feel more sexy. You'll be able to move. It's like, well, how is it that you as a company that is selling us a weight loss drug

6:28is telling us about our self-esteem and our confidence? Those things don't come from transforming our bodies, especially not by trying to shrink them. But we have been so convinced, I think, as a society that there's a consumer solution to everything. That in an ad, it might make perfect sense to tell people, all you have to do is pay us money. We'll change your body. And by changing your body, you will have confidence. I mean, I'm like, I'm already sexy. I'm already confident. I already feel great. But then I was like, you're so brave.

6:59Oh, gosh. You're so brave to love yourself. And I think just to give people a small amount of grace on that, I think people who are saying this are themselves terrified of the way in which they may have been treated in the past, perhaps are still treated, maybe the way in which they've treated others, right? Because they understand the social rules. And they think that if you can meet them, you must. Because to refuse to do this thing is to set yourself up inevitably to be denigrated in

7:31public.

Public figures and body standards

7:33It did surprise me precisely how swiftly GLP-1s were able to, I want to say, dominate the conversation surrounding body size. Partially because, yeah. I mean, it felt like a different moment, right? It was the age of body positivity on social media. It was the age of people talking about fat liberation. It was a period in which more and more people were starting to write books about the history and ongoing trajectory of fat phobia.

8:05You had like Ashley Graham, you had Lizzo, you had all of these people who were like, I'm thick, or like whatever thick means, I'm bigger, and isn't that fabulous? But like, what happened? The reality is that those people are still there. But we have to keep in mind that GLP-1s constitute a multi-billion dollar industry, right? For Novo Nordisk specifically, when you look at their market capitalization, their business

8:38is worth hundreds of billions of dollars. And I don't think it's any secret that Ozempic, right, is their flagship product. When you have that kind of money, you have a tremendous amount of power. And you can seed ads everywhere. Like you said, your whole algorithm is supposed to be about body liberation. And somehow Ozempic ads are still getting in there, right? So you will have the ability to be able to change the conversation by the sheer force of your money. But then, how do you reckon with someone like Lizzo publicly losing weight?

9:11Or Serena Williams, who for a lot of people, including myself, admired her curvaceous figure, becoming a spokesperson for GLP-1s. Yeah. I'll start with Lizzo, because I feel like her case is a little bit different from Serena's. The situation with Lizzo was not just that she was a fat black woman, but that her brand for so long was, I'm fat, I'm black, I'm a badass bitch. I'm sexy, I move my body, I drop it low. I mean, it's like, these were the things that made people go up.

9:42Everybody was like, yes, people were craving that. We wanted to be able to see someone stand up in their power and not feel like they had to shrink themselves. So the difficulty with Lizzo was not that she lost weight, because any individual choosing to lose weight is their own personal business, right? If we believe in body liberation, we have to believe in bodily autonomy, right? But if you're standing on the idea that you have the right to be as thick as you are, right, and then you start losing weight, and not only that, you have an athleisure brand in which

10:14you make the titular product some type of body slimming, body shaping corsetry, then people are going to start to look sideways, because it's like, wait, wait, wait, this is the exact opposite of what you have been telling us for so long. Like, when she was bigger, she was literally naked on her album cover. Yeah. She's always been this just, like, gregarious figure who, like, loves herself. But it's just like, oh, I feel slightly betrayed.

10:46Yeah. And I think that's the thing. So people don't really know now if they're still fans of her. They don't really know what her message is anymore. And, you know, to me, that's a little bit different from Serena Williams. The way in which their cases are similar, in my view, is that each of them are Black women who have been in the public eye, who have been shamed, stigmatized, degraded repeatedly. And call it too big, right? And even if you love yourself, even if you're happy with your size, even if you have a wonderful community, I'm sure it still hurts to have to see that in public all the time.

11:17You know, that was something that Serena Williams had been talking about since the 90s, right? And so for Serena Williams, when she decided to take the weight loss drugs, it felt, I think, just based on the ways in which she was presenting it, as a way for her to escape the shaming. So it's like, wait, I finally did the thing that people told me I was supposed to do. And so even though we champion these Black women, even though they are powerful, they are still being subjected to physical scrutiny, and more so than the rest of us because of

11:49the fact that they are public figures. No, right. Just to give them a little bit of compassion, I think. I, well, this is like an overshare, but like I grew up, like I've, I've been fat most of my life. Like I've been in a girdle since I was like 12. But like, I think for me, my barometer for just like gauging my body acceptance is, has always been through, I guess, like Oprah. Oh, wow. That's an interesting reference. No, no, no, no.

12:19So I think when I was a child, I saw her on TV and I was like, oh, this is a, an adult who looks like me. But then, um, I think very quickly I realized that like she wasn't my, my body positivity hero. In fact, she was like actively trying to evade her fatness my whole life. And it took me a long time to like figure that out. Like, I guess like a teenager.

12:50And you know, you have to really hold Oprah in a particular way because on the one hand, she has had to suffer through so much fat shaming through most of her life. So it's not as if she hasn't suffered, but the way in which she's been able to, I want to say, overcome and really actually profit from fat phobia is to say, I know it's wrong and I'm going to do better. There's been this language of repentance that has existed in conversations with Oprah about her body from the beginning. Yeah. I mean, when she pulled the amount of fat that she had lost, the wagon of fat, and even like

13:24back then I was like, oh, that can't be good.

13:28And so what is the point of that? If not to say this was an horrendous misjudgment on my part, and now I have figured out how to be a better person. Now I'm redeemed, especially during the time period in which Oprah was at her height with her television show to have respect as a woman in public, you needed to either be thin or trying to prove to people that you're on your way to becoming thin. Like fatness was just transitory. So for someone like her, it's not just a matter of saying, Hey, I know how to be a good person. It's also like, wait, weight loss products make a lot of money.

14:01So what if I were to show that I am on my journey to weight loss and be able to monetize that? And she has done.

The history of the BMI

14:08I, okay, I want to pivot to, you've written explicitly about how like BMI or body mass index became this barometer for obesity, which is already problematic if you want to go down that rabbit hole. Um, but like, where does that come from? You know, the funny thing is that BMI body mass index was actually invented by an astronomer.

14:39And you're like, wait, what did you say? An astronomer? Astronomer. Astronomer. Yeah. There was this guy, Adolphe Kedele, a Belgian astronomer who became a statistician. And what he decided he would do is that he would take a survey of the distribution of height and weight across a population. Right. And that is exactly what BMI. It is a ratio of weight to height. Now, if you're paying attention, you might think to yourself, now you've said astronomer, you've said statistician. At no point did you say physician?

15:10No, I did not because this man was not in any way concerned with health outcomes. And that's not just my reading. His own biographer wrote that. And so this tool was taken up by a eugenicist in the early 20th century in the United States named Charles Davenport, who happened to be familiar with this astronomer's work. And he was like, you know what? I believe there is a racial obesity. So, and we need to be able to use this tool, this Kedele index to identify who's obese.

15:40Now, this tool was renamed from Kedele index and index of build, which is what Charles Davenport called it in the 1920s, to body mass index by Ancel Keys in the 1970s. And Ancel Keys was a known fatphobe. And so that's how an astronomer ended up inventing a tool that is policing all of our bodies globally. But now you're saying like with GLP-1s, that definition of obesity has broadened.

16:13Well, yes. So a couple of years ago, the American Medical Association had been working with other organizations to be able to identify, okay, well, we know that BMI is flawed. So instead, what we're going to do is we're going to add additional measurements onto BMI so that now instead of just having this flawed core, we have this flawed core surrounded by other medical instruments that make it seem more valid. Now, when they did this, right, when they added a bunch of stuff to the definition of obesity,

16:46what they ended up doing, surprise, surprise, was creating a broader pool of individuals who could qualify as obese. But how does relying on these kind of standards shape the care given to like marginalized patients? This is one of the most important parts because, as I mentioned earlier, Black people routinely report weight stigma at the doctor's office. And so what does this mean? This means that when weight is at the forefront of any analysis of health outcomes, that fat people

17:19are going to delay care. Sometimes fat people are going to simply stop going to the doctor. Fat people are going to go to the doctor and they're going to be told you need to lose weight because doctors are so invested in this fat-centric view of health. And there have been multiple instances in which a fat person will go to the doctor, the doctor will tell them to lose weight, and the doctor will miss the fact that this person has cancer. So what it does is actually lead to worse health outcomes for people, and especially for people

17:50who are labeled overweight or obese.

17:55Coming up. You see someone there in a lab coat, take this medication, you will lose weight, you will be healthy. They will almost always also say, and you will look and feel good, right? The appearance has always been right there in the mix. It's not a side effect. Stay with us. Parker, just Parker, code switch. I'm talking to author and sociologist Sabrina Strings about the current climate around GLP-1s

18:27and the new language being used around fatphobia.

Class and modern weight loss

18:31I want to pivot a little bit because I call it like the, it's like the, like the Viagra-fication of GLP-1s. How like, like Viagra was initially for people with heart conditions and ultimately became like, hey, it also helps people with erectile dysfunction. And now we have GLP-1s, which are for people, originally for people like with diabetes and like have genuine like needs for this medication, but they're like, weight loss, let's pivot to that. And because like these drugs were diabetes drugs first and Black Americans are disproportionately

19:07impacted by diabetes. I would love if you'd like talk to me about how people are critiqued for using these drugs for health means versus cosmetic means. Yeah. So this is one of the things that becomes, I think, very delicate because we of course want people to have legitimate access to medications that they need, right? If you have diabetes, we want you to have access. But one of the problems is that because there's this whole discourse about there being an obesity

19:42crisis amongst Black people, Black people, nearly 50% of Black people are obese. Then what we find is that Black people are stigmatized both for their size, right? And if they choose to use the GLP-1 medications for any reason. So this is one of the reasons why I say it's so important for us to keep in mind body autonomy. People have the right to use these medications. It's not going to help the cause of fat liberation to say no one can lose weight. And I don't think very many activists would say that. But then the other thing we have to keep in mind is that just because you have access to

20:18these medications does not mean that these medications are a cure-all for the things that are ailing Black America. But it also makes me think of, like, there's a whole section in Fear in the Black Body that's about, like, that thinness was viewed as American exceptionalism, particularly part of the early 20th century. But with things like this happening, do you think that it's still the case? Yeah, you know, I'm working on a piece right now about that. Because the widespread use of GLP-1s has really been going on for about three years, not very

20:54long at all. And already, according to recent data, we are seeing that the weight of America is decreasing. America is actually getting thinner. And so that in and of itself, I'm sure, for many people, will be considered a triumph, even though chronic illness remains extraordinarily high. I mean, let's just do a thought experiment. Does anyone listening to this believe that if we could make every single American thin, that we would eradicate diabetes, heart disease, heart failure?

21:26I doubt it, no. Of course not, right? We still find all of these chronic illnesses in people who are so-called normal weight. So making everyone thin will not make us all healthy. But thinness has always been the goal. It's never, like, they don't care about your insides. It's like, aesthetically, we have to make sure that you look thin. I had a relative who had cancer, survived it, okay now, but lost so much weight and got so many compliments. They were

21:58like, you look so good. You're so thin. Well, yeah, they're on chemo. Oh, my gosh. But that is how our society works. We don't care if you've got diabetes. We don't care if you've got cardiovascular disease. As long as you're thin, then you've succeeded somehow. Yeah. Absolutely. And that is the insidious thing, because the conversation is usually about health, because it's often someone in a lab coat telling you it's important to lose weight. But just because that's the rhetoric doesn't mean it's the reality. They're trying

22:29to convince you that weight loss is healthy. And there are so many websites, you can Google this, where even as you see someone there in a lab coat take this medication, you will lose weight, you will be healthy. They will almost always also say, and you will look and feel good, right? The appearance has always been right there in the mix. It's not a side effect. But it also seems like, not even like health, health can go away for a second. It seems like there's this like moral underpinings around fatness and GLP-1s that feel in contradiction

23:04with themselves. In thin Western society, fatness is considered a moral failing, right? But then when someone takes Ozempic or Roe or Wegovy or whatever, that's also considered somehow a moral failing, because it's like the easy way out. So then what's the point? Well, I suppose, I guess there's a hierarchy, if you will, right? The idea, according to many people in Western society, is that you're just supposed to be, you know, white and thin on your own.

23:38If you can't manage that, you know, you're not going, not everybody's going to be white, but you can at least try to fit in within this narrow BMI frame. And you should try to do it from your own industry. And part of the reason why that hierarchy exists, like you should be either naturally thin or you should work hard to be thin, but at the very least take the medication and don't stay fat. The reason why that exists is that originally the discourse surrounding quote unquote obesity was that it was a character failing. It's only very recently, you know, and

24:09this has actually been increasing with the prominence of the GLP-1s. It's only recently that the discourse within the medical field has shifted the blame from the individual and their personal failing for not trying hard enough to something that could be genetic or environmental and therefore something out of their control, right? And so, yes, absolutely. We don't have control over our size, right? But they have used that framing to say, we can have compassion for you. Just take this medication. But you're right. People still rely on this earlier trope that it was up to you to lose

24:46the weight. Start exercising more. Oh gosh. So with this like GLP-1 fervor, when does fatness become a class marker? Like what if someone can't afford to take the drug? Yeah. And the question of money is ever present when we're talking about the GLP-1s. If you have a prescription, you can get your GLP-1 for something like $25 a month. But if you don't, that amount rises something like $960 a month. It's absurd, right? And then we have to think about, okay, well, if you are a low income

25:20person, if you're a person who's living in poverty, how are you going to be able to get a prescription in the first place, right? You may not have ready access to healthcare. That means you won't get a prescription. That means you will not be able to get the $25 medication. And so absolutely, class is central to this issue. Because one thing that we are seeing as America, as I mentioned, weights in America have been declining ever so slightly in the past few years, we can see that there is nevertheless a stratification happening where it's declining more rapidly in some populations

25:54than others. And so let me just say clearly, I'm still doing the research on this, but we do know that yes, the weights are declining faster amongst people who have a high income and who are women. Really? Yeah. What does that mean? Well, it means that both women are more likely to present themselves to doctors and perhaps request the medication, that doctors are also more likely to prescribe the medication for women, that women are more likely to adhere to the routine of the jabs or the pills or whatever they get.

26:28So that's one of the reasons why we're seeing that women's bodies are actually shrinking faster now. Oh, just because the act of going to the doctor is more of a female trait. Yeah. Women of a certain class status. It's what's happening. Yeah. I understood. Okay. I, hmm. We try not to talk about people's bodies. That is like the correct thing to do. But currently online, there is this schism on the way we talk about bodies. So there's,

27:03I don't know if this is online, like plus size advocate. I don't know if you know. I follow her name is Samira. I've heard of her, yeah. She's lovely. Like her platform is all about pointing out like the major, minor injustices that come with being fat in this world. And I feel like she's become this sort of sin eater. If you want to look into her comment section, it is, oh my God, they call her everything but a child of God. But then there's also this ongoing commentary, whether it's concern

27:36or criticism about Ariana Grande. And in between those two discussions, I'm getting an ad for Roe featuring like the sister from This Is Us. And like, how can we navigate these things thoughtfully? Yeah. I think so much of what happens on social media is not intended for us to navigate it thoughtfully. It's intended for us to react on instinct. So if you want to be intelligently navigating this, it's up to you to curate your own feed that incorporates people who have done the

28:11research, who have been thoughtful about this and to be a part of a community, right? So you have Samira, you have now gone up positivity online. You have the NAAFA. There are a variety of different organizations and individuals you can find for this message, but it's up to you to do the work. But why is it so hard to talk about bodies without shaming? Yeah. Protestantism. That's, you know... Really? Yeah. I mean, that's the quick and dirty of it. This is the Protestants' fault.

28:41You know, and I wish that I could soften the blow, but I cannot. Because in reality, when the shift from Catholicism in some of the countries, like Germany was taking place, from Catholicism to Protestantism was happening in the 16th century, one of the things that people like Martin Luther himself did was, yeah, they were working in like a little workshop, distributing information about like the corruption of the Catholic church. And one of the things that they did was create

29:13this archetypal fat monk. The fat monk was the image of corruption. Because here you're supposed to be accepting alms, right? But instead you're taking these indulgences. They're hoarding. Yeah. And you're not distributing that. You're keeping that for yourself. And evidence of that is in the fact that you are a fat monk. I'm looking at the Gutenberg Bible differently. Oh my God, right? Yeah. I mean, it's... The printing press allowed for many different things. Not all of them beneficial.

29:43OG fat phobia from the Gutenberg Bible to GOP. There it is. Oh my gosh. All my fat black queens are losing weight and I'm just trying to grieve in my own way. Well, yeah. I mean, it's just on the one hand, I think it might be helpful to view that as we live in a fat phobic society. And until we address those issues, the structures that give thinner people better opportunities, there is not a single aspect of human life that fat phobia does

30:15not touch. Like what thing from working to partnerships, to where you live, to where you eat, right? To your place on a plane. There's not a single aspect of our lives that is not impacted by fat phobia. It's so many different nodes where fat phobia shows up. So fat phobic justice is justice for everyone. We're just all trying to escape it in some kind of way. I don't know if we can. We can't escape structural problems through individual solutions. We have to make it our

30:46business to start lobbying Congress to make sure that size discrimination is included in civil rights legislation. I mean, fat phobia is the last bastion of discrimination you can do well and not get like too, you won't get too much hate for it. There's like, oh, you need a larger seatbelt on the plane? Shame on you. Yeah.

31:12Like, I don't know. I mean, don't get me wrong. Misogyny is alive. It's thriving. I see F boys everywhere I go, you know, and most of them are far too old for this business.

31:21So I'm just, I'm pointing out, you know, yeah, fat phobia, people love to camp there, but guess what they get to be when they're being fat phobic? They get to be misogynistic and racist. So, you know, it's, it's a threefer. A threefer.

Credits

31:39And that's our show. You can follow us on Instagram at NPR Code Switch. But if you're also getting wild GLP One ads, please let us know or let me know. Our email address is codeswitch at npr.org. This episode you're listening to was produced by Christina Kala and Nora Gill. The audio engineer for this week's episode was Robert Rodriguez. It was edited by Jasmine Romero and Courtney Stone. And a big shout out to the rest of the Code Switch massive. Xavier Lopez, Jess Kung, Leah Dinella, Dalia Mortada, Barton Girdwood, Yolanda Sanguini,

32:13and Maya Dangerfield. As for me, I'm Gene Demby. I'm B.A. Parker. B-E-Z-O. Hydrate.